[Diagnosis] Here is my Sleep Study - Break it down please.

[slingshot383]

Here is my sleep study, can it be translated to English?

[slowriter]

Key thing to read is the "impression" section towards the end.

They conclude you have "severe sleep apnea."

What's puzzling to me is they sent you to the lab for a "split-study", which means they test first, and then if they find you have OSA, they put you on a CPAP machine and see what settings you need ("titration").

But the report says you didn't meet the criteria for that, and will need to go back for a separate "titration study." Maybe someone else can figure that out.

In any case, you have a CPAP or bilevel machine in your future.

[Sleeprider]

The upside down scan was a bit too challenging, so I corrected the orientation, and redacted personal information. Please be careful what you post.

Your apnea events included 28 central and 43 obstructive for 69 total and an AI of 12.6 per hour. AHI was 36.1 with arousal and 27 with 4% or greater desaturation. None of the events occurred when you were supine (on your back). You were diagnosed with severe obstructive sleep apnea and your doctor wants you to try CPAP and drop 3-points off your BMI. I'm concerned that half of your apnea are central and that is likely to increase in proportion when you start positive air pressure therapy. Your doctor is going to schedule a separate titration study on CPAP.

Normally, I would suggest skipping a titration study and just using an auto CPAP to self-titrate, but in your case, I have some concern your will experience some central apnea on CPAP. At the same tme, I'm certain you will receive a poor titration and still be assigned a CPAP. At least ask for a Resmed Airsese 10 Autoset because you will be a mess with a Philips with all the hypopnea and complex apnea. Don't be discouraged. You are going to have a more difficult adjustment than most, and CPAP may or may not work since it will not treat central apnea. During your follow-up with the doctor, ask him about the centrals and whether a complex apnea diagnosis might be appropriate, or if the titration study should be designed to deal with central apnea if it is present again. I would much rather see your titration study evaluate CPAP with a contingency to move to ASV if needed.

[Gideon]

AHI:   36.1 / 27 (3% / 4% Desats)

OAI:     7.8
CAI:     4.7 (37% of apneas)
HI:     23.5
          ____
          36.1 Severe AHI
RERA: 21
         _____
RDI:    57.1

All this means that your night's sleep is like getting jabbed in the ribs almost once per minute (57.1 times per hour) on average all night long.

RERA  is a series of Flow Limits ending in arousal. This means you have fairly high Flow Limits. 
The CAI means that we need to watch this.  There is a good chance that this number will climb with CPAP/BiLevel Treatment.  Note that CPAP and /or BiLevel will not treat the Centrals.  It is unlikely that they will diminish with a CPAP.

There is a continuum of events including, in order of severity, Apnea, Hypopnea (HI), Flow Limits, Normal Breathing.

The best treatment hypopneas, Flow Limits, RERAs is a split pressure, that is a different exhale and inhale pressure which we accomplish with a feature called EPR on a ResMed device, preferably the ResMed Airsense 10 AutoSet, or with Pressure Support on a BiLevel device (Has separately defined exhale and inhale pressures that can be much higher difference than the AutoSet.) 

The AutoSet is the Most Likely machine to be assigned, most often this follows another overnight at the Sleep Lab for a titration study.

[slowriter]

During your follow-up with the doctor, ask him about the centrals and whether a complex apnea diagnosis might be appropriate, or if the titration study should be designed to deal with central apnea if it is present again.  

I would much rather see your titration study evaluate CPAP with a contingency to move to ASV if needed.

I just wanted to highlight this for the OP, since this would be an action you can take now to hopefully ensure the titration study they do is more helpful, and that you don't waste months of time on bad treatment.

If they do the latter, it means they will start on CPAP. When they see that the settings required to treat the OSA cause central apneas, they would put you on ASV to see if that resolves that issue.

[slingshot383]

Here are 3 OSCAR screen shots, they gave me the machine without a follow-up study, I see the doctor on the 15th of June.

[Gideon]

I see nothing major, but how do you feel?

[Dormeo]

That is so interesting! I was expecting to see a whole lot of central apneas and flow limitations, but no. I'll be curious what your answer is to Bonjour's question.

Congrats on getting a good machine, by the way.

[slingshot383]

In reality, not any different than before I started using the machine. My nose feels the affects of having the nose pillows in the morning. Mr. arthritis kicks me out of bed in the morning.

[Gideon]

In that case change your mask to other than a pillow mask and reduce EPR to 1 and see if that helps your Cai numbers.

Your numbers are good so we go more by how you feel. Use the value of EPR that feels best for you.