[Diagnosis] Round 2 Sleep Test

[Rubicon]

"Physician Report: All sleep stages seen. The majority of the night was spent in the right lateral position. No supine REM seen. Occasional obstructive events seen with mild desaturations to the 90's in both REM & NREM."

A review of the hypnogram shows your events largely sleep-stage and position dependent (REM supine).  IDK why the guy said no supine REM seen cause cause clearly there is.  The oximetry graph looks totally messed up, I can't see the even 1 desat he claims so I'm thinking he made that up. Heart rate channel (I think it's HR channel but there's no label) is also messed up so this is pretty shoddy work (I think they pulled that from the oximeter).  Centrals can be a normal phenomena (sleep-onset, post-arousal, post-sighs, phasic REM) and with so few there's absolutely no reason to consider ASV, especially since trying to clobber those with an ASV makes things worse.

[Rubicon]

Median HR of 4? Mean RR of 150? With half the oximeter data missing poor quality work.

[Rubicon]

Now once you find even one piece of shoddy work, then you come to suspect everything. Like with only 1 desat how bad could the apneas and hypopneas have been (OK, you don't need a desat to score and apnea, and the hypopneas could have been scored by arousal) but I'd be reviewing that boy's work.

But comes the issue of mixed apneas. You got 13. Now that's a LOT. I mean, true mixed apneas are VERY rare. Like Charizard rare. I'd also be questioning their validity.

[pearlpearl]

A few centrals and mixed apnea in that as expected. A little odd how breathing was good most of the night and then real bad for about an hour. Goes to show how your apnea fluctuates and some nights could be noticeably worse than others.

If you have no symptoms why did you originally get a sleep study done? If you truly have no symptoms then sure try going without PAP but I am guessing you do have symptoms hence why you are asking for help.

If doctor isn't interested in trying ASV and you don't feel your sleep quality is adequate you might need to purchase your own machine however possible. Unfortunately lots of people end up having to do that due to incompetent doctors/healthcare systems.

It is a mystery in my sleep test 2 that the apnea in the last hour looked bad.  But i did got up for a pee at around 3am, not certain did it had an affect to the result.

Good question about the symptoms.  I have a TMJ condition on one side of my jaw.  My Dentist suspected i have Bruxism hence ordered me to see a sleep doctor for a sleep test.  My first sleep test, i was not convinced.  I was literally on my back or sit upright without sleeping the whole night and ended up with a AHI 21.  Was on Auto CPAP, Fixed CPAP for about 2 months.  I was not feeling any better but worst with the CPAP Machine.  Therefore, i ordered another sleep test.

In Singapore, the machine is not covered by any insurance.  We pay hard cash for the machine.  I am stuck with the Auto CPAP machine now hence i will use it to improve my sleep quality.  Hahaha not sure is a good idea to keep monitor the numbers despite i have not much of a sleep apnea symptoms or i shall go for a long cpap holidays.  Thank you!

[pearlpearl]

Now once you find even one piece of shoddy work, then you come to suspect everything.  Like with only 1 desat how bad could the apneas and hypopneas have been (OK, you don't need a desat to score and apnea,  and the hypopneas could have been scored by arousal) but I'd be reviewing that boy's work.

But comes the issue of mixed apneas.  You got 13.  Now that's a LOT.  I mean, true mixed apneas are VERY rare.  Like Charizard rare.  I'd also be questioning their validity.

Thanks Rubicon, i bet you understand now how i feel with the results!  The doctors comments, recommendation did not gave me an assurance that i am safe.  I was telling them, i will likely just die in my sleep without a breathe and i will mark their words and it was recorded in the national record hahaha

[Rubicon]

Well, if you believe the sleep study your O2 sat throughout the "bad" portion of the study was 98% so I'd put money on you outliving all of us.

What pressure are you "supposed" to be on?  From the data you submitted it looks like plain ol' 5 is fine.  More than that and the roof caves in with leaks and events.

Again I wouldn't worry about "The Number" on 5 as I believe in your case that's all Junk.  To be sure, one would have to get out of SkyLab view and review breath by breath.  LMK if you want to do that.

[Rubicon]

What pressure are you "supposed" to be on? 

Cause I'm wondering if we need to throw all of the "professionals" out or just some of them.

[pearlpearl]

Cause I'm wondering if we need to throw all of the "professionals" out or just some of them.

I am interested to know more and i am really curious with sleep apnea treatment at least in my case.  Because i don't really see an improvement with cpap treatment despite i have all sorts of apnea during sleep.  

For 2 months and based on first sleep test result.  My recommended setting was in a range of Fixed CPAP 8,9,10,11,12, Full ERP 3.  My CA was high and large leaks.  It was discomfort at fixed CPAP 12 during my sleep especially during the Ramp time if i slept on my side.

Second sleep test recommendation.  It was mild hence not a concern, go for a cpap holidays and observe for any symptoms. 

I took your recommendation and set at Fixed CPAP 5, FULL EPR 3 yesterday.  It was an okay sleep but i did not feel extremely refresh either.

[Rubicon]

Could be there are other issues besides sleep apnea. As in simply bad sleep.

If you want, load the contents of the SD card to Dropbox so that breath by breath can be examined, and find out if the remaining events are events that need to be treated (IMO, they probably do not. They may be a result of restless sleep).

[pearlpearl]

Could be there are other issues besides sleep apnea.  As in simply bad sleep.

If you want, load the contents of the SD card to Dropbox so that breath by breath can be examined, and find out if the remaining events are events that need to be treated (IMO, they probably do not.  They may be a result of restless sleep).

You might guess right.  I might have some kind of Inadequate sleep hygiene.  For example, i am disturb by the second hand smoke from my neigbour every night.  The smell can be quite intense.  In addition, i am a light sleeper and sensitive to noise.  I do experience insomnia some nights.

I have my SD card Datalog in my Google Drive.