[Diagnosis] sleep study review and questions

[Uzupan]

           
Hello everyone, I am new to this board, even though I have been a CPAP user off-and-on for the past year. This past week I finally had a tritration  study done. Attached, is the study. My question to you folks is this; reviewing my study I see that my overall results were better when the pressure was set at 9L of pressure The doctor that read this is recommending 15 L of pressure because there was no AHI recorded. My only concern with that is I was awake, as you look at the study for most of the time during that 15L of pressure  setting wcompared to when the setting was on 9 L pressure I was asleep most of the time. So what would you possibly recommend, stay at the 15L of pressure where no AHI is recorded but the arousal index was higher than at 9 L of pressure?

I also found out the AHI readings on my ResMed Airsense 11 are a lot lower than what is being reported on my sleep study. My AHI readings from my ResMed are generally under .7 for the night, of course I am in my own bed in my own room with my own pillow and that may make some of the difference.

Any thoughts or opinions or things to point out I would deeply appreciate everyone's help. My pulmonologist  that ordered the sleep study has retired so I know she will not be looking at this report. My primary care doctor left and they have a new one in the office that I have not met yet so as of right now I am depending on you folks to give me some insight. I will say that I will not take this as medical advice that would come from a position but just your opinion and your thoughts.

Thank you for your help!!

[Gideon]

Your study showed no apneas and a cluster of hypopneas when sleeping on your left side. The cluster suggests a form of positional apnea that typically results from chin tucking. You had serious O2 DeSats, 12+ minutes at 80-90% most of which correlated with the cluster of hypopneas when sleeping on your left side.

Based on this sleep study I don't think you need PAP therapy. You do need to not sleep on your left side. Because of your DeSats I fee it is prudent to .monitor your O2 levels overnight with CPAP but especially without CPAP. If I recall correctly 8 minutes at 88% or less is grounds on Medicare to qualify for overnight supplemental oxygen. CPAP therapy often mitigates low oxygen it in your case, with a CPAP, though not at optimum pressure, you exhibit low says.

With no CPAP you absolutely, based on this study, need to stay off your left side while sleeping. Point: one night does not make a trend, this could be left side on your sleep study night and your right side, or even your back on other nights. Most likely this was caused by a bad cervical alignment resulting in the hose we call a wind pipe getting kinked. If I see the same on a CPAP I have no way of determining if you were side sleeping so the recommendation would be to modify your pillow to keep your neck straight or to use a soft cervical collar. See my signature for the wiki link.

Going forward, as a minimum you need to monitor this clustering, a recording pulse oximeter would do it looking for cluster of DeSats.

You do need an overnight oxygen study, without CPAP, if you choose to not go CPAP. You need to manage your DeSats as a min.

It is very rare for me to not recommend a CPAP but I think with O2 monitoring and managing those clusters of DeSats you could move on without CPAP.

[Uzupan]

I did have a sleep study last year, I cant find a copy of it, I had a 36 AHI on that sleep study and I can't remember what my oxygen was but I believed it dropped to about 67. I also have an oral mouthpiece that I have been trying to get to work. My oxygen on that dropped to 82 on the last night owl test. I am expanding the settings on the oral mouthpiece this weekend so the Doctor can give me an update on the night owl test. As far as overnight supplemental  oxygen I did have it for a while with the mouth piece but my level still dropped to 86 and that was using Cpap at the same time.

I did see using the 15 l pressure the oxygen stayed above 90. I do sleep, I think, in a curved position. I do try to sleep on my right side. During my initial sleep study I slept on my back for a long while but on the titration study it seemed on slept on my back for about an hour and they woke me up around 4 am to move me back on my side.

Thanks for the insight!! Also included is a pic  I could not add to the original thread.

[Gideon]

Since you say you are curling, get and try a soft cervical collar. that bit of info adds to the need to unkink your neck.

[Uzupan]

I Ok thanks will give that a try.