Help me interpret my second Sleep Study results

[YouTakeMyBreathAway]

After still feeling tired w/ CPAP, I just completed an in-lab sleep study w/ CPAP and got the following results back, with the recommendation to continue CPAP treatment at roughly my current settings. (8-14mmH20 recommended, vs I’m doing 12-16mmH20)

Given I still feel tired, I was hoping for advice on what I can do - instead of continuing w/o changing anything, which obviously did not help…

Note that I actually had slightly more refreshing sleep during my sleep study night, so I’d expect these numbers to possibly be skewing lower than actual.

AHI: 14.1
AHI w/ 4% desat: 0.7
NREM AHI: 12.8 
REM AHI: 19.4

RDI: 22.5
NREM RDI: 21
REM RDI: 28.6

Apneas: 0.2
Obstructive: 0.0
Mixed: 0.0
Central: 0.0
Hypopneas: 13.9
RERAs: 8.5

[Sleeprider]

The sleep study shows that you have an AHI that should be treated, but it is mild sleep disordered breathing with nearly all hypopnea events that do not cause 4% or greater SpO2 desaturation. The hypopnea events are often accompanied by respiratory effort related arousals (RERA) and are a significant disruption to your sleep. Reading between the lines, these results are typical of UARS, and your most effective therapy would use pressure support or EPR to assist your inspiratory effort.

[YouTakeMyBreathAway]

Thank you! I have EPR set to 3 since the beginning of treatment multiple months ago. 

Would this indicate BiPap?

[Sleeprider]

Well, with a Resmed Airsense 11 Autoset you have a bilevel, but it's limited to 3-cm. I don't recall off-hand your current results or any need for additional pressure support. If there is residual flow limitation in the 95th percentile statistic, then higher pressure support can reduce that. It really helps when a member keeps their therapy questions in one thread because the information is readily available. All of your previous threads are probably related to this question. A quick glance shows your early threads were con cerned with CA events. You eventually transitioned to sporadic oxygen desaturations. By spreading all of these questions into different threads you don't get the benefit of a more in-depth analysis by those responding to the question du jour.

[YouTakeMyBreathAway]

Oh, that is a great point, will try to use a single thread and summarize past discussions.

Regarding my latest results - this sleep study is my latest data (with treatment).

Interestingly my home CPAP does not pick up the hypopneas, I assume they may have scored them manually. My machine also does not pick up any of the RERAs, but I think that part is by design.

Either way, with RERAs above 8/h, I assume this is the reason I am still very tired and forgetful. My question is what can I try next.

[Sleeprider]

I can merge the relevant threads into a single therapy thread if you want. If you want me to do that, you can simply summarize the resolution of the CA events and oxygen issues and move forward from there. I did not know that your latest sleep study was with CPAP. I would really like to see the technician's report and any details, especially machine settings and other observations. If you post that, be sure to redact (black-out) personal identifying information.

[YouTakeMyBreathAway]

This is what it said for clinical interpretation: 

Mr. YouTakeMyBreathAway was previously diagnosed as having moderate Obstructive Sleep Apnea, who appears to be best treated with nasal-CPAP at an airflow pressure of 8 to 14 cm of water. This pressure may need to be adjusted after the patient is habituated to the equipment and physiology has become less abnormal.

A prescription is written for auto CPAP initiation at a pressure setting of 8 to 14 cm of water.

 There were no signs of periodic leg movements [PLMS] during sleep.

A single lead ECG was monitored throughout the study, and did not reveal any cardiac issues.

And towards the top it says:

CPAP settings of 5 to 12 cm of water were used during the titration.

The patient was best fitted with a Resmed AirFit N30i with standard frame, small nasal cushion. 

[Sleeprider]

You should request a copy of the study results and recommendations. That summary doesn't show the results of different pressures. Kind of a rip-off not to see the details.

[YouTakeMyBreathAway]

Yeah it took me a while for them to even send it, pretty frustrating.

I have an appointment scheduled to discuss the results - I will ask about the numbers at 12cmH20 (the maximum they went to). 

I guess there are two outcomes:

1. My RERAs and RDI remained high even then — seems like in that case I should be asking to get a prescription for a Aircurve VAuto, is that right? Any other things I should ask for?

2. My RERAs and RDI dropped to a low level — in that case, I am confused why I am still consistently tired and forgetful. Unfortunately the night at the lab also had no oxygen desats below 92% (I was wearing my own device, that’s how I know), so it actually did not seem to be perfectly representative of my usual nights where my oxygen keeps dipping into the high 80s. What are my options if this is the case? Could I still request a BiPap?

[Sleeprider]

The reason neither of us knows it because we don't actually have a titration report to look at. We need all of the pressures tried. The titration procedure should document response at multiple pressures, and if efficacy is not achieved with CPAP, the test should evaluate bilevel. The results you cite show a relatively high treated AHI and a broad range of pressure. I don't see much value in a test that doesn't tell you anything you don't already know from your CPAP data.