New user, new diagnosis
Hello,
I'm a new member and a new CPAP user (the OSA diagnosis is still pretty fresh).
I've had insomnia for about 15 years now - both trouble falling asleep and trouble staying asleep. It's been managed with pills - until recently, it was Temazepam 30mg, Melatonin 10mg, Diphenhydramine HCl 50mg, Doxylamine Succinate 25mg.
I've been working with a therapist on "Cognitive Behavioral Therapy for Insomnia". It's helped quite a bit - my "sleep efficiency" is way up and I no longer take the Diphenhydramine nor the Doxylamine, and the Temazepam is down to 22.5mg.
Over the past year I've changed my diet and dropped 50 pounds. As the wife pointed out, "you don't snore anymore".
I get my healthcare through the VA. During my last annual appointment, the doc referred me to the Sleep Medicine folks for a consult, just to rule out apnea. They examined my throat and told me that it didn't look like the structures would be apnea-prone; perhaps I'd had more of an issue 50 pounds prior. They still wanted to get me into an overnight study just to completely rule it out but it was not critical, so the appointment was well in the future.
(I'd thought to break into chunks so I could hit 4 posts quick but apparently it just appends to the initial post)
I did not enjoy the appointment. I am a stomach sleeper - have been since I was a teen; had severe road-rash on my back and had to learn not to sleep on it. Wasn't until after they wired me up that they told me I needed to sleep on my back or side; back just isn't restful and side makes my back hurt. Followed the directives, minimal sleep (it seemed like) - too much noise, bad positions, uncomfortable tiny bed.
They did not titrate me during the study.
The followup was a few days later and was about as detailed as "they determined you have sleep apnea, you'll be contacted for an appointment to come get a CPAP machine".
No questioning, no discussion. I'd have liked to know a lot of details that weren't provided.
Detailed report follows - pulled straight from my notes in the VA's system
Active Outpatient Medications (excluding Supplies):
Active Outpatient Medications Status
=========================================================================
1) TEMAZEPAM 7.5MG CAP TAKE THREE CAPSULES BY MOUTH AT ACTIVE
BEDTIME FOR SLEEP
Patient presents to the sleep lab for scheduled PSG. PSG procedure explained to
patient. Sleep sensors applied per sleep lab protocol. Lights out: 23:03,SAO2=
96%,P=70,EKG=(supine). Patient had some difficulty falling asleep and
maintaining sleep after lights out due to mild snores and hypopneas. Supine REM
sleep displayed mild to moderate snoring and obstructive OSA with mild oxygen
desats and arousals. Patient did not sleep lab criteria for emergency split-
night (RDI>40) study after two hours of sleep as his estimated RDI was 26.2.
Diagnostic PSG continued at 01:30. Lights on: 5:55. Sleep sensors removed from
patient. Patient provided shampoo and towels for clean-up. Patient completed
morning questionnaires and departed the sleep lab in apparent distress @ 6:45.
Preliminary staging and scoring completed.
POLYSOMNOGRAPHY REPORT
Patient Name:
Patient ID #:
Sex: Male Study Date:
D.O.B. Study Type: DIAGNOSTIC
Age: 47 years Referring Physician:
Height: 71.0 in. Interpreting Physician:
Weight: 208.6 lbs. Recording Technician:
B.M.I. 29.1 lb/in2 Scoring Technician:
Neck: 16.0 in. Epworth: 12/24
CPT Code: CPT Code Description: Attended Polysomnography 4
channels or more.
Medications: TEMAZEPAM
PROCEDURE:
Polysomnography was conducted on the night of 3/14/2017. The following
parameters were monitored: frontal, central and occipital EEG, electrooculogram
(EOG), submentalis EMG, nasal and oral airflow, anterior tibialis EMG, body
position and electrocardiogram. Additionally, thoracic and abdominal movements
were recorded by inductance plethysmography. Oxygen saturation (SpO2) was
monitored using a pulse oximeter. The tracing was scored using 30 second
epochs. Hypopneas were scored per AASM definition (4% desaturation).
SLEEP ARCHITECTURE
Lights off clock time: 11:03:10 PM
Lights on clock time: 5:55:58 AM
Total Recording Time (TRT): 423.9 minutes
Time In Bed (TIB): 412.8 minutes
Sleep Period Time (SPT): 407.8 minutes
Total Sleep Time (TST): 327.8 minutes
Sleep Efficiency: 79.4 %
Sleep Onset: 5.0 minutes
WASO: 80.0 minutes
REM Latency (from Sleep Onset): 126.5 minutes
REM Latency (from Lights Off): 131.5 minutes
Sleep Staging Duration % TST Latency (from LOFF)
N 1: 32.5 minutes 9.9 % N 1: 5.0 minutes
N 2: 211.8 minutes 64.6 % N 2: 11.5 minutes
N 3: 30.0 minutes 9.2 % N 3: 114.0 minutes
R: 53.5 minutes 16.3 % R: 131.5 minutes
*Above Index Values Based on Total Sleep Time ? Hypopneas scored based on 4% or
greater desaturation ? UH + CH +OH = Hypopnea Total
CHEYNE STOKES BREATHING: None Observed
RESPIRATORY
AHI: 20.3 RDI: 23.4
CA OA MA Apnea Hypop* A + H RERA Total
Number: 22 34 5 61 50 111 17 128
Total Dur(min): 5.8 11.3 1.4 18.5 19.4 37.9 7.2 45.0
Index(#/h TST): 4.0 6.2 0.9 11.2 9.2 20.3 3.1 23.4
AROUSALS
REM NREM Arousals Awakenings Ar+Aw Ar+Aw Index
Respiratory: 2 7 10 16 26 4.8
Leg Movement: 1 9 11 0 11 2.0
Snore: 0 0 0 0 0 0.0
Spontaneous: 2 17 20 3 23 4.2
Total: 5 33 41 19 60 11.0
Arousal Index: 5.6 7.2 7.5 3.5 11.0
LIMB MOVEMENTS
Count Index (#/h)
Total Leg Movement: 58 10.6
PLMS: 0 N/A
PLMS Arousals: 0 N/A
SNORING SUMMARY
Snoring Episodes: 0
Snoring Index: N/A
Total Time with Snoring: 0 min
OXYGEN
Mean SpO2: 93%
Low SpO2: 78%
High SpO2: 98%
<=88% (min): 10.5
CARDIAC SUMMARY
Average Pulse During Sleep(TST): 63.1 bpm Lowest Pulse During Sleep (TST):48 bpm
Highest Pulse During Sleep(TST):98 bpm Lowest Pulse During Recording (TIB):48bpm
Highest Pulse During Recording (TIB): 98 bpm
CARDIAC EVENT OBSERVATIONS
TYPE YES NO RATE / DURATION
Bradycardia: x Lowest HR Scored: N/A
Unclassified Tachycardia: x Highest HR Scored: N/A
Sinus Tachycardia During Sleep: x Highest HR Scored: N/A
Narrow Complex Tachycardia: x Highest HR Scored: N/A
Wide Complex Tachycardia: x Highest HR Scored: N/A
Asystole: x Longest Pause: N/A
Atrial Fibrillation: x Duration Longest Event: N/A
TECHNICIAN NOTES
PSG was performed to evaluate for sleep disordered breathing. The study was
notable for snoring and significant sleep related breathing events with an AHI
of 20/hr. Oxgen saturation nadir was 78%.
Impression:
Moderate Obstructive Sleep Apnea
I'm a new member and a new CPAP user (the OSA diagnosis is still pretty fresh).
I've had insomnia for about 15 years now - both trouble falling asleep and trouble staying asleep. It's been managed with pills - until recently, it was Temazepam 30mg, Melatonin 10mg, Diphenhydramine HCl 50mg, Doxylamine Succinate 25mg.
I've been working with a therapist on "Cognitive Behavioral Therapy for Insomnia". It's helped quite a bit - my "sleep efficiency" is way up and I no longer take the Diphenhydramine nor the Doxylamine, and the Temazepam is down to 22.5mg.
Over the past year I've changed my diet and dropped 50 pounds. As the wife pointed out, "you don't snore anymore".
I get my healthcare through the VA. During my last annual appointment, the doc referred me to the Sleep Medicine folks for a consult, just to rule out apnea. They examined my throat and told me that it didn't look like the structures would be apnea-prone; perhaps I'd had more of an issue 50 pounds prior. They still wanted to get me into an overnight study just to completely rule it out but it was not critical, so the appointment was well in the future.
(I'd thought to break into chunks so I could hit 4 posts quick but apparently it just appends to the initial post)
I did not enjoy the appointment. I am a stomach sleeper - have been since I was a teen; had severe road-rash on my back and had to learn not to sleep on it. Wasn't until after they wired me up that they told me I needed to sleep on my back or side; back just isn't restful and side makes my back hurt. Followed the directives, minimal sleep (it seemed like) - too much noise, bad positions, uncomfortable tiny bed.
They did not titrate me during the study.
The followup was a few days later and was about as detailed as "they determined you have sleep apnea, you'll be contacted for an appointment to come get a CPAP machine".
No questioning, no discussion. I'd have liked to know a lot of details that weren't provided.
Detailed report follows - pulled straight from my notes in the VA's system
Active Outpatient Medications (excluding Supplies):
Active Outpatient Medications Status
=========================================================================
1) TEMAZEPAM 7.5MG CAP TAKE THREE CAPSULES BY MOUTH AT ACTIVE
BEDTIME FOR SLEEP
Patient presents to the sleep lab for scheduled PSG. PSG procedure explained to
patient. Sleep sensors applied per sleep lab protocol. Lights out: 23:03,SAO2=
96%,P=70,EKG=(supine). Patient had some difficulty falling asleep and
maintaining sleep after lights out due to mild snores and hypopneas. Supine REM
sleep displayed mild to moderate snoring and obstructive OSA with mild oxygen
desats and arousals. Patient did not sleep lab criteria for emergency split-
night (RDI>40) study after two hours of sleep as his estimated RDI was 26.2.
Diagnostic PSG continued at 01:30. Lights on: 5:55. Sleep sensors removed from
patient. Patient provided shampoo and towels for clean-up. Patient completed
morning questionnaires and departed the sleep lab in apparent distress @ 6:45.
Preliminary staging and scoring completed.
POLYSOMNOGRAPHY REPORT
Patient Name:
Patient ID #:
Sex: Male Study Date:
D.O.B. Study Type: DIAGNOSTIC
Age: 47 years Referring Physician:
Height: 71.0 in. Interpreting Physician:
Weight: 208.6 lbs. Recording Technician:
B.M.I. 29.1 lb/in2 Scoring Technician:
Neck: 16.0 in. Epworth: 12/24
CPT Code: CPT Code Description: Attended Polysomnography 4
channels or more.
Medications: TEMAZEPAM
PROCEDURE:
Polysomnography was conducted on the night of 3/14/2017. The following
parameters were monitored: frontal, central and occipital EEG, electrooculogram
(EOG), submentalis EMG, nasal and oral airflow, anterior tibialis EMG, body
position and electrocardiogram. Additionally, thoracic and abdominal movements
were recorded by inductance plethysmography. Oxygen saturation (SpO2) was
monitored using a pulse oximeter. The tracing was scored using 30 second
epochs. Hypopneas were scored per AASM definition (4% desaturation).
SLEEP ARCHITECTURE
Lights off clock time: 11:03:10 PM
Lights on clock time: 5:55:58 AM
Total Recording Time (TRT): 423.9 minutes
Time In Bed (TIB): 412.8 minutes
Sleep Period Time (SPT): 407.8 minutes
Total Sleep Time (TST): 327.8 minutes
Sleep Efficiency: 79.4 %
Sleep Onset: 5.0 minutes
WASO: 80.0 minutes
REM Latency (from Sleep Onset): 126.5 minutes
REM Latency (from Lights Off): 131.5 minutes
Sleep Staging Duration % TST Latency (from LOFF)
N 1: 32.5 minutes 9.9 % N 1: 5.0 minutes
N 2: 211.8 minutes 64.6 % N 2: 11.5 minutes
N 3: 30.0 minutes 9.2 % N 3: 114.0 minutes
R: 53.5 minutes 16.3 % R: 131.5 minutes
*Above Index Values Based on Total Sleep Time ? Hypopneas scored based on 4% or
greater desaturation ? UH + CH +OH = Hypopnea Total
CHEYNE STOKES BREATHING: None Observed
RESPIRATORY
AHI: 20.3 RDI: 23.4
CA OA MA Apnea Hypop* A + H RERA Total
Number: 22 34 5 61 50 111 17 128
Total Dur(min): 5.8 11.3 1.4 18.5 19.4 37.9 7.2 45.0
Index(#/h TST): 4.0 6.2 0.9 11.2 9.2 20.3 3.1 23.4
AROUSALS
REM NREM Arousals Awakenings Ar+Aw Ar+Aw Index
Respiratory: 2 7 10 16 26 4.8
Leg Movement: 1 9 11 0 11 2.0
Snore: 0 0 0 0 0 0.0
Spontaneous: 2 17 20 3 23 4.2
Total: 5 33 41 19 60 11.0
Arousal Index: 5.6 7.2 7.5 3.5 11.0
LIMB MOVEMENTS
Count Index (#/h)
Total Leg Movement: 58 10.6
PLMS: 0 N/A
PLMS Arousals: 0 N/A
SNORING SUMMARY
Snoring Episodes: 0
Snoring Index: N/A
Total Time with Snoring: 0 min
OXYGEN
Mean SpO2: 93%
Low SpO2: 78%
High SpO2: 98%
<=88% (min): 10.5
CARDIAC SUMMARY
Average Pulse During Sleep(TST): 63.1 bpm Lowest Pulse During Sleep (TST):48 bpm
Highest Pulse During Sleep(TST):98 bpm Lowest Pulse During Recording (TIB):48bpm
Highest Pulse During Recording (TIB): 98 bpm
CARDIAC EVENT OBSERVATIONS
TYPE YES NO RATE / DURATION
Bradycardia: x Lowest HR Scored: N/A
Unclassified Tachycardia: x Highest HR Scored: N/A
Sinus Tachycardia During Sleep: x Highest HR Scored: N/A
Narrow Complex Tachycardia: x Highest HR Scored: N/A
Wide Complex Tachycardia: x Highest HR Scored: N/A
Asystole: x Longest Pause: N/A
Atrial Fibrillation: x Duration Longest Event: N/A
TECHNICIAN NOTES
PSG was performed to evaluate for sleep disordered breathing. The study was
notable for snoring and significant sleep related breathing events with an AHI
of 20/hr. Oxgen saturation nadir was 78%.
Impression:
Moderate Obstructive Sleep Apnea
