[Diagnosis] Sleep Test Results and Questions

[Satu]

Greetings, 

I am very happy to have found this forum. I had a sleep test on Feb.2, 2024 (see attached) due to my symptoms of REM Sleep Behavior Disorder (RBD) during which I have been acting out my dreams, injuring myself on occasion. Otherwise I am in excellent physical condition with no other illnesses. You can see that the AHI from the test is 23.2/h. The doctor diagnosed me with RBD and OSA and prescribed a CPAP. I have a few questions that I hope someone here can help me to answer:

1. Since nearly all the Apnea and Hypopnea events occurred in the Supine position, would sleeping on my side likely solve the problem and avoid the discomfort of a CPAP? Perhaps my RBD is from the OSA which in turn is caused by sleeping on my back? In the sleep test, the technologist told me that sleeping on my back was best for the test. Halfway through when I could not sleep for an hour, they gave me a mild sleeping pill (10 mg of Zolpidem dactive) and I switched to side sleeping. AHI for this portion was 2.85/h.

2. I have been using a trial Resmed 10 CPAP machine for the last 4 nights. It currently shows a AHI of .5 or less and is using a pressure of 5.8, set to auto. I am only using the machine about 4 hours per night due to the discomfort of the P30i pillow pads on my nostrils and the noise.  I wake up and after trying to return to sleep for 1 - 2 hours, I take the mask off. Granted I have had no RBD events in the last 4 days but I am not sleeping enough or well for that matter.  I am also not taking any medication now while I trial the CPAP so no RBD is good result.   My trial of the Resmed is up in a few days and I need to decide whether or not to buy a CPAP machine?

3. The first two nights of using the CPAP the leakage was 24/L.  Since I tend to breathe through my mouth when sleeping, I tried taping my mouth last night and the leakage went down to 7/L.  Is the taping worth the discomfort?  As long as it stays under 24/L is it best to not worry about the leakage?

4. The Blood Oxygen Level from my Galaxy 6 watch shows levels 95 -98% (was using the Resmed 10) and the second part of the night with no Resmed 10 the levels went down to low 90s.  Does this mean the Resmed increases my Blood Oxygen levels?  

Thank you in advance for any comments and advice.  

   
   
   

[srlevine1]

Might I suggest that you contact your doctor and ask to extend your ResMed trial or attempt to rent a machine (possibly with the rental being applied to the purchase), download OSCAR, and post a few charts for a better analysis from the forum?

If sleeping on your side appears to lower your AHI, you may wish to adopt that sleeping posture.

As for masks and discomfort, welcome to the trial and error club. I found nasal pillows to be uncomfortable and switched to a ResMed Mirage Activa LT which has a lower lip that helps to keep your mouth shut.

As for noise, you will eventually acclimate, and it will disappear.

As for "Perhaps my RBD is from the OSA which in turn is caused by sleeping on my back?," I have never encountered this issue and the best advice as to cause and effect is likely to come from your physician. However, symptoms may come and go -- and the underlying condition remains the same. Truly a matter left to specialists. 

However, you might wish to read Prevalence of obstructive sleep apnoea in REM behaviour disorder: response to continuous positive airway pressure therapy - PubMed (nih.gov).  You may want to do a Google Search using RBD and OSA as the keywords for more results. 

I am unaware of anyone who was given any sleeping medication during a test as it would change the validity of the results.

As for oxygenation, CPAP has been known to improve oxygenation during sleep due to open passageways.  

Perhaps more enlightened forum members can respond.

Best of Luck.

[Satu]

Thank you for your thoughtful comments and suggestions.

[BoxcarPete]

Taping my mouth is essential for me, both from comfort and treatment efficacy standpoint. Think of your nose and how it warms and humidifies air meant to go into your lungs at a rate equal to your minute vent, usually anywhere from 5-9L/min depending on your size. Now with your mouth leaking air, that full amount goes through the nose and it needs to warm and humidify 24L/min in addition to your body's need, so it can be 30, 40, or even higher if the leak is bad. This is 5-10 times more air than the nose is meant to have pass through, and it can be very irritating, which could cause the soft tissue within the nose to swell up in reaction and partially block itself to limit the flow. Reducing the leak rate with mouth tape is really helpful to keep the nose happy.

[Deborah K.]

I too find a pillows mask and mouth tape way more comfortable and effective than a full face or nasal mask.

[Satu]

Thanks for your comments I taped my mouth last night with an X in the middle. Must have been some leakage because the Resmed 10 showed 28L Tonight I will try taping horizontally to see if this helps the leakage.

[BoxcarPete]

The tape I use is 2" wide, make sure you get something that can get a hold of your face on both top and bottom.

[Deborah K.]

I use 2-inch wide tape and cut it almost 6 inches long. This is the only way I can control leaks.