+- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums)
+-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area)
+--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum)
+--- Thread: [CPAP] Input needed (/Thread-CPAP-Input-needed)
RE: Input needed - eugyoo2 - 09-07-2023
Attached are the results of my sleep studies
This was what my Polysomnography report stated word for word:
Indication: snoring
Clinical Information: Height: 69.0 in. Weight: 180.0 lbs. BMI: 26.6
Test Description: Baseline Polysomnogram
Monitored: Frontal, Central, and Occipital EEG, EOG, Submentalis EMG,
Oronasal Thermocouple, Nasal Pressure, ECG, Thoracic and Abdominal
Respiratory Inductance Plethysmography effort belts, Right and Left Anterior
Tibialis EMG, Snore Sensor, and Pulse Oximetry.
Scoring: The tracing was scored in 30-second epochs according to The AASM
Manual for the Scoring of Sleep and Associated Events: Rules, Terminology
and Technical Specifications Version 2.5.
Sleep Staging and EEG Analysis: Lights out was 10:35 PM, Lights on at 5:08
AM, with a Total Recording Time (TRT) of 392 minutes. The patient slept for
246 minutes, yielding a Sleep Efficiency of 62.7%. Sleep Latency was 7
minutes with a REM Latency of 65 minutes. The patient spent 18 minutes (7.3%)
in Stage N1, 170 minutes (69.3%) in Stage N2, 10 minutes (4.1%) in Stage N3,
and 47 minutes (19.3%) in Stage REM. The total time Awake After Sleep Onset
(WASO) was 63 minutes. Body Position Total Sleep Time: Supine 246 min., Side
0 min., Prone 0 min. Any EEG findings considered significant or abnormal will
be further discussed in the interpretation below.
Respiratory Analysis: An apnea is defined by a drop in the peak thermal
sensor excursion >90% of baseline for 10 seconds or more. Hypopnea are scored
using both rule VIII.D.1A (A hypopnea is any decrease in airflow >30% of
baseline for ten seconds or more that is either accompanied by a >3% decrease
in oxygen saturation from pre-event baseline or associated with an arousal)
and rule VIII.D.1B (A hypopnea is any decrease in airflow >30% of baseline
for ten seconds or more that is accompanied by a >4% decrease in oxygen
saturation from pre-event baseline). The apnea hypopnea index (AHI), is
calculated by dividing the total number of apneas and hypopneas by the total
numbers of hours of sleep.
Under Hypopnea rule VIII.D.1A, the Apnea/Hypopnea Index (AHI) was 15.9 (Apnea
Index (AI) was 0.5 and the Hypopnea Index (HI) was 15.4). There were a total
of 65 respiratory events consisting of 0.0 Obstructive Apneas, 63 Hypopneas,
0.0 Mixed Apneas, and 2.0 Central Apneas. There were 0.0 RERAs resulting in
an RDI of 15.9. Supine AHI was 15.9. Nonsupine AHI was 0.0. NREM AHI was
13.9. REM AHI was 24.0.
Under Hypopnea rule VIII.D.1B, the Apnea/Hypopnea Index (AHI) was 2.9 (Apnea
Index (AI) was 0.5 and the Hypopnea Index (HI) was 2.4). There were a total
of 12 respiratory events consisting of 0 Obstructive Apneas, 10.0 Hypopneas,
0 Mixed Apneas, and 2 Central Apneas. There were 0 RERAs resulting in an RDI
of 2.9. Supine AHI was 2.9. Nonsupine AHI was 0.0. NREM AHI was 2.1. REM AHI
was 6.3.
The average baseline SpO2 during the study was 96% with a minimum SpO2 value
of 86%. The percentage of Sleep Time with SpO2 at, or below 88% was 0.0%.
Snoring was rated as . Cheyne Stokes breathing was not observed.
Arousal Events: An arousal is defined as abrupt shift in electroencephalogram
frequency, including theta, alpha, or frequencies greater than 16 Hertz, but
not sleep spindles, lasting three seconds or longer. In REM sleep, these
changes must be accompanied by a concurrent increase in submentalis
electromyogram amplitude lasting at least 1 second. There were a total of 42
arousals with an Arousal Index of 10.2 per hour of sleep.
Cardiac Events: The average heart rate (HR) during sleep was 51, normal sinus
rhythm. The highest HR during sleep was 73 with a minimum HR of 43. The
highest HR during the entire recording was 74. Any ECG findings considered
significant or abnormal will be further discussed in the interpretation below.
Movement Events: Periodic leg movements are defined as defined by movements
in the anterior right and left tibialis channels of 0.5 to 10 second
durations, in trains of at least four movements, with intermovement intervals
of four to 120 seconds. The total number of periodic leg movements during
sleep was 18 with a PLM Index of 4.4 periodic leg movements per hour of
sleep. The total number of periodic leg movements with arousals was 2
yielding a PLM Arousal Index of 0.5 arousals per hour of sleep.
Interpretation: This baseline polysomnogram demonstrates mild obstructive
sleep apnea.
Recommendations:
1. If there is no contraindication for auto-titrating PAP therapy, a trial of
APAP 5-20 cm of water with close clinical monitoring is recommended for the
treatment of this patient´s obstructive sleep apnea. Other treatment options
for OSA can include oral appliances and surgical procedures.
2. If the patient is over ideal body weight, weight loss may help improve the
underlying Obstructive Sleep Apnea and could serve as adjunctive therapy.
3. The patient should avoid the use of sedative/hypnotic medications as well
as alcohol in the presence of untreated Obstructive Sleep Apnea.
4. The patient should refrain from operating a motor vehicle or heavy
machinery if sleepy and avoid driving until any subjective sense of
sleepiness has resolved and has been adequately managed.
and my abbreviated sleep study:
Indication: mask interface
Clinical Information: Height: 0.0 in. Weight: 0.0 lbs. BMI: 0.0
Test Description: Daytime, Abbreviated Cardio-Respiratory Sleep Study
Monitored: ECG, Thoracic and Abdominal Respiratory Inductance Plethysmography
effort belts, Snore Sensor, Pulse Oximetry, and mask mask flow.
Sleep Scoring Data: The exam started at 10:22 AM and ended at 12:39 PM, with
a Total Recording Time (TRT) of 138 minutes.
SpO2 Statistics: The Mean SpO2 throughout the Study was -- with a minimum of
--.
ECG Analysis: The heart rate ranged from 0 to 0 with an average rate of 0 and
a sinus rhythm.
Analysis by Sleep Technologist:
NON BILLABLE Eugene Yoo presents for a pap nap. The patient is currently on
auto cpap but is having difficulty with mask leaks and comfort, he is
currently wearing the f20 med. I explained today's procedure with him and
brought in multiple masks for him to try which included the F30 med, F10 med,
Evora nasal med, Dream wear nasal med, N20 med, Wisp original large and the
Pico large. The patient liked the Wisp large DAW mask as his first choice and
the Pico large DAW mask as a second choice. The patient wanted to only do the
mask trials and so we were unable to verify that the patients current auto
cpap settings of 5-20 are effectively treating the patients osa, however the
patient does say that he sleeps better without cpap and is finding that he is
pulling the mask off in the middle of the night. Recommend check of his
download to see where his overall average presures are and lowering the auto
cpap pressures as the patient seems to be having some tolerance issues, we
had to lower the settings during the trials we used auto 5-15 and we also
used cpap 7 epr 3 he did better with the cpap 7 EPR 3. Also switching from a
full face mask to a nasal mask the pressures required maybe lower. We used
the RESmed S9 series, 82 degrees heated humidity, climate control tubing,
Wisp (original) large mask DAW and Healthcare DME as his DME provider.
Interpretation:
1. Successful PAP NAP
2. Wisp Large Mask
3. Avoid Drowsy Driving
RE: Input needed - jwest - 09-08-2023
What happened a few weeks ago that turned your sleep from x(?) hours to 2-3 hours?
With regards to your data, your leak rate is way too high. The machines typically can't compensate for leak rates that high. Anything over 25L/min is in the territory of 'large leak'. The first two hours look very clean, straight edged flow rate, just what we like to see. How did you feel after the night's sleep of the data you posted?
I noticed that you didn't sleep on your side at all for your sleep study, is there a reason for that? Typically SDB is mitigated nonsupine.
RE: Input needed - eugyoo2 - 09-08-2023
I'm not too sure about the changes in quantity of sleep. It may have been the min pressure being way too low and me starting to face issues from it now.
I felt not as alert as when I was sleeping 3 hours, but I sense that this is a good sign indicating that my sleep is normalizing whereby even with 5-6 hours of sleep I wake up drowsy as I used to in the past when sleep was decent.
Are you referring to the first sleep study? They didn't provide much instructions on how to position myself for the actual sleep.
I will be seeing my sleep doctor later today and will update you with some news on what he says.
Thanks!
Eugene
RE: Input needed - eugyoo2 - 09-08-2023
Here is my data from Sept 7, 2023:
Is this a sign that I may be better off without the CPAP?
Any input would be appreciated.
RE: Input needed - staceyburke - 09-08-2023
With leaks this high you CANNOT believe the AHI, the Cpap can not tell if you have an obstruction because the air is escaping and no obstruction can be recorded. Your leaks are mainly mouth leaks. Either a full face mask or taping the moth shut are how many people try to fix problems.
RE: Input needed - jwest - 09-09-2023
I'm having some difficulty understanding what you're saying.
I'm referring to the sleep study you posted above that starts with 'indication: snoring'.
They wouldn't typically instruct you on what side to sleep on, but instead I was just pointing out that I noticed you didn't sleep at all on your side, and so I was inquiring as to why that might be the case, especially in the context of you having SDB where for many patients side-sleeping reduces events.
To your OSCAR charts posted from September 7th, your leaks are still way too high, and they're likely compromising the ability of the machine to properly analyze your therapy.
No, I don't see any reason yet for you not to be on CPAP. There are many troubleshooting steps we can explore, the first of which being resolving your leaks. Are you familiar with recommendations for resolving leaks?
What did your doctor say?
RE: Input needed - eugyoo2 - 09-09-2023
I can start using my full face mask as opposed to my nasal mask to address the leaks. What are some other recommendations you have for the leaking issue?
My doctor just told me that he was okay with me setting a minimum pressure of 10 (pressure range 10-20) with an EPR of 3. He said we'll have to wait and see what helps my sleep the most between longer time on the CPAP and addressing my Hypothyroidism. He seemed to agree with me that addressing the Hypothyroidism will probably do more for my sleep problems than the CPAP will.
RE: Input needed - eugyoo2 - 09-09-2023
[attachment=54082][attachment=54080]New Entry for September 8, 2023. Idk why I keep sleeping 2 hours a night....
RE: Input needed - staceyburke - 09-11-2023
You have NO large leaks and you had almost NO apnea with those settings. So I think the main thing you have to do is getting use to wearing a Cpap.
Several people who just could not stand wearing the mask go over the problem by using the Cpap by wearing it while watching tv or reading. Wearing it for longer periods of time even if you are not in bed allowed them to keep it on all night.
Hope this helps.
RE: Input needed - jwest - 09-11-2023
Standard recommendations are switching masks, adjusting current mask, shaving your beard if you have one, chinstrap, lowering pressure, soft-cervical collar, changing the position of your head/face while you sleep, etc.
Your data looks clean, so I don't have any input there. Your issues seem to originate from a source beyond SDB, and my best suggestion is to consult the right experts for what else might be contributing to your sleep issues. Consistently getting 2 hours of sleep per night is severely abnormal, and I would have expected the sleep physician under who's care you are to have prescribed you a more hopeful path forward. I can't speak to hypothyroidism. Maybe seeking several second opinions by other sleep physicians/experts in your area would prove helpful.