Inconclusive sleep study

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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grapeshly
Posts: 59
Joined: Fri Oct 05, 2012 10:38 pm

Re: Inconclusive sleep study

Post by grapeshly » Sat Apr 21, 2018 2:41 pm

Maybe if I relare my story, you can get some insight.

I definitely have OSA, but it went undiagnosed for about 7 years. I suspected something wasn't right, but several different dictors I went to over that time span did not consider it a possibility. In the earliest stages, one doctor had me do a sleep study, but like yours it was evidently inconclusive. Unlike you, i never saw the test results, so I will never know if it really was inconclusive, or whether my AHI's were borderline. During those 7 years my sleep got worse and worse, to the point where I developed very bad sleep hygiene. After all, why go to bed early if you still feel bad and very tired when you wake up. I am positive that these years of sleep deprivation plus the stresses on my job caused my anxiety levels to increase. I now see that this inability to sleep, and my constant anxiety, all snow-balled into insomnia.

I finally got my diagnosis and my cpap machine, and my sleep improved. I was no longer constantly tired. But my insomnia was still there. I couldn't get drowsy enough to fall asleep, and when I did finally fall asleep, I would wake up at around 4 am and not be able to fall asleep again.

So then I went on a journey to try and figure this out. First I tried cold medications and over-the-counter drugs that caused drowsiness, such as Drammamine. But that would make me feel thick-headed the next day. Besides, using drugs to get good sleep just didn't seem like a solution. I tried meditation, but my monkey mind, caused by my anxiety, made it impossible for me.

In my researches, I found a couple of books that suggested anxiety can be caused by or exacerbated by certain nutritional deficiencies. To make an already long story shorter, I discovered I had a vitamin D defficiency. Vitamin D is actually a hormone, and is necessary for many processes in our bodies to function correctly. In fact most people in North America have this defficiency, since it is very difficult to get enough sunlight to adequately supply you with Vitamin D. Add to this our fear of skin cancer and the sun screens we are warned to wear, getting enough sunshine is even more difficult. I also learned that most people are defficient in Magnesium. This is another element our bodies require for a variety of proceeses. Our foods today don't have enough Magnesium to give us our recommended daily amount! So now I take mega doses of Vitamin D, and 1.5 times the recommended amount of Magnesium daily. One of the things Magnesium does is to relax you. Now I am finally able to get drowsy without resorting to other drugs. I can now also meditate, which I do every evening. And I have gradually calmed down enough to be able to re-learn good sleep hygiene habits. I still wake up at around 4 am some nights, but overall my sleep has improved.

I did more than all this, including improving my diet (whole foods, no gluten, limited carbs, plenty of probiotics), and stopped watching TV so much. Do I really need the nightly news upsetting me? Do I NEED to be bothered by the antics of the Lannisters and the Starks?

Recommended resource material:
https://www.vitamindcouncil.org/about-vitamin-d/
https://www.juliarosscures.com/mood-cure/
https://www.everywomanover29.com
https://www.headspace.com/meditation-10 ... meditation

SeekSleep
Posts: 120
Joined: Sat Apr 27, 2013 8:24 pm

Re: Inconclusive sleep study

Post by SeekSleep » Sat Apr 21, 2018 4:35 pm

Depression and Anxiety can definitely cause extreme issues with sleep. In my case, I had sleep apnea for at least 30 years prior to getting diagnosed and treated. Even though it was severe, and my oxygen levels were getting quite low I had adapted to it to the point I never realized how much of a problem it was until I got treated, and suddenly felt good.

Sleep apnea aside, the worst sleep issues I've experienced were a result of Depression/Anxiety, and a few other issues all grouped under the term of PTSD by the Doctor sorts. It was affecting my sleep to the point of hallucinations, all sorts of medical issues, and a mental fog getting so severe I was basically becoming non functioning. While I had been able to adapt to the issues the sleep apnea was causing, PTSD related sleep deprivation was something I couldn't get through without sleep medications coupled with counseling. It takes awhile, and finding the causes and solutions can be quite frustrating, especially being as how sleep deprivation tends to make many of the issues worse. You can get there though, as many of us have.

Good luck, and keep the dialog going with the doctors. The good ones can be quite helpful

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ChicagoGranny
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Re: Inconclusive sleep study

Post by ChicagoGranny » Mon Apr 23, 2018 8:39 am

MNsleeplessnights wrote:
Fri Apr 20, 2018 9:53 pm
sleep issues
What about this list? Have you gone through the applicable items to see if there are some areas for significant improvement?
The Oft Overlooked Part of Good CPAP Therapy

- Practice good sleep hygiene (Google it and read several sources; ignore extreme advice.)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Do not listen to your breathing or the sound of the machine as you are falling asleep.
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy. Thinking of sitting under an umbrella on a quiet beach with a warm gentle breeze works for me.
- If you are awakening at night, do not be too concerned. It is actually a normal part of sleep. (It does become a problem though for people who, when they awaken, become frustrated and have difficulty returning to sleep.)
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

This is a checklist. Some of the things you already do. Some are easy and can be done right away. Others you can work at over time.

-CG

MNsleeplessnights
Posts: 10
Joined: Thu Apr 19, 2018 11:02 pm

Re: Inconclusive sleep study

Post by MNsleeplessnights » Mon Apr 23, 2018 1:39 pm

ChicagoGranny wrote:
Mon Apr 23, 2018 8:39 am


What about this list? Have you gone through the applicable items to see if there are some areas for significant improvement?
The Oft Overlooked Part of Good CPAP Therapy

- Practice good sleep hygiene (Google it and read several sources; ignore extreme advice.)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Do not listen to your breathing or the sound of the machine as you are falling asleep.
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy. Thinking of sitting under an umbrella on a quiet beach with a warm gentle breeze works for me.
- If you are awakening at night, do not be too concerned. It is actually a normal part of sleep. (It does become a problem though for people who, when they awaken, become frustrated and have difficulty returning to sleep.)
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

This is a checklist. Some of the things you already do. Some are easy and can be done right away. Others you can work at over time.

-CG
I think I've adhered to most of those things on the list, but I think my biggest failures on that list would be bad sleep hygiene, not using my bed solely for sleep/sex, not appropriately handling emotional stress (my biggest problem, I believe), and trying not to get frustrated once I wake up from sleep. Do you mind explaining why it'd be a bad idea to not listen to breathing while you're trying to fall asleep? Also, thank you for pointing out the blog that detailed a fellow forum user's bout with insomnia. I think she and I have similar sleep troubles and I really hope to try and learn from what she's shared.

MNsleeplessnights
Posts: 10
Joined: Thu Apr 19, 2018 11:02 pm

Re: Inconclusive sleep study

Post by MNsleeplessnights » Mon Apr 23, 2018 1:42 pm

grapeshly wrote:
Sat Apr 21, 2018 2:41 pm
Maybe if I relare my story, you can get some insight.

I definitely have OSA, but it went undiagnosed for about 7 years. I suspected something wasn't right, but several different dictors I went to over that time span did not consider it a possibility. In the earliest stages, one doctor had me do a sleep study, but like yours it was evidently inconclusive. Unlike you, i never saw the test results, so I will never know if it really was inconclusive, or whether my AHI's were borderline. During those 7 years my sleep got worse and worse, to the point where I developed very bad sleep hygiene. After all, why go to bed early if you still feel bad and very tired when you wake up. I am positive that these years of sleep deprivation plus the stresses on my job caused my anxiety levels to increase. I now see that this inability to sleep, and my constant anxiety, all snow-balled into insomnia.

I finally got my diagnosis and my cpap machine, and my sleep improved. I was no longer constantly tired. But my insomnia was still there. I couldn't get drowsy enough to fall asleep, and when I did finally fall asleep, I would wake up at around 4 am and not be able to fall asleep again.

So then I went on a journey to try and figure this out. First I tried cold medications and over-the-counter drugs that caused drowsiness, such as Drammamine. But that would make me feel thick-headed the next day. Besides, using drugs to get good sleep just didn't seem like a solution. I tried meditation, but my monkey mind, caused by my anxiety, made it impossible for me.

In my researches, I found a couple of books that suggested anxiety can be caused by or exacerbated by certain nutritional deficiencies. To make an already long story shorter, I discovered I had a vitamin D defficiency. Vitamin D is actually a hormone, and is necessary for many processes in our bodies to function correctly. In fact most people in North America have this defficiency, since it is very difficult to get enough sunlight to adequately supply you with Vitamin D. Add to this our fear of skin cancer and the sun screens we are warned to wear, getting enough sunshine is even more difficult. I also learned that most people are defficient in Magnesium. This is another element our bodies require for a variety of proceeses. Our foods today don't have enough Magnesium to give us our recommended daily amount! So now I take mega doses of Vitamin D, and 1.5 times the recommended amount of Magnesium daily. One of the things Magnesium does is to relax you. Now I am finally able to get drowsy without resorting to other drugs. I can now also meditate, which I do every evening. And I have gradually calmed down enough to be able to re-learn good sleep hygiene habits. I still wake up at around 4 am some nights, but overall my sleep has improved.

I did more than all this, including improving my diet (whole foods, no gluten, limited carbs, plenty of probiotics), and stopped watching TV so much. Do I really need the nightly news upsetting me? Do I NEED to be bothered by the antics of the Lannisters and the Starks?

Recommended resource material:
https://www.vitamindcouncil.org/about-vitamin-d/
https://www.juliarosscures.com/mood-cure/
https://www.everywomanover29.com
https://www.headspace.com/meditation-10 ... meditation
Thank you for sharing what has helped you. I actually wonder if I'm suffering from any vitamin deficiencies. I started taking a 5,000 IU vitamin D supplement along with a vitamin B supplement. I haven't really noticed much improvement, but I tried taking a magnesium supplement last night and I (I believe...) think it kinda helped me stay longer in REM? I think I dreamed, but I don't remember. I find the radical change in diet and stopping watching TV (social media and computer use for me) very interesting! I will try it out. I just hope I can remain disciplined because I am hearing from many that this process takes a lot of effort and time and requires consistency.

MNsleeplessnights
Posts: 10
Joined: Thu Apr 19, 2018 11:02 pm

Re: Inconclusive sleep study

Post by MNsleeplessnights » Mon Apr 23, 2018 1:47 pm

Pugsy wrote:
Fri Apr 20, 2018 11:04 pm
Some medications can cause insomnia and/or can affect the sleep architecture and even prevent a person from getting much REM stage sleep.

It is possible that the lack of REM was nothing more than not enough sleep to move through the needed sleep stages because you ran out of time.

I had something similar happen to me.
During my diagnostic sleep study even with Ambien I had awful insomnia (which I didn't have at home) and I kept waking up.
I did have a few apnea events during non REM...around 12 per hour but it was REM where things got exciting and it was part of the reason I was having trouble staying asleep. My OSA is 5 times worse in REM stage sleep than in non REM and every time I made it to REM the apnea event would happen and wake me up. So I had very little REM during my diagnostic sleep study.

It wouldn't be impossible for you to have OSA that is markedly worse in REM but usually there is more of an indication of at least something in non REM. In my case the oxygen levels went down to the low 70% even in non rem...the apnea events weren't very numerous but they were pretty darn long to cause the desats.

Would getting a cpap machine help....honestly...I don't know. If your insomnia issues are related to sleep apnea then yeah maybe but I am not so sure that your insomnia is sleep apnea related.
There's a long list of other potential causes for insomnia or crappy sleep than just sleep apnea and the cpap machine can only help if sleep apnea is the problem.
I see it all the time...people wanting/expecting that the cpap machine fixes a problem that is unrelated to sleep apnea and they get upset because cpap doesn't resolve their issues....when all the time they had unrealistic expectations about what cpap can do.

I do understand the hope that the problem is sleep apnea because at least there's a name to what might be our problem and it's fixable.
It's easier to swallow than "we don't know why your sleep is crappy and why you feel crappy".

You didn't get a good complete study with all sleep stages...and what sleep you got was limited. If you had slept better and got some REM..... would the results have been different....we don't know the answer to that question.

I do understand the desire to at least try cpap in the hopes that it helps. Your insurance is unlikely going to want to pay for the machine or equipment/masks, etc because you don't meet criteria for the diagnosis unless they can tie in the arousals and use the RDI instead of AHI.
Worth trying...all they can do is say no.

The arousals...if related to breathing restrictions/reductions in air flow that don't meet the criteria for OA or hyponea might improve with cpap therapy IF...big IF...the arousals are related to breathing issues.
If the arousals are spontaneous and the cause is unknown...cpap most likely won't help.

The arousals are probably more of an issue than the apnea events. Now what is causing the arousals...million dollar question that doesn't always have a nice black and white answer.
I agree, it's hard to really get anything from the study other than I didn't achieve any REM. I don't know if it was because I ran out of time or if I just have a problem entering REM. I do find myself in a bit of a brain fog most days and I wonder if that's because I don't get any/enough REM sleep. I also will be honest that I had hoped that I could just get the apnea diagnosis and be done with this whole hunt to figure out what my sleep problems are. I am a bit worried that it may be too complicated to diagnose what my actual sleep issues may be. I do definitely suffer from anxiety and depression and wonder how heavy of an effect they may have on my sleep and I am even more confused on how to effectively deal with it. I am currently in therapy and hopefully my sleep sees an improvement as I work through.

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ChicagoGranny
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Location: USA

Re: Inconclusive sleep study

Post by ChicagoGranny » Mon Apr 23, 2018 3:07 pm

MNsleeplessnights wrote:
Mon Apr 23, 2018 1:39 pm
I think my biggest failures on that list would be bad sleep hygiene
What about your sleep hygiene is poor?

MNsleeplessnights wrote:
Mon Apr 23, 2018 1:39 pm
Do you mind explaining why it'd be a bad idea to not listen to breathing while you're trying to fall asleep?
That item is in the list because newbies sometimes come here stressed out by the sound of their own breathing. They may be trying to "time" their breaths with the machine. That should be avoided because a CPAP machine is designed to follow the patient's breathing. If it doesn't bother you to listen to your breathing, have at it. :D

MNsleeplessnights
Posts: 10
Joined: Thu Apr 19, 2018 11:02 pm

Re: Inconclusive sleep study

Post by MNsleeplessnights » Mon Apr 23, 2018 10:41 pm

ChicagoGranny wrote:
Mon Apr 23, 2018 3:07 pm
MNsleeplessnights wrote:
Mon Apr 23, 2018 1:39 pm
I think my biggest failures on that list would be bad sleep hygiene
What about your sleep hygiene is poor?


I think I have a real issue with staying off screens prior to sleep. Both because of work and I just have really terrible discipline staying off of electronics. I also don't do the best job of having a routine before bed and I don't do a great job limiting the amount of stressing I do before I sleep. I also eat dinner late into the night and I clock-watch because I worry so much about being able to sleep. I realize that most of these things I should be able to control, but I just can't get myself to do these things consistently...I believe I have tried before and I didn't see any marked improvements and I was very discouraged. I think my biggest hurdle to get over is finding out whether if I am able to improve my sleep fragmentation by improving on my sleep hygiene. There's just this mental hurdle of not understanding what I can do while I am conscious that will affect my ability to sleep uninterrupted and it's been frustrating me beyond belief. It's a very discouraging thing that I wonder and hope to find a solution to soon.

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grapeshly
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Joined: Fri Oct 05, 2012 10:38 pm

Re: Inconclusive sleep study

Post by grapeshly » Sun May 06, 2018 4:41 pm

I am in my 6th year of using a Cpap machine, and only now am I finally getting decent sleep. Now I even dream sometimes. And I sometimes can even fall asleep again after waking in the early hours of the morning. It took quite a combination of improved nutrition and stress relieving techniques before I could even get to the point where I am able to turn off the screen early, and just do something else for an hour before going to bed. And to ALWAYS go to bed at the same time -- even on weekends. This took me forever to learn, because it is always tempting to do just one more thing before going to bed, and then just one more other thing, and so on. So don't beat yourself up. Keep trying different things, because whatever worked for me may not work for you; you may find a different set of protocols to help you. (Go for a walk outdoors, find a hobby, take up tai chi, go "forest bathing". Yeah, that's a thing. Look it up.)

AceDiplomats
Posts: 14
Joined: Sat Oct 20, 2018 10:33 pm

Re: Inconclusive sleep study

Post by AceDiplomats » Mon Oct 22, 2018 8:57 pm

Pugsy wrote:
Fri Apr 20, 2018 11:04 pm
Some medications can cause insomnia and/or can affect the sleep architecture and even prevent a person from getting much REM stage sleep.

It is possible that the lack of REM was nothing more than not enough sleep to move through the needed sleep stages because you ran out of time.

I had something similar happen to me.
During my diagnostic sleep study even with Ambien I had awful insomnia (which I didn't have at home) and I kept waking up.
I did have a few apnea events during non REM...around 12 per hour but it was REM where things got exciting and it was part of the reason I was having trouble staying asleep. My OSA is 5 times worse in REM stage sleep than in non REM and every time I made it to REM the apnea event would happen and wake me up. So I had very little REM during my diagnostic sleep study.

It wouldn't be impossible for you to have OSA that is markedly worse in REM but usually there is more of an indication of at least something in non REM. In my case the oxygen levels went down to the low 70% even in non rem...the apnea events weren't very numerous but they were pretty darn long to cause the desats.

Would getting a cpap machine help....honestly...I don't know. If your insomnia issues are related to sleep apnea then yeah maybe but I am not so sure that your insomnia is sleep apnea related.
There's a long list of other potential causes for insomnia or crappy sleep than just sleep apnea and the cpap machine can only help if sleep apnea is the problem.
I see it all the time...people wanting/expecting that the cpap machine fixes a problem that is unrelated to sleep apnea and they get upset because cpap doesn't resolve their issues....when all the time they had unrealistic expectations about what cpap can do.

I do understand the hope that the problem is sleep apnea because at least there's a name to what might be our problem and it's fixable.
It's easier to swallow than "we don't know why your sleep is crappy and why you feel crappy".

You didn't get a good complete study with all sleep stages...and what sleep you got was limited. If you had slept better and got some REM..... would the results have been different....we don't know the answer to that question.

I do understand the desire to at least try cpap in the hopes that it helps. Your insurance is unlikely going to want to pay for the machine or equipment/masks, etc because you don't meet criteria for the diagnosis unless they can tie in the arousals and use the RDI instead of AHI.
Worth trying...all they can do is say no.

The arousals...if related to breathing restrictions/reductions in air flow that don't meet the criteria for OA or hyponea might improve with cpap therapy IF...big IF...the arousals are related to breathing issues.
If the arousals are spontaneous and the cause is unknown...cpap most likely won't help.

The arousals are probably more of an issue than the apnea events. Now what is causing the arousals...million dollar question that doesn't always have a nice black and white answer.
Hi, I'm new to the forums and thought you seemed very educated in this stuff, I wanted to ask if you could look over my post I made on my results and share what you think, literally anything. Please and thanks