Inconclusive sleep study

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
MNsleeplessnights
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Inconclusive sleep study

Post by MNsleeplessnights » Thu Apr 19, 2018 11:11 pm

Hi, I recently had a sleep study done and my physician stated that I did not have any significant apnea events or sleep disturbances registered during the study. However, I did not enter REM sleep and apparently apnea and other sleep issues become more prevalent during REM. I also suffer from insomnia and so they recommended that I attempt cognitive behavior therapy and general therapy (for anxiety and depression) to see if that may help resolve my sleep issues. Things have not improved and I can't help but really be hung up on the idea that there must be some sort of physical problem that is causing my sleep issues. Would there be a way to try using CPAP or another sleep appliance without scheduling another sleep study? Is it at all possible that depression/anxiety may actually have the potential to cause inconsistent and short sleep durations? I'm sorry if I'm rambling, but I am very confused on all this and have been depressed over my terrible sleep for the past several years. Would it at all be possible to post my sleep study (with my personal information blacked-out) to have it interpreted just as a means of easing my mind and restoring confidence in my sleep physician's interpretation?

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ChicagoGranny
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Re: Inconclusive sleep study

Post by ChicagoGranny » Fri Apr 20, 2018 7:05 am

MNsleeplessnights wrote:
Thu Apr 19, 2018 11:11 pm
Would it at all be possible to post my sleep study (with my personal information blacked-out) to have it interpreted just as a means of easing my mind and restoring confidence in my sleep physician's interpretation?
Yes, please do. You might also want to redact the names of the physician and facility.

MNsleeplessnights wrote:
Thu Apr 19, 2018 11:11 pm
Is it at all possible that depression/anxiety may actually have the potential to cause inconsistent and short sleep durations?
Yes, definitely.
MNsleeplessnights wrote:
Thu Apr 19, 2018 11:11 pm
Would there be a way to try using CPAP or another sleep appliance without scheduling another sleep study?
Yes. But, let's see your sleep study before discussing this further.

The list below is for CPAP users. But, it would be good if you go through the checklist at this point. In today's age, many people don't treat themselves well during the day, and this results in poor sleep at night.
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.

MNsleeplessnights
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Re: Inconclusive sleep study

Post by MNsleeplessnights » Fri Apr 20, 2018 10:17 am

ChicagoGranny wrote:
Fri Apr 20, 2018 7:05 am
MNsleeplessnights wrote:
Thu Apr 19, 2018 11:11 pm
Would it at all be possible to post my sleep study (with my personal information blacked-out) to have it interpreted just as a means of easing my mind and restoring confidence in my sleep physician's interpretation?
Yes, please do. You might also want to redact the names of the physician and facility.

MNsleeplessnights wrote:
Thu Apr 19, 2018 11:11 pm
Is it at all possible that depression/anxiety may actually have the potential to cause inconsistent and short sleep durations?
Yes, definitely.
MNsleeplessnights wrote:
Thu Apr 19, 2018 11:11 pm
Would there be a way to try using CPAP or another sleep appliance without scheduling another sleep study?
Yes. But, let's see your sleep study before discussing this further.

The list below is for CPAP users. But, it would be good if you go through the checklist at this point. In today's age, many people don't treat themselves well during the day, and this results in poor sleep at night.
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.
Firstly, thank you so much for your reply. I was a bit worried that I would be chased off the forum because I wasn't actually diagnosed with sleep apnea and I have other underlying concerns that can be affecting my sleep. It feels encouraging to read your input. I will post my sleep study results as soon as I get them scanned to my computer. Should I post them in this thread or start a new thread specifically asking for help interpreting my results?

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Pugsy
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Re: Inconclusive sleep study

Post by Pugsy » Fri Apr 20, 2018 10:22 am

Insomnia is a nasty little beast and sometimes it's caused by sleep apnea and sometimes it isn't.
When the cause is sleep apnea we have some chance of dealing with it but if it's caused by something else then the workload to tame that monster is greatly increased.

We have a forum member who not only has sleep apnea but insomnia not caused by sleep apnea and she had a blog that might contain some useful information. While it partly describes how using cpap made the insomnia worse for a bit...she also talks about good common sense ways of dealing with insomnia no matter what the cause and mentions some books to read that she found helpful.
So you might take a look here
http://adventures-in-hosehead-land.blog ... er_19.html

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Re: Inconclusive sleep study

Post by palerider » Fri Apr 20, 2018 10:34 am

MNsleeplessnights wrote:
Fri Apr 20, 2018 10:17 am
Firstly, thank you so much for your reply. I was a bit worried that I would be chased off the forum because I wasn't actually diagnosed with sleep apnea and I have other underlying concerns that can be affecting my sleep. It feels encouraging to read your input. I will post my sleep study results as soon as I get them scanned to my computer. Should I post them in this thread or start a new thread specifically asking for help interpreting my results?
We're here to help people that are trying to help themselves.

It's best if you stay in one thread, so that all your info's in one place... You can go back to the first post in the thread, and change the title, to keep up with what's currently going on :)

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Re: Inconclusive sleep study

Post by greatunclebill » Fri Apr 20, 2018 10:42 am

you can talk about and discuss alot of things that can help. my opinion is that you should chase the sleep study first. if you had a hard time sleeping to get valid results, the sleep study should be repeated either with the original or hopefully with a new sleep medicine qualified pulmonologist. the doctor should order a sleeping pill so you can get good results after a good sleep. people have different opinions about sleeping pills and the test. my doctor told me it would not really affect the results. in fact i had pills during my test and got results that were otherwise impossible to achieve.

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jnk...
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Re: Inconclusive sleep study

Post by jnk... » Fri Apr 20, 2018 11:24 am

MNsleeplessnights wrote:
Fri Apr 20, 2018 10:17 am
. . . I was a bit worried that I would be chased off the forum because I wasn't actually diagnosed with sleep apnea and I have other underlying concerns that can be affecting my sleep. . . .
Despite the name/url of the forum, it is also about any sleep-related issues, questions, concerns, or thoughts.

If you ever get the feeling that anyone is trying to 'chase you off,' please PM one of the experienced posters here.

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ChicagoGranny
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Re: Inconclusive sleep study

Post by ChicagoGranny » Fri Apr 20, 2018 11:26 am

palerider wrote:
Fri Apr 20, 2018 10:34 am
It's best if you stay in one thread, so that all your info's in one place... You can go back to the first post in the thread, and change the title, to keep up with what's currently going on
+1

MNsleeplessnights wrote:
Fri Apr 20, 2018 10:17 am
I was a bit worried that I would be chased off the forum because I wasn't actually diagnosed with sleep apnea
No, you're good. We just like to chase off people who wash their CPAP hose everyday.

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Re: Inconclusive sleep study

Post by MNsleeplessnights » Fri Apr 20, 2018 9:53 pm

Thank you kindly to everyone who has chimed in on my thread. I attached my sleep study documents on this post and the following post. Do you guys agree with the sleep physician's interpretation that it's unlikely that sleep apnea is cause of my sleep issues? Is the lack of any REM sleep a cause for concern and a basis for ordering another sleep study? I don't think I can afford another study at the moment and I think I would rather try and get started with a CPAP if apnea seems likely.
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MNsleeplessnights
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Re: Inconclusive sleep study

Post by MNsleeplessnights » Fri Apr 20, 2018 9:54 pm

attachments continued!
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Pugsy
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Re: Inconclusive sleep study

Post by Pugsy » Fri Apr 20, 2018 10:14 pm

Do you take any medications of any kind and if so, what?

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Re: Inconclusive sleep study

Post by MNsleeplessnights » Fri Apr 20, 2018 10:35 pm

Pugsy wrote:
Fri Apr 20, 2018 10:14 pm
Do you take any medications of any kind and if so, what?
I don't take any medications, but my physician prescribed Trazodone for me and I have yet to use it. I took a 5 mg Ambien for the sleep study but I woke within 30 minutes of taking it.

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Pugsy
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Re: Inconclusive sleep study

Post by Pugsy » 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.

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Re: Inconclusive sleep study

Post by smith972 » Fri Apr 20, 2018 11:55 pm

Have u tried therapy for anxiety and depression? I did therapy and also so a psychiatrist for meds. It took a few months to get the right combination of meds and diversion techniques but I finally found relief to my anxiety and depression. I am a changed person...I am able to sleep at night and I am able to leave my house now.

My therapist and psychiatrist worked hand in hand to get me where I am. I am finally interested in things and don't hide behind the walls of house watching the cameras all the time. When I take my meds...I sleep....when I don't...like tonight...I am up still at 2am.

If u want to talk privately send me a message....I so understand how insomnia can drive you crazy. My body felt tired....My eyes felt tired but I just tossed and turned.

Another thing that helped...once I felt good enough to leave the house...was working out, at the gym or riding my bike or walking my dog. I just got moving...took my meds....used my breathing exercises taught to me and just like that sleep found me again.

I had 30 years of stuffing it down and not dealing with all of issues from childhood and adulthood...I had children that needed me. Not until they were gone did it all start coming back up....I had a nervous breakdown and was forced to deal with it all. I am so happy I did.

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Re: Inconclusive sleep study

Post by jnk... » Sat Apr 21, 2018 6:00 am

IMO, an AHI higher than 4 and an RDI over 10 in a PSG without supine REM and with some PLMs should earn someone a titration to see response to pressure and what else gets unmasked in the pursuit of the possibility of a physical cause of the insomnia. It would take some talent to present the factors skillfully to the payers, but it should be attempted.
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