Friday, December 31, 2010

Continuous Positive Airway Pressure

So, yesterday I finally got a copy of my sleep study.

It was worse than the sleep tech said. Actually, when I went to pick up my CPAP from the local medical supply place (better price than online, AND they bill my insurance directly) the machine tech said it was the worst sleep study she had ever seen.

Quoting directly from the report:

"The patients time in bed was 352 minutes, the total sleep time was 289 minutes".

Basically I slept almost five, out of almost six hours in a rest state... which for me is actually not bad. Considering I was wired up like a Christmas tree, which was really quite uncomfortable, it's a surprising amount... of course the 200mg of trazodone I was taking didn't hurt I'm sure.

"The patient had 691 respiratory events. There were 315 apneas, 131 were obstructive, 82 were central, 102 were mixed. Patients Apnea index was 65.4. Patient also had 376 hypopneas for a total apnea/hypopnea index of 143.5. There were 7 RERAs for an RDI index of 145.4".

Severe RDI is your respiratory disturbance index. An index of 30 or over is considered severe. I was at 5 times that. And remember, that's 691 events, in 289 minutes of sleep... 2.4 times a minute.

Basically, I was experiencing either apnea or hypopnea the entire time I was asleep.

I also had 60 partial wakefulness episodes, and was awake for a total of 62 minutes after the onset of persistent sleep. That's a partial wakeup every four to five minutes.

But it gets worse...

"There were 620 respiratory events associated with a 4% or greater desaturation. The apnea/hypopnea index with a 4% or greater desaturation was 129.2"

...and worse...

"The minimum oxygen saturation was approximately 58%. The oxygen saturation was less than 90% for approximately 62% of the study".

58%... yeah... Thats REALLY not good. Really. That's brain damage territory if held that low for very long. It's well within the range of acute hypoxia, and I was probably cyanotic (blue from lack of oxygen) when it hit that low.

No wonder I'm not alert some days, have fatigue, sudden sleepiness, and microsleeps; and seem to have lost about 30 IQ points...

And clinically speaking, it's almost certainly part of why my basal metabolism is so severely suppressed. Combine that with endocrine irregularities... yeah, it's not exactly shocking.

So, last night was my first night on the CPAP machine. I didn't really have a problem with it; though I did wake up in the middle of the night, and took the mask off for a while because I was a little hot under there. I just turned the heater down on the humidifier,

I think maybe the Air Force got me used to an oxy mask better than most people when they start CPAP; since most say they take the mask off a lot at first. I'm in a full face mask (which isn't really. It's an oral/nasal without cannula), and honestly, it's pretty comfy. A lot more comfy than a military mask.

Right now I'm on a temporary machine, a ResMed S8, auto-set with a heated humidifier. It doesn't have much in the way of monitoring or data readout capability, though I know my airway pressure went up to at least 15.4 last night.

Next week my permanent machine should come in (it would be here tomorrow, but the weather has been delaying things), the new ResMed S9 AutoSet:
Which seems to be a very good machine, having the highest ratings of any machine at the various sites online:

I was looking at that one, and the Fisher and Paykal Icon Auto, which is brand new and has the humidifer all in one with the main unit, so it's smaller and quieter. Unfortunately, my insurance doesn't have the Icon on their list yet (they do have it's predecessor, so it's likely they'll update to have the Icon next year, but the machine has only been shipping for a couple months, and the insurance company is a bit behind the market).

At any rate, the new machine has central sleep apnea detection, built in oximetry, and 365 night sleep session review; so I can see each night how many events it thinks I had and what type, how effective it thinks it was, and what my O2 sats were. Really, I'm looking forward to seeing the data.

Wish me luck.