results of sleep study, need help

[sleepyt]

Well, I got the results of my study and it says "diagnosis: normal sleep study." However, if this is normal then I wonder why everyone isn't falling asleep all day like me!

It recorded a total sleep time of 344 min, during which according to the Sleep Fragmentation section I had 185 arousals - 32.3 per hour. Is that "normal?"

the results were as follows:
Total sleep time: 344 min
Sleep efficiency: 76.3%
sleep latency: 67 minutes
obstructive apnea: 0
mixed apnea: 0
central apnea: 1
hypopnea: 29

Total AHI 5.2
NREM AHI: 3.7
Stage R AHI: 13.5
Supine AHI: 6.6
Non-Supine AHI: 3.1
4% Index: 0.3 (What is this??)
Min Sa02: 93%
Baseline Sa02: 98%

WASO: 39 min
Stage N1: 9.9%
Stage N2: 56.7%
Stage N3: 17.9%
Stage R: 15.6%
Stage R Latency: 216 minutes.
Stage W: 104 minutes (???)

First of all, what the heck is the 4% Index and Stage W? I've never heard of these terms.

I realize that many of these values are normal or close to normal, but to me it seems like the arousals, Sleep latency and Stage R latency are pretty out of whack, and it said nothing about any limb movements at all.  Shouldn't this warrant some kind of interpretation other than "normal sleep study?" I can't stay awake for more than 3.5 or 4 hours without the aid of a stimulant medication. I fall asleep all day long, and apparently at night my sleep is fragmented at a rate of more than once ever 2 minutes. How can that be interpreted as normal?

[KatEyes]

Sorry, not many answers here, just questions you may want to ask to get a better understanding of what your study showed or did not show.

Were your legs wired for the study? If so, there should have been mention of limb movements in the summary, even if there were none, to clarify if there were any indicators of the cause of the high number of arousals.

Were your arousals more during REM or non REM?

Was there any mention of UARS, which can disturb sleep without being diagnostic for OSA?

Based on your numbers, your AHI was more than double when supine, and roughly quadrupled in REM vs non REM.  But of the time you slept in REM, how much of that time was supine? That can be revelatory of if this study likely captured your "worst case scenario".

If your sleep is fractured and affecting your daytime functioning, this sleep study is not the "end-of-story" but a start at diagnosing and treating your sleep. Some meds can disrupt sleep, as can some medical conditions like with the thyroid.

You may even want to ask the doctor (or a consulting doctor) to personally review the raw data from the study to look at the arousals specifically for any patterns or clues as to what happens to trigger them. Sleep studies are scored by techs and some doctors review the data before signing off on the results, but some count on the techs' interpretation of the data. No harm in asking for a review of the data if necessary to answer your questions.

[sleepyt]

Hi, thanks for the response.  Let me do my best to answer those questions.

My legs were wired, and I missed the part on the last page that said 0 PLMs.  This surprises me as there have been times at night when I've awakened briefly and felt my calf or upper arm muscles sort of quickly "jolt," but I guess that's probably just normal to feel that.  

The only mention of arousals on the report are the # of arousals was 185 and the arousal index was 32.3/hr of sleep.  But my assumption (which is based on nothing since I don't know how to read this stuff) is that since it took 216 minutes to get to REM and I only spent 15.6% of my sleep in REM that more arousals occurred during NREM.  

No mention of UARS.

I spent 61% of my sleep supine, which is definitely odd for me as I NEVER sleep on my back and usually am only comfortable on my left side. (I'm positive about this, and my husband has observed me sleeping to see if I have breathing problems, etc, and he's never seen me remain on my back.) But the tech told me I could only sleep on my back or side, and the wires made it difficult to roll over to the left, so I guess in this odd circumstance I stayed on my back more.  I spent 24% on my right and 14% on my left side.  

I didn't take any medications the day of the test.  I did recently have a thyroid ultrasound that showed a single nodule, but my thyroid levels are at normal, and actually in very optimal levels.  I've been tested for everything under the sun since these sleep troubles started five years ago, and now am at a total loss.  

I have told doctors for years "When I get up in the morning I feel like I never even slept at all," and this study at least seems to validate that feeling, but it gives me no answers which is frustrating, to say the least.  My primary is insisting I have insomnia.  I disagree and feel like she's brushing me off.  (I've been doing behavioral therapy and relaxation techniques, etc, for a long time and still have this fragmented, unrefreshing sleep and still fall asleep all day long.)

[KatEyes]

Just from what you say, it seems a review of the data would help you get answers you can be comfortable with. My sleep issues are longstanding, and my earlier sleep doctor was more concerned that I questioned him than with answering my questions. In the meantime, my health, my career, and life as I knew it was slipping away. My new sleep doctor actually took the scoring tech and I in a room and pulled my study up on the computer. The top showed the video, beneath were the graphs of the data. I can't say enough for how much of a difference it makes to one with a complicated case when your doctor sees your case as a challenge rather than you as challenging.

As far as questions for you to ask, one would be to verify that the leads on the legs were indeed recording. Everyone moves some during the study, and those movements should show on the graphs even if they didn't qualify to be reported as PLMs. You could also ask them to confirm that arousals were not associated with movements.

It is not unheard of for one sleep study to not be diagnostic, nor for there to be mistakes in interpreting the data. Either way, I wish you luck as you go forward.