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How I measure sleep quality
#1
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How I measure sleep quality
The idea of measuring sleep quality by asking the question “how do you feel?” does not work for me. I know it is the gold standard here, but I can’t say I ever felt “bad”. At least until I started feeling better. Over the last 5 years of therapy I have continued to “feel better and better” all along the way. So, as a result, I am not sure what “good” should feel like yet. ? Here is the way I measure progress. 

In the beginning (before CPAP), my nights were long, sleepless, was startled awake and very uncomfortable. 

1. The first sign of improvement was the number of times I physically had to get up, take off my  mask and get out of bed. I was getting up 3 or 4 times a night just to go to the bathroom. After a few months, this metric dropped to zero. Mask on, mask off, night over. Perfect ?

2. The next sign of improvement comes in the number of times I simply wake up, for any reason. As therapy got better, the number of times awakened lessened. 

3. The next sign was the timing of each wake up. I would wake up at the same time throughout the night, at about 1 1/2 hour intervals. This was major, since a complete sleep cycle is about 90 minutes. Also, I am now “feeling” the best I have ever felt and I am beginning to feel like I have made it to the top. Now I want to string multiple sleep cycles into groups before waking. But wait, the best is yet to come. 

4. Dreams ? I have always been fascinated with dreams. What they mean and where they come from. After googling dreams for years, I think I can relate them to sleep quality. I have to break dreams into 5 groups according to sleep quality from bad to good. The names are just to keep them straight as I will explain them in better detail. 

a. Not dreaming - In the beginning I could not sleep and was not comfortable with therapy. Not sleeping and hence unable to dream. Sleep cycle not completing.  Too many events happening.  In general, just not sleeping. 

b. Violent dreams - Once I settled down and started getting some sleep my dreams became violent. I was constantly in “fight or flight” mode. Someone was always chasing me wishing to do me harm. Because of this I had to force myself to wake up completely before I could get back to sleep. At this stage I got some sleep and felt “better”. 

c. Puzzle dreams - As therapy improved my dreams became less violent and more like a puzzle. In my dream I was presented with a challenge that I had to overcome and the solution was impossible to figure out. Again I had to wake up completely in order to get back to sleep. At this point I felt I was getting enough sleep and could say I felt good. Until the next phase. 

d. Non-event dreams - This phase could be called normal dreams even though all my dreams have been nonsensical and left me wondering where did that come from. Because I remember them, I am probably not completing the full sleep cycle. Most of my dreams now fall into this category and I am waking up feeling great. 

e. Forgotten dreams - From my research, in theory, with a normal sleep cycle, you will dream and forget most of the dream. When I am lucky enough to have this category dream, I wake up feeling the best I have felt in years. This is my gold standard. 

As I mentioned before, I am very curious about dreams and would invite any comments and feedback. If you made it this far, thanks for reading. ?
CPAP is a journey like “The Wizard of Oz”. It’s a long slow journey. You will face many problems and pick up many friends along the way. Just because you reach the poppies, it doesn’t mean you are in Kansas. 
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#2
RE: How I measure sleep quality
Interesting! I can relate to a lot that you're saying.

When I have what I call "boring dreams", that seems to be when I sleep the best.

When I have what you call "violent dreams", it's always due to some physical struggle I'm having while I'm sleeping. If I dream of someone hurting my arm, it's because I'm sleeping with my arm in a bad position and losing circulation. If I dream of being murdered, it's because my CPAP mask isn't venting my exhaled air well (and am thus not getting enough oxygen/clean air).
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#3
RE: How I measure sleep quality
(10-24-2020, 07:03 PM)Rcgop Wrote: The idea of measuring sleep quality by asking the question “how do you feel?” does not work for me. I know it is the gold standard here, but I can’t say I ever felt “bad”. At least until I started feeling better. Over the last 5 years of therapy I have continued to “feel better and better” all along the way. So, as a result, I am not sure what “good” should feel like yet. ? Here is the way I measure progress. 

In the beginning (before CPAP), my nights were long, sleepless, was startled awake and very uncomfortable. 

1. The first sign of improvement was the number of times I physically had to get up, take off my  mask and get out of bed. I was getting up 3 or 4 times a night just to go to the bathroom. After a few months, this metric dropped to zero. Mask on, mask off, night over. Perfect YES!

2. The next sign of improvement comes in the number of times I simply wake up, for any reason. As therapy got better, the number of times awakened lessened. Yes!

3. The next sign was the timing of each wake up. I would wake up at the same time throughout the night, at about 1 1/2 hour intervals. This was major, since a complete sleep cycle is about 90 minutes. Also, I am now “feeling” the best I have ever felt and I am beginning to feel like I have made it to the top. Now I want to string multiple sleep cycles into groups before waking. But wait, the best is yet to come. Yes

4. Dreams ? I have always been fascinated with dreams. What they mean and where they come from. After googling dreams for years, I think I can relate them to sleep quality. I have to break dreams into 5 groups according to sleep quality from bad to good. The names are just to keep them straight as I will explain them in better detail. Fascinating. Using cpap I never remembered dreams. Now that I'm starting apap therapy and taking control, I remember a few!

a. Not dreaming - In the beginning I could not sleep and was not comfortable with therapy. Not sleeping and hence unable to dream. Sleep cycle not completing.  Too many events happening.  In general, just not sleeping. YES!

b. Violent dreams - Once I settled down and started getting some sleep my dreams became violent. I was constantly in “fight or flight” mode. Someone was always chasing me wishing to do me harm. Because of this I had to force myself to wake up completely before I could get back to sleep. At this stage I got some sleep and felt “better”. no-no experience

c. Puzzle dreams - As therapy improved my dreams became less violent and more like a puzzle. In my dream I was presented with a challenge that I had to overcome and the solution was impossible to figure out. Again I had to wake up completely in order to get back to sleep. At this point I felt I was getting enough sleep and could say I felt good. Until the next phase. no-no experience yet

d. Non-event dreams - This phase could be called normal dreams even though all my dreams have been nonsensical and left me wondering where did that come from. Because I remember them, I am probably not completing the full sleep cycle. Most of my dreams now fall into this category and I am waking up feeling great. yes-I relate

e. Forgotten dreams - From my research, in theory, with a normal sleep cycle, you will dream and forget most of the dream. When I am lucky enough to have this category dream, I wake up feeling the best I have felt in years. This is my gold standard. Excellent--me too

As I mentioned before, I am very curious about dreams and would invite any comments and feedback. If you made it this far, thanks for reading. ?

I have a Garmin Vivoactive HR watch that gives me simple sleep studies.  When my therapy was using my old cpap machine, I would get 15-30 minutes of "deep sleep" Now that I"m using my apap machine norm is about 2 hours.  Last weekend one night was 4 hours, and I was very rested when I got up. 
I feel much better now that I've become more used to the apap machine with the settings suggested here. Thanks for your post! Sleep-well
DaveL
Compliant for about 30 Canadian years

I'm just a cpap user like you. I don't give medical advice. I hope to learn from you, and share my experiences with you. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#4
RE: How I measure sleep quality
How you feel is very subjective and is affected by lots of things other than sleep quality. I feel sorry for people who have non-data-capable machines and are therefore forced to make adjustments based on how they feel.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: How I measure sleep quality
(10-28-2020, 12:03 PM)Sleepster Wrote: How you feel is very subjective and is affected by lots of things other than sleep quality. I feel sorry for people who have non-data-capable machines and are therefore forced to make adjustments based on how they feel.

My take:  I was sleep deficient for many years.  Expecting it to change overnight isn't reasonable.
DaveL
Compliant for about 30 Canadian years

I'm just a cpap user like you. I don't give medical advice. I hope to learn from you, and share my experiences with you. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#6
RE: How I measure sleep quality
I would second the consideration of a quality smart watch with a health app loaded (most come with the manufacturers’ own versions installed). The top four sellers’ devices can parse your sleep into levels and give you a useful (high face validity) efficiency rating.  You’ll ideally be able to confidently link the sub-par sleeps with a poorer following day, and enjoy your days more when the app suggests your efficiency was north of, say, 94%. None records REM sleep or can reliably report if you have dreamt.
Serial Tapist
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#7
RE: How I measure sleep quality
Read with some interest and a whole lot of envy!

To be totally honest I could count on one hand the number of times in a month that I woke up in morning feeling rested. Many mornings need a couple mugs of coffee and an hour or two to get to the point I might have been at 10:30 pm the night before!

I was first diagnosed by my wife, who apparently has some kind of sleep problem, because she decided she needed to get me to a sleep doctor because of the number and duration of 'stop breathing" events she was seeing!

From my point of view, which at times does not correlate with her view point, my sleep quality is no better than before. I first started on this CPAP nightmare about a year ago.

I have another thread started on this forum and if I can get a couple halfway good nights and maybe a not so good night to compare I will be uploading some Oscar files in hopes that someone can see what the Doctor is not seeing.

I too at times have a variety of different dreams, many related to the work I did for 40+ years, heavy equipment mechanic. Some, I would say, can be called fun despite the lack of reality I can spot in them. But hey! Any time you can spend a few hours working on an old diesel engine or transmission and not have to wash your hands or clothes after is a good time! Now I just need to figure out who to bill for the labor!
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#8
RE: How I measure sleep quality
I can relate quite strongly to Rcgop's post. When I finally found a combination of machine and mask that improved my sleep quality, the effect was not instantaneous but cumulative. How I discovered this was when I fell asleep while reading and hadn't put on my mask. How I felt in the morning was dreadful and proof to me that my therapy was working.

Other signs mentioned are:

Nocturia vanishing and me only having to get up maybe once per night for a toilet break

Dreams: Before therapy, dreams were non-existent. The return of dreams was a good sign that my sleep was improving. The one recurring dream I have is not being able to find out where I have parked the car. Any ideas on the significance of this dream?

I occasionally have mornings where I get up and don't feel great. They are infrequent and while I haven't looked at OSCAR charts for a long while now I suppose I should investigate.

Overall, most days I feel OK. As a sexegenarian I accept that I am not going to feel as frisky as I was in my 40s.
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#9
RE: How I measure sleep quality
On dreams, my understanding is one only remembers or are aware of them if you wake up in the midst of them.

E.g. just because you are not aware of having dreamt doesn't mean you didn't dream.
Caveats: I'm just a patient, with no medical training.
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#10
RE: How I measure sleep quality
Fascinating post! By reading trusted web sites, I've learned that it is not uncommon to wake up briefly after REM sleep, and most people wake up at least several times per night. Dreaming is not confined to REM sleep. Dreams during light sleep tend to be more quotidian; dreams during REM tend to be more strange.
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