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How to identify arousals? PLM?
#1
How to identify arousals? PLM?
Hello all,

First I would like to thank you all for the support you're giving to people around the globe. This forum has been giving me so much insights. Besides that it's always wonderful to see people willing to help each other. 
From last week's tread I learned the importance of closely reading your FR curve. I think I've found the correct pressure settings for me and I do feel better than before PAP therapy. Unfortunately I still suffer from fatigue in the aftenoon and occasional brain fog in the morning. Less than it was, but still there. Therefore I plan to manually count my arousals in order to see if any adjustments are needed.

If you could take al ook at last night's report. These grassy spikes, are those arousals? Or just a sigh? 
I'm also keen on identifying any PLM. I know had quite a few of them at my PSG but assume they are far less now as a result of PAP therapy. Do you see any signs of PLM here? 
Thanks a lot for your help.

   

   

   
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#2
RE: How to identify arousals? PLM?
Given that your sleep study identified PLM and their appear to be periodic blips in peak flow rate every 20-30s I would say it's likely there is PLM here. Whether it is resulting in arousal is not clear - it's certainly not as disturbed a flow pattern as I see in my flow rate but that could be due to use of VAuto here.

What did your sleep study say about PLM (rate, arousals, etc)?
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#3
RE: How to identify arousals? PLM?
Hi Kappa,

PSG said:
PLM index: 31.6/h
PLM arousal index: 14.2/h

Sleep clinician noted: elevated PLM index, lots of PLMs are associated with a respiratory event.

I quit coffee last saturday and experienced quite a headache yesterday (sunday). Today (monday) it's still there but fortunately less intense.
Let's see where this goes.
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#4
RE: How to identify arousals? PLM?
Former PSGs stated something like: "disturbed tibialis both sides". I guess this has something to do with PLM?

No doctor ever mentioned it in the course of treatment however. Strange, because now it seems to be a relevant lead.

One time about 10 years ago, a doctor prescribed me low dose ropinirol. He didn't explain why other than some people felt better on it. Well, I did not. I did not use xPAP at that time btw.
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#5
RE: How to identify arousals? PLM?
Yeah the higher amplitude breath every 5ish breaths looks like it could be PLM related if I had to guess. A video recording would help you confirm.

The next question as Kappa alluded to is if this PLM is causing arousal, disturbed sleep etc. And the even more difficult question to answer is if the symptoms you are having is due to this PLM, related to the underlying cause of PLM or something else entirely.

Does this PLM pattern occur every night? If so that would increase the chances of a titration study noting it and confirming if breathis still a factor or if your breathing is treated now but PLM still exists/is an issue. Based on the image given I have a hard time believing breathing would be causing these PLM (assuming it is PLM) but what was possibly/likely happening before is that breathing difficulties were amplifying the PLM.
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#6
RE: How to identify arousals? PLM?
I have this grassy FR graph every night but all night long. It's more like episodes, lasting 30-45 minutes.
I also have this episodes of waxing and waning amplitudes, like a kind of periodic breathing but with less difference between highs and lows.
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#7
RE: How to identify arousals? PLM?
Edit:
*NOT all night long
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#8
RE: How to identify arousals? PLM?
That's quite a high PLM index and arousal index from the sleep study. Scoring rules typically exclude leg movements that are near respiratory events.

Caffeine withdrawal isn't pleasant.... but the few times I've done it it doesn't last for too many days.

Your flow rate trace appears grassy to some degree for the whole night, but with longer grass for shorter 30-45 minute periods as you mention. It could be that this is during REM sleep (timings seem about right in the trace above, and increased leak rate due to further loss of muscle tone during REM seems logical). Did the sleep study separate out PLM in REM vs NREM? (Have/Can you share a redacted sleep study?)
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#9
RE: How to identify arousals? PLM?
It looks like the PLM occur during NREM and possibly REM (harder to tell from your graph). When you look at the overview image you provided (full night of data) you can see how how the FR graph looks what I would call furry with the regular little spikes (for example 23:30-00:15 and 2:40-3:30), I assume these are the more obvious PLM periods.

00:15-00:45, 02:05-02:35 and 3:45-4:10 appear to be obvious rem periods as they match rem cycle (every ~ 90 minutes), have fluctuating TVs (rem breathing) and some mouth leaks from atonia. There are fluctuations during this time as well but too hard to know if caused by PLM due to other rem fluctuations and leak effects.

Speaking of which your leaks aren't bad but you can see how they are usually for a short period and then stop and then occur again. That is potentially because the leaks are causing you to wake up momentarily. Although the leak amplitude isn't an issue if they are disrupting your rem sleep like they appear to be in this example then that won't be helping sleep quality either and attempting to decrease leaks with mouth tape, FFM etc may be worthwhile.
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#10
RE: How to identify arousals? PLM?
As far as I can see the PSG did not separate out PLM in REM vs NREM. 

   

   

   
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