Need advice, Heart rate data, O2 and restricted breathing

[Zackio]

Hi

I brought a pulse oximeter to try to get a better insight on my sleep. Although my oxygen doesn't drop that low, I can see my heart rate reacting to it, it correlates with doggy looking breathing. 

I haven't been able to figure out how get a good night sleep and feel better, I have tried so many things and feel stuck.

I am limited with how high I can set the pressure because I get a gas buildup in my stomach. Wearing a chin strap seems to help to reduce the gas. I have tried getting help from the respiratory clinic but they didn't seem to have a clue. ( I am in the UK )

Without ESR I get a lot of flow limitation which raises the pressure. With ESR 0, the flow limitation mostly disappears but then the machine pressure doesn't rise when to me it looks like it needs too.


My Heart rate is all over the place.

Any advice would be greatly appreciated.

First two images are the overview and the next is a close up example of the oxygen and HR data.

   
   
   

[Sleeprider]

EPR works to suppress flow limitations and will result is much less fluctuation in pressure. Most people find this less disruptive and better for sleep. With settings of 10-20, EPR 3, minimum pressure is 10/7 (IPAP/EPAP) and appears to fluctuate only about 1-cm to 11/8. That is pretty normal. If you want higher pressure, you will have to increase the minimum pressure, but your results are very good, so try to ignore the data and do what feels best. Similarly, your SpO2 had a nadir of 95% and was mostly 97-98%. Nothing to see here, that is also very good. Pulse rate can change with sleep stage and movement. I don't see much here to suggest a problem.

There are some spikes in flow rate that might suggest movement or arousal. A closer look at that may give you some ideas of what is going on. Your comments are all about the data, and at this point, that is absolutely fine. Your quality of sleep is a lot more important.

[Zackio]

Thanks very much for your reply.

Even though the drops are small and I know not a problem of themselves, and nor would pulse rate fluctuations for the reasons you've mentioned. But looking at it closely and together, I think it's more significant. I think my heart rate is compensating for the drops in oxygen before it gets bad, then I tend to have a small arousal.

It was the same thing on my original sleep study, except that the oxigen drops were deeper.

So from a general data point, things look good, like good oxygen, good AHI, low FL. But close up I think I am getting a lot of arousals that are fragmenting my sleep.

It could look like movement from little snapshots but it's all though the night, often ending in what looks like recovery breaths. The small drops in Oxigen and Heart Rate correlate with drops in tidal volume that is also marked in the flow limitation graph.

It goes through a pattern of flow limitation that ends in a few increased breaths for a lot of the night.

From a sleep quality point of view, I wake up feeling aweful

[Zackio]

It's quite handy having a movement graph with the o2 ring and I have a snooor device where I can see what times I turned over. So there are some spikes in HR related to movement.

[Dormeo]

To pick up on something Sleeprider mentioned, there's a pattern to your changes in pulse rate and TV that suggests they may occur when you're experience REM sleep. Just a thought.

But why you are not feeling rested: that's the big question. How are you doing on the basic guidelines for better sleep? I always assumed they were mickey mouse rules that didn't apply to me, but in desperation I finally tried following them. They did really make a difference!

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

[Zackio]

Thanks, sleep hygiene, super important and I follow all the advice. I know when I don't it effects me.

When my breathing looks good, everything is OK, my pulse is low, no FL, oxygen is stable etc. But there are periods where the breathing looks horrible and that correlates with when the pulse rate goes high and when the oxygen gets rocky. Then I will do some bigger breaths and it may be ok for a while until it starts to get bad again.

   

If you see how the the breathing waxes and wains then ends in some bigger breaths

   

I know breathing and HR can be erratic during rem, it's just that scrolling though all the nights, it looks more to me like a breathing issue because of how the breathing starts ok, then starts to progressively get more unstable, leading to bigger breathes then stableising for a bit then starting to break down again. And how when it does it correlates with small drops in oxygen. Those periods are where there are clusters of FL. It could be that I am having more issues breathing during REM peroids?

On the bigger views, it's each place where the tidal volume looks rocky.

It's the exact same pattern as on my original sleep study, only the oxygen droped mucher lower. But the heart rate would follow exactly the pattern.

The breathes would get shallow, the oxygen would drop down to 90 or lower and my heart rate would rocket up. 

Which is why I think it's the same issue, it's just that the oxygen isn't dropping so low because the restriction in breathing is being partially resolved, just not completely.