PSG Results: Could this be UARS?

[slowriter]

You should probably post a screenshot of the OSCAR data.

[Geer1]

No point in increasing pressure unless you post oscar data and we can see a reason to do so.

[deebob]

Ok here's my OSCAR data from last night. I've also attached the results from my Oura ring for some additional information about awakenings and sleep cycles (it's obviously not 100% accurate - but I do remember waking up around those times).

This was actually a good night by my usual standards, other than being awake for like 90 mins from around 430 to 6AM. On a bad night I can wake up as much as 9-10 times, as you can see in this night a few days ago. And that's full awakenings where I'm conscious...not little arousals that I don't remember.

It's currently looking like I don't seem to be having airway problems, so maybe it is just some kind of insomnia/anxiety issue that is resulting in frequent awakenings.  I've also started to notice some feelings of restless legs. There did seem to be a fair bit of limb movement on my PSG.  I just don't remember having any feelings of restless legs in the past year or so when my sleep problems began so it could possibly be a new symptom related to the insomnia/sleep fragmentation.

My biggest concern is dismissing UARS because the CPAP isn't improving my sleep, without knowing for sure if that's just because the CPAP has been failing to prevent RERAs. Are there any little clues of RERAs that would be visible in the OSCAR data? Like flow limitation or abnormalities in the breathing curves around the time of an awakening?

           

[slowriter]

You might try raising the min pressure to 7. This will ensure you get the full benefit of EPR, which can help address the flow limitations (which you do have and) which can lead to RERAs.

And raise your max pressure to 20 for now, or at least 15, to give your machine room to work. It won't go up unless it needs to.

[slowriter]

On sleep stages, two things:

1. I'm skeptical how accurate the Oura is. I use a Dreem 2 headband, which has EEG sensors, and I even wonder sometimes about their algorithms.
   
2. But assuming it is totally accurate, what you're shooting for is 20-25% of a normal night in REM, with 4-6 blocks of REM, each at least 15 minutes. Barry Krakow has suggested a "REM Consolidation Index," which is basically this. You're looking, in other words, for a certain quantity of REM, and also for it not to be fragmented. If you have that, you probably are controlling RERAs.
   

[Dormeo]

For what it's worth, and if the ring is accurate, you are getting good amounts of well-consolidated deep sleep. The total of REM is within the normal range, but it's less well consolidated.

[deebob]

I'm usually able to get enough deep sleep (often between 2-2.5 hours)...and a big chunk of this is usually in the first two hours of sleep.....my problem seems to be with waking up during REM sleep. Regardless of what the Oura ring says, I remember very clearly waking up during dreams. So whatever is causing me to wake up, it seems to be most likely due to something that happens during REM sleep, whether that's because airway muscles are relaxed, or my heart rate goes up really high, or my limbs start doing something....it seems to be related to elevated sympathetic nervous system activity during REM sleep, and I notice it become more severe if I'm generally more stressed/anxious.  When I've had a good day, filled with exercise/work/socializing and some relaxing activity before bed, I tend to wake up less frequently. But I'm still not able to sleep through the night without fully waking up at least 4 or 5 times even on a good night.

[slowriter]

Deep sleep is normally concentrated in first part of night.

How long have you been on CPAP?

[Dormeo]

Dreams are not confined to REM-stage sleep, so waking up from a dream is not, by itself, evidence of a wake-up from REM. More here:

http://www.dreamscience.ca/en/documents/..._reply.pdf

https://www.ncbi.nlm.nih.gov/pubmed/30201768

[Geer1]

That sleep stage data and oscar data do not agree with each other(arousals not at right time, overall duration and times all different etc). They are from the same night?

Edit: If from the same night maybe took the cpap machine off and left off around 5 am(going by time on sleep stage data)?