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cpap and apap not effictive
(10-21-2016, 10:01 AM)robysue Wrote: Ezil71,
I have a question and an idea: Do you have a FitBit or similar device that can measure movement during the night? In other words a fitness monitor that claims to distinguish sleep from wake based on movement?

If you have a FitBit or are willing to get one, it would be interesting to correlate whether the FitBit shows you as being in "Deep Sleep" or "Light Sleep/Wake" during the worst of your long event clusters. The cheaper FitBit data is not anywhere close to being 100% accurate and it doesn't claim to make an effort to reliably detect sleep stages. But if a cheep FitBit is set to "Sensitive" for "Sleep Detection", it will mark any period with significant body movement as "Restless, Light Sleep, Wake" And it is true that in both REM and Stage 3 sleep, body movement is at a minimum. So if there's a correlation between when the FitBit data says you're restless and when the CPAP data says there's a lot of events going on, you'll have another data point to use to infer whether the event clusters are likely to be SWJ and/or sleep transitional vs a real cluster that is potentially tied to REM sleep.

Just a quick reminder from early in this thread, Ezil71 has indicated RLS, so this may be playing a part. With that, might a FitBit have problems distinguishing steep stage vs RLS movement?
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Here are the screenshots as best I could get them in order:





I don't have a fitbit but I may be able to borrow one, I'll look into that.

Prior to cpap my pattern was about the same. I fall asleep fast, wake up once, fall back to sleep fairly fast and most nights sleep after that until morning, bad nights I would be awake around 3:30-4 or just wake up for good around 4:30 or five. Good nights I could stay asleep until 6:30-7:30. Never felt rested, ever.

I pretty much never remember any dreams either. The only time I do is if there is a strong wifi signal around (a topic for another thread, but I am convinced that at least for me, and my wife, having strong wifi around messes with sleep quality). I can tell if there is strong wifi around because it gives me crazy dreams. I keep my wifi on a timer and turn if off around midnight and manually on in the morning.

For all the charts posted I have ended up just taking off the cpap and trying to get another hour or two, sometimes feeling not horrible, others feeling like a zombie for a few hours when I get up.

I will do my best to keep it on for 6-7 hours min, although often I take it off in a semi conscious state.

Thanks - Ed
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(10-21-2016, 11:06 AM)Sleeprider Wrote: Just a quick reminder from early in this thread, Ezil71 has indicated RLS, so this may be playing a part. With that, might a FitBit have problems distinguishing steep stage vs RLS movement?
If Ezil71 has RLS then the FitBit data may be even more useful in teasing out what's going on during those long clusters that may be SWJ or being stuck in sleep transition. If he's doing a lot of moving around in bed during those times, it may very well point to "can't get into real sleep because I'm moving around too much."

I've never been officially diagnosed with RLS, but my father has it bad. He's been on gabapentin for several years in order to allow him to get to sleep and stay asleep. Last summer when I met with my sleep doc to talk about the fact that my CPAP data and my FitBit data both indicated that I continue to have multiple arousals/awakenings that I don't remember. He suggested trying gabapentin. I've been taking it now for about 2 months. There's some good reasons to think that the gabapentin trial is addressing (but not eliminating) the problem of too many wakes and too much restlessness in my own sleep.

So Ezil71, are you on any medication for the RLS? And on a related note, did your sleep study indicate any problem with periodic limb movements? PLMD is NOT the same as RLS, but PLMD can play havoc with people's sleep continuity just like RLS can.

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I'm not on anything for RLS, but I wake myself up from it at times, mostly flexing and straightening my ankles. I'm still trying to get an actual copy of my sleep studies, I was given very little feedback by my doctor.

As far as sleep positions, I sleep mainly on my left side, largely because I have/had a bad shoulder which I had surgery on a couple years ago.

It still isn't 100% so even when I try to be on my right side, I end up back on my left. Same goes for my back. I have never been able to sleep on my back. I've tried wedges, tried to prop pillows around me, and I always, consciously or unconsciously, end up back on my left side. As quickly as I fall asleep on my side, trying to fall asleep on my back keeps me awake for hours, until I give up.

If I happen to be on a firmer mattress, I end up on my stomach too, but I'm pretty consistent with my left side.
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(10-21-2016, 04:49 PM)Ezil71 Wrote: I'm not on anything for RLS, but I wake myself up from it at times, mostly flexing and straightening my ankles.
Can you try to remember to turn your CPAP OFF and then immediately back ON when you wake up from the RLS for at least a few days? That would help us figure out how much of the weirdness is SWJ being triggered by RLS and how much of might be real clusters

I'll look at your graphs later this evening and write more after I've had a chance to really study them.

Quote:I'm still trying to get an actual copy of my sleep studies, I was given very little feedback by my doctor.
Call the doc's office daily if you have to. You may have to fill out a form requesting the sleep studies in writing. You may even have to pay a small per page fee to get them. But if you keep bugging the receptionist at the sleep doc's office for a copy of the report, you should be able to get it.

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I've now had a chance to look at the images you posted.

Just to make it easer:

https://1drv.ms/i/s!AgFs7hWqVGNflXjLoRToJ6Eh4bRo is from 0:48 to 1:10, which is when you woke up, turned the machine off, and went to the bathroom. Based on the timing (roughly 90 minutes after you turned the machine on and went to sleep) together with the variability in breathing, I think you probably were in REM sleep prior to this wake. My guess is the CAs at 1:02 and 1:04 along with the H at 1:04 are sleep transition events that occurred as you were in the process of waking up.

https://1drv.ms/i/s!AgFs7hWqVGNflXV_U9LwkULUhwS8 is from 1:14 to 1:26, which is just after you went back to bed after the bathroom break. The breathing in this snippet settles down into a pattern by 1:17, but it's not the usual "sleep breathing" pattern we usually see when someone is sound asleep: The exhales seem very sharp and there's a certain periodicity that is no where near pronounced enough to be called "periodic breathing". Could you zoom in again on the breathing here giving me a shot that shows the same set of graphs, but only from 1:20 to 1:25?

I'll also note, that if this were my data I'd be thinking that I fell asleep really briefly right around 1:15 and then woke right back up and started tossing and turning. I'm basing that on what my normal sleep breathing looks like when I'm sleeping soundly. More on that later.

https://1drv.ms/i/s!AgFs7hWqVGNflXZuKB1I25Y5wSgs is from 2:09 to 2:20. This is just before things start to fall apart for the rest of the night. Between 2:09 and 2:15, the breathing is stable enough in terms of RR and TV, and the shapes of the inhalations and exhalations is a continuation of the shape that is established by 1:17. My guess is that you are lightly asleep here, but probably not soundly asleep. Again, I'm basing that on the usual shape of high quality sleep breathing.

Just before 2:14:45 there are a few LARGE inhalations. You can see this in both the size of the inhalations in the wave flow as well as the spike in the TV graph. My guess (and it is just an educated guess) is that this is a spontaneous arousal or a miniwake. But instead of getting back to full sleep after the arousal, it looks like you get "stuck" in trying to transition back to full sleep: You have a cluster of events after that arousal at 2:14:45, so the arousal is not caused by the event cluster. So it is reasonable to hypothesize that the cluster is a sleep transition cluster. And the periodicity in your breathing pattern becomes distinct enough to be flagged as "periodic breathing" for a short period of time. (For what it's worth, this bit of periodic breathing is not long enough to be a huge issue and it does NOT look like classic Cheney-Stokes respiration.)

https://1drv.ms/i/s!AgFs7hWqVGNflXceFpQh0D28nRtA is from 3:06 to 3:17. This is the peak of the nastiest cluster of events during that last 90 minutes of the data on this night. My first question is whether any central apneas were scored on your diagnostic sleep test. Because all these events, including the ones labeled OAs, look like they are CAs. And the question is whether they're CAs that happened when you were awake or semi-awake and hence not technically "sleep disordered breathing" OR whether they are evidence that every time you are stuck in sleep transition because everytime you almost complete the transition to sleep, a CA happens that arouses you just enough to prevent you from getting to full sleep. In other words, the question is: Are you stuck in Stage 1 sleep unable to transition to Stage 2 sleep because of the CAs.

Stage 1 sleep is very light sleep and when you are sleeping well, you quickly progress from Stage 1 to Stage 2 sleep, which is "light" sleep, but Stage 2 is persistent light sleep and actually is restorative sleep, unlike Stage 1 sleep. In a normal sleepy hypnogram, only 5-10% of the night is spent in Stage 1 sleep whereas 45-55% of the night is spent in Stage 2 sleep.

An important question is whether any CAs were "scored" on your sleep test or not. If CAs happen when the EEG says you are "AWAKE" during a PSG, the CAs are typically NOT scored since they're not sleep disordered breathing events because sleep disordered breathing has to occur when you are actually asleep. So if there was nothing said about CAs on your diagnostic sleep test, then my guess is that if you had any breathing periods that looked like the stuff between 3:06 to 3:17 on your PSG, the EEG said you were in WAKE when they happened.

Finally I want to again comment on the shape of your inhalations from the parts of the night where it appears you were sleeping your best: As I said, the breathing pattern in the wave flow doesn't really look like high quality normal sleep breathing, even though it is very regular in terms of RR and TV. The usual shape of the inhalations in high quality sleep breathing are very round and the exhalations are a bit more V shaped, often with a small pause between the end of the exhalation and the beginning of the inhalation. In my own CPAP data, when I am in high quality Stage 2 or Stage 3 sleep, my breathing pattern looks like this:

[Image: FZu5i1xl.png]

My guess is that if you zoom in on your own breathing during this night it will not be this regular looking even during the times you appear to be most soundly asleep.

I'm beginning to wonder whether the RLS may be a bigger problem than you may realize. RLS would explain why you might get stuck in Stage 1 sleep for long periods of time, and if you are getting stuck in Stage 1, that may then increase the tendency for you to have clusters of sleep transition CAs. And if you frequently have periods where the breathing is as ragged as it is on this night between 3:00 to 3:15, that might explain your on going problems with feeling unrested on waking in the morning.

If I were you, I'd consider asking the sleep doctor about whether taking something for the RLS might help you get more restful sleep.

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You posted above that you switched to nasal pillows. Were you were using the nasal pillows during your most recently posted graphs? If so you may have found relief from the aerophagia you were suffering in the earlier chart postings. I like robysue's analysis of your most recent sleep charts. It does look like your sleep breathing issues are now more focused on various central apnea problems. I agree that these central apnea problems are mostly related to sleep hygiene and maybe pressure issues. Please post the segments of your chart requested by robysue. Also do follow up on the RLS and try to get a full nights use of your machine.

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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I managed to get 7+ hours last night. I can't say that I feel good, but I at least feel slightly less bad than the previous nights.

I ran at 7-11, aflex 3. I began the night using nasal pillows, but switched back to my full face during the night. My problem with the pillows is that the hose gets in my way which wakes me a bit. Having it run through the strap on my head solves that, but then pulls the pillows up and out enough that it is unconformable and I get leaks. I do have a nasal mask I can try if if really looks like having the full face isn't working as well

I'm not sure what to zoom in on here since there are so many events all night. The first part of the night wasn't horrible feeling, but I did feel like I was tossing and turning a LOT last night, especially after I had gotten up. I tried turning off/on a few times during all that tossing and turning, but I can't say it was really timed around possible RLS events.

Aeorophasia is there for sure today, and I was well aware of it during the night, but not at a painful level, just very present and annoying. If I actually was getting real rest, it is at a level I could live with, but certainly isn't good.

I will get my hands on my two studies as soon as possible to help answer some of the questions, but I never really had a good explanation or much detail.

Here is the overview from last night, let me know which areas to zoom in more on.


Thanks again for all the help.

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Here is the zoom from the previous night (Thurs) from around 1:20-1:25

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Ezil, put a fleece cover on your CPAP hose. I have used one nearly from the beginning, and it makes it soft and warm like part of the bedding, rather than hard plastic medical stuff. You need to give yourself every shot at being comfortable, and this is a big one for me.
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