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does this make sense?
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readyforsleep Offline

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Post: #1
does this make sense?
Hi all

last night I had a very big cluster - 32 events between 11 and 12 pm. This seems to be a trend, though this was the biggest cluster yet. Seems like as my body gets used to a pressure setting I sleep deeper, and the Rem clusters kick back in. The rest of the night was just normal spacing of events. I ended up with an
ahi of 7.8.
I have been at this cpap pressre of 16, 16,2, or 16.4 for 12 days now.

Any thoughts about my theory?

2010 sleep study 63 AHI, 2014 3.0
08-12-2014 06:41 AM
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justMongo Offline

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Post: #2
RE: does this make sense?
(08-12-2014 06:41 AM)readyforsleep Wrote:  Hi all

last night I had a very big cluster - 32 events between 11 and 12 pm. This seems to be a trend, though this was the biggest cluster yet. Seems like as my body gets used to a pressure setting I sleep deeper, and the Rem clusters kick back in. The rest of the night was just normal spacing of events. I ended up with an
ahi of 7.8.
I have been at this cpap pressre of 16, 16,2, or 16.4 for 12 days now.

Any thoughts about my theory?

I think that part of your theory is not correct. However, every night is different; and you may just be in for a run of REM apneas.

Having said that, I would think perhaps you might do a bit better with a little higher IPAP max pressure. Giving the Autoset a bit more top room to deal with apneas. REM apneas are difficult to avoid altogether.

My theory on REM apnea (and I'm as far from being a neurologist as I am from being an astronaut) is that during REM, the brain is too busy to take care of some functions like maintaining the airway. That may be totally incorrect -- but, it's my working hypothesis. I just woke from a rather vivid dream about an hour ago: Some person had stolen my watch; and I found them with it -- "dead to rights." Unfortunately it had been disassembled.

Although a person is more diffcult to arouse in REM, it is a transitional stage as one comes out of deeper stages of sleep.
"...Sleep proceeds in cycles of REM and NREM, usually four or five of them per night, the order normally being N1 → N2 → N3 → N2 → REM. There is a greater amount of deep sleep (stage N3) earlier in the night, while the proportion of REM sleep increases in the two cycles just before natural awakening."

From:http://en.wikipedia.org/wiki/Stages_of_sleep#Stages_of_sleep

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.
(This post was last modified: 08-12-2014 07:28 AM by justMongo.)
08-12-2014 07:19 AM
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robysue Offline
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Post: #3
RE: does this make sense?
(08-12-2014 06:41 AM)readyforsleep Wrote:  Hi all

last night I had a very big cluster - 32 events between 11 and 12 pm. This seems to be a trend, though this was the biggest cluster yet. Seems like as my body gets used to a pressure setting I sleep deeper, and the Rem clusters kick back in.
Without knowing the following, it's impossible to make an intelligent guess as to whether this was a REM-related cluster or not:
  • Time you went to bed and estimate of sleep latency
  • Make up of the events in the cluster
  • Some basic diagnostic information: Is your OSA documented as being substantially worse in REM? And is there any mention of central apneas on your titration study or your diagnostic study?
  • Is there any history of other REM-related sleep disorders?

Quote:Any thoughts about my theory?
In normal sleep, the first REM cycle usually occurs roughly 90 minutes after falling soundly asleep AND the first REM cycle is usually very short---as in 5 minutes or so. The REM cycles increase in length as the night progresses, and the longest REM cycles are usually just before you wake up.

So unless your REM cycles have a pattern that is very different from the average person's REM cycles, this cluster most likely does not fit the pattern of REM-related OSA-clusters.


Quote:The rest of the night was just normal spacing of events. I ended up with an
ahi of 7.8.
I have been at this cpap pressre of 16, 16,2, or 16.4 for 12 days now.
Given the high pressures, it is worth asking the question: Is there any chance that these events might be pressure-induce central events?

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08-12-2014 08:41 AM
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justMongo Offline

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Post: #4
RE: does this make sense?
@readyforsleep:
Perhaps you could post some graphs from SH.

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.
08-12-2014 08:54 AM
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readyforsleep Offline

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Post: #5
RE: does this make sense?
[attachment=987][attachment=987]]Thanks for your wisdom, again.

My last sleep study was in 2010. Titrated at a pressure of 12. Used a straight pressure untl March 2014. I do not have any data that says I have a rem sleep disorder.

2010 sleep study 63 AHI, 2014 3.0
(This post was last modified: 08-12-2014 11:06 AM by readyforsleep.)
08-12-2014 10:42 AM
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robysue Offline
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Post: #6
RE: does this make sense?
(08-12-2014 10:42 AM)readyforsleep Wrote:  My last sleep study was in 2010. Titrated at a pressure of 12. Used a straight pressure untl March 2014.
How did your data look when you were using straight pressure at 12cm?

Why did you switch to APAP in the first place?

Did this kind of cluster start only after the switch to APAP? Or were you having these kinds of nasty clusters before you switched from CPAP to APAP?

And what is the pressure graph doing during this nasty cluster of events?

Finally: While the timing of the start of the cluster is about right for a REM cycle, the first REM cycle is NOT likely to last 60 minutes in length. It looks to me like there might be something else going on. If this were my data and I was often seeing this kind of event, I'd be talking with my sleep doc and asking for his feedback on what the data most likely means.

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(This post was last modified: 08-12-2014 11:25 AM by robysue.)
08-12-2014 11:23 AM
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surferdude2 Offline

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Post: #7
RE: does this make sense?
I noticed your cluster occurred while flow limitations were down but at the same time when leakage was at a high point. Perhaps a mask problem or sleep position change affecting mask fit.
08-12-2014 11:43 AM
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justMongo Offline

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Post: #8
RE: does this make sense?
Robysue: Looks like, from the pressure statistics, that she's running CPAP mode at a fixed pressure of 16.4 cm-H2O with zero ERP.
ergo: appears the question: "And what is the pressure graph doing during this nasty cluster of events?" cannot be answered.

Always best to ask the doctor. Prima facie, it appears running Auto with a window of 12 to 18 might suppress the OSA cluster. There is a lot of flow limitation there; and all apneas scored as OSA.

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.
08-12-2014 11:51 AM
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readyforsleep Offline

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Posts: 233
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Machine: Resmed S9 AutoSet for her
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Sex: Female
Location: Lawrenceburg, Indiana

Post: #9
RE: does this make sense?
(08-12-2014 11:23 AM)robysue Wrote:  
(08-12-2014 10:42 AM)readyforsleep Wrote:  My last sleep study was in 2010. Titrated at a pressure of 12. Used a straight pressure untl March 2014.

How did your data look when you were using straight pressure at 12cm?

When I had a straight pressure of 12 I had a brick. No data.

Why did you switch to APAP in the first place?

Current therapy was not working. I borrowed an apap from my dme to determine if
my pressure needed to change. My average pressure was 16. Requested a new machine and doctor set my range to 10-20.








Did this kind of cluster start only after the switch to APAP? Or were you having
these kinds of nasty clusters before you switched from CPAP to APAP?



And what is the pressure graph doing during this nasty cluster of events?

Finally: While the timing of the start of the cluster is about right for a REM cycle, the first REM cycle is NOT likely to last 60 minutes in length. It looks to me like there might be something else going on. If this were my data and I was often seeing this kind of event, I'd be talking with my sleep doc and asking for his feedback on what the data most likely means.

2010 sleep study 63 AHI, 2014 3.0
(This post was last modified: 08-12-2014 12:38 PM by readyforsleep.)
08-12-2014 12:33 PM
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readyforsleep Offline

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Machine: Resmed S9 AutoSet for her
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CPAP Software: SleepyHead

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Sex: Female
Location: Lawrenceburg, Indiana

Post: #10
RE: does this make sense?
(08-12-2014 11:43 AM)surferdude2 Wrote:  I noticed your cluster occurred while flow limitations were down but at the same time when leakage was at a high point. Perhaps a mask problem or sleep position change affecting mask fit.

Thank you. Good observation. Especially since RobySue stated that Rem cycles don't last this long. I'll see what happens tonight.

2010 sleep study 63 AHI, 2014 3.0
08-12-2014 03:00 PM
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