periodic leg movement

[2SleepBetta]

... it's uniformly repetitious enough, with each movement having a clear beginning (sharp inhale) followed by a reduction in flow for a few breaths, to imply similarity to my pattern known to be associated with plm.  happy to show more examples if anyone is interested.

sheepless,

That 9 min 46 sec period of yours, above, on 6/5 is amazingly uniform. Would you consider zooming to 2x height the two short periods shown below, including leak and FL? I'd like to learn more about the plm condition by taking a close look at the associated FR?

With AHI down I'm now looking at my occurrences of kevrx's "sigh" and concentrating on the many other deformations (of the several 4-6 worsened inflow peaks--one or more with very irregular top of curve) that precede one or more much more significantly disturbed inflows, those "minor" non-scoreable breathing disturbances. I wandered into this quest by looking at correlation of my sleep motions with inhale curve irregularities and by trying to understand if I should just rest assured I'm sleeping the best that is possible for me. Lacking EEG info, I hoped something more about arousals could be learned from those sleep disturbances that were accompanied by significant motions (which a 3-axis accelerometer data logger records for OSCAR display). 


Along my way I have only recently sought (and tried to understand enough) the research related to RERA, UARS and just unrestful sleep. There are studies of relative sleep disturbances from several kinds of deformations of those peaks. I had never before paid much attention to my flows apart from apnea, but had noticed that maximum inflows were not smoothly rounded, but are always at least slightly deformed. 


The FR disturbance pattern seems to be increased deformation of one or more peaks, then a FL or a more significant unscored disturbance (or both) and sometimes neither. The sigh is often preceded by one or more more deformed inflows and the timing seems to indicate that the sudden plunge from peak inflow to peak exhale (after the two step inhale) frequently triggers a FL just past the exhale's peak. Apart from sighs altogether, when worsening deformations of tops include a two prong fork-like or saddle seat like peak, there is then, most of the time, an immediate FL.


I had until now wondered about but dismissed those sighs that occurred quite regularly every 15-30 (?) minutes and had never zoomed them. Further, I have posted questions, too, about the non-CSR but CSR-like waxing and waning periods of sleep I have. Now I believe I see (in zoomed views) series of increasingly deformed inhale peaks before sighs and before the wanings, those local TV minimums. 

Too many years of not being aware of my terrible SA left  me (one who has dramatically improved his sleep with xPAP therapy) not knowing what good sleep would feel like. Accordingly, the search goes on for a while. For now, I see my condition as having a low level UARS baseline that grades toward FL and OSA levels, but the Vauto and side-sleep now quash the OSA and suppress FL. But at airway narrows, quite possibly at soft tissue stretches or from somewhat mobile and flexible mucus (like a stuffy nose), my breathing is variably though continuously susceptible to partial closure by high rates of air flow. It's somewhat like open doors slam closed from venturi effect of wind through their passageway.

ASB

       

[sheepless]

s2b, I'm not sure how to make a shot look like the ones you posted above but will these do?  if not, please tell me exactly how you want it and how to do it.

btw, I expect you know but am clarifying that what I'm showing you is plm and not sighs. I have some of those sigh spikes every night if you want to see examples of those. I haven't noticed that there's any periodicity to them but maybe I get a couple per hour.

[2SleepBetta]

sheepless,

Thanks for responsive reply. 


My bad on the sigh, was too lazy to do a separate post and should not have mixed it in. Those are more noteworthy to me only recently as I see the +peak deformations worsen within about 4 or 5 breaths before or including the first part of the sigh's two part inhale. I often see a FL (up to half the instances?) immediatedly after that bottom -peak of the exhale (plus possibly a small short leak and slight motion). A quick check of one night showed sighs happened at 8-12 minute intervals.

The height zoom you had was great, but, the horizontal scale takes in too many breaths to get a good look at the shape of the FR (mainly) at its maximum. If the curve peak had the profile of a worn rubber eraser on wooden a pencil held in the vertical about a foot out from the nose (or a bit wider top), that is what is desired to get a good look at the tip.

The clip with the small FL shows it starting at the bottom, at a bottom "-peak" reached simultaneously, just as I see in a majority (I think now) of my small, if not all, FL. Interestingly, there is a forked inhale maxima just before the FL, as I noted in some of mine--FR researchers classify that forked shape as a more sleep troubling flow shape. There is a striking difference of timing of the start of small leaks in the two clips. In one clip, the small leak starts simultaneously with the exhale peak flow rate (the bottom peak). In the other clip not so. (Presently I'm sensitive to matters of exact timing, affecting as it does, the question whether a motion caused a breathing irregularity or vice-versa.)

One of your clips showed what I think are two small coughs and both have some irregularities (I don't see in my FR curves' irregularities) after some of yours cross the 0-flow rate line downward on way to the exhale's maximum negative flow rate. Also, as zoomed, more vertically and less horizontally it seemed your maximum inhale rate peaks are sharper and, like mine, often deformed. 


I'm trying to recall the context you gave for the 9' 46" clip of yours. I think that was an example of what you see from time to time, but not all night or necessarily every night. Does it span a period with plm?  If so, do moves happen according to the "beat" set by the FR peaks?

Anyway, as I type this more thoughts and questions arise with accompanying questions about what I saw, let alone what you or I can do with any observations. I think I'm trying to bring a lot of pieces together and come up with a breathing understanding that does apply at least to me. Your case with few FL, low AHI and plm is most interesting.


Again, thanks for responding. If you care to expand and post from those views I'm most interested.

2SB

[sheepless]

I'll have to study your last couple posts as I'm not really following. meanwhile, it's probably a simple thing I'm missing but maybe you can explain how I can narrow the horizontal scope of the screenshot to give you the view you want.

for context, what you see in my screenshot are not 'normal' sleep disordered breaths. the pattern is my respiratory response to periodic limb movement. it happens in episodes of less than a minute to an hour or so throughout the night. it's disturbing to sleep & even with medication usually wakes me fully a couple times.

pressure will not overcome it. in fact, the resmed machines' response to raise pressure or pressure support against flow limitations is as disturbing as the movements.

I believe I respond to a movement by inhaling sharply, so I'd say yes the peaks roughly correspond to the movements. the 'coughs' you mentioned are moans/groans in protest. I surmise that the physical tension produced by the movement & groan result in several relatively flow limited breaths until it starts all over again.

let me know how to narrow the horizontal view & whatever else I need to do to give you the view you want...

[2SleepBetta]

sheepless,

I've not made clear what I was asking. Here are a couple of trys.


My guess would be that for your attachment above you clicked on the beginning moment of your plm session somewhere in the middle of that illustrative sleep session and you held your mouse button down while dragging on the FR curve until you had highlighted the to the end point of what you wanted to show in detail. Then you released the mouse button. By doing that you  filled the full  the width of your OSCAR screen with and only with that 9' 46" view exactly. That stretched the FR curve out so the individual spike pattern could be seen. I'm asking you to do the same to stretch the curve more at each of a couple of spots by just clicking on and dragging over a few-breath span of time until you release the button at the end of the part you want to expand. 

If we had a whole night of sleep, 8 hours, OSCAR would show the FR graph filling the full default width of FR window. I could ask to see the middle two hours in detail, that is I could ask the full width of the FR window be filled with just that two hour part of the session. Then you would click on the FR curve and hold the mouse button  beginning at the end of hour 3 and drag, drag while holding the button down to the end of hour 5. There you release the button. Then the full width of the FR window would be filled with just those 2 hours now 4 times as wide. 

2SB

A side note:
Fiddling with copying, pasting, matching OSCAR graph and Excel graph scales, etc. I've bumped into 3 or 4 developers whose tool inventions have proven invaluable (as I bet you have if you care to share their name). The following names are searchable for  three--what I'll call special utilities--not included in Windows: "A Ruler for Windows" (a ruler or plain guide that gives you a switchable horizontal or vertical cursor or ruler that is independent of the application (like OSCAR) and can be dragged, shortened or lengthened at will as it stays on screen only as long as you wish, application by application); "ClipMate" (an amazing clipboard extension, best to visit the Thornsoft site to read about it, 'have had it for years. Cost? Hmm. About $30 if I recall). Additionally, though I use it less, there is "Meazure" that not only measures on screen lines and angle but can provide spaceable grids and so much more. Then there is "Snipping Tool" in Windows itself (W10 anyway): you can click its icon and select whether you want a whole window screenshot, a rectangular part or a free form copy of anything shown on screen. For less than a screen full you click and drag to enclose what you want to copy to clipboard (or copy to CiipMate).

[sheepless]

sorry, I think I understand what you describe but I still don't know what you want.  initially I thought you wanted the 2 pics in post #31 stretched vertically.  I narrowed the horizontal scale the only way I know how, by moving the event tab slider from 10 minutes to 2. the closest view oscar can manage is 1 minute filling the width of the screen.  

now, do I understand correctly that you want a 2 hour wide view with 22:16:30 & 22:18:45 at the center or is that just an example?

okay, try these, which using your method got me zoomed closer than the earlier 2 minute shots.  4 kicks (larger inhales) are visible, 2-3 breaths between them. 

sorry I'm not getting it; if these aren't it, I need a little more direction please.

[2SleepBetta]

sheepless,

Those are perfect zooms. Thankyou. No need to respond at all after your troubles, but I'd like to understand the--your--experience of plm if you care to respond.

I've marked the zoom that raises my questions from both of them and seems most notable.  I marked a 5-second instance at the shaky-mouse-marked red arrows. There there is what I've mentioned before about a large percentage of my own FR deformations: just one or a few suddenly increased wave deformations after a consistent FR pattern  often "announce" or signal the immediate sudden arrival of a FL after a period without any. Often a FL is coincident with and seems to have been caused by my breath, inhale or exhale flow rate being  greater than more recent peak rates. 


Aside from that one FR-deformation-FL pairing--a fact my so limited insight and knowledge must accept, say, accept as a turbulence effect for stream flow in an irregular channel with non-rigid, elastic and flagging surfaces--I have nothing to contribute or say except to wonder what your FR set of irregularities tell about your and many of our particular breathing and sleep disturbances. 


I do think it would be beneficial to have a kind of wiki in a thread where AB apneics would post a small snip showing Oscar's left sidebar summary and a sleep segment or two that shows how their best breathing transitions into their most troubling one, show that along with a few words explaining how they sleep and how they and their MD interpret that sample. I believe it would help those who try to tease all they can out of data from their SD cards--frustrated, so often it seems, by their regular or sleep MDs.

Now, here are some other things noted, trivial or not--I know not. I should go read again and read more of your related posts where you have probably dealt with most of the below items:

Re your attachment with the only FL-


The 3 yellow marks are at lesser groan-like phenomena after spikes as are better illustrated in the other clip? Aren't they a kind of strained or stressful start of the exhale?

The every-fourth FR increases are concurrent with a single leg motion aren't they? 


Are the + peaks  sharper and the - peaks less sharp, as I'd guess, than they are in the better time of sleep? 


Are you doing a kind of panting with a sharp inhale rise and stop and a slower initial rate of exhale with little normal slowing or tapering off of an exhale before inhaling again? 


The #1 bar is placed in the center of the only Leak instance shown, but your 9+ minute clip indicates, as I recall, that most every spike (and its causal leg move, correct?) disturbs the mask or lip seal a bit. Correct? Leaks often accompany and signal motions and motions often cause them, too (many of my FL do likewise).

It seems most leak starts take place after peak inflow and right at or just after beginning of exhales along with starts of the groan or groan like irregularities. Have you any idea when the leg motion starts in the flow curve. Is there a pain? Does any pain begin at the start of those indicated groans? Where do any pain or motions begin or end if you can have any sense of this at all since it occurs in asleep? I try to get at such an answer for motion registered by an accelerometer and the metrics from the Vauto SD card, but two real time clocks are involved for two devices that I know I haven't been able (probably will never be) to synchronize close enough to determine exact sequencing. 


Is it just a coincidence, apparently, that the two green arrows at the FR curve coincide with the start and end indicated for the FL. Such irregularities show at the ends of exhales at 39-, 48- and 02-second marks as well as in most of the FR curve in your other attachment.

I assume--correctly?--that plm is neurological like my slightly impaired swallowing and the progressive nerve destruction (loss of muscle nerve activating firing that would otherwise maintain muscular function) that became noticeable with slight toe dragging at age 45 and that by age 60 had destroyed (high mountain backpacking enjoyments and) all muscle function below the knees, requiring braces to maintain reasonably safe ambulation that continues at age 80. (It, CMT, was diagnosed after a few years as an untreatable with no need to struggle trying to medicate for it and its lesser effects, a blessing I should and do appreciate. I gotta remember that if it affects my breathing, as it does in some others, it is not that bad and there are thousands of worse conditions and pain I don't have   that are far worse for others, I am sad to say. ) 

Separate from the CMT nerve problem, I was put on a drug a couple years ago for benefit of my heart that was changed to a similar one that had the off label benefit of reducing tremor, Propranolol. I think it was substituted for Inderal. Totally irrelevant--like most all else here no doubt.  Oops, now I lapsed into what my deceased younger brother hated who was medically discharged from the AF in his early 20s with an on and off (intermittently remitting?) kind of MS but had a productive life as a buliding contractor until retiring and then death at age 65. He was weary of so many people making suggestions after having studied all kinds of sources and becoming a lay expert on the topic.

I hope you find relief and have appreciated learning more from you.

2SB

   

[sheepless]

s2b, first, I have very little empirical information about this pattern because I am completely unaware of the plm.  

btw, I believe you have used an accelerometer to monitor your movements; do you suspect plm?  I should get a video camera and would like to figure out how to use my phone to record movements...

the following is copied from your last post. my reponses in blue.

Re your attachment with the only FL-


The 3 yellow marks are at lesser groan-like phenomena after spikes as are better illustrated in the other clip? Aren't they a kind of strained or stressful start of the exhale?

not sure I understand the question.  I concluded these squiggles are groans after listening to an audio recording in which I can hear the kick (sheets moving) and the groan.  usually they follow the large inhale in the flow rate, sometimes they precede it.  could be a real difference but I've always assumed it's due to how / when the data is recorded by the machine or reported by oscar (also, see similar comment about flow limitations below). 

The every-fourth FR increases are concurrent with a single leg motion aren't they? 

that's my assumption although idk if it's always a single motion.  my wife tells me she thinks sometimes it's a whole body thing.  could be two legs at once for all I know.  really need to get a camera...

Are the + peaks  sharper and the - peaks less sharp, as I'd guess, than they are in the better time of sleep? 

a fair assumption but idk.  I'll have to watch that for a while.

Are you doing a kind of panting with a sharp inhale rise and stop and a slower initial rate of exhale with little normal slowing or tapering off of an exhale before inhaling again? 

again, unfortunately idk.  my wife only mentions physical movement and moaning.  before cpap I used an android sleep app which among many other features included a noise recorder.  I would listen and label the things I heard.  one label was 'panting'.  I think I can safely say these would come after an apnea event or on awakening but can't remember if I thought it associated with with 'kick', another label I used.

The #1 bar is placed in the center of the only Leak instance shown, but your 9+ minute clip indicates, as I recall, that most every spike (and its causal leg move, correct?) disturbs the mask or lip seal a bit. Correct? Leaks often accompany and signal motions and motions often cause them, too (many of my FL do likewise).

I think so.  I'm aware of very few mask leaks.  I know it happens occasionally but I'm mostly prone to lip leaks.  these are less a function of pressure in my case than depth of sleep.  otoh, I do think the movements contribute to leaks. I sometimes recreate while awake what I think is happening while asleep by inhaling sharply and groaning.  plm is much more mild but think how you'd react to a punch in the stomach.  well, that'd probably begin with a sharp exhale. how about someone giving you a good shove to stop you snoring.  we'd respond with a bit of an arousal leading to a quick and maybe larger inhale.  a moan/groan in protest would restrict the airway at least during that exhale and I am guessing that's why the intervening breaths appear 'flow limited'.  regarding leaks, I think the moan almost certainly, and maybe the suddenly larger inhale, frequently involve opening my mouth.  most of my leaks are lip leaks on exhale.  anyway, most of these intervening breaths are simply shorter than the sharp ones (no flat, jagged, slanted tops) so maybe they're flow limited only in the sense that they're less volume than the larger one. my experiences with runaway pressure and pressure support on 3 modalities of cpap lead me to think the machine treats these as flow limitations but I don't know how to test or confirm that.   


It seems most leak starts take place after peak inflow and right at or just after beginning of exhales along with starts of the groan or groan like irregularities. Have you any idea when the leg motion starts in the flow curve. Is there a pain? Does any pain begin at the start of those indicated groans? Where do any pain or motions begin or end if you can have any sense of this at all since it occurs in asleep? I try to get at such an answer for motion registered by an accelerometer and the metrics from the Vauto SD card, but two real time clocks are involved for two devices that I know I haven't been able (probably will never be) to synchronize close enough to determine exact sequencing. 

sometimes I have restless legs before going to sleep and while I wouldn't characterize it as pain, it is very uncomfortable.  that makes me suspect there's some feeling associated with sleeping plm but if there is, I'm completely oblivious to it.  again, I should get a video camera and I'd like to figure out how to use my phone accelerometer to learn more about this.  as mentioned elsewhere, I can only speculate about timing of what I'm doing vs the graphs and also suspect the the timing of the flow rate and flow limitation graphs may not be completely coincident.

Is it just a coincidence, apparently, that the two green arrows at the FR curve coincide with the start and end indicated for the FL. Such irregularities show at the ends of exhales at 39-, 48- and 02-second marks as well as in most of the FR curve in your other attachment.

the red arrow to the left of bar #2 points to a clearly flow limited breath.  I can only guess that is associated with my reaction to a movement, maybe a longer or multi part groan.  again, I see them (the squiggly lines I think are groans) mostly after the inhale but often enough before too, but chalked it up to machine and software variability.  if it means something, I don't have enough info to figure it out.  in addition, while you may be on to something regarding the coincidence of what the green arrows point to and the graphing of the flow limitation, eyeballing these things for a few years lead me to suspect that the notation on the flow limit graph always comes later than the indication of the flow limitation on the flow rate graph, i.e., the flattened flow rate curve comes first.  I figure there must be a slight lag between the event and the machine's ability to record the event.  all speculation. 

I assume--correctly?--that plm is neurological like my slightly impaired swallowing and the progressive nerve destruction (loss of muscle nerve activating firing that would otherwise maintain muscular function) that became noticeable with slight toe dragging at age 45 and that by age 60 had destroyed (high mountain backpacking enjoyments and) all muscle function below the knees, requiring braces to maintain reasonably safe ambulation that continues at age 80. (It, CMT, was diagnosed after a few years as an untreatable with no need to struggle trying to medicate for it and its lesser effects, a blessing I should and do appreciate. I gotta remember that if it affects my breathing, as it does in some others, it is not that bad and there are thousands of worse conditions and pain I don't have    that are far worse for others, I am sad to say.  ) 

it's curious you mention impaired swallowing.  idk, but believe plm (mine at least) is neurological.  among other things, ropinirole's primary use is apparently for parkinsons, which I assume is neurological.  I have idiopathic central (now mixed) apnea, which I believe to be neurological.  also attention deficit disorder, which could be entirely due to sleep deprivation but I believe apnea and plm mostly exacerbate my ADD, which may also be neurological.  anyway, I've noticed recently some trouble swallowing, sometimes I have to try a few times, and an increasing frequency of choking on my own saliva.  very subtle and incremental, so I'm not really sure it's happening, but enough to wonder.  from what you say it sounds like that could be a brain issue too.

I admire your positive & inquiring attitude; we have to play the hand we're dealt they say.

I'm interested in your thoughts and what you are learning so feel free to continue the conversation if you like.  I learn something with every visit to the apnea board.

[Damiansd]

My sleep doc trialled me on an anti epileptic medication to address the PLM. Seems to be working so far.

[Sleeprider]

Interesting, keep us posted. You have plenty of company with that issue.