Low AHI and Poor Sleep

[ironhands]

AHI hasn't gone above 1.8 in 3 months, and I'm still just as exhausted in the morning. Lethargic, and I'd do just about anything for even an extra 5 minutes in the morning. still showing around 30-50 spontaneous arousals on my PSG's

Problem is: Spontaneous arousals are NOT caused by sleep disordered breathing. And so the CPAP can't fix them.

Out of curiosity: How many PSGs have you had and are the 30-50 spontaneous arousals the total number of arousals or the arousal index (arousals/hour)?

Spontaneous arousals (if they're not merely lab effect) can be devilishly hard to deal with since they're not caused by any identifiable underlying problem that can be "fixed" to eliminate them.

In an ordinary night in your own bed, how many wakes do you typically remember?

Yes, I'm well aware of that which is why I'd almost rather stop using it completely at this point. My AHI was only in the mild range, hitting moderate when I was on my back when I was untreated. It's really made no impact since I've started using it.

I've done 3 PSG's at this point, the second included an MSLT, the 3rd was a titration. It was 30 spontaneous arousals in a one hour period, from what I remember, I don't have a copy of the results on hand, but I believe it was 50 over the 6 hour period, with a cluster of 30 during one point (but i'm pretty tired right now). I usually wake every 2 hours and remember it.

[musculus]

AHI hasn't gone above 1.8 in 3 months, and I'm still just as exhausted in the morning. Lethargic, and I'd do just about anything for even an extra 5 minutes in the morning. still showing around 30-50 spontaneous arousals on my PSG's

Problem is: Spontaneous arousals are NOT caused by sleep disordered breathing. And so the CPAP can't fix them.

Out of curiosity: How many PSGs have you had and are the 30-50 spontaneous arousals the total number of arousals or the arousal index (arousals/hour)?

Spontaneous arousals (if they're not merely lab effect) can be devilishly hard to deal with since they're not caused by any identifiable underlying problem that can be "fixed" to eliminate them.

In an ordinary night in your own bed, how many wakes do you typically remember?

Hi Robysue, with all due respect, however you are wrong stating "Spontaneous arousals are NOT caused by sleep disordered breathing". They call it 'spontanenous arousal' because the software/algorithm of the sleep labs cannot associate those microarousal with any events (SDB, PLMS, bruxism, etc). However, some of them are indeed caused by sleep disordered breathing, and that's particular true in my case (everyone is different, though). Since I have the full sleep study data, I will post some figures here later to show how some SDB related microasousals were neglected by the algorithm.

My sleep doctor, a prominent expert in sleep medicine/neurology at UPenn, told me their PAP titration study is usually done to minimize number of arousal in deep sleep.

[robysue]

Hi Robysue, with all due respect, however you are wrong stating "Spontaneous arousals are NOT caused by sleep disordered breathing". They call it 'spontanenous arousal' because the software/algorithm of the sleep labs cannot associate those microarousal with any events (SDB, PLMS, bruxism, etc). However, some of them are indeed caused by sleep disordered breathing, and that's particular true in my case (everyone is different, though). Since I have the full sleep study data, I will post some figures here later to show how some SDB related microasousals were neglected by the algorithm.

My sleep doctor, a prominent expert in sleep medicine/neurology at UPenn, told me their PAP titration study is usually done to minimize number of arousal in deep sleep.

All I know is that my spontaneous arousal index went UP on my titration tests rather than down. And that's been across two diagnostic sleep tests and four titration tests. And each and every time, the SDB was "well controlled" with PAP.

If there is flow limitation going on before the arousal, then it should be able to be scored as a RERA, which is NOT a spontaneous arousal.

I'm not saying that some spontaneous arousals aren't mis-classified RERAs, but at a certain point, some of us simply have some (or many) spontaneous arousals that are NOT tied directly to SDB. And CPAP cannot fix those.

In my case, every time I have experimented with using more pressure to iron out the remaining FLs and "maybe FLs" in my nightly breathing in the hopes of reducing arousals and wakes that might be related to FLs and "maybe FLs", the number of wakes and arousals INCREASES because the pressure itself causes me enough discomfort to arouse and start swallowing air which triggers aerophagia which triggers more arousals which triggers more swallowing which triggers more aerophagia ....

[musculus]

Hi Robysue, with all due respect, however you are wrong stating "Spontaneous arousals are NOT caused by sleep disordered breathing". They call it 'spontanenous arousal' because the software/algorithm of the sleep labs cannot associate those microarousal with any events (SDB, PLMS, bruxism, etc). However, some of them are indeed caused by sleep disordered breathing, and that's particular true in my case (everyone is different, though). Since I have the full sleep study data, I will post some figures here later to show how some SDB related microasousals were neglected by the algorithm.

My sleep doctor, a prominent expert in sleep medicine/neurology at UPenn, told me their PAP titration study is usually done to minimize number of arousal in deep sleep.

All I know is that my spontaneous arousal index went UP on my titration tests rather than down. And that's been across two diagnostic sleep tests and four titration tests. And each and every time, the SDB was "well controlled" with PAP.

If there is flow limitation going on before the arousal, then it should be able to be scored as a RERA, which is NOT a spontaneous arousal.

I'm not saying that some spontaneous arousals aren't mis-classified RERAs, but at a certain point, some of us simply have some (or many) spontaneous arousals that are NOT tied directly to SDB. And CPAP cannot fix those.

In my case, every time I have experimented with using more pressure to iron out the remaining FLs and "maybe FLs" in my nightly breathing in the hopes of reducing arousals and wakes that might be related to FLs and "maybe FLs", the number of wakes and arousals INCREASES because the pressure itself causes me enough discomfort to arouse and start swallowing air which triggers aerophagia which triggers more arousals which triggers more swallowing which triggers more aerophagia ....

Totally agree that pressure can cause arousal. I actually sleep worse if EPAP>~10cm or IPAP>~14cm. Have your tried narrower pressure range since arousal can certainly be caused by changes in respiratory effort.