OSA resolved, but still poor quality sleeping

[Mogy]

Thanks for all the links Jnk. That should keep me busy for a while.

[tedtomato]

Trying to chase down the cause of spontaneous arousals may not prove to be helpful. A certain number of arousals are normal and an AI of 20 may not be significant.

I think this is a bit confusing: an AHI of 15 would be considered mild apnea, and probably needs to be treated, but you are saying another 20 micro-arousals per hour wouldn't be an issue, in term of disruption of sleep patterns?

Also, if a CPAP machine was to report an AHI of 15, it's not even confirmed that such events meant an arousal, as the machine can't analyse EEG patterns and wouldn't know if the patient was woken up or not.

I use a Fitbit device too, to measure sleep cycles/stages, and the amount of deep sleep and REM sleep per nights are well below what they should be. Frequent awaking is also measured.

Numbers from last night for instance:

REM sleep: 6%
Light sleep: 65%
Deep sleep: 14%
Awake: 15% (without the perception of actually being awake)

[jnk...]

Thanks for all the links Jnk. That should keep me busy for a while.

Enjoy.

Was a good question.

[Jay Aitchsee]

Trying to chase down the cause of spontaneous arousals may not prove to be helpful. A certain number of arousals are normal and an AI of 20 may not be significant.

I think this is a bit confusing: an AHI of 15 would be considered mild apnea, and probably needs to be treated, but you are saying another 20 micro-arousals per hour wouldn't be an issue, in term of disruption of sleep patterns?

Micro arousals as reported by your PSG are not the same as fragmented sleep. Did you read the papers linked? Your non-respiratory/movement arousal index was essentially normal.

From your Fitbit results, you would appear to suffer fragmented sleep and suppressed REM. What were your sleep stage percentages reported by your PSG? Are you taking any meds which could suppress REM? These might include alcohol, anti depressants, stimulants, diuretics, caffeine, and more.

If one's AHI is satisfactory and fragmented sleep which results in next day fatigue and tiredness remains, then one needs to look elsewhere for the cause, IMO. No amount of cpap machine tweaking will fix poor sleep resulting from non respiratory causes. Finding the cause(s) of poor sleep can be a rather tedious process which requires a disciplined methodology in ruling out potential problems. Granny's checklist is a good place to start:

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep [including alcohol]
- Use the bedroom for sleeping only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems
CG

BTW, I would consider a satisfactory AHI to be under 2.0 resulting from 100% therapy adherence - while recognizing that home machine AHI can be artificially inflated by the inclusion of CA resulting from other than SDB - commonly referred to as Sleep Wake Junk.

Ted, have you posted any of your SleepyHead Charts? I looked but didn't see any. Your charts might give us a better understanding of your poor sleep.

[tedtomato]

Please see below an example of report from Sleepyhead



As you can see, I believe the respiratory/OSA-related issues are completely resolved by the CPAP treatment, so cause of fragmented sleep must be elsewhere...

[TedVPAP]

Please see below an example of report from Sleepyhead



As you can see, I believe the respiratory/OSA-related issues are completely resolved by the CPAP treatment, so cause of fragmented sleep must be elsewhere...

Your data looks great.
Why do you believe that you are have too many arousals? Please post the respiratory rate data.
You are showing spikes of leaking. The leak rate is not large but they could be disturbing your sleep.

[Jay Aitchsee]

As you can see, I believe the respiratory/OSA-related issues are completely resolved by the CPAP treatment, so cause of fragmented sleep must be elsewhere...

I agree. It would appear that your non-restorative sleep is not a result of untreated SDB. Further, your sleep doesn't really look fragmented, either. Perhaps, as TedVpap has implied, your Respiratory Rate Graphic might indicate some disturbances, but I doubt that it will be very telling. You only have one CA. Usually with disturbed sleep, one would expect to see more.

What were your sleep stage percentages (Deep, REM, etc.) from your PSG?

If you want to measure some shorter term disturbances, you can go to SleepyHead/Preferences/CPAP/Check Custom CPAP user Event Flag and set a Flag to something like 30% for 5 seconds and Show in Breakdown as desired and check under CPAP events. This setting will flag apneas of a 70% reduction with a duration of 5 to 10 seconds (Greater than 10 seconds will be scored as regular apneas). If your sleep is disturbed, this flag could help you determine when and how much and might offer a clue as to why.

At this point, my suggestion would be much the same as before: Begin to methodically look for the cause(s) of your poor sleep using the checklist previously provided or something similar. I know you would like to use your spontaneous micro arousal index to determine the cause, but the problem is, I don't think anyone can tell you why they occur, only that they do.

You might be able to use the user flag as a sort of surrogate for micro arousals as you work through possible causes (If I do this, does the number of user flags decrease?). As you are looking for causes of poor sleep, one of the best measures will be subjective, how you feel (if I do this, do I feel better?). Your Fitbit might also serve to more objectively measure results, using the results as a baseline rather than an absolute measure (are my Fitbit results improving if I do this?).

I suggest you first have a complete medical workup to screen for possible causes of fatigue. Google it. Ask your doctors to do tests that are not normally included in routine physicals (at least not in the US). Test for Vitamin D, Ferritin, Magnesium, B12,Thyroid Function (T3 and T4), and probably a couple more I don't remember off the top of my head. Many people have low Vitamin D levels but still fall into the normal range. Many believe the normal range should not extend so low. Strive for a D3 serum level around 50 ng/ml.

Look carefully at any meds you are taking. Google all to see possible side effects. Don't use alcohol as an aid to sleep. Eliminate caffeine, if possible, if not, curtail all use after 10 AM.

Get regular moderate exercise, an early morning walk or bike ride is ideal.

Be screened for depression. Consider talk therapy as an aid to better sleep.

Make Sleep Hygiene precepts your bible.

Don't expect quick results, but do expect that you can sleep better.