What causes repiratory effort related arousals ?

Day_Dreamer wrote:It seems this [respiratory effort related arousals] is the main cause of my sleep disorder

What causes it?

I believe that two of the nonanatomic causes[1,2] of sleep apnea are involved and indeed interrelated

[Low] arousal threshold

[High] respiratory control loop gain

Technically it is the respiratory effort which causes a respiratory effort related arousal. But the arousal threshold is a variable here because if it is low[1] it takes less respiratory effort to cause the arousal.

Also respiratory control loop gain comes into the picture. If the gain is less than one as it should be then breathing follows metabolic need and the blood gasses are held stable. However if the “loop gain” rises above one the system over compensates with breathing going lower than it should be but then going beyond catching up to levels much higher than they should be. So during the “higher than should be” catch up times you have much higher respiratory effort resulting in respiratory effort related arousals.

Any arousals which do occur release stress hormones which tend to raise the respiratory control loop gain and lower the arousal threshold.

Day_Dreamer wrote:what can be done in addition to CPAP to reduce it's occurrence?


Thanks in advance!

To lower the respiratory control loop gain:

1. Check your vitamin D3 levels and correct if below 50 or above 80. See The Vitamin D Counsel for details as to the proper assay. D3 just tends to make the respiratory control system run better.

2. Try to lessen the stress in your life. Stress is another “gain factor” where the respiratory control system is concerned.

3. Pursue metabolic health. If your cells work better everything works better. This means learning to eat well and move well. Dietitian, personal trainer, three years or so. As you move toward an active lifestyle I do believe you will find your respiratory control systems working better along with a whole bunch of other things as well. After doing this for a couple of years I was able to half my CPAP pressure – which also reduces the respiratory control loop gain as CPAP pressure tends to raise it.

All of the three above also tend to help with arousal threshold.

[1] Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, and Andrew Wellman "Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic Targets", American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 8 (2013), pp. 996-1004. doi: 10.1164/rccm.201303-0448OC

[2] Sairam Parthasarathy M.D., Emergence of Obstructive Sleep Apnea Phenotyping. From Weak to Strong! American Journal of Respitory and Critical Care Medicine VOL 188 2013
-- critical closing pressure [Pcrit] - Arousal Threshold - ventilatory control Loop gain - and genioglossal Muscle responsiveness. Pcrit, Loop, Arousal, Muscle (PALM)--

Thank you SO MUCH, Todzo, for the incredibly helpful information on RERAs and arousal threshold and so on. All of your suggestions pinpoint issues I still need to solve--stress, low vitamin D, not enough exercise. These are in my control, and I'm encouraged to know that addressing them will help with sleep.

I was feeling very discouraged, having just returned this afternoon from my first follow-up appointment with a nurse at a sleep center, who crowed over my wonderful AHI and lack of snoring when I feel like something the cat dragged in. I tried to explain that I keep waking up and seem to have a low arousal threshold and irregular air flow issues. She was of no help whatsoever and was irritated that I wanted to have a copy of the data she consulted.

How come they're the ones getting paid, when almost all the help I've gotten has been from this forum? Thank you, everyone, for wonderful info. and support through so many threads. You make it possible to get through these tough early months.

Found this old thread
oddly enough the Dr. who posts all the Deviated septum myth videos (Dr. Stephen Park ) is doing the surgery on me on 1/20/15

deviated septum
tirbinate reduction
(nostril fortification ) not sure of the correct term. My nostril constrict when I inhale deeply
& a reduction of any saggy throat tissue

The pre surgery consultant said anticipate being out 2 weeks

My boss is already asking if I can come in sooner

Anyone with a more realistic time table for recovery??????

thanks

Day_Dreamer wrote:Found this old thread
oddly enough the Dr. who posts all the Deviated septum myth videos (Dr. Stephen Park ) is doing the surgery on me on 1/20/15

deviated septum
tirbinate reduction
(nostril fortification ) not sure of the correct term. My nostril constrict when I inhale deeply
& a reduction of any saggy throat tissue

The pre surgery consultant said anticipate being out 2 weeks

My boss is already asking if I can come in sooner

Anyone with a more realistic time table for recovery??????

thanks

2-3 week recovery is reasonable. Complete healing after rhinoplasty will take up to one year, my doc said