Breathing disturbances still causing awakenings?

Anything specific that you would like to see for charts?

I'm just learning how to interpret flow rate charts. I definitely can use some guidance and help in that regard. To me it looks like I am having some awakenings caused by breathing disturbances. Other times it appears that I wake for no apparent reason. I have noticed awakenings caused by breathing events that are not flagged. Maybe the first thing that needs to be addressed is whether or not I'm interpreting awakenings properly. All that I am certain of it that I am conscious of waking 6-10 times per night. A good night being 6 times and a bad night being 10 times. Rarely it's more than that but it does happen. And just as rare is waking only 4 times per night.

The problem is we don't know when you were awake.
So if we don't know when you were awake we have no way to know if any of the flagged events played a part in the awakening or not.

It's normal to wake briefly after REM stage sleep...most of the time we aren't awake long enough to remember the awakening but sometimes we do remember it. It's a normal expected wake up.
Unfortunately we really can't tell sleep stages with any accuracy with the data from the machine.

You need some way of marking known awake times so you can look at the breathing that went on just prior to the wake up to see if anything might point to a breathing issue as causing the wake up.

Now you could look at a flagged event up close....and observe the breathing after that flagged event (assuming you were asleep when it was flagged) and see if it looks like arousal/awake breathing right after the flagged event.

If you can find examples of those...you might post them.

If you wake up during the night and have the presence of mind to reach over and turn the machine off and then right back on again then we would have a break in therapy line which would definitely give us a known awake time so that the breathing just prior to that break in therapy could be evaluated.


So post examples of what you are seeing and needing to learn which is arousal breathing and which is asleep breathing and we can help you get started understanding what you see.
Did you watch those videos???

Oh....I need my usual questions answered.

Any medications...if so, what?
Any other health conditions?

When you wake up during the night...do you have trouble going back to sleep?

And remember ...it's normal to wake after REM...so there's a potential for 4 to 7 wake ups just from REM ending.

I have a couple of threads where I have posted several examples of asleep vs arousal breathing and flagged events but I don't have time to go find them.
Getting ready for bed.
My butt is dragging. I slept poorly last night (less than 5 hours) and I need to catch up.
I am on some medication that is well known to mess with sleep....prednisone type...3 more nights of it and I will be done.

I did watch the videos not to long ago but I think I should do a refresher. I'm quite tired and off to bed for now. I'll start pausing the machine on awakenings. Tomorrow I will watch the videos again. Is there no way for you to zoom in and look at my flow rate chart on your end? That will be a pain the butt to figure things out if you only get zoomed in snippets from my end.

Rob K wrote: ↑

Thu Jan 30, 2020 11:15 pm

Is there no way for you to zoom in and look at my flow rate chart on your end?

Only way for me to zoom in on anything of yours on my end is if I have your SD card loaded in my computer and I am running the software.
I have done that for people but I don't have the time right now because you have to get the SD card contents to me and I have to put it on a SD card and then download and then take hours sorting through 15 second breathing flow rate sections at a time.
I have been ill (hence the meds) and quite honestly I am not 100% yet and just don't feel up to the work.

I would rather teach you how to do it for yourself. It isn't that hard...watch the videos again and tomorrow I will dig up the threads where I have already done a lot of teaching explaining stuff.

And I would want you to do the on/off thing first anyway so that I would know for sure when you were awake.
No sense at all in my zooming in without knowing if you were really awake or not.

No medications.

I normally don't have trouble getting back to sleep. Unless I have a lot going on. In the past I made some life changes and reduced the stress load and that helped a ton with sleeping.

Other health problems that I have been dealing with for a long time would be joint, muscle, and nerve aches, pains, numbness. Pretty much everything hurts at times. I've been tested many times and the doctors have said that I have nothing out of the ordinary going on. For a while they figured I had fibromyalgia but are still not certain on that. The worse part of it is equally both arms and hands get painfully numb most nights no matter the sleeping position. Hands are quite stiff and painful in the morning. When I'm doing a lot of physical labor things can get pretty bad, then it's whole body pain and stiffness. The worse is when I'm stationary or not moving much for periods of time. Driving for hours and laying in bed at night can be a problem. Things were much worse several years ago before I got help from the forum. Now that sleeping has improved my aches an pains are far less. If by some miracle I get 10 hours of sleep I feel pretty good and have minimal aches and pains. This tells me I don't get adequate rest most nights. My body never recovers. I do know I wake occasionally do to pain, but I also know that I wake just as often even when I'm not in pain. This is a whole other subject so the focus here on the forum should be my breathing related awakenings which seems pretty obvious at times according to the flow chart. The question would be is it enough to be a concern.

I had no idea people wake so many times from REM sleep. I never remembered waking up before I developed sleep apnea. I felt amazing at that time. I sure miss those days. That was probably 10 years ago. I guess now when I wake up I have to change positions and adjust my equipment, maybe that's why I remember waking up now. I sure don't feel rested.

Another thing, my apnea is a good deal worse in REM sleep.

Pugsy that's too much. I can't believe you get that deeply involved with helping people. That says a lot. There's no way I would expect you or anyone else to get the data from my sd card and start sorting through it all. That's what the docs should be doing. Heck you already do a ton of stuff that the docs should be doing and don't.

If you wanted to get that involved with people I wonder if you could get just the files for certain days via email that way you wouldn't need the entire contents of the sd card. Still that's a lot to deal with and you have so many people that could use your help on a daily basis.

I might be seeing a bigger picture now. Maybe having wake ups from breathing disturbances, pain, REM, etc. It could be that these are adding up to be significant. I used to have wake ups from apartment living and neighbors being to loud during night hours but I solved that by wearing ear plugs to bed.

Rob K wrote: ↑

Fri Jan 31, 2020 12:11 am

I wonder if you could get just the files for certain days via email that way you wouldn't need the entire contents of the sd card.

That can be done but only after I have an entire SD card to start with. There's more on the SD card than just data files from each night that the software needs to do what it does.
What we can do once you maybe have known awake times (like a weeks worth) ...we can have you zip/compress the SD card contents and then it will be too big to attach to an email, since you have lots of files, is have you upload it to my dropbox account and then I can download it, unzip it and then use my software and create a new user...and then I have all your stuff in my software...then I can play with it.
I prefer to teach you though so that you always can just check yourself....I might not always be around. Better to teach you how to fish for yourself than to keep buying fish for you....kinda of thing.

Anyway, it really isn't all that hard to learn with just some time put into looking. It's not always clear cut black and white but most of the time you can figure it out with just taking some time to do a lot of looking. There's always some "iffy" ones that I can't decide for sure and those I consider real flagged events. Better to err on the side of caution in my mind. It's not perfect but it can get us close enough.

I have been meaning to come up with a little tutorial but I just haven't had the time or energy to compose a good one.
I have bits and pieces floating around in various posts where I have done an ultra short version of a tutorial.

Here's a couple of examples. See if this helps you out.

Here I have circled the asleep flow rate breathing.....and all the stuff after that is arousal or awake related breathing.
Even the hyponea flagged isn't real. It's arousal related. Note the highly irregular breathing that happened just prior to the flagging.


Now with this segment...pretty much all asleep breathing and the flagged events are real asleep flagged events.


And a not so zoomed view....asleep circled...the rest is all sleep wake junk or arousal related breathing. Either awake or half awake.
Can you see the difference in the flow rate? Asleep is boringly smooth and regular and rhythmic and predictable. Arousal is just irregular and jagged.


And here's a bigger image from a different machine's different software that really makes the flow rate evaluation go fast and easy.
This guy does NOT have OSA but he does have crappy sleep quality. I think you can easily see when we was asleep and when he wasn't... Any flagged events aren't real asleep events. He had an in lab sleep study and came out with AHI of less than 1.0...OSA isn't a problem...UARS might be but I doubt it...He was taking some medications that really messed with his sleep quality/architecture which I think compounded his problem.

I watched the videos again. Very informative but wish they went into more detail. Do you know of any source that goes into greater depth analyzing breathing patterns?

Right off the bat from looking at my zoomed out flow rate chart, the first thing I notice is a lot of spikes and irregularity in my breathing. When you zoom in closer my breathing looks a lot like the example you gave where the ahi was low the sleep quality was crappy. My breathing is quite erratic throughout the night. This would probably indicate a lot of arrousals and why I feel unrested most days.

I'm off work today so I'll get to posting some zoomed in images.

I have never found anything better than Jason's video. Might be out there but I haven't found it.
Quite honestly though...haven't looked.

I know it all seems Greek right now but with some time and experience...you can learn it.

You do sound like me though. You have other issues that mess with sleep. I know we would like to blame all our poor sleep on airway issues so we can expect the machine to fix them but unfortunately life isn't that simple.

There are respiratory related arousals...
There are what's called spontaneous arousals...which essentially mean no known cause.
The machine fixes only respiratory related arousals but unfortunately most of the time most of us are having more spontaneous arousals than we are respiratory related arousals.
I get a lot of spontaneous arousals ...in my case back/pelvis/should pain is a significant culprit.
But I also have pets and sometimes it's the cat or dog...and sometimes I simply don't know why I woke up. Maybe it is a post REM normal wake up where I don't just go back to sleep.

A good night for me is probably a half dozen remembered awakenings. I know I probably have more but I go back to sleep too soon to form a memory. I have gone through entire nights of flow rate and just counted arousal related breathing segments...gone through essentially breath by breath...and my overall average is probably at least 2 dozen. When I have a high pain night and no I slept horribly...maybe 40 to 50 arousal segments can be spotted. I won't remember that many but I had them.

On a rare occasion I might spot arousal breathing right after a real asleep flagged event but it's really not common at all. Most of the time what I have would fall under the "spontaneous" category. I know that 75% of my AHI for any night is false positive flagging.

Now what to do to fix crappy sleep quality when it isn't related to the airway (which is all the machine can fix)...million dollar question and not easy at all even when we know the cause. Like my pain stuff...I know the reason but I can't fix it to the point it doesn't wake me often during the night. I do the best I can to reduce the pain but when you get old and arthritic and your back and pelvis has been broken and you got massive degenerative changes....there's just only so much we can do.

I had the same issue... "treated" at 2 AHI, but with constant wake ups at night from full and even like you <10 second events. What helped me was higher pressure, Tumeric and Pepper before bed, and Gastrodia elata which seems to help me sleep deeper. Now i'm consistently .1-.4 AHI and don't seem to wake up, at least that I remember, except occaisionally around 5am. I haven't bothered to see if that's apnea related.

nicholasjh1 wrote: ↑

Fri Jan 31, 2020 2:03 pm

I had the same issue... "treated" at 2 AHI, but with constant wake ups at night from full and even like you <10 second events. What helped me was higher pressure, Tumeric and Pepper before bed, and Gastrodia elata which seems to help me sleep deeper. Now i'm consistently .1-.4 AHI and don't seem to wake up, at least that I remember, except occaisionally around 5am. I haven't bothered to see if that's apnea related.

https://www.healthline.com/nutrition/tu ... ack-pepper

hmmm. i may want to look into this.