6th month update

robysue wrote:One question for both you and NotMuffy: What the heck is cyclic alternating pattern (CAP) in language a mere mathematician can understand?

Robysue, researcher Avram Gold, MD just so happens to specialize in SDB patients with your symptomology. I wouldn't necessarily suggest changing sleep doctors. But I would suggest a second-opinion consult some day----perhaps during an extended-weekend vacation to the NY city area:
http://www.stonybrookphysicians.com/doc ... AM_883.asp

robysue wrote: And give serious thought to your idea of a second opinion if/when we ever get to the NYC area.

robysue wrote:IYou asked about the graphs for the sleep studies. I don't have the detailed breath by breath data. I only have the summary graphs. I've got that data for all four sleep tests. If you want to see them, just let me know and I'll scan them in.

robysue wrote:What the heck is cyclic alternating pattern (CAP) in language a mere mathematician can understand?

CAP is organized in sequences of two or more CAP cycles. Each CAP cycle consists of a phase A and a phase B, lasting 2-60 seconds. All CAP sequences start with a phase A and stop with a phase B. In NREM sleep, the phase A patterns are characterized by single or clustered phasic events, peculiar of each sleep stage:

• NREM1:
  • intermittent alpha rhythms (EEG synchronization) and
  • sequences of vertex sharp waves (EEG synchronization)
• NREM2:
  • sequences of two or more K-complexes alone (EEG synchronization) or
  • followed by alpha-like components (EEG desynchronization) and
  • beta rhythms (EEG desynchronization)
• NREM3:
  • delta bursts (EEG synchronization) which exceed by at least 1/3 the amplitude of the background activity
• NREM (all):
  • transient activation phases (EEG desynchronization) and
  • EEG arousals (EEG desynchronization)
• The period between 2 successive A phases separated by an interval longer than 60 seconds is scored as nonCAP (n-CAP)
• Phase A Subtypes
  • A1 Subtype: A phases with synchronized EEG patterns (intermittent alpha rhythm in stage 1; sequences of K-complexes or delta bursts in the other NREM stages), associated with mild or trivial polygraphic variations.
  • A2 Subtype: A phases with desynchronized EEG patterns preceded by or mixed with slow high-voltage waves (K-complexes with alpha and beta activities, k-alpha, arousals with slow wave synchronization), linked with a moderate increase of muscle tone and/or cardiorespiratory rate.
  • A3 Subtype: A phases with desynchronized EEG patterns alone (transient activation phases or arousals) or exceeding 2/3 of the phase A length, and coupled with a remarkable enhancement of muscle tone and/or cardiorespiratory rate.

"Look at that, willya? Eewwww!!

NotMuffy wrote:And therein lies (one of the) problem(s). In the search for an effective New Wave Scoring Methodology, researchers try to come up with "mathematical" explanations for phenomena when sometimes one must simply resort to "art form" analysis:

"Look at that, willya? Eewwww!!

robysue wrote:Since the beginning of January, the serious CBT work on the insomnia has been addressing at least some of those other issues. And even with the sleep restricted schedule (max of 6 hours in bed; typically getting 4 1/2 to 5 1/2 hours of sleep NOW), I'm feeling much more alert and much, much more functional during the daytime than I was at any point last fall. I don't think it's a coincidence: Even if I only get 4 1/2 hours of sleep out of 6 hours in bed, that's still a sleep efficiency of 75%, which is better than I got on any of my sleep tests. And most days I'm getting much closer to 5 or 5 1/2 hours of sleep if I'm sleepy enough to go to bed at 1:30 in the first place. So most days my sleep efficiency in terms of (Time asleep)/(Time in bed) is now on the high side of 80%.

So I do think I'm finally grappling more successfully with other causes of my poor sleep efficiency. But I have not yet "solved" all of them. And certainly the Feb. 4 sleep study's data on arousals and sleep staging bears this out: Healthy amounts of both REM and Stage 3/4 sleep for the first time in any of my sleep tests, but still a long WASO period and reduced sleep efficiency. I'll look the data up if you want me to.

As for dial wingin' vs. simple acclimation: I think you're onto something here. The two most critical aspects of my acclimation to xPAP have been (1) simply getting used to the sensory overload to the point where it no longer feels like sensory overload and (2) finding a pressure setting that my stomach can tolerate that effectively treats the sleep disordered breathing.

robysue, I'd be interested to hear some of the CBT techniques you've found useful (and otherwise). I don't really think I've got insomnia, but it does seem I'm waking up somewhat more frequently with cpap use (as opposed to without).