New to ACPAP/UARS

[Rubicon]

While that's from Da Rules, lots of people look at 1.5 second arousals (I think most of the guys call those microarousals)(although some people call 3.0 second arousals)(actually I think a lot of people just make stuff up as they go along)(I do).

[Seb-Sanfilippo]

That's very helpful
My mind is racing, I am tired but wired and I am trying to figure out many things at once.
Basically I cannot for the life of me understand why I feel so exhausted every day
That's why I convinced myself that I have UARS based on the list of symptoms one finds all over the net
Sleep doctors says that they checked for RERAs and I don't have any and therefore no UARS
What I have though is 104 micro awakenings TST and 27 obstructive hypopnea during REM, that's more or less 24 awakenings par hour
Sleep stages is a roller coaster and sleep efficiency is scored at 49.9% and AHI 5.6
All this might be nothing to write home about for doctors but my list of symptoms says otherwise.
I don't know how much more I can push and try to advocate for myself considering that doctors don't believe it's UARS and that there are no facilities in Belgium to do a test with Pes (as far as I know)

- Basically I am trying to figure out from the Oscar graph if I can see evidence of flow limitation
Would you be kind enough to look at this graph and tell me if you can see clear evidence of recurring flow limitation
I mean if I have 104 micro awakenings and if they are all RERAs I should see them in the Oscar graph, right?
https://sleephq.com/public/8bd32265-46a ... 405f33bb6c

- I am also bewildered that the APAP hasn't flagged any obstructive hypopnea since they are clearly present in my PSG
would that mean that a pressure of 4 as ironed out those obstructive Hypopneas?

[Miss Emerita]

In an earlier post I mentioned a number of tests you might ask your doctor to run to determine whether something other than a sleep-breathing issue is causing your fatigue. Have you followed up on that?

Also, I continue to wonder why your pressure is fixed at 4. As robiesue1 notes, pressure helps flow limitations. I would add that EPR is especially helpful. I recommend that you set your pressure to 7 with EPR of 3. Your pressure when you exhale will still be 4, but you'll get a boost to 7 when you inhale, which may support smoother inhalation.

And yes, obstructive events, including hypopneas, can be well treated for some people at low pressures. I was diagnosed with moderate sleep apnea and have almost no obstructive events with a a pressure of just 5 when I exhale.

I spot-checked your flow rate for the most recent chart you posted. Your breathing in areas that were not flagged as flow-limited looked normal; the inhalation curves in the areas that were flagged as flow-limited definitely looked flow-limited.

[Seb-Sanfilippo]

Thanks for your reply Miss Emerita

In an earlier post I mentioned a number of tests you might ask your doctor to run to determine whether something other than a sleep-breathing

I did see it but I saw nothing that rang a bell, 5 months ago when it all started I was doing fine health wise

I spot-checked your flow rate for the most recent chart you posted. Your breathing in areas that were not flagged as flow-limited looked normal; the inhalation curves in the areas that were flagged as flow-limited definitely looked flow-limited.

If you look at the screenshot below I've got three periods of 30 minutes of ragged flow over a period 7:30 hours of sleep
Although not flagged we agree that is not good, right?
https://imgur.com/a/BEDk79g

Also, I continue to wonder why your pressure is fixed at 4.

Actually I am not using the CPAP, I was discourage after the sleep doctor telling there's no point using it
I want to try again but since I stopped I developed pretty bad insomnia. I now have anxiety about using the CPAP

[robysue1]

...
a RERA is a very short (10-30 second) EEG arousal from one sleep state to wake or a lighter sleep stage ...

An arousal is 3 to 15 seconds (after 15 seconds the epoch would be wake). The 10 second rule for intervening sleep between arousals... OK, overboard.

Rubicon,

Thanks for the correction. You're the professional and I'm just the reasonably well read math prof. I appreciate you pointing out the subtle parts of the the definition of arousals.

[Rubicon]

And when you think about-- that could be only a single breath.

[lazarus]

The concept of "length of arousal" is confusing to me both in print and in conversation, since many authors seem to use "arousal" as shorthand for "RERA," the length of which as an "event" (10 seconds or more) includes the increase in respiratory effort, not just the actual moment of arousal from one stage of sleep to another, as I understand it. And even that aspect of arousal is often confusing to me, since the change in stage is often spoken of as "arousal from sleep," even though "wake" isn't necessary meant by that.

Then again, I'm easily confused. Or at least I think I am. I don't know.

I prefer the earlier clarification:

actually I think a lot of people just make stuff up as they go along

Only context sometimes helps to differentiate what is actually being discussed, since even directly opposite statements can both be true depending on the perspective of the specifics of a writer's assumed implied context.

I am particularly entertained when people say "that isn't OSA; it is UARS." That's when this chart can come in handy:



https://sleepapneamatters.com/apnea-vs- ... a-vs-rera/

Words can be too clear when a nebulous area is under discussion.

[Miss Emerita]

Thanks for your reply Miss Emerita

In an earlier post I mentioned a number of tests you might ask your doctor to run to determine whether something other than a sleep-breathing

I did see it but I saw nothing that rang a bell, 5 months ago when it all started I was doing fine health wise

I spot-checked your flow rate for the most recent chart you posted. Your breathing in areas that were not flagged as flow-limited looked normal; the inhalation curves in the areas that were flagged as flow-limited definitely looked flow-limited.

If you look at the screenshot below I've got three periods of 30 minutes of ragged flow over a period 7:30 hours of sleep
Although not flagged we agree that is not good, right?
https://imgur.com/a/BEDk79g

Also, I continue to wonder why your pressure is fixed at 4.

Actually I am not using the CPAP, I was discourage after the sleep doctor telling there's no point using it
I want to try again but since I stopped I developed pretty bad insomnia. I now have anxiety about using the CPAP

Please get those tests. The fact that "nothing rings a bell" is irrelevant. Something has changed since five months ago, and you need help figuring out what.

Actually there are lots of FL flags in the zoomed view you posted. The amplitude of your flow changes during the zoomed period, but that might or might not be an indication of sleep arousals.

As you are not using CPAP any longer, I'm not sure where the discussion should head at this point. I'm distressed to think of all you're going through, but I hope you will expand your focus and consider working with your doctor on uncovering the root cause of the problem.

[robysue1]

I spot-checked your flow rate for the most recent chart you posted. Your breathing in areas that were not flagged as flow-limited looked normal; the inhalation curves in the areas that were flagged as flow-limited definitely looked flow-limited.

If you look at the screenshot below I've got three periods of 30 minutes of ragged flow over a period 7:30 hours of sleep
Although not flagged we agree that is not good, right?
https://imgur.com/a/BEDk79g

Seb-Sanfilippo,

In looking at that data you posted over at SleepHQ for Jan 23, I note that the flow limitations seem to come in three periods, each of which are about 90-120 minutes apart, and the first cluster of flow limited breathing seems to start around 100 minutes after you seem to fall asleep. Give that you said your sleep study picked up OAs during REM (and nowhere else), it could be these flow limitations are occurring during REM sleep. In other words, it could be the case where 4cm is enough to prevent your airway from collapsing completely during REM, but 4cm is not enough to prevent the flow limitations from occurring. In other words, the OAs when using no CPAP get turned into flow limitations when using CPAP @ 4cm.

And had your AutoSet been in Auto mode, it would have increased the pressure during those periods with flow limited breathing and more than likely the inhalations would have become more normal in shape.

I don't have the time nor the energy tonight to try to scroll through the whole night to count possible arousals based on what looks like might be recovery breaths. But if you were arousing a lot during these stretches of flow limited breathing, then more pressure may have reduced the number of arousals.

Also, I continue to wonder why your pressure is fixed at 4.

Actually I am not using the CPAP, I was discourage after the sleep doctor telling there's no point using it
I want to try again but since I stopped I developed pretty bad insomnia. I now have anxiety about using the CPAP

Your insomnia got worse after you stopped CPAP? Can you describe how the insomnia got worse?

Why exactly are do you have anxiety about using the CPAP? Is the anxiety that your insomnia is going to get worse? Or is the anxiety more along the lines that using CPAP isn't going to help fix your overall sleep problems?

What are you doing to address the insomnia? Because regardless of whether you do or do not have a problem with sleep disordered breathing, insomnia can destroy your sleep and the way you feel in the daytime all by itself.

[ozij]

Looks to me like you're focused on trying to prove that your self-diagnosis of UARS is correct, and trying to find other treatments for it.

Reading this thread, which started about a month ago, I see that 8 days after you started it, on 24 Jan you:

followed Nicko's advice from SleepHQ and fixed my pressure to 4cm the whole night.
Not sure what he meant by that but I did it anyway.

And you have done nothing since in attempting to improve your present therapy.

As long as you're focused on finding proof of UARS in you data, and not in attempting to make your CPAP work for you, you won't do better.

As for "anxiety about using CPAP": when you last used it, it was giving you no therapy at all, that's the only meaning of a pressure of 4. And I'm guessing that Nicko suggested it simply as a way for you to see your own breathing without therapy since that is what seems to concern you. He's neither a fool nor is he that irresponsible as to assume you'll be getting any therapy from CPAP at that pressure.

You have flow limitations - you've been told you have them, they're there when your machine is tracking your breath without giving you therapy. And after having used CPAP at non-therapeutic pressure you "now have anxiety about using the CPAP".

Will CPAP work for you? I don't know.
I don't know, because this is how the whole thing started:

I started feeling very fatigued in September 2022 and it progressively got worse until December when I finally consulted a doctor because I couldn’t work anymore and was understandably depressed about that.

His first reaction was to prescribe antidepressants and dismissed my concerns about OSA and UARS.

In other words, you presented your doctor with you self-diagnosis, and he disagreed. And then the doctor prescribed anti-depressants without any medical checkup? What kind of doctor would do that?

You wait from September to December to address your fatigue until you literally can no longer work, and now in February you still haven't done anything in the way of a medical checkup. Nor have you done much about improving your CPAP therapy.

And you don't even sound worried about that sudden fatigue that seems to have come out of nowhere.
Something happened is September. Physical, or emotional, and you need professional help in figuring out what happened to cause this sudden fatigue and detrioration.

[robysue1]

That's very helpful
My mind is racing, I am tired but wired and I am trying to figure out many things at once.
Basically I cannot for the life of me understand why I feel so exhausted every day
That's why I convinced myself that I have UARS based on the list of symptoms one finds all over the net

Sometimes Dr. Google is our friend. And sometimes Dr. Google is not all that reliable in terms of what's wrong with us.

Given what little you have told us about what the report from your NPSG says about the data gathered during that test, if I had to guess, I'd say that you've got at least two different sleep problems: (1) REM-based OSA and (2) Some kind of significant insomnia. The UARS you think you have and the REM-based OSA can be folded into a more general sleep disordered breathing problem if you want. But I think the insomnia includes some aspects that are not directly tied to sleep disordered breathing.

Keep in mind, I'm a math professor, not a doctor. So take everything I say about your diagnosis with a large grain of salt. Still from what I've read in your posts and seen in your data, I think you are underestimating the affect the insomnia is causing on your life and you are hoping that fixing the UARS will fix everything. But if your daytime symptoms are caused by UARS/OSA plus the effects of insomnia plus a potential depression and/or anxiety problem, then CPAP isn't going to fix everything all by itself.

And since you've stated things deteriorated rapidly last September, that points to other causes for your symptoms that should be investigated, in addition to getting some professional help for the sleep problems. Sleep disordered breathing usually does not suddenly deteriorate into a life-crushing daytime fatigue; it creeps up on people over several years or decades---and over time you finally start to realize that its been years since you felt rested or refreshed on waking and you realize that you can't dismiss that feeling as you are just getting older any more.

As ozij states:

You wait from September to December to address your fatigue until you literally can no longer work, and now in February you still haven't done anything in the way of a medical checkup. Nor have you done much about improving your CPAP therapy.

And you don't even sound worried about that sudden fatigue that seems to have come out of nowhere.
Something happened is September. Physical, or emotional, and you need professional help in figuring out what happened to cause this sudden fatigue and detrioration.

And I concur: You need to get professional help in figuring out what's going on to create this sudden fatigue and its rapid deterioration.

Sleep doctors says that they checked for RERAs and I don't have any and therefore no UARS

It would help us help you if you would post images of the actual written report from your sleep test. Correctly measuring RERAs is still a bit controversial in the world of sleep medicine and not all labs even attempt to measure them.

What I have though is 104 micro awakenings TST and 27 obstructive hypopnea during REM, that's more or less 24 awakenings par hour
Sleep stages is a roller coaster and sleep efficiency is scored at 49.9% and AHI 5.6

We need the actual data from the report. In other words, the numbers you quote are somewhat meaningless without knowing such things as:

Total time in bed (TIB)
Total sleep time (TST)
Total time in REM
Total wake after sleep onset (WASO)
Latency to sleep onset
Latency to first REM period
Total number of each kind of respiratory event
Total number of each kind of respiratory event in REM
Total number of PLMs
Total number of PLM arousals
Total number of respiratory arousals
Total number of spontaneous arousals

I can say that a sleep efficiency of 49.9% indicates that insomnia is a pretty significant problem. But even there, we don't know if the insomnia problem is mainly a "get to sleep problem" with an extremely long latency to sleep onset or if it's mainly a "can't stay asleep problem" with a significant WASO or a problem that involves both a long latency to sleep onset and significant WASO.

And are the 104 micro awakenings broken down into types? How many are respiratory related? How many are related to PLMs? How many are listed as "spontaneous"?

If all 27 obstructive hypopneas occurred during REM, the REM AHI would be particularly important, and it would probably be significantly higher than the overall AHI for the night.

And if the overall AHI for the night was 5.6 and the only respiratory events were the 27 obstructive hypopneas recorded during REM, that would mean that you must have gotten about 4.8 hours of sleep during the sleep test.

It would also be useful to see the hypnogram in order for us to really understand what you mean when you say "Sleep stages is a roller coaster"

All this might be nothing to write home about for doctors but my list of symptoms says otherwise.

All this could point to insomnia being a significant contributor to your list of symptoms, even without adding in the possibility of some significant contribution of REM-based OSA. And then the question becomes: What's causing the insomnia? And how do you and your doctors address the problem?

I don't know how much more I can push and try to advocate for myself considering that doctors don't believe it's UARS and that there are no facilities in Belgium to do a test with Pes (as far as I know)

First of all, you might not get as much meaningful data from a sleep test with Pes as you think: Pes monitoring is even less comfortable than all the usual stuff you deal with during an in-lab NPSG study. And clearly you had problems sleeping in the lab.

I think you need to raise the issue of REM-based OSA with your sleep doctor(s): How much REM did you get during the sleep study? And did all of the hypopneas occur during the REM periods? If so, the REM-based AHI may be the figure that needs to be looked at rather than your overall AHI.

- Basically I am trying to figure out from the Oscar graph if I can see evidence of flow limitation
Would you be kind enough to look at this graph and tell me if you can see clear evidence of recurring flow limitation
I mean if I have 104 micro awakenings and if they are all RERAs I should see them in the Oscar graph, right?
https://sleephq.com/public/8bd32265-46a ... 405f33bb6c

1) Yes, there are plenty of periods in this data that include flow limitations in your breathing. But it may not be as significant as you think it is. And some of the periods flagged as flow limited breathing may be sleep-wake-junk breathing where the real problems is insomnia rather than sleep disordered breathing.

2) You can't tell immediately from the CPAP data whether any of this flow limited breathing may have resulted in RERAs. If you scroll through all the data very carefully looking for recovery breaths at the end of each series of flow limited breaths you might be able to get a rough estimate of how many RERAs may have occurred during this night. I don't have the time, nor energy to do that. But at the end of this post I provide some examples from this data that illustrate what you need to be looking for as you scroll through the whole 7 hours of data while looking at the breaths in 5 minute long sections.

3) Given what you have said about your sleep study report, there's no real reason to believe that all of the 104 micro awakenings on your sleep study were RERAs. Some, possibly most of them, could have been plain old spontaneous arousals, which could indicate more of a problem with sleep maintenance insomnia than sleep disordered breathing. Some of them could be related to periodic limb movements, an in that case, we need to know how many PLMs you had and how many of those PLMs were associated with an arousal. Because untreated PLMD can also play havoc with the quality of sleep. And there is evidence of non-respiratory arousals in your CPAP data.

4) Given what you've said in your sleep study report about both the total number of micro arousals and the overall sleep efficiency of 49.9%, there ought to be significant periods of so-called sleep-wake-junk (SWJ) breathing mixed into your CPAP flow data: SWJ breathing is breathing that just doesn't look like sustained sleep breathing: It's breathing that has characteristics of wake breathing (larger breaths than sleep breathing that are more ragged over all) combined with very short stretches of breaths that might be sleep breathing, but they don't last long enough to make it clear that you actually got all the way to a real, light (stage 2) sleep. In other words, the overall breathing appears to either be wake breathing or breathing that's bouncing back and forth between wake breathing and possibly stage 1 sleep (transition to real sleep) breathing.

- I am also bewildered that the APAP hasn't flagged any obstructive hypopnea since they are clearly present in my PSG would that mean that a pressure of 4 as ironed out those obstructive Hypopneas?

Yes, the most likely explanation is that 4cm is enough pressure to turn your OAs and hypopneas into flow limitations. The fact that worst of your flow limitations occur in three clusters that are about 90-120 minutes apart does raise the question: Are the worst of your flow limitations related to REM periods? There are also places in your CPAP data that look like "near misses"---i.e. things that are close to hypopneas but were not scored as hypopneas either because they didn't last a full 10 seconds or the decrease in flow rate was not quite steep or sudden enough to meet the machine's criteria for scoring a hypopnea.


Final comments:

In starting the tedious process of going through your flow rate data at a sufficient zoomed in level to see evidence of probable arousals based on the breathing pattern, it's possible to find examples of non-respiratory related arousals as well as examples of respiratory related arousals.

Here's a very good example of something that I believe is an arousal (and probably an actual wake) that does not appear to be respiratory related since the breathing preceding the arousal is decent sleep breathing with no noticeable flow limitations:



The arousal occurs at 12:22:50, and it looks like you get back to sleep by 12:23:30.



Here's a possible RERA, but this is actually pretty ambiguous in terms of whether there are recovery breaths indicating a RERA has likely occurred:



Here the flow limited breathing is pretty obvious even if you don't bother to look at the flow limitation graph. The breaths between 1:17:20 and 1:17:40 are "bigger" than the running baseline for the breathing before this snippet, they immediately follow the flow limited breathing, and they are a bit larger than the more normal looking sleep breathing that follows them. Hence they might be recovery breaths and a RERA may have occurred.



Finally, I want to show two images that together show a stretch of what is most likely SWJ with some flow limited stuff thrown in. This stretch occurs just before you wake up enough to turn the machine off and back on.





Whether the wake was triggered by real flow limited breathing or whether the flow limited breathing is just part of the "junk" breathing caused by drifting in and out of stage 1 sleep before you finally wake up enough to turn the machine off is above my pay grade. But clearly you were quite restless for several minutes before you turned the machine off, and it is reasonable to assume that you were not truly asleep this whole time.

Because your NPSG identified a real problem with sleep efficiency, it might be worth getting a FitBit or similar device that attempts to measure your sleep cycles based on pulse rate and related data. While these things are nowhere near 100% accurate, they do a decent enough job of measuring the time it takes for you to fall asleep and WASO---the times you are awake during the middle of the night. If you have a long latency to sleep on most nights and/or a lot of WASO, particularly when using a CPAP, then you know you've got an insomnia problem.

[Seb-Sanfilippo]

Wow, thanks a lot for the in depth reply.
Really appreciate giving me the tips for understanding my Oscar data better.

I didn't post the PSG initially because it's in French, but maybe the graphs are standard enough for you to make sense of it. Or maybe you do speak French
https://imgur.com/a/lNenhF9

[robysue1]

Wow, thanks a lot for the in depth reply.
Really appreciate giving me the tips for understanding my Oscar data better.

I didn't post the PSG initially because it's in French, but maybe the graphs are standard enough for you to make sense of it. Or maybe you do speak French
https://imgur.com/a/lNenhF9

Thanks for posting the sleep study data.

As for it being in French: Most of the abbreviations are pretty standard, and my (very old) high school French is enough to make out most of what's not in abbreviations and there's always Google Translate if something is really puzzling to me.

My initial impressions are:

You have a very long latency to sleep---as in 172.5 minutes, or almost 3 hours. Was that because the lab forced lights out at 21:00 when you never go to bed that early? Or do you often go to bed that early?

You also have a significant amount of WASO (Wake after sleep onset): The total WASO time is 118 minutes, or almost 2 hours. Also notable is the fact that you have one very long WASO episode from what looks to be about 4:20 to 5:30. Again, the relevant question is whether this is a lab effect or whether you often wake up in the middle of the night and take an hour or more to get back to sleep. And then there's another 25 minutes of wake at the very end of the test---i.e. your final wake happens at 6:17, but lights on (i.e. the end of the test) doesn't happen until 6:57.

It would help us if we knew what your normal sleep schedule looks like: When do you normally go to bed? When do you normally wake up? How long do you think it takes you to fall asleep on a typical night? And do you often wake up for extended periods of time during the night? Answers to all of those questions will help us help you understand how much of the overall bad sleep architecture is due to lab effect and how much is likely real insomnia.

You do have a number of periodic limb movements (PLM) recorded. They seem to all be related to your left leg, but none of them seem to be associated with arousals. In the US, those PLMs would likely be ignored specifically because they don't seem to be related to arousals.

I do have one question about the abbreviations: On the event graph, there's something labeled as Saup. Is that an SaO2 desat event like I assume? If so, a good question is why are there so many of them during the long WAKE period that occurs between 4:20 and 5:30?

Another possible translation-related question: What does the Phono graph measure? Is this a visual representation of the loudness of the noises you were making or is it something else? And again, why is one of the most active periods in the Phone graph during the long middle of the night WAKE period?

My reading of your sleep study is that all of 104 of the micro-wakes (i.e. arousals) were considered "spontaneous"---i.e. they were not tied to respiratory events and they were not tied to limb movements. Could some of them be RERAs? I don't know. But it's also possible that none of them are RERAs and that they are all spontaneous. But that raises the question of what is causing them and what you might do about them. And I don't have the answers to that since I'm just a math professor, not a sleep medicine professional.

Finally, the percentage of REM (25.6% of TST) is normal, but the fact that it's all in one REM cycle is a bit unusual. Still, that could just be a lab effect: Try as we might, sleeping in a lab with all those wires attached and knowing that someone is watching us sleep usually messes with our sleep and sometimes teasing apart lab effect from real problems is something that has to be done.

I do think it's significant that all of your hypopneas occurred during REM. And I do think it is significant that your REM AHI = 21.7. In REM your OSA is definitely well into the moderate range (here in the US) even though your overall AHI barely makes the definition of OSA (here in the US).

Back earlier in this thread you wrote:

Just got the results of my psg from the doctor. She says there’s nothing to explain my extreme fatigue. She said there were a few hypotonias and some sleep fragmentation but according to her nothing that would cause such debilitating symptoms.

You need to ask that sleep doc why she seems to think that a REM AHI = 21.7 is not significant.

[Seb-Sanfilippo]

Merci robysue1

You have a very long latency to sleep---as in 172.5 minutes, or almost 3 hours.

Actually it was a home sleep study. I don't explain the long latency as I remember not having major problem falling asleep that night

Also notable is the fact that you have one very long WASO episode from what looks to be about 4:20 to 5:30.

I remember being awake at some point, don't remember being that long though

It would help us if we knew what your normal sleep schedule looks like

Before the fatigue problem started I used to go to bed at 1ish am and up at 9ish am,
I used to fall asleep pretty quickly and I hardly ever woke up in the middle of the night.
Although, it's difficult to put a time line to it but I did have increasingly more WASO events accompanied with headache and dry throat in the last year.
Lately it's a bit of a mess and it's changing a lot because my nights are really messed up.
I'd say in the last 7 days I went to bed around 12:30 but I often have to get up after 30 minutes because I am not falling asleep.
I'll watch a bit tv for 30/40 minutes and usually I'll be asleep by 2:00.
I take Trazodone to help me feeling drowsy before bed.
I'll experience multiple WASO throughout the night, ranging from 1 to 5 or 6. I had a couple of nights with WASO every hour or so.
Waking is really unpredictable, could be 4:30 but then I can usually fall back asleep after a while, if I wake up after 5 I end up getting up because I cannot get back to sleep. If I am really lucky I'll get 8 hours sleep but it's been getting harder in the last few days.

I do have one question about the abbreviations: On the event graph, there's something labeled as Saup. Is that an SaO2 desat event like I assume? If so, a good question is why are there so many of them during the long WAKE period that occurs between 4:20 and 5:30?

Sorry, I can't find what this acronym stands for.

Another possible translation-related question: What does the Phono graph measure? Is this a visual representation of the loudness of the noises you were making or is it something else? And again, why is one of the most active periods in the Phone graph during the long middle of the night WAKE period?

Yes, I think that's the sound recording. I assume I move a lot when I am awake

But it's also possible that none of them are RERAs and that they are all spontaneous. But that raises the question of what is causing them and what you might do about them.

I guess that's a good question for my next appointment

Finally, the percentage of REM (25.6% of TST) is normal, but the fact that it's all in one REM cycle is a bit unusual.

Don't know how reliable it is but I use the sleep tracker on my watch and it usually shows 2 or 3 REM periods

your OSA is definitely well into the moderate range (here in the US) even though your overall AHI barely makes the definition of OSA (here in the US).

Yes, the doc's report says mild to moderate

You need to ask that sleep doc why she seems to think that a REM AHI = 21.7 is not significant.

There were no intention from the doc to do follow ups, I was pretty much dismissed and marched out. I am seeing 'top notch' sleep ENT and sleep psychiatrist next.

Again, thanks for your time

Edit: you mention leg movement, to me it looks like the right leg. I didn't notice that in the graph. But now that you're mentioning it, It makes me think that it could be because of ostheo arthritis I have in the right hip. You say they are not connected to arousals so that excludes pain related arousals I guess

[Miss Emerita]

I'm glad you'll be getting help from a sleep ENT and a sleep psychiatrist. But, like ozij, I really hope you'll explain your history to them (see one of my previous posts about this) and emphasize the sudden onset last September. Please also ask them to order tests to rule out causes for your condition that are not sleep-related.

You seem somehow reluctant to pursue these ways of exploring your problems. Is there a particular reason why?