Apnea and sleep stage question

[ksilb]

Hi again and thanks to all who have taken the time and interest to read and/or reply to my first post last week. It really helped me to be able to monitor a bit when you told me how to get to the data available on my machine.

I have been thinking about sleep stages and apnea and have a question. I thought the goal was as much deep sleep as possible especially REM which at my study I think I got none (report on the way, should have it this week but glanced that when the DME was here setting up my machine). If it takes 60-90 minutes to reach that deep a sleep level but you are having even 1 apnea event per hour, how would you ever reach the deeper level of sleep if that event takes you back to a lighter sleep level? Is it just that the apnea event backs you up a little but not all the way to stage 1? I'm really just curious about this more than anything but I know those of you out there who are so knowledgeable about sleep might be able to answer to satisfy my curiosity.

I am happy to report that I continue to feel very good and very rested. I've slept over 9 hours each of the past weekend nights. Obviously catching up on some mighty sleep debt. And I had a great dream last night that I even remembered when I woke. I'm now one great big one week into therapy as of tonight. My AHI which was trending upward and making me nervous has come back down to very good numbers on a whole and my leaks seem pretty minor despite using a nasal mask and being a side sleeper. The whole subject of masks is pretty complicated with so many different kinds. I wanted the nasal pillows but with my high pressure settings (12-18 and seeing that I'm averaging between 16-17) they weren't recommended which made sense to me. Has anyone used them with pressure settings this high? I do have the humidifier going at 2.5. Anything over that seems to make my face sweat.

That's enough about me. I wish you all a very good night's sleep and any answers or comments that come forth, thanks in advance!!!

[JohnBFisher]

... I have been thinking about sleep stages and apnea and have a question. I thought the goal was as much deep sleep as possible especially REM which at my study I think I got none (report on the way, should have it this week but glanced that when the DME was here setting up my machine). If it takes 60-90 minutes to reach that deep a sleep level but you are having even 1 apnea event per hour, how would you ever reach the deeper level of sleep if that event takes you back to a lighter sleep level? Is it just that the apnea event backs you up a little but not all the way to stage 1? I'm really just curious about this more than anything but I know those of you out there who are so knowledgeable about sleep might be able to answer to satisfy my curiosity. ...

Not every apnea brings you to stage 1. In fact, not every apnea results in an arousal. Or more correctly, an AHI of 1 may not be an issue, if most of that is due to hypopneas, which often do not cause arousals. An apnea often (but not always) causes an arousal. Depends on how long it lasts and if you need be just awake enough to clear it.

If you check your letter of medical necessity (your prescription) you will probably find some legalize that the therapy is REQUIRED and not optional! Why? Because lack of deep sleep (and REM sleep) can be VERY dangerous. Prior to diagnosis, I was to REM sleep deprived that I started to dream when I blinked. In the middle of meetings. While driving. Yikes!

... I wanted the nasal pillows but with my high pressure settings (12-18 and seeing that I'm averaging between 16-17) they weren't recommended which made sense to me. Has anyone used them with pressure settings this high? I do have the humidifier going at 2.5. Anything over that seems to make my face sweat. ...

Depends more on the headgear than it does nasal pillows. If the nasal pillows fit well, you can probably use them at higher pressure without problems. I have. But the headgear must hold the nasal pillows in place.

Hope that helps.

[ksilb]

Hi John,

Yikes indeed! Well I was falling asleep in front of my computer daily. AND snoring. So wrong on so many levels. Thanks for your reply. I appreciate your taking the time and interest in helping me understand this new world of sleep. Used to come so easy years ago, didn't it?...LOL. Kathy

[Mount Snorius]

I am afraid that my question may seem silly, but this thread makes me wonder about something that I have been experiencing. Why is it that on nights when I have fallen asleep without the mask on, I have had some intense dreams. But, any night that I have been on cpap therapy, I don't remember any dreams that I may have had.

I wear a SleepTracker Pro watch at night. It is very rare that I achieve periods where there are 60-90 minute time periods of deep sleep. Mostly it records "arousals" averaging about every 15 to 20 minutes (maybe events would be a better word).

Just trying to understand better why? Seems like the dreams would be more intense on it than off it.

[kteague]

Mount Snorious - I had plenty of dreams before cpap, many of them very unpleasant, and I believe due to the apnea. My experience was similar to John's with dreams happening at the blink of the eye. I don't know if those who have been sleep deprived for a long time can expect anything to be textbook, at least until their treatment gets them normalized. There's always a chance you are sleeping all the way thru your REM sleep (a good thing), and I've read dreams are best remembered when wakened while still in REM. Not remembering dreams is not necessarily proof there have been none.

ksilb - When you get a chance to review your study report, notice that the number of events that caused arousal is likely a small percentage of the total number of events. Many we sleep right thru. So if, on cpap, you had say 8 apneas in a night, seems a good chance few or none of them caused arousal.

About getting a machine thru Medicaid - I thought providers weren't allowed to charge the patient above the amount Medicaid pays. Does anyone know if I'm wrong about that? And I'm wondering if the person who suggested you get a script for a bilevel, wouldn't hurt to call and speak to another person and see if you are told the same thing. Be careful about accepting an expensive machine you don't really need then finding it gets denied coverage due to lack of documentation of failure on cpap or conditions more likely to necessitate a bilevel. Have them put it thru for prior authorization, and find if there's any possibility of still hitting a snag. Some contracts include a clause making you responsible for payment if the other source falls thru. Let us know how this turns out.
Another Kathy