Obstructive Apneas in the late morning ?

Justin_Case · Post by **Justin_Case** » Fri Aug 25, 2006 8:43 pm

This is odd...I have been noting when I have my apneas. The majority of my AHI is in the form of hypopneas UNTIL the late morning when I am groggy or what I feel, trying to get back to sleep (probably stage 1). For example, if I go to bed at 1AM, around 7 to 9/10AM i get virtually all my apneas in the form of OA.

During the high OA events I dont feel like I am sleeping and I typically get up after awhile, after saying "%$#! it, I am tired but I can't sleep".

Has anyone experienced what I am going through?

GoofyUT · Post by **GoofyUT** » Fri Aug 25, 2006 9:00 pm

Well, most REM sleep occurs towards the end of our "night" (sleep session), and most SDB events occur during REM.

Hope this helps.

Chuck

Justin_Case · Post by **Justin_Case** » Fri Aug 25, 2006 10:24 pm

The thing is though...I am not in REM state. I am almost fully cognitive. Probably in the "waking stage or at the border between waking and stage 1". REM stage is near the end: http://www.sleepdisorderchannel.com/stages/

Justin Case · Post by **Justin Case** » Thu Sep 07, 2006 10:53 pm

I was at my doc today, he also has OSA. He told me that he feels that my Respironics machine is being confused into thinking that I have OSA events instead of the usual hypopnea events in the early morning. Although this makes sense, but I have read that many people have tried to trick their machine but have been unsuccessful.

Just in case, he's wrong, we are going to do a sleep study. My DME has a "Remmers Sleep Recorder" and maybe we will try that, but I prefer the PSG instead.

Any thoughts?

Snoredog · Post by **Snoredog** » Fri Sep 08, 2006 12:19 am

Justin Case wrote:I was at my doc today, he also has OSA. He told me that he feels that my Respironics machine is being confused into thinking that I have OSA events instead of the usual hypopnea events in the early morning. Although this makes sense, but I have read that many people have tried to trick their machine but have been unsuccessful.

Just in case, he's wrong, we are going to do a sleep study. My DME has a "Remmers Sleep Recorder" and maybe we will try that, but I prefer the PSG instead.

Any thoughts?

"usual hypopnea events in the morning."?
"just in case, he's wrong, we are going to do a sleep study."

Sounds to me like your sleep doc is more interested in making his Mercedes Benz payment. I would also wager he has a financial interest in the sleep lab's success. Don't forget he gets like $600 for intrepreting your sleep study even if someone else does it.

But the facts are: you spend MORE time in REM in the late morning hours as already mentioned above, that is where all the SDB events such as hypopnea and apnea are more likey take place.

What is the goal of the sleep study? to find a new pressure?

Justin_Case · Post by **Justin_Case** » Fri Sep 08, 2006 1:18 pm

Actually, it's my GP, who also has OSA who said this. I asked for a referral back to my sleep doc. But, with the Remmers Sleep Recorder, there is no huge price tag since I believe my DME will be doing this at no charge. My OSA events are also high in *trying* to fall asleep, not just in the morning. So, something has changed.

I believe the goal of the sleep study or Remmers SR is to see if there are any new respiratory or sleep disturbances, central apneas, and to verify if I am truly having OSA events during thost times, thereby preventing me from falling asleep and staying asleep. APAP is trying to compensate but in doing so, is causing me to have "arousals", once again preventing me from falling or staying asleep.

CollegeGirl · Post by **CollegeGirl** » Fri Sep 08, 2006 2:14 pm

I can't believe your doc didn't think of this -

More than likely, you're having apnea events related to being in REM (as already mentioned). These events are waking you up. Your machine is not recording "events" that happen after you wake, but rather, the events that cause you to wake. If you see multiple events in a time period where you thought you were "mostly" awake, they're probably times where you just barely fell asleep, had an event, and woke again, without being aware it happened.

That would make the most sense to me. That's what happened to me at my sleep study. I was *positive* I hadn't slept at all - but my brain waves said otherwise.

Justin_Case · Post by **Justin_Case** » Fri Sep 08, 2006 3:02 pm

CollegeGirl, makes sense...that's why aI am pushing for a sleep study..actually I prefer a PSG over the Remmers which I know nothing about.

So, how did you resolve your issue?

Tonight, I will increase my minimum pressure but I have done so recently while on a trip to Vegas and there was no difference in my OSA events despite jacking up the pressure considerably (in small increments/intervals of course)

CollegeGirl · Post by **CollegeGirl** » Fri Sep 08, 2006 3:31 pm

How did I resolve it? I got CPAP, and stopped the apneas.

To me, it sounds like either your apneas are not being treated with the current pressure you have (ie, it is too low), or your pressure is too high and causing central apneas (ie, too high). I know, I just told you a heckuva lot, eh?

Hopefully a sleep study will iron things out for you.

Justin_Case · Post by **Justin_Case** » Fri Sep 08, 2006 5:05 pm

I thought about CA but supposedly (somebody correct me if i am wrong) the CPAP machine would/should not record the CA as OSA?

If I increase the pressure too much, I get swallowing of air and then I can't sleep anyways.

Sleepy Dog Lover · Post by **Sleepy Dog Lover** » Fri Sep 08, 2006 10:18 pm

When I had my sleep study that was one thing that they mentioned. My AHI was not too bad through most of the night, but towards the end of the study it was off the charts. I don't think this is unusual. I have an auto so I don't have to have the hurricane blowing for the entire night, just a tropical storm, then the hurricane.

Justin_Case · Post by **Justin_Case** » Fri Sep 08, 2006 10:27 pm

Unfortunately, in my case, the increase in OSA events is fairly new and recent. What my GP may have dismissed as me fooling the CPAP into thinking I have OSA events is probably not as I feeling worse, day by day, night by night.

Maybe something else is going on...I dunno.

Sleepy Dog Lover · Post by **Sleepy Dog Lover** » Sat Sep 09, 2006 1:17 am

You don't list your equipment, you made need a pressure increase to take care of it. My auto takes care of it, well, automatically.

Snoredog · Post by **Snoredog** » Sat Sep 09, 2006 1:33 am

Below is a chart which shows how you get more REM during the late morning hours (observe the timeline across the bottom). You will notice as the night progresses you spend more and more time in REM (assuming the machine is keeping all SDB events at bay).

Justin_Case · Post by **Justin_Case** » Sat Sep 09, 2006 2:32 pm

Thanks Snore Dog. The equipment I use is the Respironics Auto w/CFLEX w/Humidifier, Mirage Acitva Nasal Mask, and Fisher & Paykel Flexifit 405 nasal mask. I interchange depending on the comfort level. Pressures 8-13cm. 90% @10cm

This morning, I had big insomnia. I have been on prescription sleeping meds for about 6 months (Zopiclone) and Seroquel for anxiety. With my GP's consent I have stopped both drugs during the last few days. The Seroquel was making my PLMS worse or creating it. It should up as being bad in my initial sleep study without titration but not in my second one. I am now taking LYRICA for the PLMS. I also have a "touch" of asthma.

I had to turn-off my CPAP because of the noise and because I was getting "brain jolts" separate from the PLMS. I didn't notice getting them when I was getting these "brain jolts". I also have chronic back pain...perhaps the nervous system is compromised in some way. Furthermore, I am sensitive to the increase in pressures when I am not fully asleep, so I can't fall asleep when the machine is ramping up, recording my OSA's and reacting (sometimes) to them. My doc commented that I am not getting enough stage 4 but I don't think I am getting past stage 2.

In addition to the above, I suspect other breathing or REM disorders. I have to call up my DME today to recommend to my GP to send me back to my sleep doc instead of using the "Remmers Sleep Recorder".