flow rate irregularities during REM

[jcpruitt89]

hello,

Little back story first. I've had a cpap for over a year and still not really satisfied with my sleep. I've had two titration studies. first was was supposedly 7cm, second was 13 cm all on nasal masks. I quickly found out I wasn't getting results on the higher pressure. I ended up having to use tape, chin strap and a scunci band around my lips to eliminate leaks. even with tape neither made me sleep better. I often wake up a couple times a night and have trouble falling back asleep. I often throughout the day feel fatigued, have hand tremors and feel wired but tired. have a horrible time falling asleep. I feel like I drank a pot of coffee even though I didn't drink any caffeine. My ahi usually falls between 1-3. One of my doctors says it could be my adrenals are burnt out from going awhile without cpap? I've noticed looking at my flow chart I have a nice smooth flow rate during my deep sleep. light sleep can be on occasion a bit rough but I suppose it's just SWJ. But.. during rem sleep I get these rough flows, often with falling and rising rates. I feel like this interupts my rem sleep. The top of the curves look like I'm getting flow limitations. I'm confused as I've changed my pressures up to 15cm and I feel like that's a pretty high pressure. past this pressure I feel like I get a lot of nasal congestion and aerophagia. does this look too much pressure? how am i still getting these dips on flow curves? Is this enough to cause my stress responses? sorry i know this post is all over the place.. but its kind of a train wreck.

[Julie]

Why is your min. pressure so high? Oh, and you can omit the calendar.

[jcpruitt89]

My sleep titration test put me at 13cm for my minimum. But I keep getting flow limited breathing and other events so I went up on my pressure myself. I can't get below a 1 on my ahi ever and I'm still tired every day

[Morbius]

I've noticed looking at my flow chart I have a nice smooth flow rate during my deep sleep. light sleep can be on occasion a bit rough but I suppose it's just SWJ. But.. during rem sleep I get these rough flows, often with falling and rising rates.

How did you determine that to be deep, light and REM sleep?

SWJ

Interesting acronym. Where'd you learn that from?

[Morbius]

I often wake up a couple times a night and have trouble falling back asleep. ... have hand tremors and feel wired but tired. have a horrible time falling asleep. I feel like I drank a pot of coffee even though I didn't drink any caffeine.

One of my doctors says it could be my adrenals are burnt out from going awhile without cpap?

You can't simultaneously have adrenal fatigue (assuming there really is such a thing) and be wired to the gills.

[jcpruitt89]

I use a Fitbit to monitor my sleep stages and I also look at respiratory rate graph. I know it's not 100% but should be close.

I learned the acronym "SWJ" from on here. Sleep wake junk.

Maybe not burnt out but I recall adrenal dysfunction being used to describe my situation. Is it possible to feel like I'm all wired up with sleep like this?

[Dog Slobber]

SWJ

Interesting acronym. Where'd you learn that from?

I learned the acronym "SWJ" from on here. Sleep wake junk.

around here, it's referred to as "swj" or "sleep/wake junk" a term reportedly coined by our very own morbius, to describe the irregularities in the breathing pattern as you go from awake breathing to asleep breathing, and it's common to have weirdness as things settle down, or you're waking up.

SWJ is Sleep Wake Junk (a term I invented), used to describe single channel data that appears to contaminated by Wake, Movement, Earthquake, etc.

[jcpruitt89]

Can anyone tell me on here where flow limitations would be occurring if it is resistant to pressure changes. Ultimately I think the root problem for me is the inspiratory flow limitations that are not responding. I feel like it could likely be a nasal issue. I was told by a ENT that I have a slightly deviated septum but it didn't look to be horrible. The pulmonologist I keep seeing do not want to investigate as long as the ahi is under five which to me is archaic thinking. Would a sleep endoscopy reveal my issues or is there something else that can determine my calls of flow limitations?

[Miss Emerita]

Do you experience nasal congestion, e.g., from allergies? If so, that could be responsible for the FLs. As Pugsy explained recently in another thread, pressure settings are unlikely to address FLs arising in that way. You'd do better to try Flonase and nasal rinses. If you don't have congestion, you might try introducing some flex to see whether that helps with the FLs. (And even if you do have congestion, using some flex might be worth an experiment.) You could try a setting of 2 and see how it goes.

[jcpruitt89]

Do you experience nasal congestion, e.g., from allergies? If so, that could be responsible for the FLs. As Pugsy explained recently in another thread, pressure settings are unlikely to address FLs arising in that way. You'd do better to try Flonase and nasal rinses. If you don't have congestion, you might try introducing some flex to see whether that helps with the FLs. (And even if you do have congestion, using some flex might be worth an experiment.) You could try a setting of 2 and see how it goes.

How does flex help with FL? I've tried c-flex before and I didn't like it. Felt like it caused my breathing to feel out of sync. I also experienced more centrals with it. I'm not really congested, however I don't believe I breath great through my nose. I use a pulse oximeter at night and even when I'm winding down before I even fall asleep I notice my oxygen staying around 94-95%. I feel like it should be higher when still awake. I also use Flonase as a prophylactic to ensure I don't get congested.

[jcpruitt89]

Bump

[Dog Slobber]

Your O2 levels are within the normal range,well above what's considered low.

Your device appears to be treating your apnea very well. Perhaps increasing your pressure, *might* optimise it a bit more. You had 3 flagged Flow Limitations and given the last one occured at the end of the session it's probably not real.

You're not allowing your device to increase pressure should it need to. Why?

Increase your maximum pressure, but I don't think whatever problems your having will be fixed by changing your CPAP settings.

[Jlfinkels]

Be careful relying too much on a fitness watch for accuracy in sleep state. They are all using algorithms developed in-house that may or may not be accurate. A good site for information on accuracy is a YouTube channel by a PhD student who analyzes these devices for accuracy "The Quantified Scientist" @ https://www.youtube.com/channel/UChNWxr ... Sevon1X93g

[Morbius]

... during rem sleep I get these rough flows, often with falling and rising rates. I feel like this interupts my rem sleep.

There are 2 types of REM-- tonic and phasic. In phasic REM there is usually significant respiratory variability, so what you are seeing (assuming your Fatbit is correct) could conceivably be absolutely normal.

[Morbius]

The top of the curves look like I'm getting flow limitations.

So how many? Your software says you got 2. Isolated single FLs, if they do not disturb sleep continuity (i.e., generate an arousal)(and you sorta hafta guess if all you got is a flow waveform) are totally benign. IMO you're trying to fix something that doesn't need fixing.