How to begin evaluating sleep?

[AHI15]

Hi,

Since starting CPAP I've upped my sleep hygiene a little bit, mainly by turning the clock away. The impossible thing still is getting up at the same time every day. But I do that for several day bursts, and when I deviate I get back on track within 1-2 days.

I seem to be having worse misperceptions now than before of sleep latency, how long I am sleeping, and how many wakes per night. This is partly due to the invisible clock. I feel like I wake up and change position (turn to/fro from R side to L side) more than 3-4 times a night.

Since I believe my degree of restoration is most dependent on number of wakes, I want to get a better handle on this.

So I get the data from my machine and look at it in Sleepyhead. The most interesting info is the breathing waveforms, from which I try to confirm or refute my perceptions about when I was actually sleeping. Sometimes it is clear that I had been sleeping when I thought I wasn't. Though that might still be as good as not sleeping if it was light sleep followed by an insomnia, which seems to occur on days in which I took certain meds, or these days if I get restless muscles when I wake at 1am.

I think the following are the most valuable pieces of info that want to know each night:

1. how many wakes
2. initial sleep latency and successive latencies

What's the best way to get these accurate? Video monitoring?

The breathing waveform? Are there any detailed tutorials on how to interpret the breathing waveform?

I've considered to use a counter and press its button every time I change position, but I don't like this since any extra intentional action increases the likeihood of not getting back to sleep immediately.

Later I'd like to know if I've had deep sleep and REM. I'm considering a Zeo, but I'm still skeptical about accuracy. I'm also not sure I want another thing on my head.

Thanks for comments.

[Jay Aitchsee]

Check the links in my signature block for some ideas. Also, see Maxdarkside's and BDG's posts for more sophisticated position tracking.

Jay

[Todzo]

Hi,

Since starting CPAP I've upped my sleep hygiene a little bit, mainly by turning the clock away. The impossible thing still is getting up at the same time every day. But I do that for several day bursts, and when I deviate I get back on track within 1-2 days.

I seem to be having worse misperceptions now than before of sleep latency, how long I am sleeping, and how many wakes per night. This is partly due to the invisible clock. I feel like I wake up and change position (turn to/fro from R side to L side) more than 3-4 times a night.

Since I believe my degree of restoration is most dependent on number of wakes, I want to get a better handle on this.

So I get the data from my machine and look at it in Sleepyhead. The most interesting info is the breathing waveforms, from which I try to confirm or refute my perceptions about when I was actually sleeping. Sometimes it is clear that I had been sleeping when I thought I wasn't. Though that might still be as good as not sleeping if it was light sleep followed by an insomnia, which seems to occur on days in which I took certain meds, or these days if I get restless muscles when I wake at 1am.

I think the following are the most valuable pieces of info that want to know each night:

1. how many wakes
2. initial sleep latency and successive latencies

What's the best way to get these accurate? Video monitoring?

The breathing waveform? Are there any detailed tutorials on how to interpret the breathing waveform?

I've considered to use a counter and press its button every time I change position, but I don't like this since any extra intentional action increases the likeihood of not getting back to sleep immediately.

Later I'd like to know if I've had deep sleep and REM. I'm considering a Zeo, but I'm still skeptical about accuracy. I'm also not sure I want another thing on my head.

Thanks for comments.

Hi AHI15!

They are now making in home sleep lab equipment including the EEG - but - way beyond my budget.

I used to have a Zeo (it did not make it to me through the move) and I did find it useful. I was more worried about the percent of REM and Deep Sleep. I learned by experiance that REM was a measure of how effective the CPAP treatment was going and Deep Sleep seemed most related to how much exercise I took (little exercise, little Deep Sleep). I think feedback is good.

It does seem to know the difference between awake and first stage sleep, at least it did for me. Day feel seemed to track well with what Zeo displayed.

I do not think that Zeo works well for everyone. Sort of, your results may vary. Looking at the Amazon reviews I think it works for about 75% of the people who purchase it.

If you do try the video thing, please let us know how it went.

My audio equipment also did not make it through the move and the netbook I use is down for repair (CPU Fan/Heatsink). I did find the audio recordings very useful. An actual professional microphone chosen for the task is best - but - my little "Sonic Super Ear" will probably go back into service as the microphone using Linux Sox as the recording software and Audacity (there is a Windows version of this Open Source Software) as the audio playback with graphical display software. I highly recommend the recording of your nighttime audio. You will not remember they guy with the loud motor cycle starting the beast in the morning - but - it caused and awakening nonetheless. Audio recorded during incidents on other channels (e.g. Flow Waveform) can help determine what happened as well.

I have always wanted to be able to track arousals and considered getting a WatchPAT to do so ($6K!). Looking at the research about this and remembering some things I saw using my pulse oximeter it occurs to me that perfusion (the amount of blood in the finger) would likely change in the same way as the arterial tone they measure with the WatchPAT. When we have an arousal blood tends to flow to the core for a time – like away from the finger – so the “signal” from the light getting through the finger to the receiving sensor changes. The same kind of change occurs with each heart beat – it is how they measure your pulse rate. My guess is that SleepyHead may well show these changes but I have not checked it out yet.

Have a lot of fun!!

Todzo

[robysue]

AHI,

You write:

I think the following are the most valuable pieces of info that want to know each night:

1. how many wakes
2. initial sleep latency and successive latencies

What's the best way to get these accurate? Video monitoring?

From a simple "let's treat the insomnia point of view" the accuracy of your estimates of the number of wakes and the accuracy of the latencies to sleep is less important than your perceptions of them. And the harder you work at trying to get accurate estimates, the more likely you are to remember each and every wake in enough detail for it to really be a disturbance to your overall sleep architecture.

You see the thing is: Even people without insomnia and without OSA wake up periodically during the night. It's just that these "normal" folks wake up, assess the situation and realize there's no need to be awake, turn over and go back to sleep. And in the morning they don't even remember the wakes. And that's one of the main goal in trying to treat insomnia with CBT: Get the wakes down to the point where you don't remember them.

You also write:

I seem to be having worse misperceptions now than before of sleep latency, how long I am sleeping, and how many wakes per night. This is partly due to the invisible clock. I feel like I wake up and change position (turn to/fro from R side to L side) more than 3-4 times a night.

Why do you think your "misperceptions" on sleep latency and number of wakes is worse now than when you were staring at the clock? Have the estimates of sleep latency gotten longer or shorter? Have the estimated number of wakes increased or decreased?

And you write:

Sometimes it is clear [from the SleepyHead data] that I had been sleeping when I thought I wasn't. Though that might still be as good as not sleeping if it was light sleep followed by an insomnia, which seems to occur on days in which I took certain meds, or these days if I get restless muscles when I wake at 1am.

If the meds or restless muscles are triggering real wakes that you have real problems getting back to sleep afterwards, then you need to think about whether the meds are doing more harm than good and you need to figure out what to do about the restless muscles.

But in any case: Sleep is sleep. And light (stage 2) sleep is part of healthy sleep, even though we tend to focus on DEEP (stage 3) and REM sleep here. And one problem insomniacs have is that their minds seem to be less able to distinguish between WAKE and LIGHT sleep. But that does NOT mean their bodies (and brains) don't benefit from the LIGHT sleep which they remember as WAKE time.

There's a study I read a while back where the researchers had the subjects sleep with EEGs. Several times during the night they would go in and wake the subject up and ask: Were you awake when I came in to wake you up? Sometimes the researcher would wait until the EEG indicated that the subject was clearly asleep before waking the subject up. Other times the researcher would go in and "wake" the subject up when the EEG clearly indicated the subject was awake, but still had their eyes closed. The "normal" non-insomniac subjects had a pretty high degree accuracy in correctly answering the question---Most of the time (something like 75% of the time if I recall), they both correctly identified when they were asleep when woken and they identified when they were already awake when the researcher came in to wake them. The self-described insomniacs, however, typically were WRONG about their sleep state about 65% of the time when they were woken up when the EEG said they were SLEEP. (They were more accurate when they were "woken" up when the EEG said they were already awake.)

And the study's conclusions about insomniacs' inability to tell when they are actually asleep is at the heart of another important part treating insomnia with CBT: It is extremely important to get insomniacs to understand they are most likely getting much more sleep than they think they are. And that when(if) an insomniac can genuinely accept this fact, then the subjective quality of their sleep usually improves, sometimes dramatically. In other words, one thing that insomniacs without any other sleep problems need to do is simply to learn to NOT over worry about their sleep----they need to remind themselves (often) that if they're in bed for 8 or so hours every night and they are not obviously wide awake staring at the ceiling or the clock with wide open eyes for long periods of time, then they are more than likely getting 7 hours (or more) of decent enough sleep during the night.

You also write:

Since I believe my degree of restoration is most dependent on number of wakes, I want to get a better handle on this.

The degree of restoration maybe a lot more dependent on your perception of the number of wakes rather than the actual number of wakes.

Nonetheless, there is one surefire way of tracking the number of times that you wake up enough to know that you are indeed awake at night: Turn your CPAP off and then back on.

The end of one session and the start of the next will be clearly visible in SleepyHead when you look at the data. And then you can start asking: Do you remember being awake when you obviously were awake enough to turn the machine on and then off. As the insomnia starts to resolve you may find yourself looking at a given night's data and realizing that even though you (obviously) were awake enough to turn the machine on and off, say 5 times, that you only remember 3 of them. Or that the period that you somehow think you must have been awake not only has a nice smooth "sleeping" waveform, but also absolutely no evidence of your turning the machine off and then back on.

True story: I routinely turn my machine off and on every time I'm consciously awake at night mainly because I have a psychological need to know that my pressure is at 6/4 when I'm trying to get back to sleep. Used to be in the morning I'd remember almost every single one of those short wakes. Now? I look at my SleepyHead data and I'll see as many as 4 or 5 "off/on" cycles, but I'll remember one or two of them at most. Sometimes I don't remember any of them. And as far as insomnia goes----a wake that is so short you don't remember it is a wake that is NOT a disturbance to your overall sleep architecture.

So I get the data from my machine and look at it in Sleepyhead. The most interesting info is the breathing waveforms, from which I try to confirm or refute my perceptions about when I was actually sleeping.

I think waveforms do a pretty decent job of giving you a ball park figure on sleep latency at the beginning of the night---if there's a big enough difference between your breathing when you first lay down and when you get to sleep. And maybe after something (like an off/on cycle) that you know for sure is WAKE. If you'd like me to post some of mine so you can see what I mean in my own data, let me know.

But just because you suddenly see a 30-60 second period of breathing that kind of looks like WAKE does not mean that you've genuinely woken up. It could easily be that you've aroused enough to turn over in bed or rearrange your sleeping position. Sometimes when you go into REM, the breathing pattern can look a bit like WAKE (based on what I see when I try to compare my zeo sleep stage data to the wave form and I've got reasons to believe the zeo is not vastly over scoring WAKE when I'm actually in REM). Again, if you'd like to see some of what I see in my own data, I'll be happy to share.

Later I'd like to know if I've had deep sleep and REM. I'm considering a Zeo, but I'm still skeptical about accuracy. I'm also not sure I want another thing on my head.

The Zeo is not all that accurate for me, but I still find it amusing to use and not too much additional trouble to sleep with. I do think that it does a decent job of identifying DEEP sleep most of the time. In my case, the Zeo sometimes is clearly very inaccurate at scoring WAKE vs REM, but if I look at both the Zeo data and the SleepyHead data at the same time, I can usually figure out just when the Zeo is out of its cotton-picking mind when it comes to my sleep stage.

Another thing I've noticed about my Zeo: It does NOT always identify really short wakes. There have been a number of times that I've turned Kaa off and on, but the Zeo data blithely says I'm asleep---usually in LIGHT sleep, but occasionally in REM or DEEP.

[Todzo]

Hi again AHI15!

I have never had the time to check this out but the number of EEG sensors used in a PSG is usually about 3 so perhaps...

http://openeeg.sourceforge.net/doc/

Over the years I have found the monitoring of SpO2 and pulse, nighttime audio, CPAP Data, and daytime parameters (BP, etc..) to be a very useful way to zero in on what is actually going on and use it as a way to do good lifestyle management.

Too little Deep Sleep - move more. Unstable breathing, reduce stress and demand. AHI - lay off the harsh TV and eat better. For all I mention that we do need to deal with reality, not what we would like to think is real - after all.

Have a lot of fun!

Todzo