Sleep with Itamar Watchpat 200 tonight

[papzombie]

So a sleep doctor has lended me his Itamar WatchPat 200 to measure my arousal and snore tonight, after hearing that I am still tired regardless of a low AHI.
He has asked me if I have restless leg, to which I say I don't know
- During day time, I don't see to feel the high urge to move my legs
- During sleep time, I don't know if my leg moving wakes me up
- But in the first 15-30 minutes of falling asleep, sometimes my moving leg wakes me up: this is when I dream that I step on something that is falling

I asked this sleep doctor why this machine is superior than reading from my "Philips respironics system one remstar pro with C-Flex+" to Sleepy Head, he said that my CPAP machine cannot detect effectively any RERA or Vibratory Snore.

I am excited to hear what you think about this Itamar WatchPat 200.

[robysue]

I am excited to hear what you think about this Itamar WatchPat 200.

The Itamar WatchPat 200 is quite reliable in terms of measuring overall movement and restlessness during the night. If you are having a large number of arousals/wakes that you do not remember, the WatchPat should be able to catch them.

I asked this sleep doctor why this machine is superior than reading from my "Philips respironics system one remstar pro with C-Flex+" to Sleepy Head, he said that my CPAP machine cannot detect effectively any RERA or Vibratory Snore.

Your CPAP can only infer a possible RERA or snoring from the shape of the wave flow data. It's better than nothing, but it's not as good as the WatchPAT that can detect the subtle, but significant changes in the cardiovascular system that accompany apneas, hypopneas, RERAs, arousals, awakenings, and snoring during the night.

You can learn more about how the WatchPat works at Itmar's web site: http://www.itamar-medical.com/pat-technology-watchpat/

[avi123]

Watch-Pat 200 on you tube:

https://www.youtube.com/watch?v=HglO75tDlQs

[papzombie]

Hi Robysue,

Yeah, now I know that RERA are only inferred from the airway pressure that the CPAP machine can measure, and that is much less accurate than the finger and chest sensors used by the WatchPad together with the Peripheral Arterial Tone algorithm.

[papzombie]

So I wake up on average 2-3 times per hour, mostly from deep sleep, each time at least 1 minute
(A health person should wake up 1-2 times per night, and 15 seconds each time on average).

My doctor is unsure if that is caused by any body movement / muscle contraction (so the WatchPAT-200 is unable to detect if I have any PLMD/RLS/myoclonus).

My doctor thinks instead more about the psychophysiological insomnia, and suggests me to visit a psychologist specializing in sleep training / coaching, and this is more than just sleep hygiene.

[robysue]

So I wake up on average 2-3 times per hour, mostly from deep sleep, each time at least 1 minute
(A health person should wake up 1-2 times per night, and 15 seconds each time on average).

My doctor is unsure if that is caused by any body movement / muscle contraction (so the WatchPAT-200 is unable to detect if I have any PLMD/RLS/myoclonus).

My doctor thinks instead more about the psychophysiological insomnia, and suggests me to visit a psychologist specializing in sleep training / coaching, and this is more than just sleep hygiene.

Yes, sleep training/coaching can indeed be much more than just sleep hygiene.

Did your doc recommend a particular psychologist specializing in sleep training/coaching? Or are you on your own for trying to find someone to direct the sleep coaching?

Please keep us informed about what your sleep training/coaching winds up involving. I would really like to know some of the details since it has been documented on several tests, including both PSGs and an Actigraph test that I have frequent wakes during the night that are not attributable to anything in particular (i.e. spontaneous wakes).

[papzombie]

Robysue: I need to find such a psychologist myself. Quite a challenge.

The thing is I would need to know what sleep training is about, in order to find the correct person. Googling does not help me understanding more about "Sleeping training for psychophysiological insomnia".

Anyone suggest anything ?

[robysue]

Robysue: I need to find such a psychologist myself. Quite a challenge.

The thing is I would need to know what sleep training is about, in order to find the correct person. Googling does not help me understanding more about "Sleeping training for psychophysiological insomnia".

Anyone suggest anything ?

You should asked the doc's office for help. Yes, they may just say, "Find someone" but the doc probably has an idea of what kinds of things he thinks might help you, and if you understood what he's thinking it would help you find the right psychologist to help you.

My best guess is that "Sleeping training for psychophysiological insomnia" means cognitive behavior therapy for insomina or CBT-I. So it may be worth googling that phrase instead of "sleep training".

Sleep hygiene is always a component of CBT-I. But CBT-I goes beyond sleep hygiene. The other components of CBT-I are dependent on the particular person and the particular problem that needs to be solved. As an example, when I was dealing with a major insomnia episode back in 2010-2011 that was triggered by my starting CPAP, a major component of my CBT-I was a sleep restricted schedule so that my body had to learn how to both get to sleep faster at the beginning of the night and get back to sleep faster during middle-of-the-night wakes and how to just not wake up so frequently to begin with. A sleep restricted schedule is not appropriate for all chronic insomnia problems, but it was appropriate for my particular problem. You can get a better idea of what my CBT-I involved by reading the link on Taming the CPAP-Induced Insomnia Monster in my signature.

As I recall, you are not in the US. Is that correct? I can't tell you how you would go about finding a psychologist anywhere except for the US. But when you are contacting psychologists to find out if they might be a good match, you do need to tell them that you are looking for someone who has some experience with using CBT-I to treat insomnia patients.

[papzombie]

Robysue:

- I will ask my doctor about CBT-I
- I have read your note about CPAP induced insomnia, quite an eye-opener. You are good at writing.

For me specifically, I am looking to understand if what I have is really insomnia, because
- My waiting time before sleeping is very small: less than 5 minutes
- While I wake up several times per day, I could easily fall back to sleep.

So I might think more about investigating what wakes me up 2-3 times per hour at night, than dealing with insomnia directly.
Thanks

[robysue]

Robysue:

- I will ask my doctor about CBT-I
- I have read your note about CPAP induced insomnia, quite an eye-opener. You are good at writing.

For me specifically, I am looking to understand if what I have is really insomnia, because
- My waiting time before sleeping is very small: less than 5 minutes
- While I wake up several times per day, I could easily fall back to sleep.

There are three basic descriptors for insomnia:

• Sleep onset insomnia or bedtime insomnia. This is when you can't get to sleep at the beginning of the night for an excessively long time.
• Sleep maintenance insomnia. This is when you wake up too many times during the night. Some people with sleep maintenance insomnia have problems with getting back to sleep when they wake up in the middle of the night; some people simply wake up too many times during the night, and the wakes can't be tied to apneas or PLMD problems.
• Wake to early insomnia. This is when you wake up 1-2 hours earlier than your desired wake up time and then you cannot get back to sleep.

It is also quite possible for a particular person's insomnia to involve more than one of these three basic types of insomnia.

It sounds to me like your WatchPAT results show that you have a potential problem with sleep maintenance insomnia: The data shows that you are waking up multiple times each hour and the doctor is assuming those wakes are most likely spontaneous wakes rather than related to something else. The frequency of the wakes indicates that you are not getting full sleep cycles between the wakes. (Sleep cycles typically run about 90-100 minutes long). And because you are still tired in the daytime, it is reasonable at this point to assume that the continuing daytime symptoms are related to the frequent wakes even though you don't have problems getting back to sleep.

So I might think more about investigating what wakes me up 2-3 times per hour at night, than dealing with insomnia directly.
Thanks

There's this thing called a spontaneous awakening which means an awakening that has no obvious cause: You just wake up. Since the doc is recommending what sounds like CBT-I, it seems reasonable to assume that the doc thinks your wakes have a high chance of being spontaneous awakenings.

Questions: Do you remember any of the wakes in the morning? And were you surprised that the WatchPAT data indicates that you are waking up 2-3 times per hour?

Now I'm not saying that it's not worth digging into whether there is a cause for the wakes that can be dealt with. On the other thread it sounds as if you are not yet willing to say that PLMD has been eliminated as a potential cause for your wakes. Kteague is the forum expert on PLMD and I believe she has given you some advice on how you might gather some data to try to determine whether you are dealing with PLMD. And it's worth pursuing that idea.

[papzombie]

Hi Robysue,

In the last PSG done by the WatchPAT-200, I woke up about 14 times during the 6 hours sleep, mostly from deep phases. And I remembered about 2-4 times of them.

Thanks to your mentioning about spontaneous awakening, I found this spontaneous arousals and what Dr. Park has written about all kinds of possible causes for those arousals is very plausible as well. http://doctorstevenpark.com/spontaneous ... leep-apnea

By the way: when my data is not able to detect flow limitations, should I request the insurance to change to some machine capable of detecting them ?

About PLMD: I will set up a camera at night to film my body movements. Thanks

[papzombie]

One more question: can the WatchPAT detect UARS ? I could not google for it. Thanks (my doctor says it is very sensitive thus can detect UARS)

[Pugsy]

UARS is a difficult thing to diagnose and in a lot of cases it's more of a "rule out" diagnosis...rule out all the other potentials and what's left might be UARS.
I don't see how a WatchPat can come close to accurately sensing real UARS. From my understanding the real for sure criteria is a PES device along with an inlab sleep study.

https://en.wikipedia.org/wiki/Upper_air ... e_syndrome

Polysomnography (sleep study) with the use of a probe to measure Pes (esophageal pressure) is the gold standard diagnostic test for UARS.[1][2][3] Apneas and hypopneas are absent or present in low numbers. Multiple snore arousals may be seen, and if an esophageal probe (Pes) is used, progressive elevation of esophageal pressure fluctuations terminating in arousals is noted. UARS can also be diagnosed using a nasal cannula/pressure transducer to measure the inspiratory airflow v. time signal.

[robysue]

Thanks to your mentioning about spontaneous awakening, I found this spontaneous arousals and what Dr. Park has written about all kinds of possible causes for those arousals is very plausible as well. http://doctorstevenpark.com/spontaneous ... leep-apnea

Thanks for posting the interesting link.

By the way: when my data is not able to detect flow limitations, should I request the insurance to change to some machine capable of detecting them ?

You could. But you might not learn anything definitive. You might get an idea of whether UARS or FL might be part of your problem by scrolling through a few nights of data where you're zoomed in far enough to see maybe 2 minutes worth of breathing at a time. If most of the inhalations look nice and round and most of the flow rate data is very regular, that is indirect evidence that if UARS is an issue, your CPAP is probably doing enough to treat it. On the other hand if you see a whole lot of ragged looking inhalations at times you are pretty sure you were sound asleep, then that's indirect evidence that UARS and flow limitations might be worth investigating.

If you are really worried about UARS, you ought to bring that idea up with the sleep doc and see what s/he has to say about it. If it looks like UARS might really explain your problems, it could be that the sleep doc might be willing to send you to a sleep lab that has the equipment needed to properly diagnosis UARS.

[papzombie]

@Robysue: thanks for the tip about zooming out and find the pattern for UARS.

So I receive the doctor's full report today:
- 16 wake-ups in 6h30min sleeping in 8h30min wearing the device (on bed).
- Percentage wake/sleep: wake 23.35%, sleep 67.65%. Actually I was woken up by my children 3 times at night, and stayed awake because of them for about 50 min. So the real percentage of wake / sleep when I sleep alone is: wake 1h10min / sleep 6h30 = 15% / 85%.
- Percentage REM-Deep-Ligh while sleeping: REM = 16%, Deep = 27%, Light = 57%. A healthy adult should have 25% REM, 30% Deep (N3 phase) and 55% Light (N1 and N2 phases), as observed by https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4246141/






What the doctor writes:

- Respiratory arousal index = 0.9, AHI = 0.8, back sleeping 100%, low snore index. Spontaneous arousal index = 4-5 with a lot of awakenings.
- Conclusion (by the doctor): CPAP works well for OSAS, but sleep fragmentation makes sleep quality bad and could explain the insomnia complaints and daily fatigue. Need to have form of psychophysiology treatment for insomnia for a patient with co-morbidity. Patient is advised to follow a course on Cognitive Behavioral Therapy for Insomnia. Expect the treatment to have good result after 6 months because the patient also has co-morbidity. Patient is invited to come back after 3 months for further check.