djam's therapy thread

[djams]

Can I use my respiratory rate to spot periods of REM sleep? In the respiratory chart below from last night, I'm looking at the hump just after 23:00, and some higher respiratory rate that starts around 3:15. I see this pattern pretty regularly. As I noted previously, can easily spot my wakeup about an hour after I fell asleep.

During both of these times I've also got some really odd shapes in my breathing waveforms (2nd screenshot)- does this happen due to REM?

EDIT: I included the snore and the event chart very intentionally, because the first "suspected REM" period, if it is indeed that, came right after a big snore, and a flagged RERA. Perhaps this reduces this likelihood of REM happening? Don't know, guessing here.

[Pugsy]

I have never been able to spot anything that I could call definitive because I had nothing to compare it to that was a known for sure REM flow rate or respiration rate. I need a known factor to compare to and I haven't ever really had one to learn from.

My OSA is 5 times worse in REM and I can usually tell more by timing of the pressure changes than anything else but that's me.
I know some people say they can spot the sleep stages by tidal volume or ventilation or respiration rate but I have never been able to reliably set a standard to go by with any confidence as to accuracy.

I would love to do a home study that did sleep stages and let me look at the data and get it all explained to me so that I could learn but I don't want to pay for it and no one I know wants a free guinea pig for a Type II home sleep study.

You can study normal sleep stage hypnograms and get a decent enough idea when REM normally happens and probably come close and you may well be on to something that you can deduce is probably REM related if you see it consistently enough.

First REM stage normally happens about 90 minutes or so after sleep onset and then as the night goes on REM comes on more frequently and lasts a little longer with each cycle. The greatest amount of REM is going to happen in those wee hours of the morning.
Google "sleep stages" and look at all the normal hypnograms to get an idea what I am talking about.

If you see a similar pattern consistently then you may well be onto something. I just have never really been able to spot enough difference myself and to be honest I haven't worked all that hard at it because I have pretty much relied on pressure changes as more of my cue for REM. When my pressures are too low I get clusters of events that are textbook for REM cycle timing.
I have a good example somewhere in my archives. If I can find it I will share it.

[palerider]

Can I use my respiratory rate to spot periods of REM sleep?

I'd say "no". not reliably.

[djams]

Sorry for delay in responding - life happened over the past couple of days...

My OSA is 5 times worse in REM and I can usually tell more by timing of the pressure changes than anything else but that's me.

This sent me back to look through a couple of weeks. For me, these patterns are appearing at near my minimum pressure (first one), or in periods of declining pressure (second one).

I would love to do a home study that did sleep stages and let me look at the data and get it all explained to me so that I could learn but I don't want to pay for it and no one I know wants a free guinea pig for a Type II home sleep study.

Haha - I'd actually like to do this sort of thing too. But honestly, my wife already thinks I've gone off the deep end just from me looking at the SH charts. Couldn't imagine what she'd think if I paid for a home sleep study kit "just for fun". I have caught her showing a little interest when a big mask leak shows up and I ask her if I woke her up at "X" time.

You can study normal sleep stage hypnograms and get a decent enough idea when REM normally happens and probably come close and you may well be on to something that you can deduce is probably REM related if you see it consistently enough.
First REM stage normally happens about 90 minutes or so after sleep onset and then as the night goes on REM comes on more frequently and lasts a little longer with each cycle. The greatest amount of REM is going to happen in those wee hours of the morning.
Google "sleep stages" and look at all the normal hypnograms to get an idea what I am talking about.

If you see a similar pattern consistently then you may well be onto something. I just have never really been able to spot enough difference myself and to be honest I haven't worked all that hard at it because I have pretty much relied on pressure changes as more of my cue for REM. When my pressures are too low I get clusters of events that are textbook for REM cycle timing.
I have a good example somewhere in my archives. If I can find it I will share it.

I really do believe that I see this frequently enough to feel like I'm on too something. However, I googled as you suggested, and what I found out is that my understanding of the sleep stages and sleep cycles was very poor. I was under the impression that REM was the most beneficial/important stage of sleep. What I would like to be able to spot and keep track of is the deep restful sleep. Stage 3. I think I'd have to buy brain wave monitoring equipment to do this, so that's not gonna happen. Is there even any benefit in knowing when the REM cycles happen? Other than confirmation(maybe) that I am indeed having it?

[djams]

Can I use my respiratory rate to spot periods of REM sleep?

I'd say "no". not reliably.

But I can use it to say I might maybe possibly had REM sleep here.

[Pugsy]

Is there even any benefit in knowing when the REM cycles happen? Other than confirmation(maybe) that I am indeed having it?

I don't see any special benefit to knowing for sure. It's not like we can change it anyway. It is what it is.
I don't need some sort of machine telling me I slept poorly last night....I usually have a really good measuring tool that is free...my own body.

What they really need to come up with is something that tells us why we slept poorly so that we can maybe do something about it....but there's not really any such little gadget.
Other than the time you go to bed and get up...we really don't have any control over sleep itself.

[palerider]

I would love to do a home study that did sleep stages and let me look at the data and get it all explained to me so that I could learn but I don't want to pay for it and no one I know wants a free guinea pig for a Type II home sleep study.

I've got a spare Zeo...

[palerider]

I found out is that my understanding of the sleep stages and sleep cycles was very poor. I was under the impression that REM was the most beneficial/important stage of sleep. What I would like to be able to spot and keep track of is the deep restful sleep. Stage 3. I think I'd have to buy brain wave monitoring equipment to do this, so that's not gonna happen. Is there even any benefit in knowing when the REM cycles happen? Other than confirmation(maybe) that I am indeed having it?

The latest theory is that rem just heats up your brain...

You can still find zeos on eBay.

[Pugsy]

I've got a spare Zeo...

Thanks but no thanks. I actually did do the Zeo thing a while back. Someone was kind enough to loan me theirs since I was too much of a tightwad to buy one just for a little experiment. Not enough under the microscope detail to suit me.
What I want is a home study that will show flow rate breath by breath and brain wave step by step so I can correlate for sure asleep breathing with awake breathing and have a zero baseline for further comparisons.
And it also needs to be free.
Not that having all this means I can do anything about it but I have long been curious about alpha waves and pain, etc.
Not curious enough to spend any money though because again...not much I can do any different than I am doing now. I would just have some "maybe answers" to some "maybe questions".

If I was going to wish for something...I wish for the cpap machines to do brain waves as an option for sleep status. All built in to one little handy dandy little gadget.

[djams]

Is there even any benefit in knowing when the REM cycles happen? Other than confirmation(maybe) that I am indeed having it?

I don't see any special benefit to knowing for sure. It's not like we can change it anyway. It is what it is.
I don't need some sort of machine telling me I slept poorly last night....I usually have a really good measuring tool that is free...my own body.

What they really need to come up with is something that tells us why we slept poorly so that we can maybe do something about it....but there's not really any such little gadget.
Other than the time you go to bed and get up...we really don't have any control over sleep itself.

You're right of course. How I feel is without a doubt the most important consideration.

Along those lines - on Wednesday night, I decided to fall asleep on my back - just to see if my minimum pressure has reached the point where it will keep my AHI low, regardless of my sleeping position. Full 7 hours of sleep. AHI was 1.25 for the night, but I was feeling beat all day Thursday. AHI was mostly obstructives. Snoring that my wife confirmed woke her up. And my "event-free zone" at the start of the night, which has been gradually lengthening with side sleeping(reaching 3.5 hours sometimes), was < 1.5 hours. Also had 7 large leak events in the 40-60 L/min range, the longest of which was 10 minutes (on the dot). Don't know why, but leaks seem to degrade the effectiveness of therapy for me- even when they don't wake me up. I sure won't be intentionally falling asleep on my back anymore.

Anyways - it's as you're always saying Pugsy - Numbers aren't everything. And I want to thank you again for identifying the positional aspect of my AHI, as well as suggesting ideas to help get me on my side. The buckwheat pillow is fantastic for me. For whatever I stay on my side for long periods of time. I've graduated to a full sized queen model. Thing weighs over 10lbs. I'm a shoo-in to win any pillow fights that might break out.

[djams]

Trying out a new mask. New experience for me.

I've got a Dreamwear FFM loaner for a couple of weeks. My thought was that it'd make it a lot easier to read. Which it does. Also thought that I'd like the hose inlet on top of the head as a bonus. Well it turns out that the latter is unexpectedly what I like the most about the mask. I couldn't believe the feeling of... freedom, I guess that came when I didn't have to deal with the hose. Like getting a hose-ectomy. If you'd asked me if the hose on the chest was bothering me, I'd have said "absolutely not". But it's pretty awesome when it isn't there.

Chart below shows how the fist night with it went. Not so good, lots of leaks compare to what I normally see. I might be willing to accept this leakage because of the other benefits of the mask - EXCEPT, I remember waking up a handful of times due to the farting/squeaking/whistling noises. The SH chart shows that it was much more than a handful. Lots of RERA's, and the little dips in my respiratory chart show more wakeups that aren't flagged.

For tonight I've gotten some mask liners. I just did 20 minutes of testing/adjustment tweeks at my max pressure with the mask liners. Rolling around, letting my jaw drop. Trying to simulate some of the stuff I do in my sleep. Didn't get a single one of the audio effects that were waking me up. Definitely not the same as a full night's sleep but encouraging. Will see in the morning. If it doesn't get significantly better, I'll be looking for advice on how much large leak is acceptable.

[djams]

Well, utter failure. This leakage was enough to render my machine useless.

This was the last thing I expected after testing and adjusting the mask last night. Can't imagine what happened. The mask liners stopped the noises that were waking me up - but as you can see, I needed to wake up and fix the leaks.

I'm throwing in the towel on the Dreamwear FFM. Too bad, but certainly not the end of the world.

Question about my flow rate chart - the whole thing is a mess once the leaks start, but from 23:45 to 00:45 it's un-centered to the low side. Normally pretty equally distributed about the 0 line. Does this mean anyhing significant?

[palerider]

Well, utter failure. This leakage was enough to render my machine useless.

You're totally wrong about that, your leaks weren't too high for the machine, it maintained therapy pressure, but if you had had any apneas, it probably would have reported them as unknown.... But it would have detected them, and flagged them.. and probably responded to them. (At some point, auto machines start dropping pressure with excessive leaks, yours might have spiked to that point at times.)

Yes , your leaks we're bad, but not disasterously so, it, the machine maintained therapy pressure, and was able to track breathing.

Question about my flow rate chart - the whole thing is a mess once the leaks start, but from 23:45 to 00:45 it's un-centered to the low side. Normally pretty equally distributed about the 0 line. Does this mean anyhing significant?

It means you were exhaling more forcefully than you were inhaling.

[djams]

Well, utter failure. This leakage was enough to render my machine useless.

You're totally wrong about that, your leaks weren't too high for the machine, it maintained therapy pressure, but if you had had any apneas, it probably would have reported them as unknown.... But it would have detected them, and flagged them.. and probably responded to them. (At some point, auto machines start dropping pressure with excessive leaks, yours might have spiked to that point at times.)

Yes , your leaks we're bad, but not disasterously so, it, the machine maintained therapy pressure, and was able to track breathing.

OK. I was pretty discouraged when I posted this. I was looking at my FL's, and comparing to the norm for me. The magnitude of the FL's is much smaller than what I usually see in my charts. The FL's are primary trigger for my pressure increases (of which there are almost none last night). I figured that based on this alone, the entire data set for the night would be rubbish. I want to make sure that I understand, so a couple of more questions.

Do you feel that the reported AHI is accurate despite all of the large leaks? There is one UA in the event chart.

In a round about way, does this screenshot show how I would've done on CPAP mode last night, given that the pressure graph is pretty much a straight line?

Can a mask change have the effect of nearly halving the magnitude of my FL's?

Question about my flow rate chart - the whole thing is a mess once the leaks start, but from 23:45 to 00:45 it's un-centered to the low side. Normally pretty equally distributed about the 0 line. Does this mean anyhing significant?

It means you were exhaling more forcefully than you were inhaling.

Hopefully this is nothing ominous.

[palerider]

Do you feel that the reported AHI is accurate despite all of the large leaks? There is one UA in the event chart.

Maybe not perfectly accurate, there's a brief period around 1:00 and around 2:30 where it looks like the flow was greatly depressed, maybe to the point where, for a few minutes, the machine may not have been able to detect breathing... maybe, you'd have to zoom in and look.

When doing so, also look at the mask pressure line, and see how the measured pressure shows... was it dropping of significantly? As far as the rest of the night, you can zoom in and look at your breathing, if you're breathing, you're not having an apnea....

The 24lpm line from Resmed is where they're *sure* that their machine can determine what *kind* of apnea you've had... (and usually, they're able to differentiate it up into the 30's)... not whether or not you're having an apnea at all.

In a round about way, does this screenshot show how I would've done on CPAP mode last night, given that the pressure graph is pretty much a straight line?

Well, there were increases in pressure. but not a lot of them. cpap mode. blech. not a fan.

Can a mask change have the effect of nearly halving the magnitude of my FL's?

Yes. Some masks pull the lower jaw back more than others, and that narrows the airway, needing higher pressures and causing more events. My pressure needs dropped when I went to a pillow mask.

Question about my flow rate chart - the whole thing is a mess once the leaks start, but from 23:45 to 00:45 it's un-centered to the low side. Normally pretty equally distributed about the 0 line. Does this mean anyhing significant?

It means you were exhaling more forcefully than you were inhaling.

Hopefully this is nothing ominous.

I don't think so. after all, that was *before* your leaks started happening... it'd be interesting to see what the breath shapes look like.. (make sure the zero dotted line is turned on when zooming in.