CompSA, Hypoventilation, PLMs, Bradycardia and Hypotension?

[SleepingUgly]

OMG, Rebecca, I just wrote a PM in which I said it was like a Rorschach!! Literally just hit sent on it and then came to this thread.

P.S. Those blots really shouldn't be on the internet.

[Rebecca R]

OMG, Rebecca, I just wrote a PM in which I said it was like a Rorschach!! Literally just hit sent on it and then came to this thread.

P.S. Those blots really shouldn't be on the internet.

Maybe not--but they are, and not just once. The online interpretations on the other hand...http://www.stupidstuff.org/main/rorschach.htm or http://theinkblot.com/

[Rorshach's Originals are in the public domain now, which is the reason they are widely available]


PS Instructions to access the clinical menu or change pressure on XPAP machines really shouldn't be on the internet.

Does is count against us if we guess wrong? Or do we get credit just for trying? And do you promise not to yell at me?

'Cause with the dancing belts, I'm guessing obstructive, and with the dancing thermo-thingy, I'm guessing hypopneas maybe?

Besides, I hear that UARS has been cancelled due to lack of interest.

Please don't fire me. It's my first day. And I cry easy.

jeff

JNK can you lend me your copy of the Cliff's notes for PSG Interpretation or do you have PSG Interpretation for Dummies? I can't find any reference to how to interpret the "dancing thermo-thingy." This is much harder than the "Test, just a test[s]" than you used to issue when I first joined the forum.

[SleepingUgly]

The online interpretations on the other hand...http://www.stupidstuff.org/main/rorschach.htm or http://theinkblot.com/

The irony of a subjective test with multiple choice scoring! Thank goodness Exner isn't here to see this.

[Muffy]

Are those piezo or RIP belts?

Not sure Muffy. If they are easy to differentiate visually I could try and tell from the video files. Are you referring to the sensors that measured thoracic and abnominal effort?

Right. Periodically, one of the band signals suddenly inverts (phase reversal), which can occur with piezo belts. While that in itself is not a real big deal (just electrically invert it back), RIP belts are more accurate and hence more valuable in discerning central apneas and deciding when you have truly paradoxical breathing (otherwise, you'd be inverting when you shouldn't).

Muffy

[blizzardboy]

Right. Periodically, one of the band signals suddenly inverts (phase reversal), which can occur with piezo belts. While that in itself is not a real big deal (just electrically invert it back), RIP belts are more accurate and hence more valuable in discerning central apneas and deciding when you have truly paradoxical breathing (otherwise, you'd be inverting when you shouldn't).

Hi Muffy, I have emailed the sleep centre to ask. Cheers,

[Muffy]

So anyway, having downscored most of the obstructive apneas, let's take a close-up view of one of the ones that remains:



Things that suggest this is obstructive in nature include the snoring and flow-limited nature of the surrounding breaths.

On the other hand, the arguements that this, too, has a heavy central flavor include:

• the abdominal and thoracic belts also decrease in intensity
• the event is post-arousal
• the effoct belts do not progressively increase to try to overcome obstruction

Muffy

[blizzardboy]

So anyway, having downscored most of the obstructive apneas, let's take a close-up view of one of the ones that remains:

MA=MicroArousal? If so, can you please briefly describe their significance? Cheers,

p.s. Sleep centre just replied: inductive RIP bands were used on me.
p.p.s. Still no reply from DME so I have resent the request for the S9 detailed DLs

[Muffy]

So anyway, having downscored most of the obstructive apneas, let's take a close-up view of one of the ones that remains:

MA=MicroArousal? If so, can you please briefly describe their significance? Cheers,

That little guy?



To be frank, I don't know we're going to do with him. He's too short to be a real arousal (1.75 seconds) and since there hasn't been 10 seconds of continuous sleep since the last one, he can't be an arousal at all. Since you've got your K-complex there, that's N2 activity, so perhaps the best possible explanation is alpha intrusion rather than alpha arousal.

Muffy

[blizzardboy]

Since you've got your K-complex there, that's N2 activity, so perhaps the best possible explanation is alpha intrusion rather than alpha arousal.

N2 activity=Stage 2 NREM EEG patterns (sleep spindles and K complexes), right?

Wait...BB remembers to consult the Goog-oracle above all others..."Yes BB, the answer is yes." ("Even Wiki knew that" adds Goog-oracle, leaving BB feeling silly.)

[Muffy]

Since you've got your K-complex there, that's N2 activity, so perhaps the best possible explanation is alpha intrusion rather than alpha arousal.

N2 activity=Stage 2 NREM EEG patterns (sleep spindles and K complexes), right?

Wait...BB remembers to consult the Goog-oracle above all others..."Yes BB, the answer is yes." ("Even Wiki knew that" adds Goog-oracle, leaving BB feeling silly.)

Wiki, eh? I see they relate K-complexes to Restless Leg Syndrome, which is incorrect (Restless Leg Syndrome is a disorder of Wake). As we have discussed, K-complexes can be associated with PLMD, a disorder of sleep (which, if you're having K-complexes, you have to be).

Muffy

[Muffy]

Sleep centre just replied: inductive RIP bands were used on me.

OK, cool. There isn't very much phase reversal:

Normal:



Out of synch:



but it's important to know if the belts are RIP to insure overall accuracy.

Muffy

[Muffy]

OK, I think we're getting ready to finish up here, we just need to look at REM (actually those previous epochs are in and around REM).

OSA is usually worse in REM, and also when supine, so looking at the combination of REM and supine is quite important. You don't have a great deal of supine REM:



and once you go to side, that obstructive breathing disturbance appears to subside (note the position change on bottom):



Muffy

[blizzardboy]

K-complexes can be associated with PLMD, a disorder of sleep (which, if you're having K-complexes, you have to be).

So would you say that I have jumped the fence into the PLMD paddock?

BTW, I just read that PLMs can be associated with spinal injuries. I have two compressed discs where the sciatic nerve comes out of my spine, probably as a result of falling off a horse when I was young. I have had x-rays and a CT scan to verify this, particularly on the LHS. Over the past 10 years I have been afflicted with lower back problems but I seem to manage it pretty well now and haven't had an episode for quite a while (nearly a year). I mentioned back problems on the questionnaire I filled out prior to the PSGs but no-one along the I-live-to-help-you-with-your-sleep-disorder(s) chain seemed concerned about it. As there is nothing apart from core exercises, good posture, CBT, SSRIs, sleep hygiene, CPAP, lifestyle improvement, relaxation therapy, vitamin and mineral supplements, and invasive surgery that can help my back, I think I might just need to go Back To The Future for a Rx. Just as an aside, from the age of 14 'til 18 I used to regularly be told that I looked like MJFox.

Just as an aside to the aside, a bit over 3 years ago I was part of a TV show that involved a search for my Dad's car-crash site from the early 70's. Following airing of the show a former work colleague of my Dad sent a letter to the TV station in an attempt to make contact with me, and to offer me a record player that my parents gave to this person nearly 40 years ago. Well the letter was misplaced by the station until being found last week and I only recieved it yesterday, over 3 years late. I rang the person straight away (fortunately due to Oz's sophisticated time zone system COB had not yet been reached in their part of the world) and, after some cordial discourse, I declared that I would love to take possession of the record player. But, much to my amazement, this person told me that they figured that I didn't want the player because I hadn't contacted them for over 3 years so they had thrown the player out...just the day before I rang (yes, that's right, after 40 years of happy residence in the cabinet the doomsday for the player was the day before I sought to take ownership!) So the telecon was terminated in good time and this person was on the hooter to the dump, SWAT team, etc, to try and re-secure the player before it was turned into matchsticks (my SDB was slightly worse that night as I waited for the outcome - please see my DLs for the facts. ) After Windoze booted this morning at work I was relieved to read an email from this person declaring that the record player is now safe and sound and in good health. Hence soon I will become the proud owner of the only possession still in existence that once belonged to my parents - fortunately rescued from the tracks of a D9. Now isn't that a feel good story? Cheers,

[blizzardboy]

and once you go to side, that obstructive breathing disturbance appears to subside (note the position change on bottom):

Hi Muffy, Is it significant that my abdominal effort is reduced when supine when compared to me breathing on my side?

[Muffy]

and once you go to side, that obstructive breathing disturbance appears to subside (note the position change on bottom):

Hi Muffy, Is it significant that my abdominal effort is reduced when supine when compared to me breathing on my side?

Everything picks up when you go to side, so that exchange looks like respiratory stuff > arousal/wake > position change > improved breathing.

Muffy