Dreaming and AHI

[DoriC]

Can vivid dreams result in a higher AHI? I've been noticing Mike's AHI has been higher the last 2 nights and he's been telling me he's having "crazy dreams" that don't make any sense. He's usually between 0.8-1.8 but the last few nights at 3.0 and 2.9. I also have been experimenting with the humidifier at the same time. He's always slept with passover but I wanted to try it set to 1 since the air is so dry and thought he might like a little humidity. He says he feels no difference. He doesn't have nasal problems so could there a be a connection between the HH and higher AHIs or is it just a coincidence that's happening along with the dreaming? Thanks.

[newhosehead]

Dori, I cannot offer much in the way of good answers, but I have to tell you I have experienced this and wondered about it myself. I typically run an AHI of 2.2 or so. At one point earlier in treatment I was averaging 1.7-1.8. However, there HAVE been a couple of occasions when I had a few nights of really vivid dreams and my AHI was always higher those nights, up to 3.3 or so. I didn't know what to think of that. Also, I seldom remember any dreams at all, something I wonder about as well since it seems a lot of people report dreaming again after starting treatment. I will be interested to see the responses you get. I just wanted you to know this has happened to me and it was comforting, in a way, to read your post and feel I was not the only one!

Jeanette

[rested gal]

I also have been experimenting with the humidifier at the same time. He's always slept with passover but I wanted to try it set to 1 since the air is so dry and thought he might like a little humidity. He says he feels no difference. He doesn't have nasal problems so could there a be a connection between the HH and higher AHIs or is it just a coincidence that's happening along with the dreaming?

Dunno. Since he says he feels no difference, I'd go back to passive humidification and see if that lowers the AHI again. Some people need heated humidification to keep the nasal passages from stinging and burning, but others might find that the warmer air causes their nasal passages to become congested.

So, even if Mike says he feels no difference between passive humidification and having the heat barely turned on, there's always a small chance the the warmer moist air is just enough to cause a bit of swelling in his nasal passages. Maybe.

If going back to the passive humidification doesn't drop his AHI back down in a couple of nights, here we go... a bit of judicious dial wingin' comin' up!

I may be mistaken about some of this, but here's my understanding:

Apneas are more apt to hit people during REM (rapid eye movement sleep...when most "vivid" dreams occur.)

If a person doesn't wake up during REM, they will not be aware of the dream they had during REM. We dream in other stages of sleep too...not just in REM... but the most vivid dreams are said to occur in REM. "Crazy dreams" even.

We have to be awake for at least 15 seconds (maybe it's 20 seconds..whatever) to be aware of something and commit it to memory.

If an apnea during REM causes an arousal to get the throat open for breathing, and the arousal goes all the way to "wake," and the person is awake for ___ number of seconds (15, 20, whatever it takes) the person will be aware of having been dreaming.

If an apnea during REM causes an arousal of only, say, ten seconds, or eight seconds...just long enough to get breathing going again, but not long enough to be aware of the awakening... the person has no awareness of "dreaming" and no memory the next day of having had a dream during the night.

All that said... ...
Dori, if Mike has been waking up more than usual lately with an awareness of "crazy dreams," it sounds to me (and you know, I ain't no doctor!) that he's getting hit more than usual with apneas. During REM, remember, is when apneas are most likely to happen if CPAP treatment is not preventing them.

So, his increased wakeups during (probable) REM, along with what your seeing as an increase in the AHI data from his machine...sounds to me like the pressure isn't doing as good a job at preventing apneas as it did before. Might be that a pressure increase is needed. We get older, soft tissue in the throat gets saggier...you know the drill.

If it were me, this is what I'd do -
if I were using:

A straight CPAP - I'd raise the pressure 1 or 2 full cms.
Or, if I had been using EPR with a ResMed machine and didn't really need EPR, I'd try turning off EPR and leave the CPAP pressure where it was.
Or, if I had been using EPR with a ResMed machine at a setting of EPR "2" or "3", I'd set EPR at "1."
Or, if I had been using EPR set for "fulltime" with a ResMed machine, and felt I needed EPR only to get to sleep, I'd set EPR for "ramp" only at whatever EPR setting I liked ("1", "2", or "3.")

An autopap - I'd raise the minimum pressure setting 1 or 2 full cms. I'd leave the max pressure setting where it was.
Same "or's" about EPR apply if it were a ResMed autopap machine.

None of the "EPR or's" apply if using C-Flex or A-Flex with a Respironics machine -- no change of C-Flex, C-Flex+, or A-Flex needs to be done. Those features work very differently from the way EPR works. I'd simply raise the pressure (or the minimum pressure setting) and continue using whatever "Flex" I liked.

A bilevel machine - I'd raise the EPAP pressure. I'd leave the IPAP pressure where it was unless it had to be raised to accomodate the increased EPAP pressure.

A bilevel auto machine - I'd raise the minimum EPAP pressure setting. I'd leave the maximum IPAP setting where it was unless it had to be raised to accomodate the increased EPAP pressure.

Bilevel and bilevel auto machines have other settings, but for the purpose of trying to prevent obstructive apneas "EPAP" is the setting to raise.

And all THAT said -- maybe just give it some more time and the AHI will settle down on its own, without needing to change anything.

Good luck!

[DoriC]

Thanks RG, I think I have a plan! I'll set the HH back to 0 for a few nights and see if that was the problem. If not then I'll change his setting back to cpap at 11 or 11.5 and then 12 again if necessary. I've been setting it at 10.5-13 for awhile now because he seemed more restless lately with straight pressure at 12 and since AHI was about the same either way, I was happy to have his 90% at 11cms most nights. What I forgot to mention is that he still has an open wound that requires dressing changes 2x daily (RN comes 3x/week to help me) and although it's getting smaller and he says it's not hurting him much anymore I wonder? He can tolerate a lot of pain without a whimper. So maybe all bets are off at this point.

Jeanette, I hope you got some answers too!

[Wulfman...]

Thanks RG, I think I have a plan! I'll set the HH back to 0 for a few nights and see if that was the problem. If not then I'll change his setting back to cpap at 11 or 11.5 and then 12 again if necessary. I've been setting it at 10.5-13 for awhile now because he seemed more restless lately with straight pressure at 12 and since AHI was about the same either way, I was happy to have his 90% at 11cms most nights. What I forgot to mention is that he still has an open wound that requires dressing changes 2x daily (RN comes 3x/week to help me) and although it's getting smaller and he says it's not hurting him much anymore I wonder? He can tolerate a lot of pain without a whimper. So maybe all bets are off at this point.

Jeanette, I hope you got some answers too!

Dori,

Remember what I told you last month about my numbers? Well, they've come back down since the first of this month. I still have no idea what that was all about in January, but I was having quite a few nights of vivid dreams, too. I had more nights over 1.0 in January than I had in all of the four months of last year combined.
There may be some "cause and effect" going on with Mike. Maybe the effects of the wound are affecting both the dreaming and the AHI. This is one reason why I keep my pressure settings the same.......so I can tell when these cycles begin and end. And, I do see them fluctuate at similar times of each year. However, this year I'm not going to be rotating my machines so I can eliminate the possibility that it could be a difference in the firmware or other sensor differences (even though they're all virtually identical machines).


Den

[Wulfman...]

I meant to say the LAST four months of last year.......

Den

[rested gal]

I meant to say the LAST four months of last year.......

Den

Serves you right (not being able to do a quick edit ) for not posting under your good old Wulfman registered name!

Seriously, I'm always glad to see your great posts and great advice, Den. However you choose to offer it.

[Rogue Uvula]

Just as reinforcement of what has been said, here are the numbers from my original sleep study (no CPAP)
AHI (not including REM sleep) = 5.4
AHI (during REM sleep) = 25.9

So, if we can believe these numbers reflect a general trend, it seems reasonable that the more time in the course of a night spent in REM, the higher the average AHI would be.

Of course the CPAP has reduced these AHI numbers, but I still see an increase in AHI during the time I am in REM. If I wake up at 6:30 remembering a dream, I'll check my data the next morning and see more activity in the minutes before 6:30.

[DoriC]

Den, thanks for that "gentle nudge" in the right direction. I think that's where RG was leading me too! When will I ever learn to leave settings alone and just watch for general trends over a longer period, especially when husband is recovering from surgery??? His AHI last night was again 2.8 back in passover HH, so that's almost a week of these high numbers with "strange dreams" so events may be getting through if pressure is too low as RG says. So I'll set pressure back up to cpap at 12cms where he did well for so long, and attribute any restlessness to the surgery for now and just watch the numbers. I wish someone can tell me why I'm so fixated on getting his pressure lower than it probably should be. Because Mike is so helpless and I think because I don't wear the mask myself, I envision that it must be blowing so hard and is very uncomfortable for him (never mind that he has to put his hand up to the exhaust to see if machine is on! ) I did try the mask myself once or twice at 6cm for a few minutes and I didn't like it at all! (never mind that I tell newbies they'll get used to it!). Well, that's my vent. I've put myself in this state of confusion before and after the pros put me back on track I always promise myself to stop playing guessing games and overthinking this process thinking I can make it even better for my DH.