Help Analyze My ResScan Flow Data For Wake Ups

[Otter]

@Otter - I think Minute Ventilation as reported in ResScan may be the "respiratory rate trace" you mentioned. I'll pay attention to that to try to get a non-REM Flow data example posted here. Here's the Wikipedia definition I just looked up:
http://en.wikipedia.org/wiki/Respiratory_minute_volume
I'm on APAP set to 13 min and 16 max and I never see it go up to that max.

Not that either. Also not tidal volume. I looked at the Data Management Guide, and RR isn't in there. Duh. Mark must be calculating that from the data. It wouldn't be hard to do at all. Pretty interesting if you dare to try the SleepyHead alpha, though.

But please tell me more about this comment, "...it is assumed that FLs define REM macrostructure, then one could argue that the overall sleep architecture actually isn't all that bad."

You have periods of flow limitation about every two hours. People usually cycle into REM about that often if nothing is messing with their sleep. And in REM your throat will relax more, which could cause the FL in your data. Hence, the frequency of your flow limitation seems to be telling you that you are going in to REM about like you should. And from that, we can infer that your sleep isn't half bad.

[avi123]

FWIW, looking at your flow patterns, I see an awful lot of irregularities. The sharp, deep negative spike would indicate expiratory puffing, were you using a nasal mask or nasal pillows, but with a FFM I'm scratching my head. The well defined periods of flow limitation are spaced about right to correspond to periods of REM sleep, when irregular breathing and most events seem to occur. The leaks don't look bad, and you aren't having many events.

But you have a lot of flow limitations. The positive peaks should be sharper. Yours are plateauing, truncating, slanting, all very irregularly. The top flow trace appears to show a period of awakening between 2:10:35 and 2:11:00.

I wonder what your breathing is like during a period of quiet non-REM sleep. That should be your basis for comparison.

My impression is that your OSA is being handled just fine. But something else, perhaps neurological, is keeping you from sleeping effectively. A sleep study with EEG might be in order. I know a good lab in San Clemente.

Starty, I agree with you about the "awful lot of irregularities" of the curves and also about mouth breathing b/c of the negative spikes. The vibrations on the curves could be from snoring, heart beats, neurological ailment, etc.

[deltadave]

But please tell me more about this comment, "...it is assumed that FLs define REM macrostructure, then one could argue that the overall sleep architecture actually isn't all that bad."

You have periods of flow limitation about every two hours. People usually cycle into REM about that often if nothing is messing with their sleep. And in REM your throat will relax more, which could cause the FL in your data. Hence, the frequency of your flow limitation seems to be telling you that you are going in to REM about like you should. And from that, we can infer that your sleep isn't half bad.

RIght (except REM cycles are about every 90 minutes):



However, apparently there is also some citalopram (a REM suppressing SSRI) that must be accounted for, so this theory may not hold when placed under close scrutiny.

Where sleep restriction may be of some value is the morning hours. That last block looks disheveled enough to be Wake or Wake/NREM1, and if so, and have little value. Getting rid of that might be a better approach. The point of sleep restriction is to get rid of worthless TIB.

Did you start your sleep log? That would help to answer many of these questions.

[deltadave]

and if you can point me to where Jeffster claims to have a high level of energy, please do so. 'Cause that means I've missed an important part of his story.

My insomnia has been bad since last December. My doctor started me on Trazodone in January, which does help me fall asleep but not stay asleep. I'll get maybe 3 hours sleep, then fragmented 20 - 40 minutes sleep periods until it feels like time to get up after around 8.5 hours of mask time. Daytime mental clarity can really suffer, but energy level can be quite high.

[deltadave]

If this person claims to have UARS (maybe, although one needs to look at a bunch of other stuff because it's "apparently" OOC)

Why is the idea of UARS out of character?

"Out Of Control".

[Jeffster]

@deltadave - the energy level quote is from an older post of mine. I am more relaxed than that now. Sometime after that post I updated things to say I sometimes miss that higher energy level because it was easier to get workouts done, which you must have missed reading. But really, I am more comfortable without that extra energy, and that is better for me. Also, you said, "However, apparently there is also some citalopram (a REM suppressing SSRI) that must be accounted for, so this theory may not hold when placed under close scrutiny." What is the reference to citalopram, as a way to reduce REM and so reduce REM related awakenings?

@Otter - thanks for the additional info. So my throat relaxing in REM sleep, as supported by the observation of increased Flow Limitation at that time, could be the cause of the irregular Flow breathing patterns?

OT - I have a forced experiment tonight - my electric company has notified us that power will be turned off and on between 12:30 AM and 6:30 AM, so I won't be using the S9 at all tonight! It's been a while since gone without it.

[deltadave]

@deltadave - the energy level quote is from an older post of mine. I am more relaxed than that now. Sometime after that post I updated things to say I sometimes miss that higher energy level because it was easier to get workouts done, which you must have missed reading.

I did not. That claim occurred during rampant insomnia which makes it significant. The claim of increased energy persisted up to at least June 20th where Otter brought up the important distinction between "sleepiness" and other types of decreased mental acuity. Looking globally, an important concept of insomnia is "Insomnia is a problem only if it's a problem". All 5 of your references spoke of "energy" in a physically positive way, which brings to mind 3 (at least) points:

• The insomnia may not contribute to EDS ("mental fog" needs separate microanalysis. Shoving in a fistful of drugs every night may not be completely side effect-free. 61, eh? OK, we'll leave that for now).
• The "high energy" in December may have been the initial cause of the insomnia.
• The present insomnia may be a running behavior from December.

Also, you said, "However, apparently there is also some citalopram (a REM suppressing SSRI) that must be accounted for, so this theory may not hold when placed under close scrutiny." What is the reference to citalopram, as a way to reduce REM and so reduce REM related awakenings?

No. It means that those first 2 or 3 proposed REM periods in the flow chart would not exist if you're taking citalopram.

BTW, since citalopram (and for that matter paroxetine) are a reuptake inhibitors, there would be a significant serotonin load build-up with concommitant tryptophan and 5-HTP. With the relationship of trazodone previously noted, I think a historical drug timeline may be helpful to sort out the serotonin-wingin'.

And sleep log.

[deltadave]

So deltadave... what would you advise him to try since the current nightly mix of OTC stuff has not addressed the BIG WAKE issue at all?

Make the 100-mile round trip to get a good course of CBT. Time-wise, that's my daily commute, and apparently pretty close to one (or 2) "BIG WAKES".

[deltadave]

BIG WAKE

"BIG WAKES"

Perhaps it's all that yelling that's keeping him up.

[Otter]

@Otter - thanks for the additional info. So my throat relaxing in REM sleep, as supported by the observation of increased Flow Limitation at that time, could be the cause of the irregular Flow breathing patterns?

Yes. For most people, OSA is worse when they're in REM. Of course, if you had a good airway to begin with, you could dream without choking on yourself, but we're all on the sleep breathing short bus here.

[Jeffster]

@deltadave - I appreciate you taking the time to give me advice. Would you say it could be beneficial to get my health provider to give me an overnight sleep study? Is there anything we could learn from that to help with these wake ups? And I think I understand what you are saying about the citalopram, as you said, "No. It means that those first 2 or 3 proposed REM periods in the flow chart would not exist if you're taking citalopram." I was given a prescription for citalopram back in January of this year, but only took it for a few days before deciding I didn't want to be back on an SSRI after working so hard to wean myself off Paxil by the end of August last year. The side effects of the SSRIs concern me, like the weight gain. In the year since being off Paxil I have lost 50 pounds healthfully. Per citalopram (generic for Celexa) this report just came out a week ago showing it can cause fatal heart problems in doses above 40 mg:
http://www.msnbc.msn.com/id/44258828/ns ... es-celexa/
So that concerns me. Also with suppressing REM to get more consistent sleep hours, isn't there a trade off that the quality of the total sleep may be less due to less REM? And please, tell me more about my being 61. I have read that insomnia can worsen in the elderly.

On a side note, I had to sleep without the mask and APAP last night since my electric company sent a notice and phoned saying they were turning off the power over night for upgrades and improvements. I have no back up power source. Lights out at my usual time 11 PM. It took a little longer to fall off to sleep since at first it felt really weird breathing on my side with my head on the pillow without the air pressure, maybe a bit like a fish out of water. Later on, though, like right on cue, I had my "wake ups" happen. There were three of them I remember because I was having a vivid dream each time, and they were about 90 minutes apart. For the first, I looked at the clock and saw 3:02 AM, the second I saw it was around 4:30 AM, and the last I remember was around 6:00 AM. And in each wake up case I was laying comfortably on my right side, wondering why I woke up. Also I forgot to mention yesterday per the drugs I am taking that I do keep 25 mg generic Benadryl by the bedside to take one for its drowsiness effect if a "big wake up" seems to have left me too awake at say 3 or 4 AM, and I want it to help fall back to sleep to get another 3 or 4 hours before finally getting up. I did take one 25 mg generic Benadryl after that 3:02 AM wake up, as I just felt too awake. It did help me fall back to sleep, but did not seem to reduce the vivid dream that came 90 minutes later, so perhaps it is not good at reducing REM sleep. If I wanted to try reducing REM stage sleep to see if it would subsequently reduce my vivid dreaming and provide more consistent sleep, is there another way to achieve that without going back on the SSRIs that have sedative properties, like the Paxil was doing for me, and perhaps the citalopram would do? I should add that I did not know that PAxil was doing that to me all those years i took it, like 8 years. I learned that about it this past January after being off it for more than 4 months.

I do use the Trazodone as a sedative, and it has helped me fall asleep, so I am thankful for that. I believe it is much weaker than the newer SSRIs for serotonin reuptake inhibiting, so not as much danger of serotonin syndrome with the 5-HTP or L-Tryptophan, but I do watch for that.

Is it possible that by taking myself off Paxil by the end of August last year, and thereby taking away the sedative effects it had been having on me, that my body rebounded in a way over the next few months that finally made my insomnia much worse by December? Since that time of year is rapidly approaching, it is also on my mind to try to stay ahead of all this so that I do end 2011 in mental and emotional state I ended 2010. I'd like to think I've made enough progress back, but I'm obviously not so sure, which is why I started this thread, especially when I thought that by capturing my Flow waveforms at the time of a big wake up and presenting them here we might get some meaningful observations. But it seems like if I really want to know more, I need a new overnight sleep study? The one and only one I ever did was back in 2002 when I had a different health plan. Then I transferred to Kaiser Permanente like 3 or 4 years ago and they just took my original sleep study and put it in their system so that I could order CPAP supplies. I've suggested that to my doctor as well in past visits, that maybe we should do a new sleep study, and she seemed to agree, but it never got schedules. Maybe I should be more demanding, if you all think a new sleep study might yield some useful information per reducing my wake ups and getting better sleep?

On a side side note, I realized last night without the mask on that in none of my wake ups did I have dry mouth. But i do get it with the mask on, especially with a "big wake up." So it would seem to me that it is likely being caused by mouth breathing in full face mask. And the best thing to try for that is probably going back to taping my mouth closed even with the FFM? I went to a FFM from a nasal mask the middle of last December because I figured out I was a mouth breather, and the FFM seemed like a better way to go than tape.

[Jeffster]

@Otter - thanks for the additional info. So my throat relaxing in REM sleep, as supported by the observation of increased Flow Limitation at that time, could be the cause of the irregular Flow breathing patterns?

Yes. For most people, OSA is worse when they're in REM. Of course, if you had a good airway to begin with, you could dream without choking on yourself, but we're all on the sleep breathing short bus here.

Thanks for the comeback on this point, Otter. Per my reply post to deltadave above, what do you think of trying to reduce REM somewhat to get more consistent sleep, where REM may be contributing to wake ups? Any ideas on how best to accomplish it? And do you think a new sleep study might be in order for me?

[Otter]

Per my reply post to deltadave above, what do you think of trying to reduce REM somewhat to get more consistent sleep, where REM may be contributing to wake ups? Any ideas on how best to accomplish it? And do you think a new sleep study might be in order for me?

I think the EEG data might be extremely valuable. It would also be nice to know if you're trying to breathe during those pauses before each inhalation. The myoelectric sensors could tell you that. If your insurance covers it and you know a good lab, I don't see what you have to loose. If it were me, though, I'd try to smooth out my breathing by adjusting pressure first. Eliminate the easy stuff so that you can focus your sleep study on the questions you can't answer on your own. I think it's possible that if you can get rid of that micro-apnea pattern, your wakeups will go away too.

I don't think trying to reduce REM is a very good idea. As a last resort, maybe, but REM is very important, so I'd do some exploring first.

On your night off the hose, it seems likely you woke up during your dreams because without the machine, you stop breathing during REM.

[Otter]

On a side side note, I realized last night without the mask on that in none of my wake ups did I have dry mouth. But i do get it with the mask on, especially with a "big wake up." So it would seem to me that it is likely being caused by mouth breathing in full face mask. And the best thing to try for that is probably going back to taping my mouth closed even with the FFM? I went to a FFM from a nasal mask the middle of last December because I figured out I was a mouth breather, and the FFM seemed like a better way to go than tape.

Have you tried a chin strap with the FFM?

[Jeffster]

@Otter - should I try adjusting the pressure up? My current APAP range is 13 min, 16 max. Should I try making the min like 13.2 or 13.4? I do not have a chin strap to try. Do you use a chin strap and have one you like? I could go look at cpap.com. or try eBay! I've read a lot of the chinstrap v. mouth taping threads here, and I think a lot of folks report that the chinstraps leak for them so they go to taping. But if there is a good chinstrap out there, I'd be willing to try it.;