Help Analyze My ResScan Flow Data For Wake Ups

[deltadave]

Would you say it could be beneficial to get my health provider to give me an overnight sleep study?

Absolutely. Although this is turning into assumptions based on assumptions, if these periods are in fact REM, overall they are quite continuous and flow is actually increased throughout (up to that tiny snippet you posted):



A period of enlightenment follows REM periods, so the transition to Wake (instead of a Light NREM Stage) may not be totally unreasonable.

TS, to assume that it is an abrupt shift to Wake may not be correct either. Perhaps it's a shift to Light NREM, an open mouth now closes, there's a position change, whatever, and Wake occurs. There appears to be a subtle increase in MV there, but now this is really micro-obscessing.

If additional pressure is needed, it may be a much better plan to use bilevel (IPAP) to do that. 13 cmH2O is generally considered to be the upper limit of CPAP approach.

Lastly, there is some perplexation as to why you've lost 50 pounds and may be still having respiratory events. One would have thought 13 would be too much at this point.

Where's the MF sleep log?

[Jeffster]

deltadave wrote, "Where's the MF sleep log?"

Please explain, what is the MF sleep log? Is it a report generated in ResScan, or is something I should be hand writing upon waking up?

deltadave wrote, "Lastly, there is some perplexation as to why you've lost 50 pounds and may be still having respiratory events. One would have thought 13 would be too much at this point."
I agree on the weight loss question. I weigh 45 pounds less now than when I did my sleep study 9 years ago. My pressure was set at 13 at that time. So I had hoped to see more improvement in my current pressure needs. Lately my 95th Percentile pressure seems to run aroun=d the 14 mark.

I think I have another 25 pounds or so to lose to be a more ideal weight.

[Otter]

@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?

Look carefully at your data and see if there is a pressure below which the micro-apnea pattern does not appear.

Also check to see whether the machine is spending a significant amount of time at 16 cm h20. If it goes up to 16 and stays there, that means that the algorithm indicates there is a reason to increase pressure, but the setting does not allow it.

I do not have a chin strap to try. Do you use a chin strap and have one you like?

I don't have one yet. It's on my todo list though.

I could go look at cpap.com. or try eBay!

Secondwind is run by a good RT who is a CPAP user. They don't have a big selection, but I doubt they'd sell anything that was worthless. When I get a round tuit, my first step will be to call and ask Mark how to choose a chinstrap.
http://www.secondwindcpap.com/Accessories.html

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.

I'd start with the chinstrap simply because it's less hassle. It might not work for you, but they aren't very expensive, so why not try it? Also, there is a safety issue if you tape with a nasal mask.

With the FFM, slight leaking might not matter. In fact, it might be a good thing if you can open your mouth if your nose gets completely blocked. Maybe all you need is something to keep your mouth from hanging open when you are able to breathe through your nose.

[Otter]

Lastly, there is some perplexation as to why you've lost 50 pounds and may be still having respiratory events. One would have thought 13 would be too much at this point.

Not everyone who has OSA is overweight, and not everyone who is overweight has OSA. Excess fat may have never been a significant contributor to Jeff's apnea. And if obesity is not the problem, solving it won't make much difference, at least in regard to therapeutic pressure.

It would also make sense, though, to check and see if the machine spends the entire night at the minimum pressure.

[deltadave]

Lastly, there is some perplexation as to why you've lost 50 pounds and may be still having respiratory events. One would have thought 13 would be too much at this point.

Not everyone who has OSA is overweight, and not everyone who is overweight has OSA. Excess fat may have never been a significant contributor to Jeff's apnea. And if obesity is not the problem, solving it won't make much difference, at least in regard to therapeutic pressure.

If Jeff is projecting that he needs a 70 pound weight loss to attain (a "more") ideal weight, unless he's 8' 9", obesity is (was) a problem.

Weight loss in moderately to severely overweight middle-aged males (hey, 60 is the new 40) should produce dose-related improvement in OSA.

Recent studies:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978357/

http://www.bmj.com/content/342/bmj.d3017

While OSA may worsen purely as a function of age, if Jeff was correctly titrated 9 years ago, "IMHO", REM-related FLs at this point are unexpected.

Assuming that's REM.

And assuming he was correctly titrated 9 years ago.

[deltadave]

Please explain, what is the MF sleep log? Is it a report generated in ResScan, or is something I should be hand writing upon waking up?

The latter.

Use this:

http://yoursleep.aasmnet.org/pdf/sleepdiary.pdf

[Jay Aitchsee]

jeff for a quick temporary chin strap, try taking about a 10" piece of 1" surgical (paper) tape and run it from just in front of one ear diagonally down below the front of your chin and back up to in front of the other ear. Or, take the leg of a women's nylon and use it to fashinon a chin strap tied above the head.

I kind of like the "halo" chin strap by breathewear.

Now back to the more important stuff...
Jay

[Jeffster]

Thanks Otter, deltadave, and Jay for the additional help and info. The last two nights I tried taping my mouth shut. The first night I broke the seal somewhere early on, but the second night the tape held all night.

On the second night I only remember two wake ups before finally getting up around 7:20 AM. The first wake up, I still felt very sleepy and fell back off soon without looking at the clock. The second wake up was what I call "the big wake up" where I lay in bed for while without falling back off. That was 4:25 AM when I looked at the clock, then by about 4:50 AM I looked again, and decided to take a 25 mg generic Benadryl. That was interesting, getting the mask undone and then peeling the tape back from the right corner of my mouth to put a pill in there, and then my water mug straw to wash it down. I did get the tape to seal back up OK at the right corner. And sometime later I did fall back to sleep. The good thing with the tape is no dry mouth at my wake ups. Another good thing is I had excellent AHI reading of just .1 - it was one hypopnea around 2 AM. The leak rate was 1.2 L/min median, 10.8 L/min at the 95th percentile, and 16.8 max. Pressure stayed a little lower, just getting to 13.5 at the 95th percentile with a max of 13.8, so maybe having the mouth taped shut improved this? I should note, my numbers are not always as good as my chart I first posted, nor last night's readings, but what strikes me as noteworthy is that even when the numbers are this good, I still get a big wake up, so as noted earlier, the waking up thing may be independent of my sleep apnea and therapy.

As usual when having the wake ups, I was laying comfortably on my right side, having a vivid dream. I felt OK, except for being awake.

Shortly after the 4:25 AM wake up I did turn the S9 off and then back on again as a marker for that time. I looked at the ResScan charts this morning and they look similar to the ones I posted here.

Well, I just wanted to give an update, and say thanks again for the help. Having only two wake ups that I remember seems like an improvement to me, but still having a "big wake up" from which it is difficult to fall back to sleep is of course something I wish I could be done with. Maybe I'm just stuck with it as part of my sleep pattern. It's been with me a long time. I hope to stay ahead of it so the sleep deprivation doesn't build up too much. Again, thanks to all who posted here.

[Jay Aitchsee]

Jeffster, I don't have any good news for you, but I do want to share that others like myself share your condition. I have struggled with non-restorative sleep, multiple wake ups, and waking early (the big wake) for years. When I was younger, it wasn't much of a problem. I would just get up, drink coffee, smoke cigarettes and go off to work. As I got older, I found that I had more and more difficulty coping; fatigue, lack of concentration, depression, etc. I finally found my way to a psg and was diagnosed with moderate to severe apnea and severe PLMD. I was given a cpap and nasal pillows, was non-compliant, went through all the self learning stages that one has to with this affliction. One day I discovered I could get some data from my S8 elite. Man, was I excited and mad that no professional had bothered to tell me that data was available short of going for another PSG, of which I've had three. Anyway, since that day (about a year ago) I've worked hard at getting my respiratory events under control. I've fired and hired a number of sleep docs and become 100% compliant with an AHI around 3 and an AI about 0.5. Problem is, I still don't obtain restorative sleep. According to my PSG's and Zeo I only get about 7 minutes of deep sleep a night. I go from stage 2 right to REM, to wake, to stage 2 throughout the night.

Now here's the thing, I don't feel unsuccessful. I'm fairly certain I started with more than one problem. Afterall, I was diagnosed with severe PLMD as well as OSA. Unfortunately, treatment for PLMD came at time when I was non-compliant. CPAP didn't help, drugs didn't help, I still felt lousy in the morning. I quickly gave up on both. But now that I have my apnea under control, I feel I can tackle whatever else is keeping me from getting to deep, restorative sleep.

That's a little harder, though. Abnormal sleep architecture or fractured sleep does not seem to have a common cause or treatment. Just as an aside, I read a study which seemed to indicate that abstinate alchoholics (me) have abnormal sleep architecture for years after their last drink. Unfortunately, no treatment was suggested. Anyway, my plan is now to continue to try different drug therapies for the PLMD, one at a time, til I find the one that works. I have put together a little mini sleep lab at home with my ResScan, Pulse-Ox, IR video, and Zeo to help me objectively determine what's working and what isn't. I have determined that a new drug, Horizent, does not work for me. It decreased my deep sleep and increased my wakings. I am now starting at the beginning with ropinirole, which I took years ago but didn't give a fair chance.

So, I guess this is kind of a pep-talk. Don't get discouraged. It sounds as if you're really getting a handle on your AHI. Keep that up until you can rule it out as a disruptive issue and look to the next thing. Be careful with the drugs, I would research each, even the benadryl, and make sure it contributes to deep sleep, or at least, doesn't prevent it, and keep them to a minimum so that results aren't concealed unintentionally.

Hang in there!
Jay

P.S. See this guy's opinion on benadryl: http://www.askdrjones.com/blog/take-2-b ... e-morning/
BTW, My blood pressure has dropped significantly since I've been compliant. 145/80 to 120/70

[Jeffster]

Jay, thank you for the pep talk! It is most appreciated as this night is winding down here in SoCal, 9:29 PM, and I'll be getting off the computer soon to give an hour or so without the screen light before lights out, and hoping as many of us do here for a good night's sleep.

FWIW, last night I fell off to sleep fairly quickly, but within 15 minutes or so something woke me up; that''s unusual for me, to have a wake up then, but what I realized seemed even more unusual, that I had already been dreaming, and it was a vivid one! I let it go, relaxed and soon fell off again, but the memory of it stayed with me. How strange it seemed to me to go off into a dream state so soon after falling asleep. I've read other people here write about that happening to them, but it felt odd and yet somewhat thrilling in a way to have it happen to me.

So you're missing stages 1 and 3 of sleep, and although you get REM sleep, since you're missing the other two stages, the sleep is not restorative enough? Actually, I've read some other folks say here that we can dream in all stages of sleep. And that must be what happened to me last night, unless I jumped right into REM (not likely, I'd guess).

I gave up alcohol back in mid January 1990. And I finally gave up coffee at the beginning of April this year, even though I was only having one big mug of it in the morning. I pretty much just drink ice water all day long, with a little bit of milk at two of my 3 main meals.

That Dr. Jones link about benadryl was interesting. It is effective for me, although that could be placebo effect. I do get a hangover from it, like today. Another reason why I wish the big wake up would stop happening.

I'll wrap up for now saying I wish you all the best in your therapy, Jay!

[Otter]

Lastly, there is some perplexation as to why you've lost 50 pounds and may be still having respiratory events. One would have thought 13 would be too much at this point.

Not everyone who has OSA is overweight, and not everyone who is overweight has OSA. Excess fat may have never been a significant contributor to Jeff's apnea. And if obesity is not the problem, solving it won't make much difference, at least in regard to therapeutic pressure.

If Jeff is projecting that he needs a 70 pound weight loss to attain (a "more") ideal weight, unless he's 8' 9", obesity is (was) a problem.

Weight loss in moderately to severely overweight middle-aged males (hey, 60 is the new 40) should produce dose-related improvement in OSA.

Recent studies:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978357/

http://www.bmj.com/content/342/bmj.d3017

While OSA may worsen purely as a function of age, if Jeff was correctly titrated 9 years ago, "IMHO", REM-related FLs at this point are unexpected.

Assuming that's REM.

And assuming he was correctly titrated 9 years ago.

I'm not saying that obesity is not a problem, I'm saying that it might not be the cause of Jeff's apnea, and hence, losing weight might not make the apnea go away, or even make it better.

Neither of the abstracts you linked indicate that every person who looses weight sees improvement in their OSA. And we've had a few posters on this board who lost significant weight without being able to reduce their pressure. While I'm sure weight loss helps a lot of folks with OSA, and in any large, randomly selected group, weight loss will lower the mean AHI, that does not mean that every single person who looses weight will have a lower AHI or need less pressure. OSA has multiple causes. Obesity is only one of them. And obesity does not always cause OSA. Hence there are a few people for whom gaining or loosing weight will make little difference, at least to therapeutic pressure.

I do agree that the results from one or two nights in a lab nine years ago shouldn't be treated as everlastingly accurate titration by the gods, though.

[deltadave]

Neither of the abstracts you linked ...

Whoops!

The first is Full Text, here's the other:

http://www.bmj.com/content/342/bmj.d3017.full

And we've had a few posters on this board who lost significant weight without being able to reduce their pressure.

Can you point me to those people?

[Otter]

Neither of the abstracts you linked ...

Whoops!

The first is Full Text, here's the other:

http://www.bmj.com/content/342/bmj.d3017.full

If you look carefully at this graph, you can pick out a five participants whose AHI stayed the same or went up slightly as their weight went down. Or perhaps their AHI went down as they gained weight. Obviously that's not typical, but it's not impossible either. Five out of 63 is about 8%.
http://www.bmj.com/content/342/bmj.d3017/F5.large.jpg

And we've had a few posters on this board who lost significant weight without being able to reduce their pressure.

Can you point me to those people?

There was a thread a week or three ago. I'll try to dig it up later, but no promises. If you're strongly interested, you could start your own thread on the topic.

[deltadave]

If you look carefully at this graph, you can pick out a five participants whose AHI stayed the same or went up slightly as their weight went down. Or perhaps their AHI went down as they gained weight. Obviously that's not typical, but it's not impossible either. Five out of 63 is about 8%.

This is not contrary to my original points, that Jeff's persisent "REM" (because it might not be REM, either) -related FLs are "unexpected" with his ~22 kg weight loss (which is also basically double that of the outliers).

More important is the point that weight loss as a rule will result in improvement in SBD (as well as overall health), and while I do not ignore outliers from a scientific point of view, I prefer to concentrate on the more positive aspects that it may encourage members to fully pursue that avenue, rather that focusing on "Well see, it didn't help him, so why should I do it!?"

And we've had a few posters on this board who lost significant weight without being able to reduce their pressure.

Can you point me to those people?

There was a thread a week or three ago. I'll try to dig it up later, but no promises. If you're strongly interested, you could start your own thread on the topic.

I am strongly interested, but this thread is fine, thanks.

[deltadave]

BTW, I am not ready to concede that the outliers are, in fact, outliers.

Microanalysis of the NPSGs may show improvement such as conversion of some apneas to hypopneas (maintaining AHI) and/or improvement in oxygenation parameters (this would be an extremely noteworthy accomplishment).

While the device used (WatchPAT) does not actually measure flow, side-by-side comparison would still reveal some of this data.