Lowest AHI (success) and REM question

I have been trying to eliminate the use of Klonopin. Went from 2 mg down to 3/4 and then started having issues. I was cutting the dosage by 1/4 mg each month, so that wasn't the issue.

In the meantime, I have seen a VA psych doctor two weeks ago. She wasn't especially keen about Klonopin and agreed that I should try to get off. She started me on a regimen of 50 mg of Trazodone.

Had the best night sleep I've had since I first got diagnosed. Plan is to completely eliminate the Klononpin. Over the next three months.

I typically had been running an AHI of 1.5 with hypopnea events being the issue, even when I was running an AHI over 10.

Last night my AHI was 0.3. It has never been that low!!

Now. I have been wondering about REM sleep and what has been going on. Just because I'm sleeping I'm not necessarily going into REM sleep.

Is there anything that I can look at with the Sleepyhead data to determine how much REM sleep I'm getting in a night?

Thanks.

Download reports to Imgur.com, size appropriately and leave a link to that in this thread so we can see what's what.

Dogjudge wrote:I have been trying to eliminate the use of Klonopin. Went from 2 mg down to 3/4 and then started having issues. I was cutting the dosage by 1/4 mg each month, so that wasn't the issue.

In the meantime, I have seen a VA psych doctor two weeks ago. She wasn't especially keen about Klonopin and agreed that I should try to get off. She started me on a regimen of 50 mg of Trazodone.

Had the best night sleep I've had since I first got diagnosed. Plan is to completely eliminate the Klononpin. Over the next three months.

I typically had been running an AHI of 1.5 with hypopnea events being the issue, even when I was running an AHI over 10.

Last night my AHI was 0.3. It has never been that low!!

Now. I have been wondering about REM sleep and what has been going on. Just because I'm sleeping I'm not necessarily going into REM sleep.

Is there anything that I can look at with the Sleepyhead data to determine how much REM sleep I'm getting in a night?

Thanks.

You can dream in any sleep stage, so trying to identify REM stage sleep from reports is essentially futile.
The closest you could possibly come is looking for "events" that are about 90 - 120 minutes apart (that's the approximate time frame for sleep stage cycles). But, that still doesn't mean they're REM-related. The only way that true REM activity could be detected is in an in-lab sleep study with the wires attached.
When dreams are remembered, typically the person is in a lighter sleep stage or in the process of waking up. So, proclaiming "I remembered my dreams, therefore I was in REM." is not reliable.


Den

.

Wulfman... wrote:

Dogjudge wrote:I have been trying to eliminate the use of Klonopin. Went from 2 mg down to 3/4 and then started having issues. I was cutting the dosage by 1/4 mg each month, so that wasn't the issue.

In the meantime, I have seen a VA psych doctor two weeks ago. She wasn't especially keen about Klonopin and agreed that I should try to get off. She started me on a regimen of 50 mg of Trazodone.

Had the best night sleep I've had since I first got diagnosed. Plan is to completely eliminate the Klononpin. Over the next three months.

I typically had been running an AHI of 1.5 with hypopnea events being the issue, even when I was running an AHI over 10.

Last night my AHI was 0.3. It has never been that low!!

Now. I have been wondering about REM sleep and what has been going on. Just because I'm sleeping I'm not necessarily going into REM sleep.

Is there anything that I can look at with the Sleepyhead data to determine how much REM sleep I'm getting in a night?

Thanks.

You can dream in any sleep stage, so trying to identify REM stage sleep from reports is essentially futile.
The closest you could possibly come is looking for "events" that are about 90 - 120 minutes apart (that's the approximate time frame for sleep stage cycles). But, that still doesn't mean they're REM-related. The only way that true REM activity could be detected is in an in-lab sleep study with the wires attached.
When dreams are remembered, typically the person is in a lighter sleep stage or in the process of waking up. So, proclaiming "I remembered my dreams, therefore I was in REM." is not reliable.


Den

.

Thanks. I'm apparently using the wrong terminology. I was thinking that there are different stages of sleep and that you could sleep through the night, but you still weren't getting "restful" sleep.

Here's the image from last night.

Dogjudge.
Here's a hypnogram (graph of sleep stages) Pugsy put up a while back. It shows how one moves through the various stages of sleep thru the night in roughly 90 minute cycles. Typically, more slow wave sleep (N3) occurs early in the night and more REM occurs later. Normal is about 10-15% Slow Wave and 20-25% REM.
The answer to your question is yes, it is possible to sleep through the night and not feel rested which could result from abnormal sleep architecture as shown by an abnormal hypnogram. However, the only way to know for sure what your sleep architecture looks like is by an EEG. Many things can cause abnormal sleep architecture. Drugs and pain are two common causes, but there are a myriad more.

Dogjudge wrote:Here's the image from last night.

I would say your minimum pressure is too low.
The Flow Limitations are mainly what's driving your pressures (along with a few snores).
But, overall, your AHI is pretty good. On the other hand, if the pressure increases are bumping you out of your needed sleep stages, you're spending more time in lighter sleep stages.


Den

.

Den,

I bump it up 0.5 and see what happens.

Thanks.

I thought respiration rate was a decent proxy for REM sleep? When I look at most of my nights, I have periods of much quicker and more variable respiration that occur with increasing frequency as the night goes on, and I had been assuming those were my REM sleep. They certainly follow the pattern that Jay just posted.

(Maybe respiration is a decent indicator of REM when things are working properly, but could mean entirely different things if the sleep system is NOT working properly.)

Dogjudge wrote:Den,

I bump it up 0.5 and see what happens.

Thanks.

OK. I think you may need to work your way up to about 8 cm., but you can evaluate that along the way.


Den

.

Changing your pressure by 1-2 cm at a time is no big deal unless it's very high to begin with.

Just curious - any chance you sleep in such a way that your head falls forward cutting off your airway somewhat (or a lot)?

If so, have you ever tried a soft cervical collar that would keep your head up, airway more open and (if it applies) mouth more closed?

Julie wrote:Changing your pressure by 1-2 cm at a time is no big deal unless it's very high to begin with.

Just curious - any chance you sleep in such a way that your head falls forward cutting off your airway somewhat (or a lot)?

If so, have you ever tried a soft cervical collar that would keep your head up, airway more open and (if it applies) mouth more closed?

Sleep on my side. I use one of the pillows that are made from some type of husks or seeds (can't remember the plant). So, my head dropping down isn't a problem. I've never slept with my mouth open, unless I have a very bad head cold.

Dogjudge wrote: Now. I have been wondering about REM sleep and what has been going on. Just because I'm sleeping I'm not necessarily going into REM sleep.

Is there anything that I can look at with the Sleepyhead data to determine how much REM sleep I'm getting in a night?

The short answer is no. Your CPAP does not have an EEG and it cannot determine when you are in REM. But there can be some hints that indicate you may have been in a REM cycle.

Morchella wrote:I thought respiration rate was a decent proxy for REM sleep? When I look at most of my nights, I have periods of much quicker and more variable respiration that occur with increasing frequency as the night goes on, and I had been assuming those were my REM sleep. They certainly follow the pattern that Jay just posted.

For some people the respiration rate can be a decent enough proxy for REM, but it's not definitive and it takes practice to figure out how to read your particular data.

Morchella wrote:(Maybe respiration is a decent indicator of REM when things are working properly, but could mean entirely different things if the sleep system is NOT working properly.)

Exactly. If the sleep is troubled and you're not getting a lot of full, complete sleep cycles for some reason, variability in RR might not be tied to REM at sleep. There are a lot of things that can show up as more variability in the respiration rate. One of them is likely spontaneous arousals. However likely spontaneous arousals are usually very short changes in the RR as well as the tidal volume. (Likely spontaneous arousals are usually easier for me to pick out directly from the zoomed-in flow rate.)

Wulfman... wrote: I would say your minimum pressure is too low.
The Flow Limitations are mainly what's driving your pressures (along with a few snores).

Nope. I don't think FL are the major culprit here.

I've taken the time to add a couple of boxes to Dogjudge's data:



In the Blue Box, VS snores and FL combined with the PR Search algorithm increase the baseline pressure from to 8 or 8.5 cm.

But the big increase in pressure inside the RED box is due to nothing except for the PR search algorithm that's active at the beginning of the red box. A few isolated VS snores and FLs along with a RERA prevent the machine from lowering the pressure back down from where the search algorithm decided it needed to be. Moreover, there is also some evidence that this rather steep increase in pressure may also have contributed to a largish leak, albeit a leak that is still below official Large Leak territory.

Personally, if this were MY data, I'd be thinking about lowering the max pressure down from 11.5 to about 9cm because there is absolutely no hard data that justifies that huge pressure increase at the beginning of the red box. Then again, I'm very, very sensitive to too much pressure.

Still my advice to Dogjudge is this:

If you have no trouble getting to sleep with the min pressure set at 6.5, I'd leave the min pressure alone. I don't think increasing the pressure is going to really do anything to clean up your already very good data. If you are "air hungry" when you are trying to get to sleep, then bumping the pressure up to 7 might be reasonable.

If you don't have any problems with aerophagia and the leak that happened when the pressure was up around your current max of 11.5 didn't wake you up, I'd also think twice before changing the max pressure. If you do have problems with aerophagia OR if leaks tend to wake you up, I'd seriously think about lowering the max pressure down to 10cm to see if the data stays about the same or not. If it stays the same, I'd keep the max pressure capped at a lower level. If the data deteriorates with a smaller max pressure, then you can always bump it back up.