Sleep with Itamar Watchpat 200 tonight

Who is saying this, if the Doc is saying it then where are the specs for the CPAP?

Conclusion: CPAP works well for OSAS, but sleep fragmentation makes sleep quality bad and could explain the insomnia complaints and daily fatigue. Need to have form of psychophysiology treatment for insomnia for a patient with co-morbidity. Patient is advised to follow a course on Cognitive Behavioral Therapy for Insomnia. Expect the treatment to have good result after 6 months because the patient also has co-morbidity. Patient is invited to come back after 3 months for further check.

Also, what are your co-morbidities and why the Doc does not specify them?


_________________

avi123 wrote:Who is saying this, if the Doc is saying it then where are the specs for the CPAP?

Why do we need CPAP specs ?

papzombie wrote:

avi123 wrote:Who is saying this, if the Doc is saying it then where are the specs for the CPAP?

Why do we need CPAP specs ?

Reply,

Your first post above shows Additional Comments: CPAP pressure 9 H2O, Machine = PR System One REMstar Pro CPAP Machine with C-Flex Plus

Did you buy the Remstar machine without a prescription?

Question:

Are you interested to correspond with Dr Peretz Lavie who was a co-inventor of the Watch PAT system (he did it in the U.S.) ?

Read here about him:

https://en.wikipedia.org/wiki/Peretz_Lavie

The Technion was my alma matter.

I dont understand why you mention CPAP spec here. But thanks for the link to the PAT inventor. I have read it with great interest

papzombie wrote:@Robysue: thanks for the tip about zooming out and find the pattern for UARS.

So I receive the doctor's full report today:
- 16 wake-ups in 6h30min sleeping in 8h30min wearing the device (on bed).
- Percentage wake/sleep: wake 23.35%, sleep 67.65%. Actually I was woken up by my children 3 times at night, and stayed awake because of them for about 50 min. So the real percentage of wake / sleep when I sleep alone is: wake 1h10min / sleep 6h30 = 15% / 85%.
- Percentage REM-Deep-Ligh while sleeping: REM = 16%, Deep = 27%, Light = 57%. A healthy adult should have 25% REM, 30% Deep (N3 phase) and 55% Light (N1 and N2 phases), as observed by https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4246141/

<images deleted but you can find them at http://i.imgur.com/ijPkMtw.png and http://i.imgur.com/mTgpwWy.png>

What the doctor writes:

- Respiratory arousal index = 0.9, AHI = 0.8, back sleeping 100%, low snore index. Spontaneous arousal index = 4-5 with a lot of awakenings.
- Conclusion (by the doctor): CPAP works well for OSAS, but sleep fragmentation makes sleep quality bad and could explain the insomnia complaints and daily fatigue. Need to have form of psychophysiology treatment for insomnia for a patient with co-morbidity. Patient is advised to follow a course on Cognitive Behavioral Therapy for Insomnia. Expect the treatment to have good result after 6 months because the patient also has co-morbidity. Patient is invited to come back after 3 months for further check.

papzombie,

Just to clarify things: These are the WatchPAT results from a night in your OWN bed while USING your current PR DreamStation CPAP PRO at its current SETTING of 9cm. Is that correct?

Next: I agree with the doc's conclusion: The current CPAP therapy is working well to keep the OSA under control, but you still have a lot of spontaneous awakenings and sleep fragmentation. In other words, the doc is saying that you have a problem with sleep continuity, or in other words, you've got sleep maintenance insomina. Hence the recommendation for CBT-I.

He's also giving a very realistic time line: It may take six months of CBT-I to see real improvement (it did take that long for me), and he'd like to see you back three months after you start the CBT-I to see if you are making progress towards getting better sleep.

So I receive the doctor's full report today:
- 16 wake-ups in 6h30min sleeping in 8h30min wearing the device (on bed).
- Percentage wake/sleep: wake 23.35%, sleep 67.65%. Actually I was woken up by my children 3 times at night, and stayed awake because of them for about 50 min. So the real percentage of wake / sleep when I sleep alone is: wake 1h10min / sleep 6h30 = 15% / 85%.

I don't think trying to figure out a "real percentage of wake / sleep when I sleep alone" ratio. Yes, this may be a bad night in terms of the kids, but if the kids are responsible for waking you up on a regular basis and keeping you up for extended periods of time, then that factors into your overall sleep problems. How old are the kids? Hopefully they will need you less at night as they grow older.

At any rate, even if it makes sense to recalculate the sleep efficiency to try to take out the kid stuff out of the data, a sleep efficiency of 85% is "marginally ok"---i.e. a sleep doc might not think that is low enough to worry about. But some people don't really feel like they've slept well until their sleep efficiency is up around 90% AND they're consistently getting at least 7 hours of sleep a night. And there's still the issue of sleep fragmentation: It looks to me like you are not getting any full sleep cycles in between the wakes, and that's an issue. You would feel better if you were getting more full sleep cycles in between the wakes.

So I think you should follow the sleep doc's recommendation to do some CBT-I designed for your particular insomnia pattern.

Hi Robysue,

That's correct, with one correction of the machine: "These are the WatchPAT-200 results from a night in your OWN bed while USING your current Philips Remstar Pro System one with C-Flex+ at its current SETTING of 9cm"

One question: so what's the biggest problem in my sleep pattern on that night: the fact that I don't get enough sleep cycle, of my REM percentage is low (15% instead of normally ~25%), or my awakening per hour is too much, or the percentage of time being awake (due to the awakenings) is to high ?

Thanks

papzombie wrote: One question: so what's the biggest problem in my sleep pattern on that night: the fact that I don't get enough sleep cycle, of my REM percentage is low (15% instead of normally ~25%), or my awakening per hour is too much, or the percentage of time being awake (due to the awakenings) is to high ?
Thanks

I think the single biggest problem is that it doesn't look like you got a single 90+ minute stretch of sleep without at least one wake.

It looks to me like you got four somewhat fractured sleep cycles in---between the wakes caused by the kids and the wakes caused by whatever else. And I suspect that the major reason the REM is low is that you didn't really get a full fourth sleep cycle in at all AND third one was interrupted by a long wake (associated with the kids?) AND the fourth sleep cycle ended (possibly prematurely) before you got into REM. REM sleep usually increases as the night goes on and Stage 3 usually decreases. But your longest bit of Stage 3 is during your last sleep cycle and your first sleep cycle has no Stage 3 and is interrupted several times by short wakes.

In other words, I think its really tough to figure out how much of "what went wrong" on this night is due to the kids waking you and keeping you awake vs how much of it is bad sleep architecture due to sleep maintenance insomnia.

How often do the kids wake you up? Every night? Most nights? Or only on a few nights?

And how often do the kids keep you awake for extended periods of time during the night? Most nights? Or only on a few nights?

And how old are the kids?

Hi Robysue,

I have looked at my sleep log, and here is the marking of the event

Among the 14 awakenings during sleep of that night, 4 were caused by my children, in this picture I mark two event
- Child 2: a child of 2 years old
- Child 5: a child of 5 years old

The total awake time due to the children is about 35 min, so my true awakening due to myself is about 1h25 min during the 8h30 min sleeping , which is 82% sleep efficiency

http://imgur.com/uoGvww8.png


For your question: do they wake me up often: yes, about 3-5 times per night.
- During that night doing the PSF I slept alone, let the children sleep in their room, but they cry when they don't see me, so I need to come to care for them for a short while until they fall back to sleep.
- Normally I sleep with a child of 2 year old, he wakes me up also 3-5 times per night.

For the next PSG or a video of myself, I need to ask my partner to take care of the children to see how many times per night I do wake up by myself.

But, now I think that perhaps my awakenings are not too much a big deal, and they alone must not be the only reason why I always feel bad in the whole morning and tired in the early evening. I would need to do a video at home, a PSG in a hospital, together with other stuff (blood check for magnesium, ferritin, ....)

Thanks

papzombie wrote: For your question: do they wake me up often: yes, about 3-5 times per night.
- During that night doing the PSF I slept alone, let the children sleep in their room, but they cry when they don't see me, so I need to come to care for them for a short while until they fall back to sleep.
- Normally I sleep with a child of 2 year old, he wakes me up also 3-5 times per night.

If your 2 year old wakes you up 3-5 times every night and those wakes are as extended as they were on the night for the WatchPAT, I think that's the most logical explanation for why you are still tired. If you and the child are waking up that many times every night, then its likely that you are not getting even one or two full sleep cycles in between the wakes. And it's also possible that your child's sleep is just as fragmented as yours is during the time both of you are in the bed and s/he is waking you up this frequently.

And since your 2=year old is waking you up 3-5 times every night, then a really good question that should be asked is why does your 2-year old wake up this often? By the time a child is 2, he or she should be sleeping through the night and/or capable of getting themselves back to sleep after a random wake for no reason. Although it's often true that a lot of 2-year olds do have problems with night time fears (when they do awaken) and some have problems with nightmares.

Also how old are the children who don't sleep in your bed? Do they wake you up almost every single night? Multiple times? And why do they cry for you? Once children are getting to be 4 or 5 years old, they really should not be waking up needing a parent's attention every night. Does

For the next PSG or a video of myself, I need to ask my partner to take care of the children to see how many times per night I do wake up by myself.

Yes. But it's a shame that you did not do this on the night of the WatchPAT test. It's also possible that one thing you might need to do is to ask your partner if you can take turns taking care of the children at night---as in ask your partner to deal with the children's night time wakes for 3 days a week.

But, now I think that perhaps my awakenings are not too much a big deal, and they alone must not be the only reason why I always feel bad in the whole morning and tired in the early evening. I would need to do a video at home, a PSG in a hospital, together with other stuff (blood check for magnesium, ferritin, ....)

Personally I think you are grasping at straws in an effort to avoid facing the reality that the fact that main reason your sleep is badly fragmented is most likely your children's inability to sleep through the night. Most parents are sleep deprived until their children are sleeping through the night, and many parents are exhausted during the daytime when their children are still too young to sleep soundly through the entire night.[/i] And before a child is old enough to sleep through the night, there's not much anybody can do to to fix the parents' fatigue. But by a time most children are 2 or 3 years old, they are sleeping through the night without the need of a parent's comforting during the night.

So in my humble opinion, you need to be addressing your children's sleep problems as well. It starts with taking a good hard look at your children's sleep patterns and figuring out why they still need to see you when they wake up at night. If the major reason they need your comfort at night is simply because they're afraid of the dark, you might want to just let them sleep with a light on all night. You might also want to look at their nap schedule. And if the oldest of the children are in school, you might also want to tease out whether there is something going on at school that is leading to anxiety. Finally if any of the children are excessively sleepy during the day compared to other kids their age, you might want to consider whether one or more of the children might have sleep apnea.

Hi Robysue,

Thanks for spending time with me.

This post is only about how I deal with my kids, so probably after writing down I might have some discipline to start doing something. Readers might want to skip this as this is not about CPAP at all .

The night doing the PSG, my partner was unfortunately not home. I let the 2 kids sleeping in their room, and I slept alone.

When my partner is home I sleep with the 2-y.o. child, and she sleeps with the 5 y.o. child.

1) Currently:
- The 2-y.o. child wakes up 3-5 times per night (that I can remember), he changes his position during the night and many times he wants to lie on my left hand if he wakes up and finds that he is not lying on my left hand.

- The 5-y.o. child wakes up 1 time per night, and if they probably wants to touch the parent's ear (he likes to fondle our ear to seek for sleep).

2) If we don't sleep with the kids
- The 2-y.o. child would cry a bit when he wakes up and does not find the pacifier --> actually I could find the way to fix the pacifier to something, or to train this kid to sleep without the pacifier
- The 5-y.o. child would cry if he wakes up (1 - 2 time per night) and finds that he sleeps alone. I heard that letting light on is not good for the kid (some chemicals are not generated under the light). He has been having this habit since 3-4 years, has been to the daycare since he was 4 month, and now at school since 1 year.

3) We do admit that we don't know the optimal way to deal with the kid. About sleeping we have to lie down with them (especially the 2-y.o. kid) to let him sleep.

We have many times tried sitting next to him, hold his hand while he lies in his bed, but we do face two problems
- My wife cannot let this guy sleep: he has too much energy and upon seeing that his mother is there would continue jumping around, is very active up to 1 hour after the supposed sleep time. My wife is also tired after a working day and cannot afford that stress caused by this kid.
- I am often very tired starting from 20:00, the time I let this 2-y.o. sleep. So it would cost me too much energy to sooth him if I don't lie down next to him and let he lie on my hand. Imagine I would have two options. Option 1 is to sit next to him and hold his hand while he is in his bed, during this time I would read my phone and that makes me also very tired as I have the tendency to read any kind of crappy news on facebook and online newspaper just to avoid the void and tiredness in me. Option 2 is to train him by letting he cry a bit, then come and sooth him a bit and go away for a while, but this guy can cry upto the point he vomits, which would cost me extra energy to clean things up. At around 20:00 I am often already tired and I like to lie down as well.

I know there is something missing in my educating the kid and setting rythm to myself, but I don't know a better way.

PS: None of the kids are sleepy during the day. The 2-y.o. is always very active the whole day, and the 5-y.o. is quieter, but only complain about tiredness around 19:30-20:00 (he does not sleep after lunch, and wakes up at 7:00 AM). So I don't think of children OSA.

Thanks

papzombie,

I have real sympathy for you in dealing with the kids sleep problems.

Our oldest (daughter) was a night owl from the time she was born---the fact that she gave up her 6:00AM feeding before she gave up her 3:00AM feeding was an early hint. And she was extremely frightened of the dark as well. My son was not as much of a problem. Both of them, however, loathed bedtime and getting them to bed when they were in preschool was a problem at times.

papzombie wrote:I heard that letting light on is not good for the kid (some chemicals are not generated under the light).

Yeah. The chemical is melatonin. But here's the thing: It's not going to kill your kid if s/he sleeps in his/her room with the light on if that's the kid's preference. It may change their circadian rhythm a bit, but if sleeping with a light allows the kid to get themselves to sleep in his/her room and helps s/he get back to sleep without needing your assistance, then it may be an overall plus for everybody to just leave the light on for the kid. In other words, if waking up alone in the dark in his/her own room is the problem, then it's worth seeing if leaving the light in the kid's room on helps fix the problem.

As I said, my daughter was really frightened of the dark when she was young. And she was a pretty severe night owl from the time she was an infant. I had a 50 minute commute to work at the time and was frequently teaching classes that started at 8:00 or 9:00am, so my own sleep was on a much earlier schedule than it is now. By the time my daughter was about 2, my hubby and I would put daughter to bed (in her room) with her stuffed toys and her picture books and the light on around the time I needed to get to bed and we would tell her: You can stay up and play with your stuffed toys and look at your books for as long you want to, but you have to stay in your own bed and you can't expect us to come in just because you're lonely. She usually would look at her books and "read" them to her stuffed toys for 20 minutes or more at the beginning of the night before she fell asleep. If she woke up, she learned to get herself back to sleep by "reading" her books to the stuffed toys rather than crying for us. By the time she was about 8 or 9 she finally started turning the light out *sometimes* when she went to bed, but she still took books to bed with her. By the time she was a teenager, she had gotten to where she remembered to turn the light off most of the time, but she still took books to bed with her. She's now in her late 20s and sleeps well in the dark most nights, but even now she can sleep just fine with a lot of light in the room as long as she's got books in her bed. (And yes, she still sleeps with books in her bed.)


You also write:

2) If we don't sleep with the kids
- The 2-y.o. child would cry a bit when he wakes up and does not find the pacifier --> actually I could find the way to fix the pacifier to something, or to train this kid to sleep without the pacifier

Our kids were really attached to their pacifiers when they were 0-10 months old, but both of them gave the pacifier up around 10 months on their own. I do remember that we loaded up the crib with lots of pacifiers (as in about 6-8 of them) when each of them was still sleeping with a pacifier in their mouth in the hopes that if the kid woke without a pacifier, that s/he would be able to find one before starting to cry. I think it worked at least part of the time by the time they were around 6 months old or so. But there is a big difference between a 6 month old's attachment to a pacifier and a 2 year old's: The 6 month old is not likely to be able to tell which pacifier s/he found, and any pacifier of the same basic type is likely to satisfy them, but a 2 year old can tell the difference between pacifiers and s/he may want only their one, preferred pacifier.

3) We do admit that we don't know the optimal way to deal with the kid. About sleeping we have to lie down with them (especially the 2-y.o. kid) to let him sleep.

A regular bed time routine can help. My hubby and I were not great at doing routines, but we did find that more we could stick with a meaningful routine, the easier bedtime was. The trick seems to be that the bedtime routine has to start well before the kid is actually getting sleepy or tired---it's easy for young children to get over tired and that can key them up and make it harder for kid to fall asleep on their own.

Both our kids loved being read to from the time they were about 1 year old through about age 8 or 9. So the biggest part of our bedtime routine was to have plenty of story time on the living room couch. We often would read to them for a full hour before putting them to bed. Since our kids hated baths, bath time was NOT part of our bedtime routine---taking a bath really keyed them up and it was harder to get them to sleep after fighting at bath time. So we always tried to get baths in early in the evening and well before the kids' bedtimes. But a lot of kids like baths and find them relaxing. So if your kids like baths, incorporate that into the bedtime routine. A lot of parents try to make "picking up the toys" or some other small chore part of the bedtime routine. In our house that failed miserably since it resulted in the kids getting stubborn about it and the nagging/fussying about it wound up winding both me and the kids up even more, and made it harder for all of us to get to sleep.

We have many times tried sitting next to him, hold his hand while he lies in his bed, but we do face two problems
- My wife cannot let this guy sleep: he has too much energy and upon seeing that his mother is there would continue jumping around, is very active up to 1 hour after the supposed sleep time. My wife is also tired after a working day and cannot afford that stress caused by this kid.

As I said before, after our daughter was potty trained we had to use the rule, "You can stay up in your own bed playing with your stuffed toys and your books as long as you want to, but you cannot get out of bed and bother us after bedtime." If she called out or started to cry after we went to bed, we would call out to her and tell her: "If you need to go to the bathroom, you can do that without us. Otherwise, please settle down so we can sleep." (Our bedroom was directly across the hall from hers and both her bedroom door and ours were open.)

- I am often very tired starting from 20:00, the time I let this 2-y.o. sleep. So it would cost me too much energy to sooth him if I don't lie down next to him and let he lie on my hand. Imagine I would have two options. Option 1 is to sit next to him and hold his hand while he is in his bed, during this time I would read my phone and that makes me also very tired as I have the tendency to read any kind of crappy news on facebook and online newspaper just to avoid the void and tiredness in me. Option 2 is to train him by letting he cry a bit, then come and sooth him a bit and go away for a while, but this guy can cry upto the point he vomits, which would cost me extra energy to clean things up. At around 20:00 I am often already tired and I like to lie down as well.

Why not try Option 3: Starting at around 19:30 invite the 2 year old to sit by you on the couch in the living room and snuggle up and chat with him while you are snuggling on the couch about his day and what he did during the day. And once he's done telling you about his day, read a story to him. You'll need to start with a very short story since he may not have much of an attention span. You can also increase his attention span for being read to by asking him questions about the pictures in the storybook and what he thinks is going to happen next. And after story time is over and it's getting to be 20:00 or 20:15, take him to his bed and tell him that he doesn't have to go to sleep, but that it is time for him to play with his stuffed toys in his bed for a while. Tell him he can play in his bed as long as he wants to, but that he does have to play by himself. And tell him that you'll check in on him in 15 or 20 minutes.

In other words, it's possible that the 2 year old is rambunctious because he wants some high quality one-on-one time with one of his parents. And it's possible that the fact that he knows he is supposed to be asleep and he can't get to sleep is what works himself up to crying to the point of vomiting if you simply try to let him cry it out. It's possible that if you gave him permission to play quietly in his own bed (with the light on), that he wouldn't get so worked up about it being bedtime.

I know there is something missing in my educating the kid and setting rythm to myself, but I don't know a better way.

It's counterintuitive, but give the little guy a bit more "control" of his own circadian rhythm: Let him play quietly in his own bed for a while with the light on, and check on him every 15 or 20 minutes---even if he's NOT crying---just to say "Hi" and to remind him that he has to stay in the bed while he's playing. My guess is that he will fall asleep after playing in bed for about 30-40 minutes---if he is NOT over tired and over wound up about it being "time to sleep", and he may start falling asleep after playing in his own bed without any need for you to lie down next to him and soothe him.

PS: None of the kids are sleepy during the day. The 2-y.o. is always very active the whole day, and the 5-y.o. is quieter, but only complain about tiredness around 19:30-20:00 (he does not sleep after lunch, and wakes up at 7:00 AM). So I don't think of children OSA.

That's good news.

Thats a very good tip to let the kid play in his bed at bed time Robysue. I will try this tomorrow evening. Thanks

So your daughter sleeps with light on for most of her infancy. I admire your spending time with the kid.

Why not try Option 3: Starting at around 19:30 invite the 2 year old to sit by you on the couch in the living room and snuggle up and chat with him while you are snuggling on the couch about his day and what he did during the day. And once he's done telling you about his day, read a story to him. You'll need to start with a very short story since he may not have much of an attention span. You can also increase his attention span for being read to by asking him questions about the pictures in the storybook and what he thinks is going to happen next. And after story time is over and it's getting to be 20:00 or 20:15, take him to his bed and tell him that he doesn't have to go to sleep, but that it is time for him to play with his stuffed toys in his bed for a while. Tell him he can play in his bed as long as he wants to, but that he does have to play by himself. And tell him that you'll check in on him in 15 or 20 minutes.

My 27 month son does not speak yet (max sentence length is about 5 words), and he does not speak much, but spends most time running, climbing, saying hello to everyone, interacting with everyone. He is extrovert.

Yesterday I was so tired and was not able to implement your great tip. Actually the problem in my educating this 2-y.o. child starts all around 18:30-19:00 everyday, when I have difficulty encouraging/forcing him to eat. Then at 20:00 I am totally exhausted and just want to lie down with him.

I need to have some Cognitive Behavior Therapy not only for my insomnia, but also for my dealing with the kids.

Thanks

Sorry for being so late with coming back to this thread. I am still not able to sync my videos with timestamps.

I use a CCTV camera with SD Card to film my sleep, it has a infra red, which is very nice. But it stores the recording to the video chunks of 15 minutes, in .h264 file extension. I am using VLC (with H264 Demux) or a MPLayer to view it, but both players don't seem to show a normal video
- VLC 2.4.2 does not show the duration nor the time advancement while playing back
- MPlayer does not have the slider, and it stops after 8 minutes (still half of the video)

I tried using FFMPEG to concatenate all the video chunks into 1 big file, but I have several errors.

It is 3-4 times per hour that I move my body: either scratch my face (ear, cheek, ..) or my nose (where the mask covers), or simply change the body position (turn my neck, move my leg position, put my hands under my head, or remove my hands from my head).

But I am sure it is not RLS or PLMD: it is not periodic nor a shaking of the legs/arms.

About 25% of the time I scratch my nose, so the mask is to blame, but not for all my awskenings.

So is it true that my sleep doctor, thanks to his WatchPAT 2000, thinks that it is about psychophysiology ?