Rem Sleep Increased Respiratory Rate

One thing I have noticed since starting PAP treatment is that during what I believe is rem sleep often times my breathing goes sort of wonky. The flow rate fluctuates and looks rough and my respiratory rate increases (nearly doubling at times). During my sleep study I had prolonged oxygen desaturation during what I am assuming was a similar situation.

I wondered if increasing pressure would help with this but as you can see the following chart still shows this at 12 cm pressure similar to what it showed at 6 cm.

Just curious if anyone has any thoughts on this flow rate form, if you would consider it normal or potentially indicative of something?

My respiration rate in other sleep is fairly consistent around 15.

Geer1 wrote: ↑

Tue Dec 10, 2019 1:29 am

Just curious if anyone has any thoughts on this flow rate form, if you would consider it normal or potentially indicative of something?

It does look like REM so leave it alone. It's supposed to look like that (phasic REM anyway).

What are you trying to fix with increasing pressure?

Your post suggests that increasing pressure will reduce your respiration rate. No and an increased respiration rate is associated with REM, for many.

Some people, myself included, have got very distinctive respiration rates while in REM.
I've highlighted my REM periods, note the increased Resp. Rate., and Flow Limit activity. You can also see my pressure increase as a result of the increased flow limitation during REM.

I increased my minimum, not because I wanted to reduce Respiration Rate, but because my Apnea is worse during REM. Often, I would have events waiting for my machine to respond.

Dog Slobber wrote: ↑

Tue Dec 10, 2019 5:13 pm

What are you trying to fix with increasing pressure?

Mainly I am trying to understand if the increased respiration and odd fluctuating flow graph is normal in rem or indicative of SBD. I often wake up during rem(both before treatment and still now 3 weeks into treatment) and I wonder what is causing it and I was having trouble finding examples of proper rem breathing flow data on google.

Here is a more zoomed in section from last night. You can see how it kind of looks like flow limitation, periods or reduced flow and in general just rough uneven looking flow. I was curious if increasing pressure would help smooth this stuff out.
Here is one with 6 cm minimum for comparison. Different days, times etc so hard to judge if there is any real difference.

Not related to this topic specifically but I have tried the following pressures.

6 cm min, 14 obstructive apnea or hypopnea in 51.5 hrs use, 0.27 OAI
8 cm min APAP mode, 10 obstructive apnea or hypopnea in 85 hrs use, 0.12 OAI
8 cm min auotset for her mode, 5 obstructive apnea or hypopnea in 15 hrs use, 0.33 OAI
10+ cm min, 0 obstructive apnea or hypopnea in 20 hrs use, 0 OAI

Other than the 2 nights on autoset for her (might have been bad nights) the increasing pressure seems to have provided some improvement (numbers are good at all settings though). Currently I have been using 10 cm and think it is best.

Geer1 wrote: ↑

Tue Dec 10, 2019 11:58 pm

You can see how it kind of looks like flow limitation...

Yeah, not really seeing that.

And not for nothing, I'd push for a real sleep study. This one looks overscored, and certainly submitting obvious artifact as valid lab data ranks somewhere between lazy and completely bogus.
Although what you could do is ask for the raw data file and take it to a another lab for a second opinion (if you could fine someone trustworthy).

Geer1 wrote: ↑

Tue Dec 10, 2019 11:58 pm

Dog Slobber wrote: ↑

Tue Dec 10, 2019 5:13 pm

What are you trying to fix with increasing pressure?

Mainly I am trying to understand if the increased respiration and odd fluctuating flow graph is normal in rem or indicative of SBD.

http://healthysleep.med.harvard.edu/hea ... cteristics

med.harvard.edu wrote:Respiratory Changes Our breathing patterns also change during sleep. When we are awake, breathing is usually quite irregular, since it is affected by speech, emotions, exercise, posture, and other factors. As we progress from wakefulness through the stages of non-REM sleep, our breathing rate slightly decreases and becomes very regular. During REM sleep, the pattern becomes much more variable again, with an overall increase in breathing rate.

Dog Slobber wrote: ↑

Tue Dec 10, 2019 5:13 pm

I've highlighted my REM periods, note the increased Resp. Rate., and Flow Limit activity. You can also see my pressure increase as a result of the increased flow limitation during REM.

Very cool and educational chart! Thanks for posting it.

Morbius wrote: ↑

Wed Dec 11, 2019 5:02 am

And not for nothing, I'd push for a real sleep study. This one looks overscored, and certainly submitting obvious artifact as valid lab data ranks somewhere between lazy and completely bogus.

Sleep Apnea 2.jpg

Although what you could do is ask for the raw data file and take it to a another lab for a second opinion (if you could fine someone trustworthy).

My data was re-scored manually, they added a bunch more hypopneas in the blank area but obviously didn't look at the heart rate...

The whole process was very frustrating as I asked doctor and sleep therapist about doing an in clinic test so I could get the EEG information etc. Those tests are available privately here and I have insurance that would cover them but you still need a referral and my doctor wouldn't prescribe one because in his words if he is going to get an in clinic test done he would send me to a hospital to make sure it was done right... Not sure how a private in clinic sleep test could be worse than the 3rd party at home test with limited information and poor quality results that I got...

A little over 3 weeks into treatment now the results are becoming obvious. I was fatigued constantly and now have been working stupid hours and getting by with less sleep. It is like my body is so used to being fatigued it barely wants me to get a good length of sleep now that I am sleeping better... I also just got diagnosed with nonallergic rhinitis which I am fairly sure is a big part of this.

Geer1 wrote: ↑

Thu Dec 12, 2019 12:19 am

My data was re-scored manually, they added a bunch more hypopneas in the blank area but obviously didn't look at the heart rate...

I assume this is all part of the reason that they are sending my test data out to be manually interpreted ...

The Standard of Care is that that should have been done in the first place. That they failed to do that, and then hypopneas suddenly appear sounds bogus to me. Especially when

Dr gave me my updated results after manual review. Makes more sense now, they added a bunch more hypopneas and desaturation events in the morning hours when oxygen levels were dropping. AHI increased to 16.3, ODI increased to 13.3. Total of 3 obstructive apneas, 5 central apneas and 135 hypopneas.

lylymuch of this occurred in an area then should have been excluded completely as being artifact.

Which IMO kinda makes them LSsOS.

I obviously have sleep disordered breathing

There is nothing in your heretofore 103 posts to indicate that.

I am the same but worse being an engineer who loves to overthink everything...

I'd rather not argue over definitions,

Kinda incongruous, don't you think?

I was going to discuss oximetry and desaturations since in another thread you brought up

SPO2 dropping below 88-90%. This is the level that is usually flagged as abnormal during sleep. Your levels only dropped below 90% briefly which isn't a big deal but it does support potentially mild sleep apnea. SPO2 dropping below 80% especially for any significant amount of time indicates more severe desaturation.

and I find it difficult to identify ANY valid desatuation in your HST, as well as a fairly constant sat in mid 90's, but I'm beginning to think you're trying to make your diagnosis fit what you've decided to be your treatment (since you claim to have run out of options and it MUST be something) but

I'd rather not argue

Wow, making some big assumptions there...

I have nonallergic rhinitis, bad enough I can barely breathe through my nose at times. I do nasal rinses and now Dymista twice a day for next 4 months. After those 4 months if things aren’t better ENT is going to do surgery to shrink turbinates and correct a slightly deviated septum.

I have the symptoms, data that supports the diagnosis(sleep test and OSCAR) and another diagnosis that is obviously contributing factor if not the entire cause for my SDB and the treatment has helped... Everything points to SDB.

It also makes sense that my two desat periods in study coincided with rem because if my breathing goes this rapid and shallow on cpap it obviously is not going to be effective when my nasal passages are nearly plugged... I literally can have trouble breathing through my nose at times when awake let alone in shallower sleep breathing...

Geer1 wrote: ↑

Thu Dec 12, 2019 8:29 am

Wow, making some big assumptions here.

This should be fun

palerider wrote: ↑

Thu Dec 12, 2019 11:52 am

This should be fun

That's just what I was thinking.

JPB

jimbud wrote: ↑

Thu Dec 12, 2019 12:01 pm

palerider wrote: ↑

Thu Dec 12, 2019 11:52 am

This should be fun

That's just what I was thinking.

JPB

Great minds think alike. My eyes opened wide when I saw that response.
I'll go pop some popcorn and get drinks ready. Might have time to make some homemade Irish Creme.

Just as an example of how I know CPAP is helping me before I started treatment I was sleeping 7-9 hrs most nights, felt fatigued and like I was barely functioning. If I had a long day at work I usually needed part of the next day to rest and recover and a few long days meant spending every evening and the next weekend resting or sleeping.

After 29 days of treatment I have only averaged 6.5 hrs of sleep and work has been ridiculous (trying to finish projects for year end). I have worked 23 of the last 25 days including 12+ hr days every day this week. It has been over a year since the last time I would have felt capable of that even with more sleep.

You would have a better chance convincing me the earth was flat then convincing me I don't have SDB lol.