PSG shows increase in "spontaneous arousals" with CPAP?

Hello,

10 months after starting CPAP treatment following an OSA diagnosis, I recently did another sleep-study with CPAP followed by an MSLT to understand why my symptoms have not improved. Thankfully, the recent study showed a significant decrease in AHI (12 -> 3) and the MSLT did not show evidence of narcolepsy. However, there are some differences in the results between the two studies I am trying to understand:

- The initial study showed 0 Central Apneas, while the recent showed 7 (~1/hr).
- The initial study showed < 10 total Spontaneous Arousals, while the recent showed > 160 (~30/hr).
- My sleep efficiency fell by 5%.

What are these "spontaneous arousals"; are they normal? Why would they show up now but not in my initial study? Could they be contributing to my persistent symptoms?
If anyone has experience with this I would really appreciate your thoughts! Thanks!

Spontaneous arousals are arousals not caused by respiratory issues so no known cause.
Something caused an arousal but it wasn't related to airway problems...now what it was is anyone's guess.
No..not normal to have more than a handful (like on your initial sleep study).

As to what might cause the increase....million dollar question. The list is essentially endless for the causes of spontaneous arousals.

What medications are you taking? Medication side effects that mess with sleep and cause arousals are very common.
Any change in meds from what you were taking at the first sleep study and now?
Any other health issuses?
Pain?

excuse my ignorance, but what does PSG stand for?

ditto, what does MSLT stand for?

zonker wrote: ↑

Wed Jan 15, 2020 8:28 pm

excuse my ignorance, but what does PSG stand for?

ditto, what does MSLT stand for?

PSG.....a sleep study..can be home or in lab
https://en.wikipedia.org/wiki/Polysomnography

MSLT...test for narcolepsy...Multiple Sleep Latency Test
https://en.wikipedia.org/wiki/Multiple_ ... tency_Test

Pugsy wrote: ↑

Wed Jan 15, 2020 8:31 pm

zonker wrote: ↑

Wed Jan 15, 2020 8:28 pm

excuse my ignorance, but what does PSG stand for?

ditto, what does MSLT stand for?

PSG.....a sleep study..can be home or in lab
https://en.wikipedia.org/wiki/Polysomnography

MSLT...test for narcolepsy...Multiple Sleep Latency Test
https://en.wikipedia.org/wiki/Multiple_ ... tency_Test

thank you for the enlightenment.

Pugsy wrote: ↑

Wed Jan 15, 2020 8:25 pm

Spontaneous arousals are arousals not caused by respiratory issues so no known cause.
Something caused an arousal but it wasn't related to airway problems...now what it was is anyone's guess.
No..not normal to have more than a handful (like on your initial sleep study).

As to what might cause the increase....million dollar question. The list is essentially endless for the causes of spontaneous arousals.

What medications are you taking? Medication side effects that mess with sleep and cause arousals are very common.
Any change in meds from what you were taking at the first sleep study and now?
Any other health issuses?
Pain?

Hi, thank you for your reply. I'm not taking any medications, no pain, and other than mild allergies and asthma I don't have any other health issues. I was evaluated by an ENT surgeon recently -- I have a high-arched palate and issues with nasal breathing, but this is relevant to OSA and not the spontaneous arousals I imagine.

The biggest difference I'm aware of between the initial and recent sleep studies would be the CPAP itself. If they aren't somehow caused by CPAP use, do you have any idea why the spontaneous arousals would show up in the second study but not the first?

Hi, two things... if your min. pressure is still low (e.g. 4 or 5) raise it by at least 2 for a couple of nights to see if it helps, and the other could be even a small weight gain that can make a surprising difference to how things go.

Was this most recent sleep study done while using the cpap machine or without it?

If with cpap...then it wouldn't be impossible for the mask or machine to cause an arousal...comfort issues or whatever.
If done without cpap...then cpap couldn't be the cause of the arousals.

As to why so many now and none a few months ago...there's no way to answer that question I don't think.
We don't sleep the same each night as it is. Just too many variables.

Spontaneous arousals are really hard to deal with because we don't know, nor have any way to really know for sure, what is causing them and to stop them we need to fix whatever it is that is causing them.
Some people never figure it out and end up occasionally taking some sort of sleep aid so that they can at least get some restorative sleep some nights.

Spontaneous...no known cause. To fix a problem we first have to identify the cause of the problem and it's just something that is extremely hard to do when it comes to spontaneous arousals.
They cause sleep maintenance insomnia and poor sleep quality and we feel like crap because we sleep like crap.

Pugsy wrote: ↑

Wed Jan 15, 2020 9:11 pm

Was this most recent sleep study done while using the cpap machine or without it?

If with cpap...then it wouldn't be impossible for the mask or machine to cause an arousal...comfort issues or whatever.
If done without cpap...then cpap couldn't be the cause of the arousals.

As to why so many now and none a few months ago...there's no way to answer that question I don't think.
We don't sleep the same each night as it is. Just too many variables.

Spontaneous arousals are really hard to deal with because we don't know, nor have any way to really know for sure, what is causing them and to stop them we need to fix whatever it is that is causing them.
Some people never figure it out and end up occasionally taking some sort of sleep aid so that they can at least get some restorative sleep some nights.

Spontaneous...no known cause. To fix a problem we first have to identify the cause of the problem and it's just something that is extremely hard to do when it comes to spontaneous arousals.
They cause sleep maintenance insomnia and poor sleep quality and we feel like crap because we sleep like crap.

It was done with CPAP (hence the improvement in AHI.) Could mask discomfort really cause an arousal every 2min? My machine doesn't report any leaks.

Julie wrote: ↑

Wed Jan 15, 2020 9:07 pm

Hi, two things... if your min. pressure is still low (e.g. 4 or 5) raise it by at least 2 for a couple of nights to see if it helps, and the other could be even a small weight gain that can make a surprising difference to how things go.

It's 9 - 12 currently. I actually lost 6lb between the studies (I'm thin and in my early twenties, and I think my OSA has more to do with my maxillofacial profile than with my weight.)

It doesn't necessarily have to be mask discomfort or any discomfort for that matter. It can be anything causing the brain to cause the wake up...any sort of stimulus or sometimes lack of stimulus. Any change from normal can do it.
Something that causes the brain to tell the body to "wake up dude..somethings going on I find odd."
It took me over 3 months for my brain to stop waking me up about every hour when I first started cpap just to tell me "hey, did you know something is on your nose blowing air up your nose"...I had zero comfort issues with the mask or the machine but it took my brain a long time to quit telling me about it. It was many months before my brain was okay with the mask and machine being my new "normal" way of sleeping.

Some people are just more sensitive to the least little change in the body's normal routine. Light sleepers I guess they would refer to themselves.

Google sleep maintenance insomnia...the causes for it are likely the same causes for spontaneous arousals since they sort of go hand in hand.

Consider maybe trying a different mask just to see if it changes anything.

If you want to post a typical detailed software report from your machine we might look at it and see if anything looks a bit odd.
AHI isn't everything...there's other stuff to look at that might be a factor in the wake ups....lots of pressure changes maybe.

As Pugsy noted, spontaneous arousals are difficult to diagnose.
In my case, I wake up suddenly and fully about once a hour every night. The cause is a rare form of a really rare tumor - pheochromocytoma. Mine squirts a tiny amount of norepinephrine at these intervals which is the hormone your body uses to wake you up. It has a very short serum half-life so it is gone quite quickly. I just roll over and wait the five minutes to go back to sleep.

It is more likely that your issue is your brain still getting used to the whole CPAP blowing air up your nose and that can get better over time.