Fewer arousals without CPAP

Here is ~2 hours at the beginning of one night. Granted, the first bit is obviously awake as I'm trying to fall asleep, but the rest is what the majority of most nights look like.

Those do look impressive when presented in that format don't they?
That's actually from Encore Pro software for the Respironics machines. It's the only thing I like about their software...the flow rate graphs shown like that so it makes it really easy to compare asleep vs arousal/awake breathing. Makes the evaluation process super easy...just about anyone can spot the asleep breathing when it's shown like that.

I don't doubt you when you say you have crappy sleep quality...you know it from how you feel and how you sleep and now you can see it.
Sometimes it's not easy to spot but most of the time it's fairly easy once you look at probably a hundred miles worth of these flow rates up close.

FWIW I did run that guy's flow rate graphs by a real sleep tech (I am not one) because I wanted someone who knows this stuff to tell me if what I was thinking was going on with this guy was in truth really going on. He helped me out with some of the stuff I was unsure about.
Now, I admit I am far from perfect still yet with this kind of evaluation but it does get a bit easier with time and experience and it helps if you have someone who you can ask "is this what I think it is". The one above that you posted with the arrow....it's a bit iffy but there is some ebb and flow with the breathing and we don't normally have that ebb and flow when we are sound asleep.
Asleep breathing doesn't vary much all all. Extremely rhythmic and boring with very minimal changes.

So you probably do have some real crappy sleep quality...now what is causing it....I have no idea. If we see real obstructive events prior to some iffy maybe arousal breathing then we can blame the arousal on sleep apnea but if we don't see anything that looks obstructive...we just don't have any way to know what might have caused the irregular breathing that we have when awake or half awake.

Now it's normal to wake up or have an arousal after a REM stage is over with...so some of it might be simply normal post REM arousals...we may or may not remember them and on a good night we might have 4 to 7 REM cycles so some of it could just be normal.
I have never been able to spot REM sleep though. I just haven't ever seen enough change in anything that might correlate with a probable REM cycle. Some people say they can spot changes but I just haven't been able to see enough change consistently where I could say that so and so time frame was REM sleep and that little arousal after REM is a normal post REM arousal.

If you want to do those custom event flags and then look for arousal right after the custom flag...it might point to very small changes in air flow contributing to the arousal. It's going out on a long skinny limb...but at least it's a limb to try. Some people are extremely sensitive to the least little air flow change. Very minor flow reductions can cause arousals. This is where a lot of people come up with the UARS diagnosis.

There is so much out there that can and will affect our sleep quality though and sometimes figuring it out requires a lot of detective work and sometimes people still can't figure out why they don't sleep so great.

I am sorry but I have totally forgotten your past history other than what I see in this thread...if I have some free time tomorrow I will try to go over your past threads and see if there is anything in them that might help me get a better handle on things with you.

Finally...it is entirely possible that the use of cpap does cause more arousals (at least that you remember) than when you don't use it. If you are extremely sensitive to stimuli or get bugged easily by the least little thing...wearing a mask and have a machine blow air up your nose might increase the arousals. Anything is possible.

I just saw your new graphs as I hit the submit button.

Man, it takes you a long time to fall asleep and stay asleep.
Probably equates to it takes you a long time to fall back asleep when you wake up in the night (you may or may not remember it).

Give me a minute...let me grab a shot of how long it takes me to get to sleep.

Looks like it takes me about 2 or 3 minutes to fall asleep. Some nights a little longer if I am petting the dog or something. During the night when I spot arousal breathing they are also rather short lived. So I fall back to sleep rather quickly most of the time anyway. Sometimes the insomnia monster comes and sets up shop and when he does I just get up.

Pugsy wrote: ↑

Fri Feb 21, 2020 10:52 pm

I just saw your new graphs as I hit the submit button.

Man, it takes you a long time to fall asleep and stay asleep.
Probably equates to it takes you a long time to fall back asleep when you wake up in the night (you may or may not remember it).

Give me a minute...let me grab a shot of how long it takes me to get to sleep.

I was probably reading that night. I generally feel like I fall asleep as soon as I close my eyes. And you're right, I don't remember basically any of the arousals. I feel like I'm sleeping super soundly, that's why I was so surprised to learn that...I'm not! I'll check into the custom flag thing tomorrow. For now, off to toss and turn! Thanks for your help!

Do you take any medications of any kind? If so, what?
Drink any alcohol anywhere near bed time?

Do you feel like your sleep is poor in that you are having unwanted daytime symptoms?

We all have arousals and they don't really hurt anything unless our sleep quality is bad and we feel like crap.
Do you feel like crap or just curious about all the arousals that you didn't realize you were having?

I do take Adderall XR, but am not super compliant with it, if I'm being honest. Very little or no alcohol consumption. I, honestly, have horrendous sleep hygiene. I feel like crap a lot, but I have an inconsistent bedtime, including staying up later than I should many nights, even though I'm dead tired. So I have long been attributing any crappy feelings to sleep deprivation due to too few hours of total sleep. It wasn't until I got this Fitbit that I started wondering if maybe there was something more to the puzzle.

Adderall will keep you awake - as will most of those stimulants, and some find it helpful to take a very small amount of melatonin before bed to counteract the effect.

Ah.....prime recipe for crappy sleep quality....meds and bad sleep hygiene.
Like Julie says....Adderall is well known to mess with sleep cycles/architecture and sleep problems. Half life is around 12 ish hours and supposedly out of the system after 3 days with no more dosing but they say all that can vary a lot.
At worst it can cause various forms of insomnia...sleep onset or sleep maintenance and at best keep you from progressing through all the normal sleep cycles at normal times because it can cause you you have arousals from the least little thing because you aren't ever really sleeping deeply.
It's essentially legal speed.
Here's just one study....google adderall and it's potential side effects and/or effect on sleep and start reading.
https://delphihealthgroup.com/drugs-and-sleep/adderall/
Then there's the reason you are taking it in the first place added into the mix. I assume adult ADHD kind of thing. Might be some other thing like just trying to help with excessive sleepiness during the day.

The flow rate graphs I posted earlier from the Encore reports...that guy was taking a medication that was well known to mess with sleep architecture. He refused to listen to me when I raised that the meds might be impacting how he felt during the day. It is well known to mess with sleep and general and cause feeling of extreme fatigue, sleepiness and just feeling like crap during the day.
He definitely didn't have OSA because the in lab sleep study confirmed that fact. Any flagged events from when he did try cpap were almost all obviously SWJ (sleep/wake/junk) false positives.

Stimulants like Adderall can make a person extremely sensitive to stimuli...so back to your original question of why does the FitBit show more arousals with cpap than without....the med can make you more sensitive to stimuli like all the stuff the cpap and mask can do to the body or brain. Least little things won't cause an arousal that in normal people not so sensitive to stimuli will cause arousals in really sensitive people. Meds that mess with sleep make that problem worse....making a person even more sensitive. And if your reason for taking the medication is ADHD...your nervous system is already messed up. That's part of the symptoms of ADHD.

Now I am not going to advised going off meds...that's between you and your doctor but you can work on the bad sleep hygiene which you already admit has a lot of room for improvement. It needs to be done no matter what you decide to do about the meds.

About the FitBit results in general. It's not perfect but it does a fairly decent job I think given what it has to work with.
I had a FitBit Charge that measured pulse rate and sleep ....I used it for about 6 months until it started acting up and I decided it wasn't worth pursuing fixing it's issues. Most of the time I felt it was reasonably accurate. The nights that I knew I had a lot of arousals due to extra bad back pain it would show more arousals.
But one time it showed I was sound asleep when I was up letting the dog out to pee. It's not perfect by any means.
The only way to know for sure sleep status is with something that measures brain activity with EEG sensors.
Unfortunately that sort of technology isn't yet readily available for home night to night use. Now one of the forum members is currently using something (I forget the name) that supposedly uses some EEG like sensors that he thinks seems to be fairly accurate.
Not cheap though...if I remember right in the neighborhood of $600. If I can find that thread I will point you to it.
I don't have $600 to blow on another experiment and I already know why my sleep quality is often in the toilet. I wouldn't learn much I don't feel that would help me.

Are you actually having more arousals on cpap than without ...if your FitBit is to believed (which I feel is fairly accurate considering everything)...I feel it is possible that it is correct for the most part anyway. It's possible that you are just overly sensitive to the sensory stimuli of the cpap and mask which in turn can cause arousals which you already have a high predisposition to have anyway due to medication side effects, bad sleep hygiene, and your probable condition that earns you the medication that also comes with baggage of messing with sleep.

You bring up some points that I hadn’t considered. Since I don’t notice the arousals as they’re happening, and my AHI is low, I really have been operating under the assumption that I sleep soundly through the night. I only recently started using OSCAR to review my data because my dentist wanted me to try a MAD, but that’s a whole other thread for another day. It makes sense that the Adderall might be making me more sensitive to stimuli.

I have also long wondered if my ADHD was actually a symptom of sleep deprivation/poor sleep hygiene. I am almost positive that the OSA has been present since childhood. Kind of a chicken and egg situation, you know? I am definitely open to experimenting with melatonin, and/or changing meds/dosage or discontinuing them. I mean, if I can treat my ADHD with decent sleep, rather than meds, I’m all for it!

Lots to consider, and I really appreciate your time and thoughtful interpretation. I’ll keep you posted.

Be careful if you go with melatonin....as with all meds even the OTC stuff...it comes with some baggage that may or may not affect you negatively.
It has side effects and some are quite nasty. I can't take it at all...I get really bad vertigo with it. It's a known side effect. Not particularly common but it is mentioned in all the literature I found.

If you break/cut a 3 mg (or can you find 1 mg?) melat. in half and take before bed, see if it helps, if not don't cut it and see how that works. I wouldn't try larger because of the hangover next day, coffee or not. But speculating on which came first is kinda pointless... see what really works and give things a chance. And think about needing the Add. every day or maybe only every 2nd day, or 36 hrs, or only in the a.m.

Julie wrote: ↑

Sat Feb 22, 2020 11:06 am

If you break/cut a 3 mg (or can you find 1 mg?) melat. in half and take before bed, see if it helps, if not don't cut it and see how that works. I wouldn't try larger because of the hangover next day, coffee or not. But speculating on which came first is kinda pointless... see what really works and give things a chance. And think about needing the Add. every day or maybe only every 2nd day, or 36 hrs, or only in the a.m.

i've discover liquid melatonin. comes complete with an eye dropper so i can measure out very small doses. 4 ml=1 mg. i'm taking roughly .5 to 1.5. essentially what you are recommending, but i never quite got the hang of cutting the pills in half.

here's the link on amazon-

https://www.amazon.com/Natrol-Melatonin ... 220&sr=8-4

been using it since october and there is prolly 2/3 of the bottle left.

(yeah, i know i should be telling op directly. just using you to get the word out.)

Hey, terrific, never thought of that... I happen to have a little 'cutter' (old jewellery making tool) so it works on pills.

I’ve used melatonin before without any side effects that I’m aware of, so will try again. I also have a dust mite allergy that I don’t really treat, so I’ve been taking Zyrtec and Flonase at bedtime for the past week or so. I’ve noticed a difference in my allergy symptoms, but no difference in sleep quality.