How to determine Good Sleep?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Billymadison420
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Re: How to determine Good Sleep?

Post by Billymadison420 » Tue Sep 06, 2022 1:47 pm

Rubicon wrote:
Tue Sep 06, 2022 1:41 pm
Billymadison420 wrote:
Tue Sep 06, 2022 1:08 pm
Rubicon wrote:
Tue Sep 06, 2022 1:01 pm
Billymadison420 wrote:
Tue Sep 06, 2022 12:25 pm

Can my sleep doctor infer the disordered breathing, that you all referred to as sleep/wake/Junk, from the CPAP machine data just the same as you can?
Why would she want to? She has a sparkly new NPSG to look at.
I guess because my CPAP is at home. It seems she is disregarding in lab results because of the wires and such.
What is she disregarding? I don't understand your point. You got 7.76 hours of sleep @ 85.9% (a little low as far as efficiency goes, but told them you sleep better at home) and a normal MSLT, so IMO she thinks you're fine there.

However, sleep disruption is there, they said it's there. You need those values if you want to make a case for anything. And I'm talking about >100 arousals, a bunch of awakenings (number will vary based on length, and we only got 71 minutes of WASO to work with).
She seems to be disregarding the sleep disruptions in lab and is writing them off because I was in a foreign environment. She is assuming my at home #’s would be better.

I’m a little bit out of my league here with some of these terms. What I’m trying to say is she seems to think I’m fine, like you’re saying she thinks. I guess the million dollar question is. Given the data you’re referencing in the number of arousals. Is it possible I’m catastrophize Ing my fatigue, or the fatigue could also be from depression?

If I don’t have narcolepsy or idiopathic hypersomnia and a sleep doctor thinks that I’m doing relatively fine, maybe I am fine? Is it possible that this is something I’m just catastrophizing? Plenty of people in this world operate a little sleep and do just fine. So either there is something unique to me, or I am coping with it poorly and blowing it up.

Or there really is something wrong and it needs to get treated? I guess I’m confused as to what the case is.

Would, perhaps CBT for insomnia help sleep maintenance insomnia?

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Rubicon
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Re: How to determine Good Sleep?

Post by Rubicon » Wed Sep 07, 2022 4:01 am

Billymadison420 wrote:
Tue Sep 06, 2022 1:47 pm
Is it possible that this is something I’m just catastrophizing?
IMO if someone even asks if they're "catastrophizing" they're probably catastrophizing.

Anyway I thought you had all this figured out:
Billymadison420 wrote:
Mon Sep 05, 2022 10:16 am
Took me a while to accept that I don’t have a sleeping disorder. I think the reality is that I’m going through a major depressive episode. I don’t think any amount of sleep would make me feel well rested when I feel this way.
Cause if you look at all the new data, what you perceived was quite contrary to what is actually turning out to be:
Billymadison420 wrote:
Wed Aug 10, 2022 4:36 pm
2 previous EEGS, one done before apnea treatment, and one after. And my symptoms.

I’ve already been diagnosed with Hypersomnia by both doctors. The question before was the apnea the cause. It isn’t

I was told I have 3 times the amount of REM sessions a night as I should be having.

Symptoms:

- endless REM sleep. never refreshing.
- REM sleep during nap
- half awake state where I feel half conscious but frozen
- dreams while I am half sleep. I am consciously aware of what’s happening in the room, but I am simultaneously dreaming.
- waking up from a dream and not knowing if it was real
- when I was a kid I heard voices in that state
-hypnagogic hallucinating
- when I was younger I would act out REM dreams. Punching the air, grabbing a loved one next to me while dreaming.
- I always remember my dreams
- weak knees buckling at times (not necessarily connected to extreme emotion)
- constant need for naps that are unrefreshing
- falling asleep during movies/tv shows that are monotonous
- sleep attacks behind wheel
- always sleeping in cars/busses
- continuing with an activity without having any recollection of it afterwards (driving)
- head nodding/sleep attacks
- able to fall asleep in any position anywhere. plane. bus. car.
Billymadison420 wrote:
Mon Aug 15, 2022 3:55 pm
Doctor 2 now suspects Narcolepsy without Cataplexy... Both doctors agree.
Ritu Grewal wrote: No SOREM period noted.
Ritu Grewal wrote: Normal level of daytime alertness.
Ritu Grewal wrote: Sleep state misperception appears to be present.
So again "IMO" about the only thing left is to see exactly how disrupted the sleep architecture is and if there's something there that can be improved upon.

LMK when the requested items arrive.
All the world's indeed a stage and we are merely players.
Performers and portrayers, each another's audience outside the gilded cage.

Billymadison420
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Re: How to determine Good Sleep?

Post by Billymadison420 » Wed Sep 07, 2022 7:23 am

Rubicon wrote:
Wed Sep 07, 2022 4:01 am
Billymadison420 wrote:
Tue Sep 06, 2022 1:47 pm
Is it possible that this is something I’m just catastrophizing?
IMO if someone even asks if they're "catastrophizing" they're probably catastrophizing.

Anyway I thought you had all this figured out:
Billymadison420 wrote:
Mon Sep 05, 2022 10:16 am
Took me a while to accept that I don’t have a sleeping disorder. I think the reality is that I’m going through a major depressive episode. I don’t think any amount of sleep would make me feel well rested when I feel this way.
Cause if you look at all the new data, what you perceived was quite contrary to what is actually turning out to be:
Billymadison420 wrote:
Wed Aug 10, 2022 4:36 pm
2 previous EEGS, one done before apnea treatment, and one after. And my symptoms.

I’ve already been diagnosed with Hypersomnia by both doctors. The question before was the apnea the cause. It isn’t

I was told I have 3 times the amount of REM sessions a night as I should be having.

Symptoms:

- endless REM sleep. never refreshing.
- REM sleep during nap
- half awake state where I feel half conscious but frozen
- dreams while I am half sleep. I am consciously aware of what’s happening in the room, but I am simultaneously dreaming.
- waking up from a dream and not knowing if it was real
- when I was a kid I heard voices in that state
-hypnagogic hallucinating
- when I was younger I would act out REM dreams. Punching the air, grabbing a loved one next to me while dreaming.
- I always remember my dreams
- weak knees buckling at times (not necessarily connected to extreme emotion)
- constant need for naps that are unrefreshing
- falling asleep during movies/tv shows that are monotonous
- sleep attacks behind wheel
- always sleeping in cars/busses
- continuing with an activity without having any recollection of it afterwards (driving)
- head nodding/sleep attacks
- able to fall asleep in any position anywhere. plane. bus. car.
Billymadison420 wrote:
Mon Aug 15, 2022 3:55 pm
Doctor 2 now suspects Narcolepsy without Cataplexy... Both doctors agree.
Ritu Grewal wrote: No SOREM period noted.
Ritu Grewal wrote: Normal level of daytime alertness.
Ritu Grewal wrote: Sleep state misperception appears to be present.
So again "IMO" about the only thing left is to see exactly how disrupted the sleep architecture is and if there's something there that can be improved upon.

LMK when the requested items arrive.

I will request the items this morning.

When I feel this bad and is exhausted, and I know my sleep is disturbed, I want to find a reason as to why that is. I guess I’m still a little confused. Just a few weeks ago I was the first doctor that thought I had narcolepsy, got on a phone call with me and said that from the home sleep study one year ago he was almost absolutely sure that it was narcolepsy or idiopathic hypersomnia.

From talking with Dr. number two, and all of you, I now understand that there is no medical way to infer or diagnose such a condition with a home sleep study.

So within the span of a few weeks I have a second opinion and study that says that that is not true (N/—IH). Why was the first person so sure? And of course having a name to the issue I’m having and some sort of solution I suppose is more appealing than throwing my hands up and leaving it to chance every night.

At this point it seems like CBT for insomnia is my best bet, because it does not seem like this new doctor is in anyway interested in giving me any sort of medication to help with my sleep. But if that changes I will let you know.

I have bought a book on CBT for insomnia. Both for consolidating my sleep and possibly getting deeper quality sleep, and also reframing my thoughts around sleep and fatigue so that maybe I can catastrophize less.

Thank you for your help. Know it is much appreciated.


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Rubicon
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Re: How to determine Good Sleep?

Post by Rubicon » Wed Sep 07, 2022 1:55 pm

Also in the Glossary of Terms should be Stage Shifts:

Stage Shifts: Stage changes occur normally (not caused by arousal) about 7 times per hour, 40-50 times per night in a "normal" night's sleep, perhaps a few more in the first 90 minute sleep cycle, let's say 11 and maybe a few more after that due to "lab effect". I've seen the number 70-75 stage changes as "normal" during a first-night sleep study.

So 154 is a lot.
All the world's indeed a stage and we are merely players.
Performers and portrayers, each another's audience outside the gilded cage.

Billymadison420
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Re: How to determine Good Sleep?

Post by Billymadison420 » Wed Sep 07, 2022 2:22 pm

Rubicon wrote:
Wed Sep 07, 2022 1:55 pm
Also in the Glossary of Terms should be Stage Shifts:

Stage Shifts: Stage changes occur normally (not caused by arousal) about 7 times per hour, 40-50 times per night in a "normal" night's sleep, perhaps a few more in the first 90 minute sleep cycle, let's say 11 and maybe a few more after that due to "lab effect". I've seen the number 70-75 stage changes as "normal" during a first-night sleep study.

So 154 is a lot.
Thank you for the response!


So is (the amount of changes between sleep stages) change indicative of anything other than light sleep/anxiety/depression/stress? It also seems as though the majority are in the early morning between 5:30-8AM. This is also when I seem to have all the SWJ/Central Apneas.

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Rubicon
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Re: How to determine Good Sleep?

Post by Rubicon » Wed Sep 07, 2022 2:57 pm

Billymadison420 wrote:
Wed Sep 07, 2022 2:22 pm
So is (the amount of changes between sleep stages) change indicative of anything other than light sleep/anxiety/depression/stress? It also seems as though the majority are in the early morning between 4-8AM. This is also when I seem to have all the SWJ/Central Apneas.
You also have to look at arousals, awakenings, length of awakenings and the histogram, but yeah, looks like sleep maintenance insomnia (which is why you would need a long-acting sleep pharmaceutical. Or another strategy would take a short or ultra-short pharmaceutical in the middle of the night).

But IMO CBT-Iing the daylights out of it would be a good approach (although I guess at this point, it's the only approach).

Perhaps some of the aforementioned sleep consolidation might help as well. Get out of bed a little earlier cause a lot of that is just a wasted effort.

Might want to look at pressures here. I mean, I'm not seeing much difference between 8 and 14. And for that matter, 13 and 14 were during a big mess so I'm not seeing much informative value there.
All the world's indeed a stage and we are merely players.
Performers and portrayers, each another's audience outside the gilded cage.

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Rubicon
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Re: How to determine Good Sleep?

Post by Rubicon » Wed Sep 07, 2022 3:09 pm

Rubicon wrote:
Wed Sep 07, 2022 2:57 pm

You also have to look at arousals, awakenings, length of awakenings...
Because really, the only difference between arousals and awakenings is time. Very short awakenings carry the same weight as arousals when you come right down to it.

BUT... (there's always a "but") insomnia episodes are usually at least 20-30 minutes, and you've only got one of those, so technically we're playing a little fast and loose with definitions (fragmented sleep vs unambiguous insomnia).

HOWEVER... (fortunately, there's always a "however") CBT-I is the only tool in the tool box and besides I think it should put a pretty good dent in it anyway.
All the world's indeed a stage and we are merely players.
Performers and portrayers, each another's audience outside the gilded cage.

Billymadison420
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Re: How to determine Good Sleep?

Post by Billymadison420 » Wed Sep 07, 2022 3:18 pm

Rubicon wrote:
Wed Sep 07, 2022 3:09 pm
Rubicon wrote:
Wed Sep 07, 2022 2:57 pm

You also have to look at arousals, awakenings, length of awakenings...
Because really, the only difference between arousals and awakenings is time. Very short awakenings carry the same weight as arousals when you come right down to it.

BUT... (there's always a "but") insomnia episodes are usually at least 20-30 minutes, and you've only got one of those, so technically we're playing a little fast and loose with definitions (fragmented sleep vs unambiguous insomnia).

HOWEVER... (fortunately, there's always a "however") CBT-I is the only tool in the tool box and besides I think it should put a pretty good dent in it anyway.

I agree. That is what we were looking at here. CBT for insomnia. I’m gonna start waking up at a fixed time each morning, around 6 o’clock. Around the time that I would normally have low yield with Sleep anyway. I bought a book on it. And from what I understand I will keep building up that sleep drive by staying awake longer. And only going to sleep when I am tired.

I had thought that being on mirtazapine would keep me asleep because of how sedating it can be but I guess not. I guess it’s a little bit deeper in my brain chemistry than just that.

One more thing to note. I am currently off medication under the care of a psychiatrist. But I plan to go on Oxcarbazipine. Which was some thing I was on last year before the mirtazapine for about three weeks. From my journaling at that time I do mention that it was helping me sleep well, and that I felt more refreshed. From my cursory reading about the drug, it shows that it improves slow wave sleep.

In a perfect world I would like to be off medication. Unfortunately with my history of mental health issues, depression and bipolar or borderline personality, I have to be careful with how fast and loose I play with being off medication. That combined with my other health issue tinnitus, which is not really much of an issue during the day, but perhaps more distracting at night, I have to probably stay on the medication for now.

. Regardless of the medication or non-medication route I take I still think CBT for insomnia is the tool in the tool kit, like you mentioned. Thank you for your time!

Billymadison420
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Re: How to determine Good Sleep?

Post by Billymadison420 » Thu Sep 08, 2022 4:41 am

So last night was night # 2 of sleep restriction (only in bed when sleepy, and waking up at 6:25am). It was also night one of oxcarbazipine. What I am noticing is a night and day difference in breathing. At least with the deepness. My breathing seemed more shallow. I don't know if that is good or bad.


Last night: https://sleephq.com/public/e3db5bdd-282 ... a7ab4fe5dc

Previous night for reference: https://sleephq.com/public/685f39ce-8fd ... 7e9a7e2ceb

Billymadison420
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Re: How to determine Good Sleep?

Post by Billymadison420 » Thu Sep 08, 2022 2:21 pm

Also can someone post for me, good quality sleep? Like an OSCAR read out. I would love to see an ideal picture.

rbllhocker
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Re: How to determine Good Sleep?

Post by rbllhocker » Mon Sep 12, 2022 6:51 am

Hello all,
I was going through the site and only found one post that went unanswered in 2020, that related almost identically to my current issue. I have been on my cpap since May and its changed my life. Things were going great then the back pain started. I am experiencing pain from between the shoulder blades to my lower back. The pain moves nightly, I do not have residual during the day, only when laying in bed. I get around 5 hours of sleep per night, get up take a few ibuprofen the inflammation subsides and I can go back to sleep. I got a new bed, I've been going to the chiropractor for a month now 3 times per week no relief. Has anyone had or heard of this same issue?

lynninnj
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Re: How to determine Good Sleep?

Post by lynninnj » Mon Sep 12, 2022 10:32 am

Billymadison420 wrote:
Thu Sep 08, 2022 2:21 pm
Also can someone post for me, good quality sleep? Like an OSCAR read out. I would love to see an ideal picture.
I don't know if I would hold this out as a really good quality sleep but I feel pretty good and the numbers look good to me. Maybe this will help. There is an element of subjective "I felt good" and objective "these are the numbers". A good nights sleep would combine both. This website allows you to zoom all the way in to breaths by highlighting an area and note as well "R" will reset to full start screen, X will zoom in and z wil zoom out.

https://sleephq.com/public/ca1a812a-f68 ... 5f7bddb0d1

I am pleased that with the hours slept and AHI I had a total of 7 wakeups last night. The time spent in apnea was 1 min 1 sec. The leaks were minimal. I managed to get over five hours without having to get up to go to the bathroom. From time to time I would have to readjust the mask so you see a bigger spike in the pressures and then I fell back to sleep pretty quickly.

I will post one or two more so you can kinda get a feel for things.

This was only 6 wakeups all night with large section of sleep before finally hitting the bathroom. The flow rate data seems to be missing for a period there but the pressures are still there and quite stable. 57 seconds in apnea. A good bit more mask leakage but nothing of a high level and I felt great. https://sleephq.com/public/6fe2f632-4ce ... d11ca8f604

7 events all night. 56 seconds in apnea. I think by the next day I reported feeling like I was on speed without the jitters and heart palpiatations.https://sleephq.com/public/a86e8323-2ee ... 6541cbe062


One more thing, to contrast. I consider this a lousy nights sleep. I started cpap on 7/12 and had the first two lousy days and then this was the first lousy one since. 5 min 36sec in apnea. 26 disturbances. Probably some are false positives. I woke up with a dull headache that lasted the entire day and would not go away even with tylenol. The leaks aren't terrible but I really felt like shit after that. I have started to think of it more in terms of time spent in apnea=greatest measure of crappy feeling all day. I could maybe hold my breath for a minute, maybe two if I were practiced, but never five and a half. https://sleephq.com/public/7c32b7a3-868 ... 0b4a70fb8e

Now when I look at my own numbers and charts I look at AHIxhours slept=number of events (never felt bad any night they were less than 10), time spent in apnea (right around 2min mark or preferably less gives best clue on how I slept) then I glance at leak chart to see if something can be done to improvie.

Hope that helps.

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Re: How to determine Good Sleep?

Post by Dog Slobber » Mon Sep 12, 2022 3:02 pm

rbllhocker wrote:
Mon Sep 12, 2022 6:51 am
Hello all,
I was going through the site and only found one post that went unanswered in 2020, that related almost identically to my current issue. I have been on my cpap since May and its changed my life. Things were going great then the back pain started. I am experiencing pain from between the shoulder blades to my lower back. The pain moves nightly, I do not have residual during the day, only when laying in bed. I get around 5 hours of sleep per night, get up take a few ibuprofen the inflammation subsides and I can go back to sleep. I got a new bed, I've been going to the chiropractor for a month now 3 times per week no relief. Has anyone had or heard of this same issue?
Hi Rblhocker

It's considered bad form to go into someone elses topic to ask questions.

Please start a new topic.

Billymadison420
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Re: How to determine Good Sleep?

Post by Billymadison420 » Wed Sep 14, 2022 2:31 pm

lynninnj wrote:
Billymadison420 wrote:
Thu Sep 08, 2022 2:21 pm
Also can someone post for me, good quality sleep? Like an OSCAR read out. I would love to see an ideal picture.
I don't know if I would hold this out as a really good quality sleep but I feel pretty good and the numbers look good to me. Maybe this will help. There is an element of subjective "I felt good" and objective "these are the numbers". A good nights sleep would combine both. This website allows you to zoom all the way in to breaths by highlighting an area and note as well "R" will reset to full start screen, X will zoom in and z wil zoom out.

https://sleephq.com/public/ca1a812a-f68 ... 5f7bddb0d1

I am pleased that with the hours slept and AHI I had a total of 7 wakeups last night. The time spent in apnea was 1 min 1 sec. The leaks were minimal. I managed to get over five hours without having to get up to go to the bathroom. From time to time I would have to readjust the mask so you see a bigger spike in the pressures and then I fell back to sleep pretty quickly.

I will post one or two more so you can kinda get a feel for things.

This was only 6 wakeups all night with large section of sleep before finally hitting the bathroom. The flow rate data seems to be missing for a period there but the pressures are still there and quite stable. 57 seconds in apnea. A good bit more mask leakage but nothing of a high level and I felt great. https://sleephq.com/public/6fe2f632-4ce ... d11ca8f604

7 events all night. 56 seconds in apnea. I think by the next day I reported feeling like I was on speed without the jitters and heart palpiatations.https://sleephq.com/public/a86e8323-2ee ... 6541cbe062


One more thing, to contrast. I consider this a lousy nights sleep. I started cpap on 7/12 and had the first two lousy days and then this was the first lousy one since. 5 min 36sec in apnea. 26 disturbances. Probably some are false positives. I woke up with a dull headache that lasted the entire day and would not go away even with tylenol. The leaks aren't terrible but I really felt like shit after that. I have started to think of it more in terms of time spent in apnea=greatest measure of crappy feeling all day. I could maybe hold my breath for a minute, maybe two if I were practiced, but never five and a half. https://sleephq.com/public/7c32b7a3-868 ... 0b4a70fb8e

Now when I look at my own numbers and charts I look at AHIxhours slept=number of events (never felt bad any night they were less than 10), time spent in apnea (right around 2min mark or preferably less gives best clue on how I slept) then I glance at leak chart to see if something can be done to improvie.

Hope that helps.
Glad you’re feeling good! I actually meant to come back here. Since switching medication’s, and doing CBT for insomnia, I am feeling so much better. I have found out that my body really only needs six hours of sleep to feel good. Things have changed around very fast!


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