SWJ

Is sleep wake junk actually asleep or actually awake? Or transitioning between both?


I attempted to take a nap today. I felt like I was awake, but do these centrals mean I actually fell asleep? If so I fell asleep in 5:40 seconds. The total run time was 17 min on the CPAP machine. I got up because I felt I couldn't fall asleep.

1. https://www.dropbox.com/s/wwv4kx8s2sfb9 ... F.png?dl=0
2. https://www.dropbox.com/s/wkwnjlx0v6vgk ... n.png?dl=0


This was from my PSG at atone 6:40 in the morning when I have a lot of this SWJ.

https://www.dropbox.com/s/o1htioo6qqgq6wa/PSG.png?dl=0

This make me think I was falling asleep.

So would that be scored on an MSLT at a 5:40 sleep latency?

In the absense of a true MSLT, the best guess is at best---a guess.
There are no sharp lines between sleep stages, except when somebody draws them. Definition can be arbitrary.
Either/or, or somewhere between.

Is sleep wake junk actually asleep or actually awake? Or transitioning between both?

Yes. Yes. And yes.

For stage 1, "sleep" and "wake" may often be a distinction without a difference, in many respects, unless being tested:

The first stage of NREM sleep is known as stage 1 sleep. Stage 1 sleep is a transitional phase that occurs between wakefulness and sleep, the period during which we drift off to sleep. . . . It is relatively easy to wake someone from stage 1 sleep; in fact, people often report that they have not been asleep if they are awoken during stage 1 sleep.--https://digitaleditions.library.dal.ca/ ... -of-sleep/

It's basically a realm of dual existence between the Seen and the Unseen.

The idea is for the clutch to get popped so we can get rolling on into sleep. But when the clutch gets stuck partway down, that grinding can result in "events" that are best ignored for making treatment decisions. Just junk happening between the toggling between the two while not being "fully" asleep.

It sounds like it is safe to say that I shouldn’t infer anything definitive from my ghetto rigged, home test, then. I will trust the PSG and MSLT, over my home CPAP test.

I am seeing one more specialist from a separate hospital, Penn medicine. I will let that doctor take all of my information and hopefully make a final assessment, or order any more testing needed. I very much need to rule out this particular issue. I have also worked with my primary care doctor and ruled out Many other causes of fatigue through blood tests.

Good luck in your journey.

Billymadison420 wrote: ↑

Mon Oct 17, 2022 11:23 am

Is sleep wake junk actually asleep or actually awake? Or transitioning between both?


I attempted to take a nap today. I felt like I was awake, but do these centrals mean I actually fell asleep? If so I fell asleep in 5:40 seconds. The total run time was 17 min on the CPAP machine. I got up because I felt I couldn't fall asleep.

1. https://www.dropbox.com/s/wwv4kx8s2sfb9 ... F.png?dl=0
2. https://www.dropbox.com/s/wkwnjlx0v6vgk ... n.png?dl=0


This was from my PSG at atone 6:40 in the morning when I have a lot of this SWJ.

https://www.dropbox.com/s/o1htioo6qqgq6wa/PSG.png?dl=0

This make me think I was falling asleep.

So would that be scored on an MSLT at a 5:40 sleep latency?

During a MSLT they monitor brain activity to determine whether or not you are asleep, the data from your APAP is not adequate to definitively determine sleep stages or even whether or not you are asleep. With narcolepsy you would expect to see both short sleep latency and to see you entering into REM sleep within 15 minutes of falling asleep during your nap. Even if you fell asleep quickly if you’re barely in and out of N1 during a short nap that would not meet the criteria for narcolepsy.

Hopefully your new doctor from Penn can settle the narcolepsy question for you and if that isn’t the cause figure something else out.
I wonder if you have ever considered seeing a psychiatrist/ sleep medicine doctor? I’m not saying that i think your fatigue is simply the result of mental health stuff, just saying one small piece of the puzzle could be seeing a doctor who has expertise in the complexity of how both mental health and mental health meds can impact sleep.

I hope you are able to find some answers to your fatigue!

colomom wrote: ↑

Mon Oct 17, 2022 9:27 pm

Billymadison420 wrote: ↑

Mon Oct 17, 2022 11:23 am

Is sleep wake junk actually asleep or actually awake? Or transitioning between both?


I attempted to take a nap today. I felt like I was awake, but do these centrals mean I actually fell asleep? If so I fell asleep in 5:40 seconds. The total run time was 17 min on the CPAP machine. I got up because I felt I couldn't fall asleep.

1. https://www.dropbox.com/s/wwv4kx8s2sfb9 ... F.png?dl=0
2. https://www.dropbox.com/s/wkwnjlx0v6vgk ... n.png?dl=0


This was from my PSG at atone 6:40 in the morning when I have a lot of this SWJ.

https://www.dropbox.com/s/o1htioo6qqgq6wa/PSG.png?dl=0

This make me think I was falling asleep.

So would that be scored on an MSLT at a 5:40 sleep latency?

During a MSLT they monitor brain activity to determine whether or not you are asleep, the data from your APAP is not adequate to definitively determine sleep stages or even whether or not you are asleep. With narcolepsy you would expect to see both short sleep latency and to see you entering into REM sleep within 15 minutes of falling asleep during your nap. Even if you fell asleep quickly if you’re barely in and out of N1 during a short nap that would not meet the criteria for narcolepsy.

Hopefully your new doctor from Penn can settle the narcolepsy question for you and if that isn’t the cause figure something else out.
I wonder if you have ever considered seeing a psychiatrist/ sleep medicine doctor? I’m not saying that i think your fatigue is simply the result of mental health stuff, just saying one small piece of the puzzle could be seeing a doctor who has expertise in the complexity of how both mental health and mental health meds can impact sleep.

I hope you are able to find some answers to your fatigue!

Thank you colomom! I will be seeing a neuropsychologist for CBT-I! I agree with you. I think it’s largely obsessive as I have a history of latching on to a particular symptom and obsessing about it.


Btw this was my MSLT: https://www.dropbox.com/s/az1jk4c9175gekt/MSLT.pdf?dl=0


And the letter from my doctor: https://www.dropbox.com/s/076r58ihmi7lg ... s.pdf?dl=0

Billymadison420 wrote: ↑

Mon Oct 17, 2022 11:23 am

Is sleep wake junk actually asleep or actually awake? Or transitioning between both?


I attempted to take a nap today. I felt like I was awake, but do these centrals mean I actually fell asleep? If so I fell asleep in 5:40 seconds. The total run time was 17 min on the CPAP machine. I got up because I felt I couldn't fall asleep.

1. https://www.dropbox.com/s/wwv4kx8s2sfb9 ... F.png?dl=0
2. https://www.dropbox.com/s/wkwnjlx0v6vgk ... n.png?dl=0

All those CAs look like SWJ: In other words, it looks to me like you were trying to fall asleep, but you were not succeeding in falling asleep into real sleep. If there had been EEG leads attached to your head, the EEG data might have indicated that you were bouncing back and forth between very light sleep and wake. Or it could be you were actually awake the whole time.

This was from my PSG at atone 6:40 in the morning when I have a lot of this SWJ.

https://www.dropbox.com/s/o1htioo6qqgq6wa/PSG.png?dl=0

This make me think I was falling asleep.

That snippet you provided is not very useful since we are missing two critical items: The time scale on the horizontal axis and the sleep stage labels on the vertical axis.

So would that be scored on an MSLT at a 5:40 sleep latency?

Not sure what you are asking about. Are you asking about the data from your PSG? Or are you asking about the attempted nap that you provided some OSCAR data for?

In either case, colomom gave you a good answer:

colomom wrote: ↑

Mon Oct 17, 2022 9:27 pm

During a MSLT they monitor brain activity to determine whether or not you are asleep, the data from your APAP is not adequate to definitively determine sleep stages or even whether or not you are asleep. With narcolepsy you would expect to see both short sleep latency and to see you entering into REM sleep within 15 minutes of falling asleep during your nap. Even if you fell asleep quickly if you’re barely in and out of N1 during a short nap that would not meet the criteria for narcolepsy.

Today you write:

Billymadison420 wrote: ↑

Tue Oct 18, 2022 4:26 am

Thank you colomom! I will be seeing a neuropsychologist for CBT-I! I agree with you. I think it’s largely obsessive as I have a history of latching on to a particular symptom and obsessing about it.


Btw this was my MSLT: https://www.dropbox.com/s/az1jk4c9175gekt/MSLT.pdf?dl=0


And the letter from my doctor: https://www.dropbox.com/s/076r58ihmi7lg ... s.pdf?dl=0

I think it's time to stop obsessing about the idea that narcolepsy is the cause of your daytime fatigue. Notably in the letter from your doctor, she writes, "I would recommend continuing CPAP for obstructive sleep apnea and evaluation for depression as a cause of daytime fatigue and dysphoric mood." Are you willing to be evaluated for depression? And lots of various medical conditions other than sleep apnea, narcolepsy, and insomnia can daytime fatigue. Do you have any other known medical conditions? And are you on any kind of medication that might cause fatigue as a side effect?

I do think seeing the neuropsychologist for CBT-I is a good idea. But you will need to be open minded about the CBT-I suggestions: They can require real effort on the part of the person doing the CBT-I and some of the suggestions may seem counter-intuitive. For example, when I was actively fighting the significant war on the insomnia that settled in during my very difficult adjustment to CPAP therapy back in 2010--11, major parts of the CBT-I included a (temporary) restriction on time in bed, a mandatory wake-up time regardless of how little sleep I felt like I got, and a restriction on bedtime to insure the restricted time in bed. The idea was to help consolidate my sleep cycles so that I would both fall asleep more easily at the beginning of the night and have far fewer wakes during the night. Did it work? Yes, but it took quite a bit of time (several months) and a lot of hard work on my part. Was it worth it? For the most part it was. Have I been able to back off on those CBT-I restrictions? Yes, once I was sleeping well I was able to start slowly moving back to a more "normal" sleep pattern for me.

So back to the million dollar question. I couldn't resist my daily 4PM nap today.


https://www.dropbox.com/s/evjxcjcq664pt ... M.png?dl=0

according to the CPAP data it took 16 minutes before transitional breathing started.


so A. I can't even prove that that transitional breathing would be marked as light sleep on an EEG.

and B. even if it was, it took 16 minutes to get there.

What is even more crazy to me is I felt aware of what was going on the entire time. And I certainly do not remember having lapses in breathing of 30 seconds or more. That seems crazy to me. But that's what it seems like from the transitional breathing.

Billymadison420 wrote: ↑

Sat Nov 19, 2022 4:09 pm

I felt aware of what was going on the entire time.

Of course you did.

Billymadison420 wrote: ↑

Sat Nov 19, 2022 4:09 pm

And I certainly do not remember having lapses in breathing of 30 seconds or more.

Of course you don't, see part 1.

You were wrong about both of the things you remembered, because the brain doesn't form memories while you're asleep.

palerider wrote: ↑

Sat Nov 19, 2022 6:57 pm

Billymadison420 wrote: ↑

Sat Nov 19, 2022 4:09 pm

I felt aware of what was going on the entire time.

Of course you did.

Billymadison420 wrote: ↑

Sat Nov 19, 2022 4:09 pm

And I certainly do not remember having lapses in breathing of 30 seconds or more.

Of course you don't, see part 1.

You were wrong about both of the things you remembered, because the brain doesn't form memories while you're asleep.

So I was asleep during that disordered breathing?

If that’s the case I can regularly fall asleep for a nap in less than 7 minutes.

palerider wrote: ↑

Sat Nov 19, 2022 6:57 pm

Billymadison420 wrote: ↑

Sat Nov 19, 2022 4:09 pm

I felt aware of what was going on the entire time.

Of course you did.

Billymadison420 wrote: ↑

Sat Nov 19, 2022 4:09 pm

And I certainly do not remember having lapses in breathing of 30 seconds or more.

Of course you don't, see part 1.

You were wrong about both of the things you remembered, because the brain doesn't form memories while you're asleep.

PaleRider,

I'm asking this as a real question, not a snarky one: What evidence do you see of Billymadison falling asleep in this data?

I mean, I see a lot of places where he might have been unsuccessfully transitioning to sleep, but I don't see any evidence of actual, established sleep. To lazarus's analogy, it looks like the clutch never got "popped" and the whole time, Billy is grinding the gears trying to go from wake to sleep and not really getting there.

robysue1 wrote: ↑

Sat Nov 19, 2022 9:10 pm

I'm asking this as a real question, not a snarky one: What evidence do you see of Billymadison falling asleep in this data?

It's a supposition, based on the fact that people are notoriously bad at knowing when they drift off, and based on the way the breathing is, (without going in and looking at individual breath shapes), the reasonable assumption is that he was drifting in and out of sleep.

Reflect on how many people come in here and say that they didn't sleep at all during their sleep study, yet the eeg says different.

Am I certain he didn't drift off? no, is it very likely? I'd bet on it.

But, again, without looking at individual breaths, and even then, we can't be sure

Short naps are notorious for giving unreliable data.
We just don't get a chance for good solid sleep data so there's often lots of SWJ stuff happening during a nap.

Seeing the report using SleepHQ so people could zoom in on the flow rate and better evaluate things would probably help clear up potential questions but I would bet my last dollar that the majority of the flagged stuff is arousal related.....maybe with occasional transitional...but as a whole that hour wasn't an hour of solid sleep.