Callen's questions...

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Re: Callen's questions...

Post by Rubicon » Thu Apr 27, 2023 5:29 am

..you gotta try to look and identify stuff like

Image

That includes blowing up the area and counting squiggles

Image

It might be alpha intrusion, but more likely just a lot of spindling. If you get a clean study, something to look for.

In re:
My sleep latency is documented as 2 minutes on the PSG – THAT IS NOT CORRECT, I even told my neurologist, I know it’s incorrect because I couldn’t get to sleep for at least 30-40 minutes, and I kept looking at the clock.
IMO your sleep is much worse that the report indicates. It's considerably overscored, with a lot of Wake scored as N1, and N1 scored as N2.
The 2023 results are 2 weeks without any medications (no SSRI/SNRIs, stimulants, etc...)
But now you are, and an entire set of variables come into play.

IMO the new study needs to be done with what you do now. Meds, sleep schedule, caffeine, THC, everything. I mean, wading through this study is fun (although I wouldn't want to do it for a living) but what's the point if it's not what you're doing any more.
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Re: Callen's questions...

Post by Callen » Sat Apr 29, 2023 12:09 pm

IMO the new study needs to be done with what you do now. Meds, sleep schedule, caffeine, THC, everything.
I don't entirely disagree with this statement; however, there's the issue of SSRIs suppressing REM sleep (at least, the data shows that during initiation of the medication it suppresses REM - It does appear that REM sleep comes back after a few months. It's unclear if REM sleep returns to the pre-medication baseline.) There's the possibility of the MSLT being a false negative for narcolepsy if REM is suppressed.

Which, as you know, narcolepsy is what my MD is hellbent on diagnosing me with.

I also wanted to keep you updated on the HLA-DBQ1*0602 testing. I am going to get the test done once I start a new job - it's $800 out-of-pocket without insurance. If that's negative, then I'll be certain that I do not have Narcolepsy type 1. That specific HLA is associated with WBCs (white blood cells). It causes your WBCs to attack the neurons that produce hypocretin. Regarding Type 2 Narcolepsy, I'm of the opinion that it has nothing to do with Narcolepsy at all. It's either an entire disorder all on its own, or a known disorder that's causing people to present with narcoleptic-like symptoms. N1 is a diagnosis based on the body attacking the hypocretin-producing neurons in the lateral hypothalamus. It can be diagnosed by testing the CSF for hypocretin. If hypocretin is low or not present, then the diagnosis is made. N2 is a diagnosis of exclusion.
Did you adjust the filters?
Yes, I've messed around with the gain to make things somewhat coherent. I wouldn't even say I have a basic understanding of Polysomnograms. I don't have formal education on how to interpret them, so my opinion holds little value at this time. I'm doing my best to educate myself, but it's difficult to learn something in such a short amount of time with no guidance.
IMO your sleep is much worse that the report indicates. It's considerably overscored, with a lot of Wake scored as N1, and N1 scored as N2.
From your experience, do you notice any patterns or signs that indicate the cause of my poor sleep?

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Re: Callen's questions...

Post by Rubicon » Sat Apr 29, 2023 1:00 pm

OK look at it this way:

There are 2 of you.

One is getting worked up for N. and has PSG and MLST with one set of variables.

The other is on a boatload of crap but represents current day-to-day life:

Celexa 20mg once daily
Cymbalta 30mg once daily
Adderall XR 30mg one tablet BID
Atenolol 50mg once daily

Even if I could edit PSG and MSLT (one can't edit with reader software)(OK I could but it would be with a pencil and paper, and that would be a little tedious) using poor quality obsolete data may not help a lot.

That said, IMO your sleep was bad then and substantially worse now.

So the plan could be "Some nut on the internet told me to stop all my meds cause they're bad so I did".

OTOH, getting PSG with current therapy will provide objective data and help with direction. Specifically, looking at sleep efficiency, total sleep time, stage percentages and arousals especially spontaneous cause IMO all that stuff is destroying your sleep.

BTW are you a shift worker?

How'd you get on atenolol?
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Re: Callen's questions...

Post by Rubicon » Sat Apr 29, 2023 1:46 pm

Callen wrote:
Sat Apr 29, 2023 12:09 pm
Did you adjust the filters?
I've messed around with the gain to make things somewhat coherent.
You have to set the filters first to get rid of all the too slow and too fast stuff. AAMOF, filter settings are from Da Rules. Gain ~7 uV/mm.

This is the epoch where sleep begins - page 217 (And it's N1, not N2).

Image
Last edited by Rubicon on Sat Apr 29, 2023 2:02 pm, edited 1 time in total.
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Re: Callen's questions...

Post by Rubicon » Sat Apr 29, 2023 1:59 pm

Gain of 20 uV/mm. Eyeball SEMs look better. IMO this is the hot set-up:

Image
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Re: Callen's questions...

Post by Callen » Sat Apr 29, 2023 2:20 pm

That said, IMO your sleep was bad then and substantially worse now.
Is the implication here that my baseline sleep is bad (due to an unknown cause), and the medications are exacerbating the problems?

Also, I stopped taking the SNRI (Cymbalta), because I detest taking medications and wanted to see how I did without it, and if I could minimize the number of exogenous substances I am taking.
BTW are you a shift worker?
No, sir. I haven't worked the night shift in over 2 years now.
How'd you get on atenolol?
My gradual tolerance to Adderall -- (Prescribed due to "Idiopathic Hypersomnia" [translation: "Yep, you're tired. FIIK what's wrong, take these stimulants!"] as evidenced by the 2018 PSG and MSL 5min 30 sec.) -- lead to a gradual increase in dosage. I noticed my blood pressure was starting to run higher than normal and I was having increasing amounts of palpitations. So, I mentioned it to my doctor, and he prescribed a low-dose beta blocker, atenolol. If I did not take Adderall, then I would not need the BB. I've subjected my body to copious amounts of stimulants, non-stimulants, and Gamma-hydroxybutyrate (Xyrem AND Xywav), but Adderall has been the best of the worst. So, it was either take a cardio-protective medicine or not. My family history alone was reason enough for me.

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Re: Callen's questions...

Post by Callen » Sat Apr 29, 2023 2:30 pm

Rubicon wrote:
Sat Apr 29, 2023 1:59 pm
Gain of 20 uV/mm. Eyeball SEMs look better. IMO this is the hot set-up
Why do you limit the view to ECG and EKG and not include TFlow, PFlow, RIP bands, etc... ? Are you only assessing the validity of sleep staging? Maybe I'm asking a stupid question, but AAMOF, I'm uneducated.

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Re: Callen's questions...

Post by Callen » Sat Apr 29, 2023 2:42 pm

OTOH, getting PSG with current therapy will provide objective data and help with direction. Specifically, looking at sleep efficiency, total sleep time, stage percentages and arousals especially spontaneous cause IMO all that stuff is destroying your sleep.
This may provide no value whatsoever, but here are the results from my 2018 PSG and MSLT. I was on Paxil at the time, which was my only medication, and these were the results. Again, probably irrelevant, but yeah.

https://imgur.com/a/VkQ5NlK

In other news, I was able to get my hands on a ResMed Vauto. Aerophagia was too much with CPAP (even with EPR), so maybe this will be more effective. Unless my issue isn't airway related, then, oh well.

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Re: Callen's questions...

Post by Rubicon » Sat Apr 29, 2023 2:48 pm

Callen wrote:
Sat Apr 29, 2023 2:30 pm
Why do you limit the view to ECG and EKG and not include TFlow, PFlow, RIP bands, etc... ? Are you only assessing the validity of sleep staging?
Correct. Scoring is done in 30 second epochs so the other stuff doesn't mean much. Also you have to count the little waveforms within each second to categorize the frequency (delta, theta, alpha, beta (spindles) to stage sleep. There's somewhere between <1 to 16 little waves in each second (sometimes 60 if there's electrical interference and the filters aren't set right). After about 25,000 epochs (seriously) you can pretty much get a feel for an epoch in ~0.5 seconds and stage it with 90% agreement.
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Re: Callen's questions...

Post by Callen » Sat Apr 29, 2023 4:06 pm

arousals especially spontaneous cause IMO all that stuff is destroying your sleep.
I just noticed you specified spontaneous arousals. Are you seeing many SAs on my PSG that are unmarked? My understanding is that I am having a majority of “arousals with respiratory events.”

Wtf could I even do to reduce SAs? What does having SA’s indicate other than fragmented sleep? The implication is that it’s essentially without an identifiable cause.

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Re: Callen's questions...

Post by Rubicon » Sun Apr 30, 2023 2:35 am

Callen wrote:
Sat Apr 29, 2023 4:06 pm
arousals especially spontaneous cause IMO all that stuff is destroying your sleep.
I just noticed you specified spontaneous arousals. Are you seeing many SAs on my PSG that are unmarked? My understanding is that I am having a majority of “arousals with respiratory events.”
OK let's back up there cowboy. I said
getting PSG with current therapy will provide objective data and help with direction. Specifically, looking at sleep efficiency, total sleep time, stage percentages and arousals especially spontaneous cause IMO all that stuff is destroying your sleep.
and
That said, IMO your sleep was bad then and substantially worse now.
Specifically, in the current PSG there aren't a lot of arousals (53 total all sources by my count) but too many awakenings (18) and a short Total Sleep Time (6.1 hours).

So if "clean" you're running a sleep debt of 1.7 hours a night punctuated by 18 awakenings, once you load up on all that crap (Let's do some Adderall! Wait BP up? Let's do some Atenolol!! Wait that makes your sleep even worse!! Let's do more Adderol!!) your sleep is insufficient and NFW you should get a dx. of hypersomnia.

I'm thinking now we need a sleep log and the trend summary for the last few months from Oscar.
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Re: Callen's questions...

Post by Rubicon » Sun Apr 30, 2023 2:40 am

Also point of confusion. PSG report says trial of CPAP suggested but in the PSG there's a CPAP channel going. What's up with that?
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Re: Callen's questions...

Post by Callen » Sun Apr 30, 2023 5:16 am

Rubicon wrote:
Sun Apr 30, 2023 2:40 am
Also point of confusion. PSG report says trial of CPAP suggested but in the PSG there's a CPAP channel going. What's up with that?
I’m not sure. I wasn’t on cpap during the PSG.
short Total Sleep Time (6.1 hours).
The only reason my TST was short is because they woke me up at 5am, and didn’t let me sleep until I woke up. They were only interested in getting 6 hours of sleep, so the MSLT could be done. At home I sleep much longer. Especially, when I’m off my medicines. My sleep is unrefreshing no matter how much sleep I get.

I’ve never been allowed to sleep until I naturally wake up. Would a HST be a better option? I assume not since there’s less data.
I'm thinking now we need a sleep log and the trend summary for the last few months from Oscar.
I’ll start keeping a sleep log. My Oscar data isn’t a reflection of my total sleep - sometimes I can only sleep a few hours with my PAP (i.e. last night.)

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Re: Callen's questions...

Post by Rubicon » Sun Apr 30, 2023 5:44 am

Callen wrote:
Sun Apr 30, 2023 5:16 am
My Oscar data isn’t a reflection of my total sleep - sometimes I can only sleep a few hours with my PAP (i.e. last night.)
Let's take a look anyway. All data is good data. Last 4 months anyway.
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Re: Callen's questions...

Post by Callen » Sun Apr 30, 2023 10:09 am

Rubicon wrote:
Sun Apr 30, 2023 5:44 am
Last 4 months anyway.
I started PAP 3/22/23 - here is all the data. I added it to my shared OneDrive files.

https://1drv.ms/f/s!Anq_rJGQiqX1gYF0IAV3fNxXAshFSw