Will CPAP Work for "Sleep Fragmentation?"

I'm new to CPAP as of last week. My sleep study listed only mild obstructive apnea, but severe "sleep fragmentation". My mean oxygen saturation was 92%, but apnea-hypopnea disturbance index was 21 events per hour, and respiratory disturbance was 52 events per hour, and sleep efficiency at 42%. The results were reviewed by a sleep doctor, but I have not had a doctor consultation, as it's not standard at my sleep clinic. I don't understand the results. If oxygenation is adequate, will CPAP work for me, or are the "fragmentations" a diferent kind of sleep disorder. Any insight would be appreciated.

The severe sleep fragmentation means that your sleep did not follow a normal cycle cycle. We are supposed to flow (more or less) from being awake to Stages 1, 2 and 3/4 of non-REM sleep. Then after about 90 minutes or so we move to REM sleep for a while. (Stages 3 an 4 are now typically combined on most sleep studies and by most researchers). See the following page for an older review of the stages:

http://library.thinkquest.org/11189/nfmechanics.htm

However, if you experience an apnea, your body may (and it depends on the person) arouse you to a lighter level of sleep. This causes the sleep architecture (normal pattern of sleep) to fragment (be disrupted).

And the severity of the sleep apnea often is not related to the sleep fragmentation. It depends more on the person that it does the condition. I also have lots of problems with sleep fragmentation. But with xPAP therapy my sleep is deeper, more normal (less fragmentation) than without it.

Hope that helps explain this.

John, thanks for reposting. I couldn't locate the post after it first appeared. What causes the fragmentation, if not a lack of air? Do you think it's a neurological condition? How long did it take for you to see improvement?

Papillon2 wrote:... What causes the fragmentation, if not a lack of air? Do you think it's a neurological condition? How long did it take for you to see improvement? ...

Sorry, I ... are you sitting down? ... stepped away from my computer for a while!!

What can cause sleep fragmentation? Just about anything can do that.

Let's take some examples. (Sorry this is a longish answer as a result!)

We don't always awaken when we hear sounds. Was the sleep lab in a noisy environment? But it might arouse us from a deeper level of sleep to a lighter level of sleep. That can do it. (And this is all too often a cause of problems in a sleep lab).

We don't always awaken when our bodies are uncomfortable. We may find aches and pains will cause us to arouse from a deeper level of sleep to a lighter level of sleep. We often then move to minmize the aches and pains. It's pretty normal. And that would fragment sleep.

Sometimes if we have problems breathing against continuous pressure we might arouse because it is difficult for us. That in fact is how a sleep tech about 16 years ago recognized I needed BiPAP pressure. With CPAP there were a lot of arousals. With BiPAP the number dropped quite dramatically. So, the continuous pressure of CPAP might do it.

Sometimes, it might be due to being overweight and breathing against too much bulk in the body. That can lead to hypoventillation and cause us to arouse from a deeper level of sleep to a lighter level of sleep.

And sometimes (though much rarer), if you have a neurological disorder that impacts the brain stem, your body simply fails to normally cycle between different levels of sleep. This "dysregulation" (or lack of normal regulation) tends to occur with neurological problems such as Parkinsons, MS, Brain Stem Injury, Alzheimers, Sporadic OPCA, MSA, and so on. However, the neurological issue must be fairly advanced (and evident in daily life) before it impacts sleep. So, if you don't have any other neurological symptoms, it is quite unlikely this is the underlying cause.

I do have neurological problems. I have problems with coordination. I have some serious vision problems due to that incoordination. I tend to "freeze" when confronted with emergency/overload situations. So, I no longer drive. It's just not safe for others for me to drive. I sometimes get "overloaded" and sound as if I've had too much to drink. I often fight to find the right word. I watch action filled / loud movies and walk out of the theater walking more like Frankenstein's monster than a normal human. Under severe overload conditions, I find I have a hard time sorting out what is happening around me. It's not that I can not think. I just can not sort it out. It's a bit overwhelming. I also appear to have some central autonomic nervous system problems (of a personal nature).

So, in my case, my sleep fragmentation probably does come from problems with how my brainstem works. But as I mention, unless you have really serious other problems, neurological sources for sleep fragmentation is quite unlikely. But it can occur.

There's an old "saw" that medical schools teach doctors:

If you hear hoof beats, think horses, not zebras.

Of course, there is a corollary that I teach to those I mentor (in computer systems problem solving):

If you hear hoof beats, think horses, but don't ignore that it might be zebras.

This is my understanding from both my own research and from my discussions with my neurologist / sleep specialist. However, I am not in any providing a medical opinion. In your shoes, I would see if the CPAP therapy would help improve my sleep fragmentation. If it does not, I would then ask my doctor what might cause it. And if there is anything that can be done to help. Oh, wait! That's what I've actually done in the past!

How long did it take me to see improvement? I'm wondering that myself! Really!

When I first started to use CPAP (20 years ago), I found it was a WONDERFUL relief. My sleep improved within the first week. In fact the first weekend I had it I tried to play sleeping beauty. Unfortunately, they threw me out of the cast line almost immediately... something about breaking the mirrors with a mug like mine! Seriously, I slept about 24 hours in two days. I *badly* needed sleep.

When I moved to BiPAP, I was not sleep deprived. It took about two months before I felt a lot better.

When I moved to ASV in the beginning of December, it took until the end of January to see some consistent improvement. But I still have some VERY rough days. On those nights I seem to have more problems with leaks. But I don't know if the leak makes the therapy less effective, or the leak indicates I had more problems with tending toward hypoventilation and central apneas. It might also indicate I have deeper problems with sleep architecture regulation.

So, it is likely I won't rebound to what I was before things fell apart (about the March timeframe of 2009). But it is much better than it was prior to using the ASV unit. So, I'm grateful it helps.

Sorry for the long explanation. But I hope it helps explain what can cause sleep fragmentation and how long it can take before you feel better. Unfortunately, the answer to the first is "Almost Anything" and to the second is the old standby "It Depends!"