Help Analyze My ResScan Flow Data For Wake Ups

avi123 wrote:... was told that there are many folks who have Fragmented Sleep (no REMs) through out their lives and there is nothing to cure it. ...

Even if you do have REM sleep, there is a LONG history of having "Fragmented Sleep". In fact, in some of Shakespeare's works you hear it referred to as First and Second Sleep:

http://en.wikipedia.org/wiki/Segmented_sleep
http://www.nytimes.com/2006/02/19/opinion/19ekirch.html
http://www.washingtonpost.com/wp-dyn/co ... 04044.html

Those three articles should provide some light reading to help with the insomnia!

One or two wakeups during the night is perfectly normal. In fact, it may have been a VERY useful survival trick to be certain everything was safe. We can sleep through the night, but that was not always so. And we have thousands and thousands of years of reinforcement of something that worked. We won't change it in a few hundred years.

So, unless you have bad problems with getting back to sleep, some wake ups during the night is both normal and may be a good thing. If it interferes with getting enough sleep, you might need to be certain your sleep hygiene is in order. If so, then do chat with your doctor about it.

Thanks all for the replies.

@JohnBFisher - the falling back to sleep after the big wake up is a concern. I can get several wake ups and fall back to sleep quickly, but then the one I call "the big wake up" is the one where I don't fall back to sleep easily or quickly, and in the past 10 months if I get too much of that then the sleep deprivation can be hard on me.

But can we determine anything from the Flow pattern shapes I posted? Could those be typical patterns for say being in dream state, and then could the breathing patterns brought on by dreams themselves be what stirs me to wake up?

I thought I was on to something in trying to figure out more about what was causing my big wake up when I saw how erratic those breathing patterns appeared, so any comments more on this topic will be most appreciated.

Here's a thought - I see I had a patch of Flow Limitation leading up to the point I turned off the machine. Can we make anything of that observation?

Jeffster wrote: @robysue, yes, I have read a bit about segmented sleep, learning of it from an older thread here. I think that is a strong possibility of what my condition is. I'll have to give that later lights out idea some consideration; I'm guessing I'd need to do it for several days to weeks to see any possible improved results?

You need to give it a several WEEKS to several MONTHS for it to work. And expect some "Feel soooooo tired and sleepy today I wanna nap" feelings at the beginning as well. But you can't take any naps if you try the sleep restriction idea if you want it too work.

In my case, I started out with a six hour (max) time in bed window: Back on Dec. 30, 2010, I was told by the PA I was working with to go to bed at the LATER of the following:

1:30 AM (If I was sleepy) OR first time I got sleepy after 1:30 AM

And I had to get up at 7:30 AM seven days a week.

The first week was really hard: Bedtime was often as late as 3:00 and I was still getting up at 7:30 and dragging through the day with no naps. And waking up 4--5 times a night for 10-15 minutes at each wake. You do the math to see how little I was sleeping.

By the end of January, I was usually getting to bed between 1:30 and 2:00 and the number of wakes had started to drop a bit. But aerophagia was still waking me up a lot and making me pretty miserable along with the topiramate.

By the end of Feburary, I was still getting to bed around 1:30 or 2:00 and the number of wakes had stablized at around 3--4. But the length of time to get back to sleep had dropped to less than 5 minutes unless there was an obvious problem, which is when the anger, angst, anxiety, etc. would kick in.

And that's where I got "stuck"---mainly due to problems with migraine meds (lamictral and then depakote)---for the longest, most frustrating time.

Now? My new doc has let me relax wake up time (somewhat) in an effort to get me to sleep a bit longer. On the rare exceptionally good nights I'll get to bed around 12:30 or 1:00 and sleep until 7:30 with only 1--2 brief wakes. (I WANT MORE OF THESE NIGHTS!). On a typical night, I'll get to bed between 1:30 and 2:30 and sleep until somewhere between 7:30 and 8:00 with 2--3 short wakes. On the rare bad night, I'll get to bed after 3:00am. If I can, I'll allow myself to sleep until 8:30 or 9:00, but that's not always possible. And still no naps---unless I need one to fight a migraine. I almost feel as if I'm no longer struggling so mightily with my insomnia monster: He's pretty much tied up these days, but fights back through his chains occasionally. And of course his ally is that I really am a night owl by nature.

Hi Jeffster,

Just a couple comments. You could try the Ambien therapy recommended by some. It goes like this: if you normally take 10 mg at bedtime, take half a pill (5mg) instead and when you wake 5 hours later, take the other half. The trick is not to take so much in the middle of the night that it leaves you wiped out the next morning.

I have used a time lapse video to see what I'm doing when I wake and I know that I am usually on my back. Many lap tops come with built in webcams that can do time lapse. If you want to get fancy, you can make an infrared camera from an ordinary webcam and put together an infrared light source from parts from radio shack fairly cheap (20 bucks). You can search "Infrared" for some of my earlier posts for "how to".

Another option is a Zeo which works fairly well to tell you what stage of sleep you wake from. I know from my Zeo I wake most from REM. I find the Zeo most useful, though, to compare the amount of deep sleep I get with different therapies, usually very little. Just recently I tried a new drug and was able to determine objectively with the Zeo, the longer I used it, the less deep sleep and more awakenings I had. Which explained why I subjectively felt worse.

The problem with knowing the two things above, is what to do with the information. I know I wake from sleeping on my back, but I have yet been able to prevent it. I know I wake from Rem, but so...?

Anyway, I hope you're able to determine and fix the cause of your big wakes.

Jay

@robysue - glad to read you have the insomnia monster under better control. I have it under better control than a few months ago, but I feel like this big wake up could take me out again, which is why I went ahead and *finally* posted some Flow data that I thought might give a clue.

@Jay Aitchsee - I have somehow trained myself to at least stay off my back. I am usually on my right side when I have these wake ups, and feel quite comfortable, which is part of the mystery to me. If I feel so good, then why am I waking up? My doctor didn't want to give me Ambien when I asked for it last time I saw her a few months back near the end of April. So instead lately, when I have the big wake up say 4 hours into my sleep, and feel like I'm too awake to fall back and get the additional 4 hours sleep I desire, I take a generic 25 mg Benadryl pill. That seems to help me fall back to sleep eventually. Thanks for your good wishes for me finding the cause and fixing these wake ups, and I wish you the best in your efforts to improve, like training yourself somehow to stay off your back. It sounds like we both have the wake ups from the REM or dream state.

Jeffster, here's a website you may find interesting: http://www.osahelp.com/ . He shows examples from S9 of Sleep vs Wake waveforms.
I never could tolerate benadryl. It always left me feeling to druggy the next day, and I'm not sure it promotes deep sleep. Many sedatives do not. I think I would press for the generic ambien. It's cheap now. Most people seem to tolerate it fairly well, though it does seem to cause odd reactions in some. I would not use it in conjuction with alcohol. I've kept a 10mg Rx for a long time but never use more than 5 (I always split the pill). I do think there is a risk of dependency, but not addiction.

Jay

Hi Jeff. I agree with robysue that your flow looks pretty ragged there. Do you breath like that at other times, or just before your big wakeups?

I'd be interesting to see what your respiratory rate trace looks like for that night.

Jeffster, wish I could help, but my flow waveforms are getting stranger and stranger, and now I have no confidence predicting what my waveforms means.

This board has some amazing sleep detectives, it's a pleasure to watch them troubleshoot stuff.

And I've never heard of second sleep, thanks for those providing links explaining it.

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JohnBFisher wrote:: One or two wakeups during the night is perfectly normal. In fact, it may have been a VERY useful survival trick to be certain everything was safe.

Yes, I wondered if the "second sleep" branch of this thread was going to play into a "paleo-diet is our heritage, so why not paleo-sleep?" discussion.

JohnBFisher wrote:And we have thousands and thousands of years of reinforcement of something that worked.

I'd say many millions, since none of our primate ancestors were built to hunt at night. Truly nocturnal animals have superior night vision. Of course, when man mastered fire, anything was possible.

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Jay Aitchsee wrote: I've kept a 10mg Rx for a long time but never use more than 5 (I always split the pill).

I used to employ a box-cutter to split a 10 into a 5. Never really worked, and for a year it drove me crazy as the pill fractured unevenly, sometimes skittering across the kitchen floor. Then I discovered that generic ambien is sold at 5mg doses . . .

Jay Aitchsee wrote: I do think there is a risk of dependency, but not addiction.

If you can't fall asleep without it (and I can't, been up as long as 120+ hours when I ran out), so I'd say addiction is a possibility.

@Jay Aitchsee - that is a cool website. His chart in section 6 for Hypopnea look like some of my patterns, which makes me think I am getting reduced upper airway breathing with several short inhale - exhale cycles, but most of my patterns like that are under 10 seconds, more like 5 seconds or less, so they're not being scored as hypopneas. But I'm having them in-between almost every full cycle of inhale exhale all night long, so that may be adding up for lesser quality of sleep.

@Otter - it got most ragged like that before the big wake up, but there is more of that going backwards in time. now I'm seeing that Flow patterns going back hours from there, and forward from there, are more uniformly smooth, but all still have these extra very shallow inhale - exhale patterns in-between each full inhale section, like I mention above to Jay. I think some of that can be seen in the Flow patterns I have posted already. Would it help if I post some more one minute Flow jpegs from the same ResScan date but a couple of hours back from the big wake up to show more of those patterns? Is the "respiratory rate trace" you mention the same thing as the Flow pattern charts I've been posting?

All this is making me think that I may have UARS. I just read the Wikipedia page on UARS, and it says the treatment is the same as for obstructive sleep apnea, so I guess I've got the best therapy going I can have already even if I do have UARS?
http://en.wikipedia.org/wiki/Upper_airw ... e_syndrome

@Mike6977 - good luck with improving your Flow waveforms, too.

robysue wrote:By delaying bedtime until 12:30, but keeping wake up time at 7:30, that would help your body consolidate its sleep cycles and may allow it to eliminate the big wake simply because it can only get the seven hours of sleep it needs by NOT falling back into the pre-industrial pattern of having a big wake in the middle of the night.

So it may be worth trying going to bed later, but getting up at the same time for the next several weeks. See if that eliminates the big wake or not.

An interesting thought there, RS. However, before Jeffster is sent out on an endeavor that will take weeks, can you be a little more specific as to how Sleep Restrictive Therapy may correct

Jeffster wrote:I'll get maybe 3 hours sleep, then fragmented 20 - 40 minutes sleep periods until it feels like time to get up after around 8.5 hours of mask time.

If

• He may have significant sleep state misperception that underestimates his actual sleep
• The periods of wake are not defined, so in theory there could simply be 11 periods of wake lasting 31 seconds each
• Since he takes a fistful of drugs before he goes to bed, he basically controls his sleep block. It is unclear to me how moving that up will offer alter anything, except perhaps
• Now you could make him tired during the day (and right now he claims to have "a high level of energy"). What if he falls asleep at work (assuming he works) or while driving (assuming he drives)?
• Have medical causes of insomnia (like atenolol or other medications) been ruled out?
• Why attack the beginning of the sleep period anyway? On the one hand you argue Evolutionary Sleep, then advocate an unnatural sleep period (at 0730 it's been light for at least 90 minutes).
• If this person claims to have UARS (maybe, although one needs to look at a bunch of other stuff because it's "apparently" OOC) and perhaps there's a REM component, but if it is assumed that FLs define REM macrostructure, then one could argue that the overall sleep architecture actually isn't all that bad.

Jeffster wrote:@Otter - it got most ragged like that before the big wake up, but there is more of that going backwards in time. now I'm seeing that Flow patterns going back hours from there, and forward from there, are more uniformly smooth, but all still have these extra very shallow inhale - exhale patterns in-between each full inhale section, like I mention above to Jay. I think some of that can be seen in the Flow patterns I have posted already. Would it help if I post some more one minute Flow jpegs from the same ResScan date but a couple of hours back from the big wake up to show more of those patterns?

It might. I'd be looking at that if it were my own data.

Is the "respiratory rate trace" you mention the same thing as the Flow pattern charts I've been posting?

No, it's breaths per minute. Your S9 logs RR, but maybe ResScan doesn't display it. In my own data, it seems to be a reasonable indicator of both REM and wakefullness. As near as I can tell without any kind of EEG, RR is fairly steady in NREM. When I'm in REM, the RR line moves unevenly between the NREM minimum and 150% of the NREM maximum. My waking RR traces look very similar, but are even more ragged and often go lower than NREM. It's no substitute for an EEG, but in the absence of an EEG, it's worth looking at.

All this is making me think that I may have UARS. I just read the Wikipedia page on UARS, and it says the treatment is the same as for obstructive sleep apnea, so I guess I've got the best therapy going I can have already even if I do have UARS?

Cognitively impaired minds think alike. When I first looked at your minute charts, I thought, "Maybe that's what UARS looks like in flow data." They say UARS tends to develop into OSA, hence it seems possible that CPAP could set the clock back to pre-OSA UARS. I wonder if you have enough pressure to get out of OSA territory, but need a little more to leave UARS behind too.

FWIW, looking at your flow patterns, I see an awful lot of irregularities. The sharp, deep negative spike would indicate expiratory puffing, were you using a nasal mask or nasal pillows, but with a FFM I'm scratching my head. The well defined periods of flow limitation are spaced about right to correspond to periods of REM sleep, when irregular breathing and most events seem to occur. The leaks don't look bad, and you aren't having many events.

But you have a lot of flow limitations. The positive peaks should be sharper. Yours are plateauing, truncating, slanting, all very irregularly. The top flow trace appears to show a period of awakening between 2:10:35 and 2:11:00.

I wonder what your breathing is like during a period of quiet non-REM sleep. That should be your basis for comparison.

My impression is that your OSA is being handled just fine. But something else, perhaps neurological, is keeping you from sleeping effectively. A sleep study with EEG might be in order. I know a good lab in San Clemente.

My new comments are in purple

deltadave wrote:

robysue wrote:By delaying bedtime until 12:30, but keeping wake up time at 7:30, that would help your body consolidate its sleep cycles and may allow it to eliminate the big wake simply because it can only get the seven hours of sleep it needs by NOT falling back into the pre-industrial pattern of having a big wake in the middle of the night.

So it may be worth trying going to bed later, but getting up at the same time for the next several weeks. See if that eliminates the big wake or not.
An interesting thought there, RS. However, before Jeffster is sent out on an endeavor that will take weeks, can you be a little more specific as to how Sleep Restrictive Therapy may correct

Jeffster wrote:I'll get maybe 3 hours sleep, then fragmented 20 - 40 minutes sleep periods until it feels like time to get up after around 8.5 hours of mask time.

He's trying the drugs and he's asking for ideas. All I'm doing is throwing out one more based on something that's (finally) worked for me. And I'm being honest that it's not a short term solution. I rather doubt that sleep restriction is something that Jeffster is willing to do. And that's fine. But it is an idea that he needs to be aware of---just in case he gets desperate enough to try it.

If

• He may have significant sleep state misperception that underestimates his actual sleep This is another interesting idea that Jeffster needs to think about since many folks with insomnia issue do underestimate their total sleep time---and sometimes vastly underestimate it. But why do you think he might be overestimating the length of the wake that he refers to as "the big one", which is really the only one that's bothering him substantially at this point. Oddly enough, I'm outlier on this issue too: On 3 of my 4 sleep studies (posted at Robysue's Summary Graphs), I nailed the total time asleep on the morning after survey pretty good since on those three studies I estimated sleep time as between 4 hours and 4:15 hours and the times were 238.5, 253.6, and 239 minutes. On the November study when my insomnia monster was at his strongest, however, I vastly over estimated the sleep time: I said I slept around 3 hours; the total sleep time was 111.5 minutes.
• The periods of wake are not defined, so in theory there could simply be 11 periods of wake lasting 31 seconds each But Jeffster is specifically complaining of ONE big, long wake where he cannot get back to sleep. How do 11 periods of wake lasting 31 seconds each add up to one BIG, LONG wake where you cant get back to sleep?
• Since he takes a fistful of drugs before he goes to bed, he basically controls his sleep block. He does take a fistful of drugs before going to bed. But he self reports that the drugs are NOT enough to eliminate his BIG WAKE that's continuing to cause him problems. So is his sleep block really under control? Or is it fragmented in a way that is disturbing to Jeffster? It is unclear to me how moving that up will offer alter anything, except perhaps
• Now you could make him tired during the day (and right now he claims to have "a high level of energy"). What if he falls asleep at work (assuming he works) or while driving (assuming he drives)? Is he really claiming to have "a high level of energy"? If so, then why is the BIG WAKE troubling him so much. My interpretation of his posts is quite the opposite: He's had insomnia for years and has learned to function with it, but does not feel at his best. I could be wrong, and if you can point me to where Jeffster claims to have a high level of energy, please do so. 'Cause that means I've missed an important part of his story.
• Have medical causes of insomnia (like atenolol or other medications) been ruled out?Good question. In June Jeffster listed his meds as Trazodone (prescribed FOR the insomnia) and a Centrum Silver multivitamin. This was just before he added the OTC he's now taking. I don't know if he's weaned himself of the Trazodone yet.
• Why attack the beginning of the sleep period anyway? On the one hand you argue Evolutionary Sleep, then advocate an unnatural sleep period (at 0730 it's been light for at least 90 minutes).I'm not arguing any particular point of view concerning Evolutionary Sleep. Just pointing it out as yet another idea to consider. The point remains that the BIG WAKE is bothering Jeffster. He's wanting ideas about what might be causing it; hence my suggestion to look at Second Sleep since that seems to me, as a patient, as reasonable as anything else that's been tossed around. He's also wanting any kind of ideas on how to tackle resolving the BIG WAKE; hence my suggestion of a technique that has (finally) worked for me. I was willing to do the months long work with the sleep restriction simply because I was unwilling to do the pharmacological approach that Jeffster is comfortable with. And in my darkest days plenty of folks were quite comfortable suggesting to me that maybe I needed to consider using drugs. And I did appreciate the suggestions. And I even tried melatonin for a while. All the melatonin did for me was aggravate my TMJ something fierce. But it was still worth the try.
• If this person claims to have UARS (maybe, although one needs to look at a bunch of other stuff because it's "apparently" OOC) and perhaps there's a REM component, but if it is assumed that FLs define REM macrostructure, then one could argue that the overall sleep architecture actually isn't all that bad.Why is the idea of UARS out of character?

So deltadave, what's your best guess as to why the BIG WAKE is (still) bugging Jeffster so much? And what would you advise him to try since the current nightly mix of OTC stuff has not addressed the BIG WAKE issue at all?

Slartybartfast wrote:But you have a lot of flow limitations. The positive peaks should be sharper. Yours are plateauing, truncating, slanting, all very irregularly.

My impression is that your OSA is being handled just fine. But something else, perhaps neurological, is keeping you from sleeping effectively.

What do you make of the long pauses after Jeff is done exhaling? That's the thing that really jumped out at me, because it's so unlike my own waveforms. It looks almost like there's one or two second OA between each breath. That plus the flattened peaks makes me think this is an obstructive problem, but I haven't seen anything quite like it before. Is that just the way some people breathe, or does it indicate a problem?

If this is obstructive, then it wouldn't surprise me if you're spending most of the night in mild RERA, Jeff. It looks like a lot of work. I'm really curious what happens when your pressure is higher. I forget, are you running APAP or CPAP?

Thanks for all the input everyone. It really is appreciated. I shall try to respond as best I can, but it will likely take a few tries to get to all the levels of detail:

@Otter - I think Minute Ventilation as reported in ResScan may be the "respiratory rate trace" you mentioned. I'll pay attention to that to try to get a non-REM Flow data example posted here. Here's the Wikipedia definition I just looked up:
http://en.wikipedia.org/wiki/Respiratory_minute_volume
I'm on APAP set to 13 min and 16 max and I never see it go up to that max.

@Slartybartfast - yes those irregularities look ugly to me! Thanks for confirming that thought. I have to get offline shortly but I will try to post again in a little while with a one minute Flow jpeg that shows a typical pattern when Flow Limitation and Minute Ventilation are low for perhaps a more "normal" comparison.

@robysue and DeltaDave - I was focusing on the "big wake up" as I thought it might yield the most information with the Flow patterns I posted, which I marked at the moment of waking up by turning off the machine, so I thought I might have good data to present. But please tell me more about this comment, "...it is assumed that FLs define REM macrostructure, then one could argue that the overall sleep architecture actually isn't all that bad." I had one 50 mg Trazodone and one 100 mg 5-HTP at lights out the night of this data. I also had one spray per nostril Fluticasone Propionate one hour before lights out. And the morning medicine I had a Centrum Silver Multivitamin, and 12.5 mg Atenolol (I cut a 25 mg pill in half). But I've only been on the Atenolol since mid January this year when I went to see my doctor because the insomnia had gotten much worse through December and into January. My blood pressure was very high, and the Atenolol helps that. But I have improved the insomnia problem greatly through this year, and I had the wake ups problem long before I went on the Atenolol. When I saw my doctor again in late April, my blood pressure had improved enough that she agreed i could cut the dose in half from 25 to 12.5 (cutting the pill in half) but she wanted me to stay on for safety. I don't think getting off the Atenolol is going to end my wake ups, since they they and the insomnia problems existed before taking it, and have improved since taking it. I'm trying to be proactive with the "big wake up" thing and try to understand it better, as I fear it could come on strong again at some point, and the resulting increased sleep deprivation is something I need to avoid.

I've got to log off now, but will return later with more replies.