Pressure & Spontaneous Arousals

I noticed on my titration report, that the higher the pressure treatment levels tried, the higher my spontaneous arousals were. The pressure they found to be best gave me a respiratory arousal of 4.1 & a spontaneous arousal index of 13.6. Giving me a total arousal of 17.8.

Does the spontaneous arousals go down as your system adjusts to the pressure changes?

I also noiticed that my centrals under the lower pressure tried 8/4 was index of 12, where under the higher pressure of 10/6, the central apneas were at an index about .03.

There was no stage 4 or rem sleep. I slept a total of 3.9 hours out of 5.8 hours.

In the write up it said a few things I did not understand. One of those things were "The proportion of slow wave sleep was increased, at 49% of the total sleep time. (normal -11%). It also said I displayed considerable difficulty maintaining consolidated sleep.

The latency to sleep onset was normal at 14 minutes, and the latency to consolidated sleep (5 minutes of stage N2 sleep) was delayed by 91 minutes. No Rem sleep was recorded. Oxygen saturation between 91% & 99%


Rick

Rick, this is a real failure on the side of your doctor if you didn't get a chance to go over the sleep report together.

This was the report from the recent bipap titration? You said you had an awful time due to fighting the exhale timing and that likely impacted the arousal numbers.

With frequent arousals it is not a big surprise that you didn't make it to REM and not a big surprise that they say difficulty maintaining consolidated sleep.

With proper settings on a bilevel machine and a bit of time to get used to it...the arousals should diminish.

Also remember that there can be other factors causing arousals unrelated to OSA or its treatment.

Any idea on when you are getting the bilevel machine? Did you give the AutoSet that had been on loan back to where you got it?

Rick, see if you can compare your results to this:

Sleep Terms and Definitions

• Posted by sleepycarol on March 3, 2009 at 6:12pm.
• I didn't write the following definitions but "borrowed" them from another site. Snoredog on cpaptalk.com wrote these -- or at least posted them. I would like to give him credit for this wonderful list.

DEFINITIONS:

APNEA = cessation of airflow for 10 seconds or greater.
HYPOPNEA =>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.
APNEA/HYPOPNEA INDEX (AHI) = apnea plus (+) HYPOPNEA/hour of sleep.
RESPIRATORY AROUSAL INDEX (RAI) = AHI +snoring related EEG arousals/hour of sleep.
AHI/RAI** Scale =<5 events /hour = (none); 5-15 events/hour = (mild); 15-30 events/hour = (moderate); >30 events/hour = (severe).
Respiratory related sleep fragmentation: Sleep arousals due to respiratory events or snoring.
Desaturation = Drop in O2 oximetry distribution saturation by 3% below average saturation.
SaO2 scale: >89%=(none); 85-89%=(mild);80-84%=(moderate); <80% (severe).
EPWORTH SLEEPINESS SCALE =<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytime somnolence-not excessive);>16 (indicates EDS).
RESPIRATORY EFFORT RELATED AROUSALS (RERAs)=Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.
StageIII and StageIV are combined and referred to as Deep Sleep.
Sleep Efficiency = Normal is >80%
As established by AASM/ABSM 1999.

Normal Sleep Architecture:
Stage1: 5%
Stage2: 50%
Stage3: 10%
Stage4: 10%
Stage REM: 25%

Stage3&4, REM decrease as we age.


Stuff seen on a PSG Report:

Arousal: An interruption of sleep lasting greater than 3 seconds.

BR Arousal index: The number of breathing related arousals(apnea, hypopnea, snoring & RERAs)multiplied by the # hours of sleep.

Bruxism: Grinding of the teeth.

Central apnea: A respiratory episode where there is no airflow and no effort to breathe lasting greater than 10 seconds.

EEG/EOG: Comments about sleep stages, brain waves (EEG), or eye movements (EOG)

EKG/ECG: Comments about heart rate, abnormal heart beats, etc.

EMG: Comments about leg movements and or teeth grinding (bruxism).

Hypopnea: A respiratory episode where there is partial obstruction of the airway lasting greater than 10 seconds. Also called partial apnea or hypo-apnea.

Non-supine: Sleeping in any position other than on the back.

NSR: Normal sinus rhythm.

NPSG: Nocturnal Polysomnogram, or sleep study.

(#)Number of Awakenings: The number of pages scored as wake after sleep onset.

Obstructive apnea: A respiratory episode where there is a complete cessation of airflow lasting greater than 10 seconds.
PLMs: Periodic limb movements.

PLM arousal index: The number of periodic limb movements that cause arousals multiplied by the number of hours of sleep.

PSGT: Polysomnographic technologist.

REM latency: Latency to REM(dreaming) from sleep onset.

RERAs: Respiratory effort related arousals. Episodes that are not apneas or hypopneas, often related to loud snoring, that generally do not cause a decrease in oxygen saturation.

Respiratory: Any specific comments about respiratory events.

RPSGT: Registered polysomnographic technologist.

Sleep efficiency: Total sleep time multiplied by time in bed.

Sleep latency: The first 30 seconds (one `epoch' of recording time) of sleep.

Sleep onset: The first 90 seconds (3 `epochs) of uninterrupted sleep.

Sleep stage shifts: The number of incidents of sleep stage changes.

Snoring intensity: Level of snoring loudness determined by the sleep technologist. Ranging in degrees from mild to very loud snoring.

Spontaneous arousal index: The number of spontaneous arousals (e.g. arousals not related to respiratory events, limb movements, snoring, etc) multiplied by the number of hours of sleep.

Stage 1: The lightest stage of sleep. Transitional stage from wake. top

Stage 1 shifts: The number of times the sleep stage changed to stage 1.

Stage 2: The first true stage of sleep.

Stages 3/4: The deepest, most restorative sleep.

Stage REM: The dreaming stage; Normally occurs every 60-90 minutes.

Supine: Sleeping on back.

Time in bed: The time in the study from `Lights Out' to `Lights On'.

Total arousal index: Total number of all arousals multiplied by the number of hours of sleep.

Total # of PLMs: The number of leg movements in sleep that last greater than 0.5 seconds.

Total sleep time: Total time asleep.

WASO: Wakefulness after sleep onset.

WNL: Within normal limits.

Index is total number DIVIDED by hours of sleep.

It is interesting to me that your O2 sats were high. Mine were the same. I also had a broken sleep pattern and didn't get into REM until it was time to wake me up. The tech went and took care of the other person also having a study that night so he didn't have to pull me out of REM.

Is it possible to feel crappy and tired all day even if your O2 sats are normal?

Pugsy wrote:This was the report from the recent bipap titration? You said you had an awful time due to fighting the exhale timing and that likely impacted the arousal numbers.

With frequent arousals it is not a big surprise that you didn't make it to REM and not a big surprise that they say difficulty maintaining consolidated sleep.

With proper settings on a bilevel machine and a bit of time to get used to it...the arousals should diminish.

Also remember that there can be other factors causing arousals unrelated to OSA or its treatment.

Any idea on when you are getting the bilevel machine? Did you give the AutoSet that had been on loan back to where you got it?

My sleep doc wants me to see a respirologist before deciding which machine to give me. At this point she feels the autoset will do, however I have to now wait until Jan.3, which is the date of my respirologist appointment.

I was able to rent the S9 autoset again for 1 more month.

My sleep doctor does not explain anything to me. IF I do not ask her the questions, the only thing she would tell me is the pressure they came up with. The line written in the report "HE will be seen in followup by Dr.____ to review these results & discuss further management" is a load of bull. If I did not ask for a copy of the report, I would not know anything.

I would think it important for her to discuss with me about "the considerable difficulty maintaining consolidated sleep, the high spontaneous arousals, the high centrals on part of the titration, and what ever is meant by, the proporotion of slow wave sleep was increased by 49% (normal 11%) & not reaching stage 4 or rem sleep". THey were not brought up by her at all. They seem like such obvious things for her to discuss with me.

My average respiration rate at sleep is about 22 breaths per minute. is this high?

Thank you everyone for your feedback.

Rick