Spontaneous arousal

avi123 wrote:IMO, we don't need to deal with arousals, not only b/c we can't measure them, but we can't do much about them.

(Sleep Docs like to mentioned them probably to charge some more money, or to raise their respect)

Check this:

Arousal is believed to be needed for upper airway opening in obstructive hypopneas–apneas, without compelling evidence to support this notion. The association may be incidental. I studied the temporal relation between arousal and opening and impact of arousal on flow response at opening in 82 patients (apnea–hypopnea index, 46 ± 35/hour). Obstructive apneas–hypopneas were induced by dial-down of continuous positive airway pressure. Obstructions and hypopneas occurred in 44 and 56% of dial-downs, respectively. When arousal occurred (83% of dial-downs), the temporal relation between arousal and opening was inconsistent between and within patients. Frequency of opening without or before arousal increased with milder obstructions (p < 10−9) and with delta power of EEG (p < 10−6). Time of opening was unaffected by whether arousal occurred before or after opening (18.0 ± 9.8 vs. 18.1 ± 10.5 seconds). Flow response was already excessive when opening occurred without or before arousal (180 ± 148% of initial flow decline) and was considerably higher when arousal occurred (267 ± 154%, p < 10−10). Flow undershoot after first ventilatory response was greater if arousal occurred (p < 0.01). It is concluded that arousals are incidental events that occur when thresholds for arousal and for arousal-independent opening are close. They are not needed to initiate opening or to obtain adequate flow and they likely increase the severity of the disorder by promoting greater ventilatory instability.

Source: http://ajrccm.atsjournals.org/content/1 ... l.pdf+html

Hi avi123!

I would dearly love to be able to "see" when arousals occure in my data. Anything that fractures my sleep I do consider important.

Perhaps we can. SleepyHead apparently has a graph of the pulse data that contains enough of the perfusion information to extrapolate an inferred arousal. When cross checked with the other data this might work. I will get back to you later after I attempt to make this work (so much to do, so little time).

As well, the iBrain is coming down the pike and development is being done with sleep studies in mind. Available to the common man?? - No idea.

I think that breathing is based in developed reflexes contained in varous parts of the nervous system which can recieve consious control if available. I am rather facinated by "Flow undershoot after first ventilatory response was greater if arousal occurred (p < 0.01)" as I am suspicious that a hypocapnic state preceeds apneas or hypopneas and that a better correction is facilitated by a more awake brain. As for the statement "It is concluded that arousals are incidental events that occur when thresholds for arousal and for arousal-independent opening are close. They are not needed to initiate opening or to obtain adequate flow and they likely increase the severity of the disorder by promoting greater ventilatory instability" I have come to believe that there are many "micro-apneas" that occure through the night - do not initiate an arousal - do initiate a sympathetic nervous system response. Perhaps the author is correct, that arousal - I think from greather sympathetic nervous system response - links to greater ventalatory instability however I think the concious brain does a better job controlling the system physiologically (breathing reflexes) otherwise.

I also very much believe that if AHI - AND - Breathing Stability (effort only as needed to maintain healthy blood gas levels) are brought under control, unfractured sleep results, and better health and performance result.

Have a lot of fun!

Todzo

Todzo, as I understand it, I should be able to see arousals in the ResScan Flow Waves graph from my S9 Autoset. Large breaths are associated with respiratory - related cortical arousals when periods of wakefulness are excluded. However, the machine can't distinguish between being asleep or awake.

avi123 wrote:Todzo, as I understand it, I should be able to see arousals in the ResScan Flow Waves graph from my S9 Autoset. Large breaths are associated with respiratory - related cortical arousals when periods of wakefulness are excluded. However, the machine can't distinguish between being asleep or awake.

Hi avi123!

Even my silly PR System one will tag "RERA"s. And if the audio recording indicates a moan, or I flip over, or the flow graph shows enough indication to my eyes - then - I may believe it.

Short of well understood EEG, we really do not know if an arousal occurred or not (for those of technical bent, there is an open source EEG project out there).

The perfusion data from a pulse oximeter may indicate that blood flowed to the core - or perhaps fell a bit loose from the finger - or position reduced flow. If I see flow changes, notable audio, or some other indicator then I am very suspicious of an arousal. The small bit of data we have works much better if we use it all together.

I am very glad for the data we do have for other reasons in the mean time. Along with the other data from the night I may find reason to: walk more (or less), eat more (or less), plan to sleep more (or less) - - or - - if there is a long term trend one way or the other - consider a pressure change (up - or - down). For example if my data shows me that I really did sleep 10 hours a given night I will try to walk considerably over 10,000 steps, eat well, and sleep less the next night. If my Minute Volumes go up I will do Optimal Breathing Training with my pulse oximeter as well as some interval training as well. I find my data very useful as a lifestyle management tool.

We can do a lot in the daytime to make our data at night better.

Right now I am in the process of bringing my pressure down after a move (higher altitude, weight loss, aerobic and interval conditioning, good sunshine). I really did try to make contact with a doctor in my new digs but the process was taking too long indeed!!! Well, I started at 15 and now, some five weeks later, am considering dropping another centimeter from the current 11. I think I would have been a lot healthier the last few years at a lower pressure. I think that titration should be an ongoing task, and that many, many, many arousals would be prevented if this were done. I think that we need a special "titration algorithm" run from time to time as the machine is used. I think this would work much better than AutoPAP since I believe a constant pressure is easier to develop reflexes for than is a constantly varied pressure. I think that we should work toward elimination of anything that may tend to cause arousal - such as the silly "Clear Airway Sensing" pulses. Please let us sleep for goodness sakes!

Last time I checked, at the end of the year from receipt of a PAP 50% are not using it. I believe that this is mostly because it really does not work for them. And, I believe it is not working for them because our current system does not take into account how our body varies with time. For example, I think that accurate pressure settings for some would accurately track with the seasons!

I am glad to see some research coming down the pike that may help us deal with this lack.

Have a great week!

Todzo

Todzo wrote:
Hi Sir NoddinOff!

Thanks to you and kerriberri for reminding me about suppliments. My dietitian did teach me well during our years together, and I just got finished getting "15 minutes a side with the UV index between 6 and 7" (first, I have built up to that "dose" over time, second, NOT for everyone - I have skin that tans very well) so I have my vitamin D for the day so now I need the rest to make it all work.

Part of my day will be spent preparing an exercise area to work on my arms (bursa in particular). I have never really developed my upper body. At 58 that is a sad statement indeed. Still, better late than never and I am suspicious that the efforts will spill over into better sleep and more effective PAP treatment. Also looking into Yoga.

Thanks again and have a great week!

Todzo

Todzo, I just wanted to mention, I was stunned when I was tested for vitamin D and it was extremely low, because I spend a lot of time out in the sun. It turns out, if you live very far north, the angle of the sun causes it to be too weak to stimulate vitamin D development, no matter how much time you spend in it, through much of the year. They say that if you live north of the line connecting San Francisco to Philadelphia and Athens to Beijing, you are likely to be deficient. So I just thought I'd mention it for those who are northerners like me, you can't trust that the sunshine is doing it's job, you have to get your levels checked.

sewsleepy wrote:

Todzo wrote:
Hi Sir NoddinOff!

Thanks to you and kerriberri for reminding me about suppliments. My dietitian did teach me well during our years together, and I just got finished getting "15 minutes a side with the UV index between 6 and 7" (first, I have built up to that "dose" over time, second, NOT for everyone - I have skin that tans very well) so I have my vitamin D for the day so now I need the rest to make it all work.

Part of my day will be spent preparing an exercise area to work on my arms (bursa in particular). I have never really developed my upper body. At 58 that is a sad statement indeed. Still, better late than never and I am suspicious that the efforts will spill over into better sleep and more effective PAP treatment. Also looking into Yoga.

Thanks again and have a great week!

Todzo

Todzo, I just wanted to mention, I was stunned when I was tested for vitamin D and it was extremely low, because I spend a lot of time out in the sun. It turns out, if you live very far north, the angle of the sun causes it to be too weak to stimulate vitamin D development, no matter how much time you spend in it, through much of the year. They say that if you live north of the line connecting San Francisco to Philadelphia and Athens to Beijing, you are likely to be deficient. So I just thought I'd mention it for those who are northerners like me, you can't trust that the sunshine is doing it's job, you have to get your levels checked.

Hi sewsleepy!

You are correct, right now the UV index were I live goes above 6 in the highest parts of the day so 15 minutes a side (trunks only) yeilds a light tan over several days. Next month will see lower levels and perhaps longer times. November thru most of March, even if I could stand the cold I would have a lot of trouble getting enough so I either have to rig some indoor lights or suppliment I suppose.

I am thankful for skin that can process UV, that is a blessing.

Where did you get tested??

Thanks!

Todzo