Detecting UAR with a ZEO ?

deltadave wrote:

kaiasgram wrote:What he decided to do is send me home with a ZEO for a few nights -- he said if it shows lots of arousals then I likely need more pressure.

how does this guy think he can find arousals with a Zeo (TS, if he has a setup like Max' he can do it, but I'll wager he don't)?

Beats me, DD. Even being a lay person (go ahead and have some fun with that!) I know enough to know that the Zeo will not identify arousals. Maybe my large number of wakes and disproportionately large percent of time spent in light sleep and shortage of deep sleep create enough of a general picture to suggest the possibility that arousals are happening? All this to see if a trial of bipap would allow me to use a higher pressure without bad aerophagia kicking in. Why not just do the bipap trial?

He's assessing snoring by having me download Sleeping U to my iPhone and recording myself. Is this sophisticated science or what?

Jay Aitchsee wrote:Kaiasgram,
It seems The Sheik had a similar experience, but it stopped.
viewtopic.php?f=1&t=82068&p=745401#p745401

Jay

Well this is interesting -- I used the Zeo again last night, night 3, and all went pretty well. This is very much the same as Tom "The Sheik"'s experience of a few nights of weirdness that went away. Maybe the aliens decided to return to Missouri -- they didn't like the stormy weather we're having here on the west coast.

kaiasgram wrote:

Pugsy wrote:You will need to erase or reformat the SD card or use another. They will likely blame you but it was their error.

I bought an SD card at Best Buy a few months ago to keep as a spare -- so no problem, I've already put it in my S9 and it's ready to go. And all my data to date is in my SH files on my computer, including last night. I think I'll send them a screenshot of the summary data so they'll know I had good data right up until the moment it got into their hands!

What will you do if they say "more pressure"? How's the aerophagia thing working out?

The doctor said if it looks like I might need more pressure the clinic would send me home with a bipap machine to trial for a week or so. I didn't know this was an option as sleep doctor number one never mentioned it.

If I do in fact need bipap, I'll first throw up because I'll have to buy it myself and I'm still paying off my first machine. Then I'll pull out my weary credit card and buy a Bipap. I'll look at secondwind and also post a message here. And I should be able to sell my S9 to help offset the cost.

I don't get bad aerophagia if I stay at 8-8.2 cm, much above that and it starts becoming a problem. I was originally titrated with a max pressure of 10, so the other night in anticipation of this appt I decided to set my max pressure to 10 as an experiment (also to see if having a few months of therapy under my belt would make aerophagia less of a problem now). It was almost comical what happened that night, nonstop burping and chipmunk cheeks. Thank goodness the tape I use has "micropores" to let some of that air pass through! The not so comical part was the lost sleep and the abdominal pain. When I looked at my data for that night, I saw that the machine went to 10 often during the night, reinforcing for me the idea that I might need a higher max pressure to improve my therapy and my sleep. I did appreciate that this doctor understands bipap can help relieve aerophagia even for patients at relatively low pressures, something the first doc dismissed out of hand.

Hi kaiasgram!

First a note. I went kind of crazy long here. Most essential – download the MP3 [3] !!! I think this would be good for both you and your clients! Listen to the whole thing. What you need to listen to carefully is near the end.

What I wrote - (oh well – most of application to you is also near end but understanding is not possible unless you read the whole silly thing):

I am really kind of going crazy as I read this thread!! It is kind of like knowing what will make the fire grow, seeing everybody do what will make the fire grow but being unable to tell them how to not make the fire grow. At stake - the health of my friend(s).

Over the past year I have become aware of CO2 maintenance issues. Blame my trauma related PTS. Trauma related stress really tends to drive up breathing volumes and so wash out CO2.

But lets talk about some symptoms and a very indirect if convenient way to check CO2 levels. If you think about it a blood oxygen saturation reading of 100% - would mean - no metabolism is taking place. Oxygenated blood goes into the finger and comes out of the finger unused. If your CO2 levels are indeed very low it will do two things. It will reduce circulation since CO2 in the blood is a great vasodilator and it will frustrate the transport of oxygen to hungry cells because the H+ normally supplied by the CO2 is a necessary part of that chemical transaction (Bohr effect). So the blood oxygen saturation level measurement is likely to be unusually high.

As well washing out CO2 happens as the volumes of air processed by the lungs increases - which will drive the oxygen saturation readings a bit higher. The short of it is that a pulse oximeter can be used to infer the CO2 levels in the blood indirectly. Indeed, a PhD Physiologist I know who works with athletes at extreme altitudes and conditions tells me it is the only tool she has found that proves useful in those conditions. She told me she believes my eucapnic SpO2 level would be at an SpO2 of “more like 94%” after I told her that I find the lowest heart rates at an SpO2 of 95%. At any rate it was nice to find out I am not the only one using this technique.

While doing the pulse oximeter guided breathing (a form of eucapnic breathing retraining) I have notices that certain symptoms occur at certain SpO2 levels. If I set my CPAP into it's Auto-PAP mode it will move to a higher pressure if I snore. Now note what I have for symptoms at SpO2 levels:

Blood Oxygen Saturation (SpO2) vs Nose Symptom:

99% Stuffed up, likely to sneeze
98% Stuffed up
97% Just a bit stuffed
96% Probably clear, feeling OK
95% Nice warm feeling inside

Doing the pulse oximeter guided breathing enabled me to put it together to move to a low crime city (much less stress!!! - the first and most necessary good thing) which has a lot of hills (and I do not drive) with the necessities are about a mile or two away – so – I have been loosing weight faster since I came here (April). The problem was that less tissue out there made my lungs in here easier for the CPAP pressure to move – so – breathing air volumes tended to go up. I started to note signs of unstable breathing in my data (times of high volumes, higher and more variable minute volumes, Periodic Breathing). I knew I needed a pressure reduction but finding doctors here is a big problem for me. So I thought – Auto-PAP using the originally proscribed pressure of 13 cm/H2O as the low pressure and 15 cm/H2O (then my current pressure – Dr. raised it a bit over a year ago) as the upper pressure. During the first hour I started to snore – up went the pressure!! When the titration process was finally done my pressure came out to be 8 cm/H2O – current results AHI=1.93 last 30 days.

So if my pressure is too high, my nose stuffs up which causes me to snore which causes the silly Auto-PAP machine to raise my pressure.

Huston, we have a major problem!!! I have CO2 maintenance issues at the higher pressure. The lower pressure is still a bit too high (my periodic breathing left as the pressure went under 12 cm/H2O) but the snoring causes the machine to automatically raise the pressure and so exacerbate my CO2 maintenance issues – associated health risks included (the brain despises CO2 washed out blood [1] – I think this is likely where OSA strokes come from).

This is a very dangerous positive feedback loop. Perhaps it will take some good old class action lawsuits to help people see the danger (and recover from the strokes and heart attacks and lost jobs!!)? Any good medical class action lawyers out there?

The only times I can remember dealing with CPAP bloating in recent history occurred last year near the anniversary of the assault and robbery I experienced in 2005. The stress does drive my breathing levels up as I mentioned. I was even using enhanced expiratory rebreathing space [2] to help with the CO2 maintenance issues. I still found myself with a tummy full of air several times. I also notice the following symptoms:

Blood Oxygen Saturation (SpO2) vs Stomach Symptoms:

99% Stomach in a knot, heartburn, nausea
98% Stomach in a knot, possible heartburn
97% Stomach has bloated feeling
96% Stomach beginning to relax
95% Stomach relaxed, digestion continues

I think it is also worth noting that the Hyperventilation Syndrome checking Nijmegen Questionnaire has “Bloated feeling in stomach” as item number nine. I bet both GERD and bloating are directly related to CO2 maintenance!

So when I see you telling the symptoms of unstable breathing with it's dangerous CO2 maintenance issues and going for raising pressures with one of those crazy Auto-PAP devices – also knowing that your doctor probably also has no understanding of how that is dangerous!!!! Yes, I go a bit crazy!!

In the world of today the ASV is probably for you [3]. For poor people like me – well - I am working on a device to make pulse oximeter guided breathing easier and materials on how to manage CPAP between the unstable breathing and AHI zones.

I do hope we can all find a way to live!

Todzo

1. Philip N. Ainslie and James Duffin Integration of cerebrovascular CO2 reactivity and chemoreflex control of breathing: mechanisms of regulation, measurement, and interpretation Published online before print February 11, 2009, doi: 10.​1152/​ajpregu.​91008.​2008 AJP - Regu Physiol May 2009 vol. 296 no. 5 R1473-R1495 ( http://www.ncbi.nlm.nih.gov/pubmed/22291654 )

2. Gilmartin G; McGeehan B; Vigneault K; Daly RW;
Manento M; Weiss JW; Thomas RJ. Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS). J Clin Sleep
Med 2010;6(6):529-538.
( http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014237/ )

3. The MP3 of Dr. Park Expert Interview: Dr. Barry Krakow on PTSD, Insomnia, and Sleep Apnea ( http://doctorstevenpark.com/expert-inte ... leep-apnea )

kaiasgram wrote:

shaunas wrote:Since you bring the question up about flow limitation and RERAs, Sleepyhead shows I a fair amount of RERAs. I know the definition but is a large number a problem and what is the solution for them? Also, can you tell me what you are looking for in the flow limitation graph?

I'm hoping to keep this thread about my ZEO question but yes a lot of RERAs can be a problem because they result in arousals that can stress your nervous system and pull you out of deeper stages of sleep. Increasing pressure is usually how they try to treat RERAs. There's actually a current thread about flow limitation graphs that I hope will shed some light on how to interpret the FL graph and the FL numbers reported by Sleepyhead.

Hi kaiasgram!

Please forgive my wanderings.

I used Zeo along with my CPAP data to help manage my OSA. I considered the "important parts" of sleep to be REM and deep sleep. For me REM problems were best helped by anti-inflammatory foods - which - would help with either Upper Airway Resistance issues (less swelling less resistance) or Apnea (less swelling less tendency to obstruct). I did not have the understanding to look for breathing volumes preceeding (UAR) the events or proceeding (apnea) the events so I really do not have an idea of the kinds of events I was having.

Deep sleep seemed to be related to the ammount of exercise I was doing. If I had a long sleep I was likely to lack in deep sleep the following night. If I made a point to walk some extra miles that would not happen.

One of the reasons I strongly believe that we need to have and use PAP data is that we need the feedback to help us manage our lifestyle. If we eat too much and move to little the scale corrects us. Most everything we do affects our sleep and it is critical that we have good sleep. So we need to see how our sleep is doing and do what we can to make it better.

The Zeo adds a bit of supplementray data to the mix that can help in making decisions. I would not trust it to be accurate in every case. I learned the limitations of the data by using it every night for most a year. I think the doctor is stretching things a bit thin in the data gathering department here. That said, I am glad to see someone trying to use what is of modest cost and available.

I hope you find the best treatment!

Todzo

kaiasgram wrote:

cosmo wrote:Thats cool that they use Zeo's. I just bought one 2 days ago. If medical professionals are using it, thats a good sign. I showed my doctor today the 2 night's worth of charts during a visit for something else. She never heard of it but seemed impressed.

Thanks for posting that, Cosmo! I can see the value of Zeo more in a primary care setting or in a sleep medicine dept. for looking at general sleep patterns. I'm just not sure if it's a good choice for diagnosing clinically significant UAR. I suppose if you see disordered sleep architecture in the Zeo report you'd know there's a problem, but how could it tell you what is causing the problem? I'm not very familiar with the ZEO so I'm still interested in what the experienced ZEO users think about this.

I do like this sleep doctor, though, first for just being respectful and giving me a fair amount of time, and second for believing in patient empowerment. He emailed me after the appointment and thanked me for telling him about SleepyHead. During the appointment he also pulled out his iPhone and showed me the "Sleeping U" app which records snoring. He said that UAR is usually accompanied by vibratory snoring, so the app might provide some additional clues. And though he brought up the idea of taking Nuvigil or Provigil he supported me when I said I first wanted to make sure my pap therapy was optimized before going to meds. As visits with sleep doctors sometimes go, this one was pretty good.

Hi kaiasgram!

Your doctor sounds like he really is trying hard to get there. Wow.

You might mention Phonospirometry - adding that we have come a long way in our abilities to discern sound changes and then adding that the added effort and working against the restriction that occures in upper airway resistance is most likely to have a unique sound. The sleep lab of the future may be a humble microphone with a good bit of software behind it!

Have a great week!

Todzo

Hi Todzo, many thanks for sharing your experiences with sleep data analysis and your thoughts about how to improve sleep. I will say, though I only used the Zeo for three nights (have to return it to Kaiser tomorrow) the results were consistent regarding REM and deep sleep -- I've got more than enough REM and not nearly enough deep sleep. So now I'm studying up on ways to get more deep sleep.

Thanks again, and you have a good week too.

kaiasgram wrote:Hi Todzo, many thanks for sharing your experiences with sleep data analysis and your thoughts about how to improve sleep. I will say, though I only used the Zeo for three nights (have to return it to Kaiser tomorrow) the results were consistent regarding REM and deep sleep -- I've got more than enough REM and not nearly enough deep sleep. So now I'm studying up on ways to get more deep sleep.

Thanks again, and you have a good week too.

Hi kaiasgram!

Lover of science and gadgets that I am I keep a 6th generation Ipod Nano on my belt. In the Nano - a good pedometer and some good software. It is the best pedometer I have ever had!

Today so far - 8250 steps. Short of the 10,000 I do hope to make the average someday but respectable.

Too many days this week are short. I am glad however. When I started 2000 steps was a good day (less than a mile).

Deep sleep and exercise always go hand in hand for me. I have not figured out why - but - at least it works.

May you find your deep sleep soon.

TTYL

Todzo

My Zeo records very little to no DEEP sleep per night. And lately I've been pretty much feeling as such.

lazer wrote:My Zeo records very little to no DEEP sleep per night. And lately I've been pretty much feeling as such.

Hi lazer. I feel your pain. For my four nights with Zeo I got no more than 5% deep sleep each night. Crispy critter I am. Though I don't know how my Zeo information is going to help the doc decide if I should try bipap, there was some value for me in seeing the breakdown of my sleep which was consistent all four nights I used the Zeo. Apart from whether flow limitation/RERAs are a significant factor, I'm spending some time reading more on how to increase time in deep sleep because I know I can improve my sleep hygiene. Let me know if you want me to share any cool tips I come across, I can always PM them to you. E.G., last night I learned about F.lux, a free app you can use on your computer, phone and iPad devices to filter out blue light in the evening hours. I'm still a little afraid to download it but I'm still reading reviews. Here's to more deep sleep!

kaiasgram wrote:

lazer wrote:My Zeo records very little to no DEEP sleep per night. And lately I've been pretty much feeling as such.

Hi lazer. I feel your pain. For my four nights with Zeo I got no more than 5% deep sleep each night. Crispy critter I am. Though I don't know how my Zeo information is going to help the doc decide if I should try bipap, there was some value for me in seeing the breakdown of my sleep which was consistent all four nights I used the Zeo. Apart from whether flow limitation/RERAs are a significant factor, I'm spending some time reading more on how to increase time in deep sleep because I know I can improve my sleep hygiene. Let me know if you want me to share any cool tips I come across, I can always PM them to you. E.G., last night I learned about F.lux, a free app you can use on your computer, phone and iPad devices to filter out blue light in the evening hours. I'm still a little afraid to download it but I'm still reading reviews. Here's to more deep sleep!

Yea, I'm cycling in and out as it seems fairly normally and am recording REM although sometimes the ZEO thinks I'm in REM 10 minutes into the night when I know I'm laying in bed watching ID network crime stories yet Maybe that's causing me some "rapid eye movement"?

I WANT MORE DEEP, DAMNIT!

kaiasgram wrote:

lazer wrote:My Zeo records very little to no DEEP sleep per night. And lately I've been pretty much feeling as such.

Hi lazer. I feel your pain. For my four nights with Zeo I got no more than 5% deep sleep each night. Crispy critter I am. Though I don't know how my Zeo information is going to help the doc decide if I should try bipap, there was some value for me in seeing the breakdown of my sleep which was consistent all four nights I used the Zeo. Apart from whether flow limitation/RERAs are a significant factor, I'm spending some time reading more on how to increase time in deep sleep because I know I can improve my sleep hygiene. Let me know if you want me to share any cool tips I come across, I can always PM them to you. E.G., last night I learned about F.lux, a free app you can use on your computer, phone and iPad devices to filter out blue light in the evening hours. I'm still a little afraid to download it but I'm still reading reviews. Here's to more deep sleep!

Hi kaiasgram, hi lazer!

In thinking more about why a doctor might use a Zeo - well the Zeo looks at the EEG similar signals from the pre-frontal portion of the brain and perhaps some EMG from the brow. It probably uses a very specific algorithm to analyze the signal. Perhaps some have taken note of specific trends - sort of an in process retrospective study - and he is aware of those.

Probably the both of you are headed to ASV in the future [1] - me - I am still glad for my breathing retraining and understanding of CO2 maintenance issues.

I think you may be on to something with the blue light management kaiasgram. I do have signs of Seasonal Affective Disorder (SAD) and have recently put up a lot of extra blue (high color temperature lighting - 5500K or above) and I do feel better. I make a point to have them off by 9p - to use only halogen (and that dimmed if possible) and am thinking now that Monitor Off may also be good to add. Maybe this winter I will not slip into the crazy Non-24 sleep patterns I have experienced in former winter seasons.

Writing this is reminding me about building a light rack to keep a light tan during this winter (I need the vitamin D and more anti-SAD). The halogen portion I hope to put on a computer controlled dimmer and use the thing for a non-auditory wake up device (the auditory alarm will still exist – but hopefully be turned off each day before its set time). People with Post Traumatic Stress (PTS) as I have really hate auditory alarms I think.

Well have a lot of fun you guys (not TOO much fun lazer!),

Todzo

1. MP3 of - Expert Interview: Dr. Barry Krakow on PTSD, Insomnia, and Sleep Apnea http://doctorstevenpark.com/expert-inte ... leep-apnea