Camera shows highly disturbed sleep but numbers are "good"

[geauxdbl]

First, thank you everyone for the wealth of information that is this board.  I would never be at this level of health without everything I've learned here, and I recommend you guys to everyone I meet with sleep apnea.

I'm consistently getting AHI < 1 from my bilevel machine, but I'm waking up a lot and I'm curious about why.  I also keep seeing a curious breathing pattern in OSCAR that I don't understand.  Last night I set up a night vision security camera and pointed it at myself.  The results are very interesting, to say the least:

Its motion detection flagged 26 different times I moved in my sleep, and if I look at the corresponding timestamps in OSCAR, I see weird breathing events that match up.  It's hard to tell which comes first since the timestamps are off by 30 seconds.  But I can clearly identify what looks like Periodic Leg Movement in one of them at 5:02, corresponding with a big inhale breath and then a period where I stopped breathing and triggered UF1.  

I can now see that the OA event at 1:01 isn't real, I was just tossing and turning and holding my breath too long.

Going by my detailed review of everything, I score 10 separate instances of Periodic Limb Movement associated with arousals.  If I just look at the video motion detection, I see 26 separate events of me moving in the 9 hours I was asleep.  

I will note that my two sleep studies in 2015 both showed PLM and lots of obstructive hypopneas but few if any apneas.  But it's hard to say how accurate they are given how fragmented my sleep was and how little time I was actually asleep.  I had been overlooking the PLM until now.

There's only 1 obstructive apnea last night and my pressure over the last month is holding steady at 95% of between 7.6 and 8.5.  Thus, I have to ask the big picture question:

Do I have a bigger problem with disturbed sleep than I do with Apnea?  Is using my machine making that worse?  How do I tell, and what do I do about it?  

The attached detail view is one of the clearest PLM with arousal events that I see on video.

[Geer1]

I have been wondering about this myself. After getting diagnosed I took a video of my sleep prior to starting CPAP treatment and I was having numerous arousals almost all occurring after a twitch of some sort (arm, leg and even head a couple times). I figured it is possible to either be due to the movements or breathing and I have been waiting to get feeling better on CPAP before I make another video while using CPAP.

I also get a number of those same sort of events, normal breathing then an extra bit of inhale followed by arousal. I am starting to think they are possibly/probably movements or other arousals and not breathing related.

I also just started using an oximeter to see if it would help me diagnose. Only used it one night with CPAP so far and I was having those same arousals without significant desaturations kind of confirming that they probably aren't caused by breathing issues.

My thoughts would be to try and sync data better. At the beginning of the video you can try doing a couple things to help you sync time better, look at camera and manipulate mask so it causes a leak you can see both on video and in cpap data, maybe block air supply/hold breath so it shows no flow etc. If you throw in a few actions like that at the beginning of video you might be able to sync data/video within a second or two which may be enough to see what causes what (in my video cause sometimes twitches were a bit before the arousal and if that is the case I think it would be safe to assume it is the twitch that is the issue).

Have you ever talked to doctor about the PLM? There is some medication (I have seen Ropinirole mentioned for example) use to treat it.

[sheepless]

there are many things besides apnea that can disturb sleep. I'm 3 years on apap, asv & now bilevel. despite getting ahi down to decent levels, I have continued to feel tired. my sleep has been severely fragmented throughout (but improving). about 1.5 years ago I began to realize a periodic breathing pattern in my flow rate is a reflection of my plm. no doctor told me about it but I found confirmation deep in the pages in their records of my sleep study that they dribbled out to me over 3 requests. then I corroborated it with my wife's reports & audio recordings, associating these with specific times & a unique flow rate pattern. at this point there's no question plm is disturbing my sleep & accounts for most of my events & fragmentation. I have tried gabapentin & ropinirole. subjectively my sense is that they make my waking restless legs worse. there's some evidence that ropinirole is helping with plm but the initially positive results wore off & my doctor has ignored my requests to increase dosage or try something else (so later this month I'll see a new doc).

ordinarily I'd say about the only thing cpap might make worse is ca. but I can attest to my apap responding with runaway pressure to the non passive flow limitations that follow my plm and asv responding with rapid wildly swinging pressure support. these pressure responses did nothing for plm or the associated flow limitations & contributed to still more arousals & awakenings.

I remain optimistic that my lifetime of sleep issues will finally be behind me if as when I get my plm under control.

[geauxdbl]

Geer1, that's exactly what it looks like to me. A twitch, a sharp inhale, and then an arousal. Haven't mentioned this to my doctor yet because I'm currently between sleep doctors and my appointment isn't until March. Want to go in with as much as I can.

I'll work on getting the times synchronized a little more accurately

[Geer1]

Are they just random twitches? My understanding is that PLM should be periodic in nature. Mine don't really fall into that category though, more like random twitches. I think myoclonus might be the more applicable term for my situation. I also have the odd ones during the day and have some slight hand tremors too. I was and still am hoping this is sleep disordered breathing related and that it will slowly correct with time but will have to wait and see.

[geauxdbl]

Tried it again last night. Resmed doesn't make it easy to synchronize the clock, so I think "within a few seconds" is about as close as I'm going to get. I can find where I turned my Aircurve on and where I turned it off, as well as a couple of leak events, but the clock offset is different for each. Maybe it's the famous CPAP clock drift? Who knows.

I see a mix of two problems: there are lots of events where my leg moves immediately before the sharp inhale breath and rolling over. There are also lots of events where that doesn't happen, sometimes preceded by my breath waveforms getting shorter and shorter. Then a recovery breath and rolling over. I'm almost never on my back, just going from side to side. There are no apnea events.

Edit to add: I count 28 disturbances total over 7.5 hours

[Crimson Nape]

I had the sync problem too.  There is a ramp up to pressure, regardless of the ramp feature being on or off and I'm not sure as to when the clock starts running on the Resmed.  Because of this, I waited until my CPAP was up to pressure, I then took a deep inhale, stopped breathing for the count of 10, then took a long exhale, along with giving a "thumbs-up" to the camera.   I know it sounds stupid but it provided a visual waveform at the beginning of the data and a visual reference to the camera.  Later, I compared the two device's timestamps of those markers and equated a time delta offset, if needed.  Using this "shadetree mechanic" computation, I was able to correlate within a second.  However, the video is nothing I would want posted on the internet.

I hope you may come up with a less goofy way of syncing the two times.

[geauxdbl]

Putting the clock sync aside for a second, since I can clearly identify the sharp spiking inhale breaths from the video’s sound and place them in time:

My gut feeling is that this points toward UARS, which I don’t understand all that well yet.  I did find out recently that I have a deviated septum and a small nose.  Just not sure what to do about it.

[Sleeprider]

If you have UARS, it seems well-treated by the current PS 4.2, and your pressure range varies by less than 1-cm through the night. Your flow limitation does not even show up on the 95% stat and is only 0.02 in the maximum, snore is zero. I don't see any evidence that this is affecting your therapy from the charts posted. Whatever is going on, appears to be external to PAP therapy. You may want to try changing trigger sensitivity to high. I found that helped in my own therapy, but in your case it will be mainly a comfort change.

[geauxdbl]

Thanks Sleeprider - will change trigger sensitivity and see how it goes. I agree as well that the sleep disturbances might be external to PAP therapy.