Clapping during Sleep

[r0nwilliams]

Hi I'm new here and need help

I have a weird side effect of my apneas where I clap my hands or wave my arms, and I think it's keeping me from getting any restorative sleep.  From cross referencing my nest cam with my Oscar data, it looks like my breathing changes right before I start clapping.  I have complex OSA/TECSA/hypo ventilation and use a BiPAP, which I thought was successfully treating me, but recently my nest cam says otherwise. 

I want to know if it's caused by my breathing, and also if you guys think I have my machine pressure settings ok.  I have taken over adjusting my machine (AirCurve 10ST) from my sleep doctor, bc she was really becoming annoyed with me.  It has taken about two years of lurking on here to realize that I have to take responsibility for my own care, and to find out all the mask options there are.  I finally found a mask that fits (p30i), and a pressure that didn't blow my mouth open, but still have sleep movement issues. 

During my in-lab sleep tests I got 0% REM and 0% NREM2, but still had vivid recursive dreams (how is that possible?).  I have been on clonazepam for almost two years (before my apnea diagnosis) for super bizarre dream enactments, sleep walking, and sleep paralysis

I’m on BiPAP-ST 14.4/10/10 and use p30i.  over last month my avg avi is 1.35, highest is 10.09

I’m still so exhausted all day long that I can barely function. The creative side of my brain feels like it’s gone. Nothing is interesting. I fall asleep unless I’m talking, even though on Nuvigil 250mg.  Is that bc I get 0%NREM2?

in this Oscar screenshot, I start clapping at 08:09:36 where the vert line is:
   

Here is my first sleep study.  
   

Most Recent Sleep Study:
   

Please let me know if anyone has advice or wants more info.

Thanks for everything you guys do on here.

[Jay51]

Welcome to ApneaBoard rOnwilliams.  

In order to better attempt to assist you, please read this link on OSCAR charts.  And then please upload at least one OSCAR chart example like the one shown in this link.  

• OSCAR Chart Organization
  

I have been diagnosed with hypoventilation also.  I have not heard of the hand waving clapping.  My guess from the info you provided is that it may be a side effect of the clonazepam medication that you are taking.  But not for sure.

[r0nwilliams]

Thanks for your response. When I get home I will re upload my oscar chart formatted correctly. 

I take the colonazepam primary for the clapping and other movements. It’s called REM Behavior Disorder (RBD).
pubmed.ncbi.nlm.nih.gov/27752878/

I’m just having a lightbulb realizing my breathing is changing before I start weird movements.

[Sleeprider]

You're on the wrong machine. As usual some brilliant sleep specialist thought therapy onset centrals should be treated with a ST machine, when the correct answer was a Resmed Airsense 10 ASV. I can't begin to express my disgust at the lack of professional knowledge in the treatment of idiopathic centrals in PAP therapy. Why can't the guys that get paid for this figure it out. Read the Resmed Clinical Titraation guide and see what you might come up with for a patient presenting Central Apnea without pulmonary disease, restriction or hypoventilation. https://www.resmed.com/us/dam/documents/...er_eng.pdf

Feel free to show you know more than your doctor.

[r0nwilliams]

Hi sleeprider
But I have hypoventilation bc my breaths went below 7 per minute and she said I need 10

Would an ASV work for that?  I kind of like the multiple pressures, it has become relaxing for me.

[SarcasticDave94]

I'm in agreement with Sleeprider. They're using ST to treat Central Apnea when the ASV is designed to treat the CA.

ST is for patients with lung disease.

Get the rest of the sleep study, the part where they have the chart breaking out the various events. They only mention events like Central Apnea, but are suggesting treatment emergent Central Apnea, all events mentioned ought to be in a chart.

There is mention of arm waving doing a part of the test as well.

[Sleeprider]

The ASV will maintain rate based on your "normal" respiration rate and volume over the previous 90 seconds. Hypoventilation is rarely just the rate, but is more normally related to pulmonary noncompliance, COPD and other issues. Since you have CA events with CPAP, that reduction in respiratory rate is more a function of the apnea than a physiological issue. Take a look at your current chart you posted. It is 12 BPM and governed by the timing of the ST BiPAP. The clapping happened immediately after the one spontaneous breath on that chart. What we don't see, is the full night with the respiration rate, minute vent variations and other important information we should look at. We can also see your respiration looks just like the square-wave pressure transitions of the ST. At least with ASV you could have the Easybreathe™ pressure transitions and a much more normal respiration wave. I'd like to see the full night using the Advanced View of your respiration. Go to the Oscar menu, View/Reset Graphs/Advanced view.

[Jay51]

Your OSCAR chart that you posted contains the infamous, "sqware wave".  Square wave means just what it says.  The top of your inhalation wave is flat when it should be round.  

Here are 2 graphs that show a normal, rounded top wave to compare to yours.  

   

   

How does it feel using the ST at night?  You could use this information to give to your Dr. also if you like.  

Sleeprider is right about diagnosing hypoventilation.  I was diagnosed by a Capnography (overnight, room air Cap/Ox test).  My respiratory rate has been recorded as low as 5 per minute.  Tidal volume also figures into the diagnosis of hypoventilation.  My lowest tidal volume recordings have been in the double digits.  

Minute ventilation is more important.  Minute vent = respiratory rate x tidal volume.  Some people can get away with a lower than normal respiratory rate if they have a decent to higher than normal tidal volume.  This evens out the minute vent.  Also, if someone has a lower than normal tidal volume, they can compensate by having a higher respiratory rate.

[r0nwilliams]

trying to post links wont work yet..

[r0nwilliams]

tell me if this is the correct view
   

Also, here is another night that I had an exceptionally high AHI. (for me at least)