How I perfected my sleep w/ an Apple Watch

[gainerfull]

Since Watch OS 9, the Apple Watch has been one of the best sleep tracking and heart rate monitors commercially available.

Here's a scientific review of it's capabilities as compared to an EEG:

https://youtu.be/ogJ8uEUjW_8?t=664

For a long time, I was able to sleep w/ my CPAP in APAP mode (no EPR) with great results. For reference, I was diagnosed in 2014 w/ an AHI of 85 (severe) and my AHI on CPAP was around 3 or less most days. Gradually over many years I started to develop some memory issues and brain fog so I started my journey of optimizing my sleep via OSCAR and "working" (read: fighting) my local sleep doctor to give me access to more advanced therapies like bilevel & asv. After many terrible titrations and eventually failing CPAP due to aerophagia at high pressure levels, I was approved to start using bilevel. I tried for the better part of the last year to improve my sleep but could never get consistent results on bilevel, bought an ASV from craigslist to give it a go and was similarly disappointed.

Next, I started experiencing secondary insomnia and would wake up 2-4 times per night even though my Oscar data, sp02 etc. all looked good. As I continued to research, all roads lead me to wanting my own EEG to get as close to a sleep study as possible so I could tweak settings and get overnight feedback. While I searched I even tried a couple different sleep drugs like gabapentin & doxepin to try to get me to continuous sleep but knew that I didn't want to rely on drugs if I didn't have to.

That's when I went back to basics, bought a used Resmed Airsense 10 Autoset and started my own personal titration using the Apple Watch as my guide.

The first couple of nights I set the CPAP to APAP mode and used my old range of 9cmH20 - 16cmH20, EPR off, to see where my pressure averages were night over night. Then I took the 95% value (14cmH20), switched to CPAP mode and increased it by 1cmH20 every couple of nights until I saw less and less arousals on the watch the next morning. Finally, I started to introduce EPR slowly at the end and I'm currently sitting at 17cmH20 w/ EPR 3 and I only had one non-REM arousal over the past 3 nights, feel fantastic waking up and my symptoms are getting better!

It took a lot of bad nights of sleep to get here but it's been well worth it. If you'd like to try to duplicate my results, I'm also following good sleep hygiene protocols like:

1. Going to bed around the same time every night
2. Sleep in complete darkness w/ black out shades from Ikea
3. Sleep with my upper body elevated on a 7" foam wedge
4. Turn down the A/C to 67*, have the room fan running on the lowest setting and sleep under only a bedsheet
5. No eating or drinking within 3hrs of bedtime

Other things I learned:

1. Even 0.5mg of melatonin would give me arousals in REM
2. It took 500mg of Gabapentin to sedate me enough to sleep through the night
3. My humidity is set to Auto and tube temperature 70*F
4. 95% flow limit is 0.01 and 99.5% is 0.14

Here's what a pretty bad night looked like before:




This is while taking 600mg of Gabapentin right before getting into bed:


This is from last night w/ no drugs, CPAP mode, 17cmH20 + EPR 3


Oscar for last night:



So if you've been on cpap / bilevel / asv etc and are still feeling groggy / tired, following this protocol may help you like it did me. Good luck

For reference I'm using the Apple Watch SE from 2022 and I bought it from Best Buy in Open Box "Excellent Condition" for $185

[Phaleronic]

Oscar chart looks good

[Nightynite]

Excellent results!

[joeblough]

great post. i have been on a similar trajectory, save for the gabapentin (i did try it in the past, before i knew i had apnea.) last night for the very first time in forever my apple watch claimed that i had 0 arousals. feels true as i don't remember waking up at all. AHI was 1.0.

if you are interested in the accuracy of sleep tracking devices, check out this study:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654909/

in terms of overall sleep staging the apple watch turns out not to be that great. apple has a lot of their own publications touting its accuracy vs PSG but this paper doesn't really bear that out. it turns out the best tracker is one that uses the microphone to record your breathing, but i talked to them and it isn't trained on the sound of a CPAP so it won't work for us. hopefully it's able to calculate arousals properly but even in that category it doesn't seem super awesome. personally i don't want to move to any amazon or google-based product (the fitbit seems to be more accurate) so i think i'm stuck with the AW for now.

[BigWing]

last night for the very first time in forever my apple watch claimed that i had 0 arousals. 

Where does an Apple Watch indicate number of arousals?

feels true as i don't remember waking up at all.

Surely that would be true even if you had lots of arousals, if they were the type that don't actually wake you. An arousal does not necessarily mean waking up.

[joeblough]

Where does an Apple Watch indicate number of arousals?


Surely that would be true even if you had lots of arousals, if they were the type that don't actually wake you. An arousal does not necessarily mean waking up.

you are right of course, i am using the wrong jargon. the AW really only detects if you are awake (and it's not particularly good at that either per that paper linked above.)

still every night i have multiple awakenings that it detects, and some of them i remember. surely things are trending in the right direction if there were no awakenings that it could detect. we'll see if that keeps up.

[MrIvanDrago]

@gainerfull You mentioned in your post, Even 0.5mg of melatonin would give me arousals in REM, I am curious to why this happens, and is it a common side effect of melatonin? I ask because I have been taking melatonin and haven't tried not taking it to see if that is causing my arousals in REM.

Have you read anything anywhere about this? Or did you come up with this from your experience?

[THEVGE]

Interesting read! As an Android user not willing (yet) to go Apple, I did consider the Apple Watch 10 with an iPhone, but after a good review of "The Quantified Scientist" I decided the best sleep/HR tracker smart watch currently available on Android: the Pixel Watch 3. Yesterday I wore it together with my Garmin Forerunner 745 (Elevate 4 sensor) and a finger oximeter.

Yes, just 1 night but....... the Pixel Watch 3 detected 13 "awake" moments during the night and looking in Oscar I see they all time-stamp-match with a RERA-like event. Garmin has never been valuable from a sleep tracking point of view. It never detects any short awakenings, sometimes it even misses a bio-break! In addition, the sleeping duration and sleep quality are always high while my sleep is crap. First impression is that the Pixel Watch 3 might be helpful for therapy optimization.

I really hope to achieve the same as the topic started! I will keep track of this topic and come back after some more experience.

[jimla]

Thanks for documenting your process. I am trying a similar procedure to determine the optimum CPAP pressure with EPR 3 to reduce my flow limits and arousals. I will try correlating the sleep stages from my Apple watch.

[ineedsomesleep]

OP what was wrong with ASV? I thought ASV is the end-all be-all of equipment.