REM and Sleep Stage Tracking at Home

[rwelliot]

Originally posted in response to a question about the P10 mask, but thought starting a new thread on the subject would be useful and informative to ApneaBoard members. Apologies for including links in the initial post.

These days you can track sleep stages at home! While the medical mafia will say there is nothing as good as a PSG, if you are hanging out here and watching your AHI, perhaps using Sleepyhead, you can surely use commercial devices at home to track sleep stages too.

ResMed makes a device called "S+" that is available through online outlets. I bought mine from Amazon for $80. Put it on your nightstand. You tell it when you are shutting the lights out via your cellphone and similarly when you wake up. You'll get a sleep stage report almost instantly. There is a ResMed website a little bit like MyAir that provides the information as well.

Beurer makes a device called "S-80" based on technology developed by EarlySense from Israel. It is a disc that is placed under your mattress. The operation is more or less the same as the S+ but we find it substantially more accurate, perhaps from the clinical trials done with the EarlySense hospital devices. I bought mine from Amazon UK for about $190 since it was not (yet) sold here. Watch EarlySence on the web for a US version perhaps. The EarlySense app that you install and use on your cellphone will identify potential breathing problems, which can oftentimes be a tip to use Sleepyhead for the night in question if you don't do it daily.

Both of the above systems communicate with your cellphone via blue tooth and also use the cellphone to communicate with their companion and secure cloud-based systems that likely do most of the detailed analysis.

Most likely the very best device for stage tracking is the Rythm Dreem. Unlike the above devices (and their competitors) which use respiration, movement and, for the Beurer at least, heart rate, the Dreem uses EEG. So you must wear a headband. I suspect that because it uses EEG that it is the most accurate (consumer device) for analyzing sleep stages. It's expensive, so with shipping expect to pay $370.

The Dreem also communicates with your cellphone, but not while you sleep. You use the cellphone to set up the headband and at lights out, you tell it to begin. When you wake up, you plug the headband into the charging cable and a few moments later the sleep stage analysis appears.

Dreem will transmit soothing sounds to put you asleep using bone conduction if you ask it to and will also use sound and bone conduction to extend deep sleep periods.

None of these devices are eligible for (my) insurance reimbursement, but when I read about how long it can take to make sleep therapy work for people, I have made all three investments and use them all nightly.

You will have to be somewhat picky about which CPAP mask you use with the Dreem. While I have used it with the Wisp (moderately comfortable), and the Dreamwear (quite difficult but I have made it work), I am experimenting with the P10 now. The Dreamwear works best for me so I keep coming back to it despite the somewhat awkward fit.

Note that Rythm do not want people with sleep disorders to be part of their current program (they are in a post-Beta, limited availability phase called Dreem First). Fortunately with my ASV and an AHI that hovers around 0.0, I don't have a sleep disorder anymore!

I keep a spreadsheet with key data from my ResMed AirCurve ASV, the S+, the S-80 and the Dreem. Both the S+ and the S-80 are showing increased deep sleep percentages since I've been using Dreem. I expected it to report that but continue to double check. The Dreem works.

Some here may write about the Zeo which was also based on EEG, but that product and the necessary online support disappeared a while ago. You may also read about the Basis Peak smartwatch that used several sensors, but it was also recalled -- like the Samsung Note 7, it had a battery overheating problem.

You can indeed track your sleep stages. I hope you will do it. If you are doing it, why not share your experiences here. If not, give it a try. The entry price is rather low.

[PaulaO2]

Nope. None of these devices can tell what sleep stage you are in unless they do the following:

track your eye movement
and/or
are attached to your head to track brain activity

Following your alleged movements at night is bogus. Too much depends on the too many factors. Water bed? Too much movement. Tempurpedic/memory foam? Not enough. Dogs? Too much.

Using breathing patterns? Um, no. What if I am watching a movie or reading a book while laying in bed and my breathing changes depending on the scene?

Like the SoClean, Provent, and the Airing, these things exist just to suck money out of our pockets.

[rwelliot]

Thanks for the definitive position on sleep stage tracking. I sense you are of the view that the only way to track sleep stages is the PSG.

Some of us would like to know how our sleep stages are doing in our own bed for a few dollars less than a PSG. As I explained above, you tell all three of these devices when you are going to sleep, meaning lights out as in good sleep hygiene, and in all the cases, you tell the device when you wake up too. That removes some of the variables.

I would say that the S+ the S-80 and the Dreem bear no comparison in any way to the three bogus devices you included in your list. Why on earth would a trusted brand like ResMed get behind a money sucking consumer device? Note they also bought the Zeo's intellectual property. The Beurer S-80 is based on EarlySense's breathing and heart sensors and software that has been clinically proven in hospitals.

The Rythm Dreem is a headband and is "attached to your head." As I wrote above, it uses EEG. Can you please explain why you don't think it can successfully provide useful information about sleep stages?

[KSMatthew]

I didn't see anything on their website that said Rythm Dreem is an EEG equivalent. It just says it senses "brain activity".

Best I can figure, the S+ is a microphone.

[PaulaO2]

I apologize. I typed out a response when what I should have done was close the browser tab and return later, if at all. I was harsher than I should have been.

If the end goal is to include the data set of sleep stages into the sleep study, then yes, a PSG is the only way to go. If sleep stages are not a necessary data set, then a home sleep study is adequate. Or even just titration with an APAP if diagnosis is already determined.

At this point in time, the science of DIY sleep stage devices just is not adequate enough. Sleep is a set brain patterns, electric impulses tracked by something that can pick up on those electrical impulses and translate them appropriately. REM sleep one or more of those electrical impulse sets that also involves eye movement, hence the name. Neither the S+ or, as far as I can tell, the Dreem can pick up and translate these impulses.

The S+? I am surprised ResMed invested so much into that. It is not much. It has nothing to do with monitoring sleep patterns other than your alleged movement and your alleged breathing patterns. I would think that a person with a CPAP may have more trouble with this device unless it has a CPAP setting to take that noise into account. It monitors sounds in the room and the light in the room and tells you it was too noisy or too bright. That's nice. Not exactly helpful since light and noise comfort levels are individual not standard. It has a gentle alarm to wake you. So does the alarm on my phone. It has sounds to adjust to your breathing patterns to slowly help you sleep. That I might find useful. As long as it can truly discern between my breathing and the breathing of someone else in the room. But again, sleep patterns? Eh, it would tell me how much I moved about as long as it can, again, discern if the movement was me, a dog, or a cat, or Fred the Ghost.

And I looked over the Dreem website and still can't figure out what it does. Snazzy website though. 2 minute or less video that tells me nothing about the product. I would greatly hesitate to purchase this mainly because the website shiny and the vagueness reminds me so much of the Airing.

My point is the same. Buyer beware. Understand first why do you want to know your REM sleep patterns? Is it necessary to continue treating your sleep apnea? If yes, then a PSG is needed. There are times when a sleep doc is actually necessary.

[rwelliot]

All four sleep lab visits in about eight weeks to identify my disorder and then titrate to bi-level and ASV, confirmed that apnea and hypopnea, even when treated with CPAP, Bi-level PAP and ASV, had disrupted my sleep architecture, this meaning that the "normal" progressions between and proportions of N1, N2 to N3/N4 and REM sleep were disrupted.

Even with ASV that has almost completely suppressed all apnea and hypopnea events, and a subsequent change in my RLS meds that has cleared up both pre- and during-sleep PLMs, I was still waking up more times during the night than I wanted to and sleeping less than the "recommended amount." On good nights, REM rebound is evident, but I have remained concerned that I was not getting enough deep sleep. Further PSGs are just too expensive.

While each of the devices I mentioned in my original post may not be perfect, or an equivalent to a PSG, they each claim to have trials that show they do provide an indication, using their technologies, into the distribution of time in bed between these different stages. I have read up on some of these.

None of the replies to my original post have explained the technologies completely and quite a bit of personal research was done before making the investments. These go well beyond what fitness trackers that use actigraphy to provide indications.

I am still a relative newbie here, and in addition to the help members have provided with their posts, I have spent a lot of time researching devices that can provide an interested "patient" visibility beyond the respiratory information that the modern machines such as the ResMed AirCurve vAuto originally and the ASV are able to provide me.

My doctors have told me repeatedly that they don't trust the data from the ResMed machine that all of us using SleepHead rely upon. Further, they have also said they don't trust any consumer-level device to measure anything. The doctors only trust the PSG which besides being very expensive can only be conducted in the clinic, and it is not representative of the home environment. In fact, my ASV titration in the clinic showed a AHI of 10.1 but ASV at home has delivered an AHI of 0.0 and variance has only been 0.1 or so on a very few occasions almost 50 days into treatment.

I do not think the exact numbers from the consumer sensors are that important. I think the trends are. Further online research will show that the S+ is not merely a microphone and that it uses RF to sense breathing in addition to measuring light and noise whose elimination is critical to good sleep hygiene. I am surprised that its breathing analysis algorithms could not be applied to the data the ResMed XPAP machines collect. There are two divisions, one clinical and one consumer, for a reason.

The EarlySense captures realtime heart rate and respiratory rate and uses changes in them to make predictions of light, deep, REM sleep and wake time. It consequently can also sense bed entry and exit. The EarlySense algorithms were developed clinically and like the S+ (good or bad) makes predictions into light, deep and REM sleep and time awake. This company also has two divisions, one clinical and another consumer, for a reason.

Both of the above devices produce their versions of hypnograms showing the sequence between awake, light, deep and REM sleep. Their data was vastly different in the beginning but have now converged.

The Dreem is altogether a different device. It measures brainwave activity using sensors on the forehead and captures the data in EEG electronics located in the top of the headband. That data is transferred on waking to the smartphone and to their cloud so the analysis can be shown on the iPhone shortly after. A hypnogram is produced based only on the brainwave activity. About ten days in I can see a loose correlation between the data it produces with the S+ and the S-80. It claims to use sound to stimulate deep sleep. I can see this correlation in the before and after data as well.

My sleep doctor, a pulmonologist, thinks that having technology in the bedroom is a poor idea. However, he is completely convinced that sleeping with an ASV machine and a mask is different. A night-table based and under the bed sensor is far less intrusive, even when having to tell them to start on the iPhone when starting the ASV machine. Wearing a headband is actually not a bit worse than wearing a full face CPAP mask.

Your critical remarks are appreciated and with more experience, especially as a moderator, is also appreciated. The Apneaboard has been rather silent about these devices and further discussion from many members might produce further insight.

I am not meaning to advertise these devices, but I am trying to say in my own words that the technology behind sleep measurement and tracking at home is again advancing and there are some potential solutions that we can use to help monitor what's going on while we are sleeping to see that good sleep hygiene and use of our therapies is having some positive effect on the underlying physiology.

While I agree that treating apnea and respiratory events during sleep is critical to helping us get well, I think more insightful monitoring of physiology during our time asleep can help us improve our sleep hygiene and also indicate the rate of our progress towards good health.

The other devices referenced in the initial reply to my post have not been shown clinically to treat apnea; the cleaning machine offers no better cleaning of our equipment than the DMEs and machine manufacturers recommend. The measurement devices I wrote about are not a PSG, but they do gather data and provide indications that can be used over time to provide physiological insight.

The devices and their software are insufficient on their own to provide meaningful insight. It's important IMHO at least to save the key findings from such devices in a spreadsheet and to chart progress with graphs (like Sleepyhead does). In my own case there is a trend (with setbacks) spanning 100 days of treatment that is giving me further encouragement and also some data to talk to the doctor about at my next visit. The spreadsheet and graphs were very informative to drive the progression from bi-level PAP (that induced central apnea) to ASV.

Interested people with our affliction or other kinds of sleep deprivation (which is a recognized trend in the US society at least) would be well served to read more about these three and perhaps other devices to determine if these modest investments could provide insight they may benefit from. I only hope that a robust and perhaps less antagonistic or sarcastic discussion amongst others that have experimented with them can continue here.

[rwelliot]

An overview of sleep stage tracking solutions mentioned in my posts follows.

ResMed S+. The S+ works by detecting the movement of your upper body while you sleep. The movement it detects consists of the expansion and relaxation of your chest as you breathe in and out, and overall body movements such as positional changes, arm twitches and shrugs. It includes software algorithms that recognize the combination of respiration and body-movement signals, so that the overall sleep state can be reliably assessed. For example, if you’re moving continuously, you’re less likely to be asleep; conversely, if you’re in deep sleep, there will be relatively little movement and your breathing will be much more regular.

The S+ measures movements using ultra low power radio waves (less than 1/10 of Bluetooth®). The basic principle is similar to the echo location system used by bats to hunt insects. The S+ transmits a short pulse of radio waves at 10.5 GHz and then listens for the echo of the radio wave pulse. As you move, the phase of the echo changes and is converted into a signal that reflects your movement. Clothing and blankets are almost transparent to radio waves at the frequencies we use. The echo signal is mostly generated by reflection from your body – as far as radio waves are concerned, you're a large watery object! The S+ also records the light, noise and temperature conditions in your room, and has features to help you sleep more easily.

A major component of the S+ system is the the patented SleepSensor that lets it monitor your sleep without actually touching you. No mattress strips. No wristbands. Just a nightstand monitor that can accurately record your breathing and movement. Proprietary software performs a variety of signal analysis tasks including respiration analysis and sleep quality measurement.

The S+ technology’s ability to accurately measure sleep patterns has been published in ten scientific papers, and has been tested and proven against expert manually scored patient sleep data gathered in several accredited sleep laboratories.

Beurer SE-80/Early Sense. The Beurer SE-80 with technology from EarlySense is able to detect and record mechanical signals continuously and completely contact-free thanks to its piezoelectric technology. Tucked under the mattress, the force exerted on the highly sensitive piezoelectric sensor stems from three sources: gross body movement, chest wall movement due to respiration, and recoil of the body due to heart pulse. These signals are collected and converted into electric signals by a transducer, which transfers them to smartphones or automated-home applications.

The detection algorithms of the the EarlySense system analyze the signals, differentiate between them and extract the required information to obtain continuous heart, respiratory and body movement rates, sleep patterns and trends.

Validated in clinical trials, the EarlySense™ is a unique solution for seamlessly tracking your heart, breathing rates and sleep patterns. Its patented sensor and algorithms are designed to deliver valuable insights regarding wellness and sleep and for integration with home automation systems and better living. Clinical studies can be downloaded from the EarlySense website.

Rhythm Dreem. The Dreem headband is an active and accurate sleep wearable that analyzes your sleep in real time to improve its quality. Based on years of neuroscience research that demonstrate the impact of sound on your brain during sleep, Rhythm have built a device that precisely understands and influences the quality of your sleep. The Dreem headband syncs with your brain activity and stimulates sound to enhance the quality of your sleep. As a result not only are you more rested, but you also improve your memory and other cognitive functions.

When its sensors detect that the user is in a state of deep sleep — also known as slow-wave activity (SWA) — the device starts producing a non-invasive sound using bone conduction, which mean the device does not require the user to wear headphones. Dreem builds on previous scientific findings from independent laboratories on the efficacy of audio stimulation during deep sleep. It has been shown, for example, that acoustic stimulation enhances sleep’s slow waves. It appears to be particularly beneficial to play intermittent sounds in blocks of 15 seconds, followed by stimulation-free intervals.

State-of-the-art sensors, embedded in a lightweight headband, are Dreem’s backbone. These sensors monitor brainwaves in real time and bring the consumer an opportunity to access data generally only available in a sleep lab. Understanding your sleep accurately is the first step towards enhancing it.

Allegedly the most accurate way to understand sleep is by measuring one’s brain activity (EEG). The Dreem headband acquires and analyzes this activity and the Dreem App provides a meaningful and clear understanding of your sleep on your smartphone when you wake up. A technical white paper with further detail and citations is available for download from Rythm's web site.

[FrankNichols]

As a simple endorsement, I use the S+ and find that is works well. Not perfect, but well.

[EnigmaGrey]

Apps for Android phones, along with Fitbits also provide basic sleep state tracking based on movement and sound. Don't put much stock in them personally, despite off-and-on use. They certainly didn't indicate that my untreated AHI was around 50 or that I regularly shifted position onto my back .etc. They simply showed that, at some point in X time, I moved. They were, of course, accurate for wakeup / sleep times in broad strokes, though.

Too much of this thread reads like an advertisement for the aforementioned products. " The Dreem headband syncs with your brain activity and stimulates sound to enhance the quality of your sleep."

Seriously?

[rwelliot]

I indeed copied some of the text from the websites because it seemed that some of the initial visitors to this thread either didn't believe the statements I wrote myself or weren't willing to explore such solutions further.

People that hang out here are often curious to learn more about their condition and therapy. So anyone that invests additional time reading more about the referenced products will see that these statements are not advertising. These are instead meant to be statements about the technical capability of the devices.

These three devices in provide insight using different techniques that hare been proven superior to the devices that primarily use actigraphy, which actually also earned its own chapter (124) in the "Principles and Practice of Sleep Medicine" text book.

The beginning of the thread suggested that insight into sleep patterns is complementary to apnea therapy. There was no statement that these would be a substitute for proper diagnosis and treatment of a medical condition.

Instead, the suggestion is that monitoring sleep stages using commercially available devices to produce data and tracking sleep stages at home using a spreadsheet and graphs can provide further insight during therapy.