[Treatment] Heart rate spikes

[SleeplessKnight]

I've recently been diagnosed with sleep apnea and last night I used a CPAP for the first night. I've been noticing that I have a lot of pulse rate change events and my pulse rate chart ir rather spiky. This didn't change with the CPAP but I also wonder if it's because I'm still getting used to it. Does anyone know something about this?

My chart from OSCAR is in attachment, data is from Wellue O2 ring. Last night I had 64/h pulse rate change events, even higher with the CPAP than without.

The large peaks from 3.30 to 4.30 and around 5 are periods when I was awake and moving, so don't consider those.

Later today I will add my CPAP data as I still don't had an SD card reader.

[Narcil]

instructions here to post the rest of the data, really need to see how the machine was setup etc..

[BigWing]

For me, the Pulse Rate spikes - particularly the ones with a corresponding Movement spike - represent arousals (some of which wake me briefly, but most don't).

I monitor my sleep with SomnoPose too, and that clearly shows me turning - a little or a lot - at the time of many of those spikes. 

Your Pulse Change events are 20 times what mine are though, which sounds like you can't be getting a good sleep?

Here's an example of mine.

[BigWing]

Sorry, here's one which also shows the SomnoPose data (Orientation shows the turning; Inclination is just how flat I am).

[SleeplessKnight]

instructions to post the rest of the data, really need to see how the machine was setup etc..

Thank you, I will post it here later today.

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For me, the Pulse Rate spikes - particularly the ones with a corresponding Movement spike - represent arousals (some of which wake me briefly, but most don't).

I monitor my sleep with SomnoPose too, and that clearly shows me turning - a little or a lot - at the time of many of those spikes. 

Your Pulse Change events are 20 times what mine are though, which sounds like you can't be getting a good sleep?

Here's an example of mine.

My sleep has been really bad for a long time haha, I've probably had sleep apnea at least since I was around 18, and I'm 33 now. Just managed to get diagnosed a couple weeks ago after a long time looking for the cause of my symptoms. The regular smartwatches like whoop never picked up these spikes because their sampling isn't high enough, so I'm just finding it now that I have the o2 ring.

Your pulse rate chart looks pretty alright, the PR spikes correlate with the movement. But on mine there isn't always movement so I think there's respiratory effort occurring.

[SleeplessKnight]

instructions to post the rest of the data, really need to see how the machine was setup etc..

Here's my data for last night, also included the oximetry and pulse rate. 

On the sidebar there's a setting that I couldn't get to show because of the space available but it's: Ramp Type: Ramp+

[BigWing]

If you widen the first column of "Statistics" just a smidge so that none of the descriptions wrap to a second line, more information will show overall.

I'm no expert, but I'd say a higher pressure is worth a try - and it would certainly help if you can reduce the leaks (though I find that more of an art than a science!).

Your oxygen chart is better than mine, though your AHI is far worse than mine....which just supports what I have seen many times, that there seems to be a poor correlation between the two.

[Narcil]

Agree with BigWing, raising the minimum pressure should help get rid of the remaining H/OA events. I would start with 7cm, then 8 if it's not enough to remove the remaining events. the leaks are also quite significant, maybe try a chin strap?

Can you also post your sleep study results, after redacting your personal info ? wondering if they noted anything else in your study. even if it's in portuguese.

[Jay51]

Here are some tips for reducing mask leaks:  

Mask Primer

[SleeplessKnight]

Agree with BigWing, raising the minimum pressure should help get rid of the remaining H/OA events. I would start with 7cm, then 8 if it's not enough to remove the remaining events. the leaks are also quite significant, maybe try a chin strap?

Can you also post your sleep study results, after redacting your personal info ? wondering if they noted anything else in your study. even if it's in portuguese.

Thank you, I will be raising the pressure to 7cm tonight. Regarding the leaks, last night I did mouth taping, but I think the nose pillows sometimes still get out of place with movement. I ordered a Resmed P30i mask, so probably that will be better. The one I currently have was just given to me by the sleep technician and isn't that good.

Here's the report of my sleep study translated to English, and the full statistics from the Polysomnography here. They didn't score RERAs which I guess is a common occurrence unfortunately.

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Nocturnal Polysomnographic Record Performed in Ambulatory Setting

The recorded signals were:

• Electroencephalogram (EEG): 6 channels
• Electrooculogram (EOG): 2 channels
• Submental Electromyogram (EMG), right and left tibialis
• Electrocardiogram (ECG)
• Nasal flow (cannula and thermistor)
• Thoracic and abdominal movements
• Transcutaneous oximetry
• Respiratory noise and body position

The analysis of the acquired signals is based on visual inspection and automatic calculations performed by computer. Sleep staging was performed according to the criteria of the American Academy of Sleep Medicine (AASM v2.6). The classification of hypopneas is done with 3% desaturation criteria.

MACROSTRUCTURE OF SLEEP

Lights out at 22:39 and lights on at 08:49. The total recording time was 610 minutes. The total sleep time (TST) was 584 minutes and the total wake time after sleep onset (WASO) was 22.0 minutes, corresponding to 3.6% of the total sleep period. The sleep efficiency was 95.7%. Sleep latency was 1.5 minutes and REM sleep latency was 128.0 minutes. The duration of stage 1 (N1) sleep was 29.0 minutes (5.0%), stage 2 (N2) was 272.5 minutes (46.7%), and stage 3 (N3) was 152.5 minutes (26.1%). The duration of REM sleep was 130.0 minutes, corresponding to 22.3% of sleep. There were 17 awakenings.

MICROSTRUCTURE OF SLEEP

Vertex sharp waves are clearly visible. Sleep spindles are normal and symmetrical. K-complexes are symmetrical with varied morphology. Deep slow-wave sleep is characterized by irregular delta activity. In REM sleep, rapid eye movements are clearly visible, and muscle atonia is present.

RESPIRATORY EVENTS

There were 103 sleep apneas observed, with an index of 10.6/h, predominantly obstructive type (obstructive apneas: 92, mixed apneas: 4, central apneas: 7). The average duration of apneas was 30.9 seconds with a maximum duration of 67.9 seconds. There were 108 hypopneas, with an index of 11.1/h, an average duration of 34.3 seconds, and a maximum duration of 73.8 seconds. The total number of apneas and hypopneas was 211, with an RDI of 21.7/h (normal < 5/h). The patient spent 166.5 minutes of sleep in the supine position, where the apnea-hypopnea index was 46.1/h (supine RDI). The RDI in REM sleep was 32.8/h.
The mean SaO2 during sleep was 93.7%, with 134 desaturations greater than 3%, resulting in a desaturation index (ODI) of 14.6/h (normal < 5/h). SaO2 remained below 90% for 11.7 minutes of sleep (T90). The minimum SaO2 was 66.0%.
There were 5145 snores recorded, with an index of 528.6/h, comprising 37.3% of TST.

OTHER FINDINGS

There were 104 periodic limb movements during sleep. The index of periodic limb movements during sleep was 10.7/h (normal < 15/h).
No rhythmic masticatory muscle activity was recorded.
The average heart rate during sleep was 64.7 BPM (minimum 50.0 BPM, maximum 102.0 BPM). The ECG did not show significant alterations.

CONCLUSION

Nocturnal polysomnographic recording, performed in an ambulatory setting, showing:

• An increased apnea-hypopnea index (21.7/h), with an increased ODI (14.6/h), consistent with the diagnosis of moderate obstructive sleep apnea-hypopnea syndrome. Significant positional effect, with a supine RDI of 46.1/h. Snoring was present.
• Alteration of sleep structure due to respiratory events, leading to fragmented sleep with an increased micro-arousal index.
• A normal index of periodic limb movements during sleep (10.7/h).