[Treatment] Treating UARS with CPAP and bilevel

[mper6794]

Hi, Slowriter
Nice this is working! However, as i am not familiar with the device, I am afraid I would rather go with your waveforms to opinion. Those charts and scales i suggest previously, If you don't mind.
Gl

[slowriter]

IMHO the first one is not a central, note the larger breath following the event.  At the very least it is questionable.

The second is a Central note the rapid breathing prior to the event. That would flush the CO2 out of the system. Chemoreceptors use the pCO2 of the blood as the main driver for breathing.  This is one of the known causes of Central apnea

Be aware that Central apnea can and does occur during both asleep and awake states.  Because when it occurs when we are awake does not make it non-apnea,  it only means that we in general don't care about it because it's not Sleep Apnea.

Thanks for explanation.

So best way to assess is throw out all that occur when awake, and if there are only a handful that remain, don't worry.

If much more, take a look at the details?

[Gideon]

Pretty much

[slowriter]

Responding to mpers.

Let's look at a single, clear, example. At 2:00 AM, I awake out of REM (according to Dreem). Here's what the vauto data shows.

   

[alexp]

I agree with Bonjour. I would dismiss the first one but the second one looks real. See how regular the breathing is even though it's increasing in volume and then all of the sudden there is one breath missing. No worry about one bad night though unless it becomes the new normal.  I had a night last week were my AHI was 10 with lots of OSA. No idea why as normally I get normally one. Maybe the way I was sleeping, maybe I was more stressed out than usual and woke up more, ... Who knows? Went back to normal the next day so I didn't worry about it.

You are probably waking more during REM sleep because you are not used to it. Are you dreaming more than before? 

Anyway, if your Dreem device is accurate, I see you are starting to have more deep sleep. I would really focus on this part. I think this is your main problem. I think you are right that you should get about 15-20%. You had only 6% during your sleep study. That's way too low. I understand it wasn't your typical night since you were sleeping in a lab but still that's not a lot. 

I would keep things steady for a while.  Give your body some time to stabilize and than adjust the numbers if you still see a problem. You may be waking up just because you are nervous of all these changes. Stress can have a big impact on sleep quality.

EDIT : I see you were in REM sleep. I wouldn't be too concerned about the centrals then unless you were experiencing a major desaturation. This is not disruptive to your sleep if you didn't wake up (can't tell without EEG but I don't think so).

[slowriter]

I agree with Bonjour. I would dismiss the first one but the second one looks real. See how regular the breathing is even though it's increasing in volume and then all of the sudden there is one breath missing.

OK. That one occurs during the REM stage preceding the first wakeup (the 2 AM one). But across the whole night, there are only a couple/few like that.

You are probably waking more during REM sleep because you are not used to it. Are you dreaming more than before?

Anyway, if your Dreem device is accurate, I see you are starting to have more deep sleep. I would really focus on this part. I think this is your main problem. I think you are right that you should get about 15-20%. You had only 6% during your sleep study. That's way too low. I understand it wasn't your typical night since you were sleeping in a lab but still that's not a lot.

I would keep things steady for a while. Give your body some time to stabilize and than adjust the numbers if you still see a problem. You may be waking up just because you are nervous of all these changes. Stress can have a big impact on sleep quality.

EDIT : I see you were in REM sleep. I wouldn't be too concerned about the centrals then unless you were experiencing a major desaturation. This is not disruptive to your sleep if you didn't not wake up (can't tell without EEG but I don't think so).

The Dreem has a pulse ox sensor, but not sure it reports the actual data on that. Will look into it, but I doubt it's a problem given how infrequent these are.

What the Dreem is saying is the architecture of my sleep is looking pretty good right now (and so probably the PAP settings are working), but that I need to sleep later, with fewer awakenings, I suspect, to feel better.

EDIT: given it's possible I've been living with undiagnosed and untreated UARS for years preceding all this, it does make some sense that I need to be patient.

[alexp]

I agree with Bonjour. I would dismiss the first one but the second one looks real. See how regular the breathing is even though it's increasing in volume and then all of the sudden there is one breath missing.

OK. That one occurs during the REM stage preceding the first wakeup (the 2 AM one). But across the whole night, there are only a couple/few like that.

You are probably waking more during REM sleep because you are not used to it. Are you dreaming more than before?

Anyway, if your Dreem device is accurate, I see you are starting to have more deep sleep. I would really focus on this part. I think this is your main problem. I think you are right that you should get about 15-20%. You had only 6% during your sleep study. That's way too low. I understand it wasn't your typical night since you were sleeping in a lab but still that's not a lot.

I would keep things steady for a while.  Give your body some time to stabilize and than adjust the numbers if you still see a problem. You may be waking up just because you are nervous of all these changes. Stress can have a big impact on sleep quality.

EDIT : I see you were in REM sleep. I wouldn't be too concerned about the centrals then unless you were experiencing a major desaturation. This is not disruptive to your sleep if you didn't not wake up (can't tell without EEG but I don't think so).

The Dreem has a pulse ox sensor, but not sure it reports the actual data on that. Will look into it, but I doubt it's a problem given how infrequent these are.

What the Dreem is saying is the architecture of my sleep is looking pretty good right now (and so probably the PAP settings are working), but that I need to sleep later, with fewer awakenings, I suspect, to feel better.

And feeling better can take some times. Don't expect to get up one morning and feeling like superman especially if you are not eating properly or not physically active. Don't want to lecture anyone, but if you only fix your sleep but still don't exercise, you may still feel like crap.

Just to give you an example, the first thing I noticed after switching to a bilevel and getting ride of most my RERAs is that I could walk for a longer time without feeling like I could take a nap right there on the ground. Also, I didn't need a second coffee in the afternoon to keep me going. Small victories like that. Things are still not perfect but much better. Like you I still wake up frequently during REM sleep but I think it's getting better. I expect it will only get better as time passes. As long as I'm not seeing anything abnormal, I'm not messing with my settings.

[slowriter]

Right. For the past few years, I've been pretty consistent with both weight training, and also HIIT. But that's dipped a bit of late as adjusting to the PAP therapy. I imagine will involve some give and take adjustment; as I sleep a bit better, I have more energy to exercise, which will help me sleep better, etc.

I guess we only realize how complex sleep is when something goes wrong with it!

[mper6794]

Responding to mpers.

Let's look at a single, clear, example. At 2:00 AM, I awake out of REM (according to Dreem). Here's what the vauto data shows.

slowriter, could you please add your leak chart here together? thanks
GL

[slowriter]

Zero leaks. ;-)

Using the Bleep mask, which makes it easy to eliminate leaks. Taping my mouth just to avoid mouth breathing.

Hence, zero leaks