sleep apnea

Sleep Apnea, CPAP and Zeo

English

I'm 30 year Chinese old male around 160 pounds - BMI of 23.5 (acceptable in North America, but overweight in Asian standard).

So I was diagnoised with Moderate Obstrctive Sleep Apena with an estimated 16 Apena Hypopnea Index events per hour. I was getting a CPAP machine when I read about Zeo on Smartmoney magazine.

So I decided to try the Zeo a month before getting my CPAP machine so I have a better before/after observation. I have about a month of data before using CPAP and about 2 weeks of data (and growing) after using the CPAP.

Why Do I Never Feel Rested?


Undefined

How REM Syncs with My Body Temperature

This is the final Featured Blogger post from the Hypnagogia blog. In this entry, they discuss how an experiment in monitoring body temperature gave them new insight into both REM and sleep apnea.

 

Given that we inhabit a planet with a 24 hour day, it is no surprise that our bodies have become roughly linked with the day/night cycle, with various hormones being released at certain stages in the rhythm enticing us to sleep or wake.

Not everyone's rhythm is the same, some people have theirs shifted (such as when you are jet lagged). Even a skew of an hour or two can make a huge difference to how easily you are able to wake up for work in the morning, or how late you can stay awake.

There are a couple of online questionnaires to help you determine your own circadian rhythm; I took one from Phillips and the other from the BBC. Both of these decided that my rhythm was skewed, so I decided to make my own measurements and chart them here but after seeing the first 24 hours of data, something interesting emerged...

Establishing Your Circadian Baseline

This is a normal circadian rhythm taken from the Philips website

In fact, this is a simplified rhythm, because it is normal to have a small dip in the energy levels around mid afternoon, hence the reason for many countries having an afternoon siesta, and the reason why we tend to slump at our desks in the mid afternoon and reach for a cup of coffee.

This dip can be seen more clearly in my graph from the BBC circadian test.

Core body temperature is a good way of charting your own rhythm because energy levels are reflected by our temperature. Our body temperature is not a static 37.5 C, in fact it fluctuates throughout the day inline with our circadian rhythm. Of course, it is also affected by ambient temperature and how active we are. So, all it would take to chart my own rhythm would be a decent thermometer.

The Things We Do For Science

I decided to get a data-logging thermometer, so that I could see what was happening while I was asleep. I ordered a thermometer capable of recording every 10 seconds (to weed out anomalous readings), and was expecting the probe to be a small thermocouple-type sensor that I could stick to the skin under my arm, but the probe was more like a bullet and wasn't adhesive plus the logger turned out to be a lot bigger than it looked in the photo!

I'd gone this far, so in the name of science, I shaved under my arm and fixed the probe there with Melonin (low adhesive dressing) and Tegaderm (a clear waterproof adhesive dressing). I then wedged the cables into my suit and went off to work.

After 24 hours (and a few weird looks) I downloaded the data to a computer. I noticed that generally the pattern was the same as that belonging to "normal" people, but that it had a few fairly severe drops in temp during the night.

I repeated this over several days. On the graph below, the dip is around 1:30pm and again at 4:00pm. I suspect the 1:30pm dip is my normal afternoon energy dip whilst the 4:00pm dip is environmental because I was working outside at 4:00pm.

It's also interesting that the temperature drops around 8pm. That's pretty much when I start to look forward to sleep! It plateaus at 10pm for a couple of hours in a similar way to the one produced by my answers to the BBC link. This may have been because I was already asleep by then!

I repeated this the following day and the dip was much more pronounced again early at around noon, but I ended the recording early as it was becoming awkward to carry the data-logger around with me, so I can't show a full 48 hour graph.

I also noticed that the drops in temperature during sleep are the most severe. 

 

If You Can Repeat it, it's Science

When I first saw them, I suspected that they were erroneous readings, but the probe was stuck so tightly to me that there was no way that these were due to poor contact (after all, if that were the case, why didn't this happen during the day when there was more movement?). However, as the data rate on the logger was so high (240 recordings an hour), these were clearly not erroneous as they slowly crept back up to the plateau level of around 36.5°C. I wasn't happy with this result, so I repeated it the following night.

The drops in temperature were still there.

On the second night, to eliminate the possibility that these variations were due to environmental changes, my room temperature was monitored with another probe, and it was a surprisingly constant 18°C for most of the night, so there were no corresponding dips in room temperature. I don't like my bedroom to be too warm so I switch the heating off at night.

I took a look at my sleep-stage data using the Zeo, and was surprised that the seemingly random falls in temperature coincided with awakenings from REM! (Shown as orange "wake periods" on the coloured graph, but as REM/Wake on the detailed graph). So what's going on?

Unwrapping the Mysteries of REM

Along with the muscle paralysis that comes with REM sleep (to stop us acting out our dreams), there is also a decrease in the body's ability to regulate its temperature (thermoregulation). During REM this decrease in ability to regulate our temperature causes us to be largely "Poikilothermic" (meaning that our temperature is governed by the temperature of our environment).

So, it seems that my temperature was dropping, causing me to wake in order to regulate my temperature, pretty much in the same way that my apneas cause me to wake during REM.

If this is true then it means that in order to be able to stay asleep during REM I now have two issues to deal with: apneas AND temperature!

So the key to eliminating this issue is to regulate the temperature of my bedroom better.

I repeated this for two more days, and then concentrated on the nights and gathered more data (total of 5 nights).

It seems that these overnight drops in temperature aren't always correlated with REM sleep (sometimes they are just before and sometimes just after), so until my more accurate thermometer arrives, I decided to calculate the mean temperature from the week's recordings to get a better idea of my rhythm and to try to eliminate the overnight drops.

This gives a much nicer picture and goes some way to reducing the environmental effects. The data fits well with how I feel throughout the day. I tend to get a bit tired at 1pm, then start considering bed around 8-9pm.

Compared to the BBC graph, it lines up fairly well, although my "energy drop" happens earlier in the day at a more accurate time.

All that said, I'm not comfortable with this experiment as there is much that could be improved on:

  • Better temperature sensor (on it's way)
  • Eliminate environmental temperature effects (maybe on a day where I stay at home)
  • I still am not convinced whether these changes in temperature are an effect of activity. After all, it stands to reason that when we are more active our bodies produce more heat, so it would be interesting to do this on a day where I forced myself to do nothing, stayed at home and forced myself to stay awake past my usual bedtime, that way I could see whether these changes are still evident on the graph. That said, some of the nights were recorded with an 11pm bedtime although my temperature still dropped as usual around 8pm, so it could be accurate.

One thing that it has shown me is that it is essential to have your sleeping environment just right for you.

A good sleep routine involves making sure that your bedroom is the right temperature. It should be cool but not cold. In days gone by, the outside temperature dropping in the evening acted as a cue for our ancestors' bodies to sleep. Of course, in days where our homes are heated, this confuses the body and can lead to poor sleep.

The same is true with light.

Nowadays we have artificial light filling our homes and offices, and that also interferes with our sleep/wake cycle as we don't receive the nighttime cues. 

So sunlight during the day and a cool, dark bedroom goes some way to remedying this.

Do you blog about sleep?  If so, we want you as our next Zeo Featured BloggerTell us your story today! 

How To Add CPAP Data to Your Zeo Data

This is the 3rd Featured Blogger post from the Hypnagogia blog.  In this entry, they discuss how to overlay your CPAP data with your Zeo Data in order to get a better picture of how well you sleep - and what changes you might want to make.
 

I've posted on a couple of CPAP boards (and read at more) and it's clear that there are a lot of us who like to see what the ventilators are doing overnight and how many apneas & hypopneas there are. Quite a few of us own pulse-oximeters too, so this data can also be included.

One problem is that each device has it's own printout, making comparing them tricky.  However, with a little time and Photoshop, you too can create your own sleep data page.

How to Create an Easy-as-Pie, DIY Data Report

I created an A4 page in Photoshop and found that it was then easy to align all the graphs as long as all the monitors were were started and stopped at the same time (or as close as you can manage).

You can either print all the various outputs to PDF files using either Adobe or the free CutePDF then open them in Photoshop or you can take a screenshot from each piece of software.

Then cut and paste each graph onto your A4 blank and stretch them so that the start and stop times align.

Violà - Data!

Below is an example of one from a night of a family member's BiPAP data. 

It includes: 

  • BiPAP output (Pressure, RR, flow rate, triggered breaths, apnoeas etc)
  • Transcutaneous CO2 (actually a reprocessed photo of the onboard graph)
  • Oximetry trend
  • Pulse rate
  • Zeo 30 second resolution hypnogram
  • Zeo 5 minute resolution hypnogram

 

 


I then pasted bits of relevant data from Zeo and the oximeter around the edge.

This is from a night of making adjustments to the backup rate of breaths and is a good example of what aligning the data can reveal.

What Data Overlay Can Reveal About Your Sleep

Take a look at the highlighted strip and work down from the top...

  • The backup rate had been increased a couple of hours before. 
  • Then in the highlighted part you can see that the number of breaths increased even more.
  • However, there was a much higher increase in the number of breaths they was doing

Why?

When you look down to the Zeo hypnogram it becomes clear. The extra breaths were waking them from sleep, hence their spontaneous respiratory rate increased even more.

The backup rate was too high, so I reduced it.

I have also tried the Zeo with CPAP on myself.

Here is a simple overlay of the Zeo hypnogram onto the ResScan report. (I pasted the hypnogram into a new layer in Photoshop and then made it semi transparent).

A correlation between minute ventilation and periods of being awake (actually broken REM according to the 30 second hypnogram) is easy to see.

Also the apnea flags point to me losing deep sleep due to apneas.

More about that and what I plan to do about it in another post though.

 

 
Do you blog about sleep?  If so, we want you as our next Zeo Featured BloggerTell us your story today! 

Why Booze Really Trashes Your Sleep

 

This post from the Hypnagogia blog is part of our Featured Blogger initiative.  In this entry, they discuss how alcohol consumption lead to an increase of their sleep apnea index (AHI) and a decrease in sleep quality.

 

A nightcap helps you sleep, right?

Well, yes...but not in the way you think it does.  In fact, it often makes things worse.

During my initial explorations with the flow-meter, I thought that I'd test my set-up by trying to INCREASE my AHI using a well known substance that makes sleep apnea worse:  Alcohol.

A sleep experiment where I get to have a drink or three... it's tough, but I'll do it for science. 


Alcohol Increases Your Risk of Sleep Apnea

Pretty much as it does with people, alcohol relaxes the muscles in the airways making them more prone to flopping around all over the place and causing an obstruction.
 
When it comes to the rest of the practices, gadgets, fads and ideas that I'll be exploring I'll be testing them for 5 days in a row each. To be honest I'm not going to do that with alcohol as I can't afford a week of waking up sluggish and groggy. 

So, what I did was to take 5 non-consecutive days instead. I consumed alcohol and recorded my AHI on those nights along with my 5 day no-alcohol mean AHI for comparison.

Pretty conclusive.

Alcohol increased the number of times that I either stopped breathing or breathed so little that it was ineffective.  Not only that, but it did it in quite a startling way.

It took my 5 day mean AHI from 6.95 to 12.2.(max 15.3) To get that into perspective, that's nearly double the number of times PER HOUR that I had breathing problems. As discussed in this post, I went from just scraping in with a diagnosis of "Mild Obstructive Sleep Apnea" to being firmly in the category!
 
Surely there was something positive to salvage from this bad news?

Yes.

In my mind alcohol helped me to get to sleep and I found that the Zeo data backed that up.

Again, using a 5 day mean value, my time to sleep onset (or Zeo's "Time to Z") went from 28 minutes without alcohol down to 9 with alcohol. That seemed to be the only significant difference in the data, so I haven't bothered to clutter the page with other measurements.


It may help you to get to sleep, but the chances are that the sleep will not be good sleep. The chances are that it will be disturbed sleep, the chances of having to go to the bathroom will increase, as will the likelihood of dehydration-related headaches and fragmented sleep towards the morning.

Not only would I wake up feeling slow and mildly hungover, but I'd be tired from being woken up up to 15 times an hour through apneas.

Don't misunderstand me, this isn't one of those damning posts about alcohol, but it is something to bear in mind if you already suffer with sleep apnea, and it may even cause mild apnoea in people who don't have it. 

Will I continue to drink alcohol? Of course, and that's the dilemma. So I guess the answer is "everything in moderation."


Do you blog about sleep?  If so, we want you as our next Zeo Featured BloggerTell us your story today!
 
 
 
 

Apneas, Me? My Baseline AHI

This post from the Hypnagogia blog is the first Featured Blogger post ever! In this entry, they discuss some of the reasons behind apneas (pauses in breathing), how one can track them, and what one can do about it.

 

I'm going to be exploring some of the sensible and not so sensible suggestions in order to bring down my AHI (apnea - hypopnea index).

To do that I needed reliable data, so I decided on a 5 day mean with a few basic rules:
    •    No coffee after 3pm
    •    Monday - Friday monitoring only (to ensure routine sleep and wake times)
    •    No alcohol
    •    No other supplements known to affect sleep
    •    Begin sleep on my back (supine)
    •    Motion detection IR (Infrared) camera (for verification of events if needed)
    •    The same apnea / hypopnea scoring criteria will be used throughout

I could use the IR camera to detect sleep position, but that would take a lot more time, so until I have a system that can detect that reliably then I won't include that data, and I may re-evaluate some weeks using that ability.

I did initially check the camera to see if I attempted to breathe when the system was detecting apneas. I did make some respiratory effort, so I will make the presumption (for now) that my apneas are obstructive in nature.

I also noticed that when the oxygen desaturations due to apneas were compared to the Zeo hypnogram, that like my son's, they were clustered around REM sleep. 


The top line is my oxygen level.

It does look like I'm awake for those periods, but the black line is a more detailed Zeo hypnogram (data calculated on a 30 second basis). Zeo has a scoring system and shows the highest scoring sleep stage as being the dominant one. "Wake" scores the highest; this makes sense, as being awake is probably the most important thing to show when you are supposed to be sleeping.

The 30 second graph shows that why the main Zeo graph shows a lot of wakefulness during the night... I have oxygen desaturations which in turn wake me up, hence Zeo shows "wakefulness for the whole 5 minute epoch. However, when you see Zeo's calculations of time spent in each sleep stage, these are based on the more detailed 30 second data.

Sleep apnea can run in families. Whether that is a factor or not, my diagnosis (albeit a self-diagnosis) doesn't surprise me. I sometimes snore, I wake up with headache a lot, and I could do with losing a bit of weight.

I have long suffered with sleep paralysis, and I suspect that being disturbed in REM sleep is a major factor in that, if not the sole cause.
So, how is this a problem?

My average AHI (number of apneas and hypopneas per hour) is 7, hence I am classified as having "Mild Obstructive Sleep Apnea".
The classification ranges are: 

  • <5  - Normal (unless symptomatic)

  • 5-20  - Mild

  • 20-40 - Moderate 

  • 40+  -  Severe

 
The REM element brings the name to "Mild REM-Related Obstructive Sleep Apnea"

I will say that this "diagnosis" is an amateur one, it may not correlate with a professional one in a sleep lab, but if I use the same equipment throughout this experiment the results will still be valid, just relative to my original numbers.

So, what if I don't want to have that diagnosis, what if I want to be "normal" (says the man who sleeps with electrodes on his head, prongs up his nose and a camera watching him)?

Standard advice:
    •    Lose weight if you are overweight (even a small amount can make a difference)

That's all very well, and something that I will do, but that won't help me fix my sleep tonight will it?

Other advice includes:
    •    Prop the head of your bed up by 4-6 of inches (takes the weight off your neck)
    •    Cut down on alcohol
    •    Quit smoking
    •    Use a mandibular advancement device (pushes the bottom jaw forward to hold the airway open)
    •    Use a CPAP device
    •    Avoid caffeine and heavy meals within two hours of bed
    •    Use a nasal dilator (keeps the nostrils open)
    •    Try a nasal saline spray
    •    Throat exercises
    •    Surgery

I'll evaluate some of these (plus a few more ideas that I have) and back up the findings with a 5 day mean AHI and sleep graphs.
Let's face it, we're all looking for quick-fix solutions, and I'm not trying to cut corners, but I am trying to help myself while on the journey to losing a bit of weight. However, so that I don't confuse the issue I will not intentionally lose weight until I have tried some of the other methods.

So, in essence I am looking for some way of bringing my AHI down, along with the time that I spend awake at night.


Do you blog about sleep?  If so, we want you as our next Zeo Featured BloggerTell us your story today! 

Sleep Apnea: The Scary Sound of Silence

This article comes from the team at REM Sleep Labs, an accredited sleep testing center with Sleep Centers in Orange County, Los Angeles, and San Diego   Their goal is to develop and maintain high quality healthcare service and provide education to the public and healthcare professionals.
 
English

What wakes someone from REM sleep?

 

The body also has more activity during REM, including shallower breathing, a faster heart rate and higher blood pressure. One theory of the function of REM sleep is based on providing this "transition" from the deeper sleep states to being awake. In this argument, REM helps rouse the mind and prepare for a successful launch back into waking awareness.

Undefined

Can one hallucinate when waking from sleep?

 

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