Advice on treatment (and Dreem/FitBit comment)

[philo-br]

Hi everyone,

A bit of background to start:

After years of terrible sleep, I finally got a health care specialist that explained to me that I probably had sleep apnea. After the first sleep study, I was refereed to a CPAP provider that put me on a trial in May. I started on a Philips Respironics on Minimum pressure of 7. I did a second sleep study about a month ago with the CPAP and the prescription changed to a fixed pressure of 6. I then purchased a ResMed Auto-set for Her.

The CPAP provider folks have been very helpful in giving me masks choices, but they told me to wait to discuss my treatment with my sleep doctor. The problem is that I only had a quick discussion with her during my trial period and my next appointment is early next year. So, I've been anxious to better understand what I am going through and see what else I can do. I've done a lot of reading and even went so far as purchasing a FitBit and a Dreem headband. I wish I had found out about this website much earlier though. I just started using SleepyHead and became less anxious after seeing that I am not the only one having trouble adapting to this.

Anyway, here is why I am writing:

I feel that the treatment is going well. Subjectively, I feel much better (less headaches, more energy, etc.). I am also trying every trick on the book to improve my sleep habits (I am slowly getting back into exercising, taking magnesium pills, going to bed at the same time, keeping the room cool and dark, etc). But I still wake up three times every nights and have trouble going back to sleep. Looking into SleepyHeads, it seems that I wake up after the longer apnea events.

I am averaging around 1.8 AHI and between 2-3 minutes of total time in apnea, which seems to be good numbers. But I was wondering if this looks good only because I am sleepless for a couple of hours every night. The CPAP provider folks told me that since I am way below 5 AHI, I shouldn't worry too much about. But, for instance, my number look particularly good today because I was wide awake after 5 am (I also woke for a bit after 2am). So, even though I spent 7h20 hours in bed, I was probably only actually sleeping for 5h or less. I worry that this is probably not enough for long-term health.

So, I guess my basic question is: is there anything that I can do to improve my numbers? Here are a couple of things I am wondering about:

1) I seem to have some central events. Could this be the reason why they lowered the pressure?
2) I am using an EPR of 1. Any suggestions regarding moving it up or down?
3) I am on a full face mask, because I was opening my mouth during the first nights. Would my numbers improve if I got a nasal mask and some kind of tape?

Also, as a side note, I was so freaked out during the past months that I bought a Fitbit and, more recently, a Dreem headband to track my sleep. I am still feeling the financial burn, but I was so anxious about my sleep that I felt it was worth it (at my worst, in April, I was feeling so crappy that I was afraid of not being able to work anymore). However, their number are so divergent that I don't know whether I should believe it. For instance, in the same night of the attached image, Fitbit said that I was in REM sleep for 1h24, while Dreem says that I was in REM for 3h48 (for that night, deep sleep was actually closer between both -- 50 min vs 70 min).

Anyway, here is a screenshot of my latest night. I appreciate any advice.

Thank you!

EDIT: I corrected a bit of the grammar (English is not my first language) and inserted the numbers from Dreem and Fibit for the same night as the attached image.

[slowriter]

Also, as a side note, I was so freaked out during the past months that I bought a Fitbit and, more recently, a Dreem headband to track my sleep. I am still feeling the financial burn, but I was so anxious about my sleep that I felt it was worth it (at my worst, in April, I was feeling so crappy that I was afraid of not being able to work anymore). However, their number are so divergent that I don't know whether I should believe it. For instance, in the same night of the attached image, Fitbit said that I was in REM sleep for 1h24, while Dreem says that I was in REM for 3h48 (for that night, deep sleep was actually closer between both -- 50 min vs 70 min).

In general, the Dreem will be MUCH more accurate, since it has EEG sensors.

The one exception is where it has poor signal quality because of some headband fit issue. You can always email support to ask them to check for you.

Almost 4 hours of REM does seem a little implausible, unless maybe it represents REM rebound?

I have a thread here with a link to some python code that allows you to integrate the sleep stage data into OSCAR, if you can figure that out.

Edit: direct link to the code.

https://gist.github.com/jeremyblow/542d ... 1284f9aec4

[philo-br]

Thank you, slowriter! I actually sent you a PM after reading your previous post.

My REM numbers seem so high that it made me doubt the Dreem accuracy. It actually states that I had more than 4hours of REM for the first two days. But I guess it might be a rebound after years of lack of sleep. I got a poor signal warning on the first two days, but I tightened it yesterday and it seems ok. I will keep track to see if goes down with time.

[philo-br]

Another question that I forgot to put in the first text: Should I consider asking them to go back to pressure range (such as 6-7) instead of a fixed pressure of 6? Is there any reason why a fixed pressure would be better?

[Okie bipap]

There is not much point in having an auto adjusting machine if you are using a fixed pressure. Your setting looks pretty good, but I would change it to auto adjusting. Set it for 6 to 20. The machine may never go much over six. It will only go as high as it needs to in order to control your sleep apnea. If you don't want to go to an auto setting, bring your pressure up to 7.

[Miss Emerita]

Your numbers look pretty darned good, but clearly your sleep isn't what it should be yet. It may improve over time as you adapt to your apnea therapy, but it's certainly worth seeing whether some adjustments to your settings might help.

Looking at your posted chart, I notice two things. One is that you are having mask leaks that might be interfering with restful sleep. Do you think that might be the case? Or do you simply not notice them? If the latter, don't worry about them.

The other thing I notice is that you have a fairly active flow-limitation graph. Flow limitations mean that your airway, while not obstructing your breathing, is limiting it, often by relaxing the muscles in the tissues that line it. That can make you work harder to get the air you need, which in turn can disrupt sound sleep and cause you to feel tired the next day.

For many people, an increase in EPR can help with flow limitations. EPR lowers your pressure while you exhale, then boosts it back up when you inhale. If you do want to try an increase in EPR, though, you should also increase your pressure setting. It'd be best if one of the experts could weigh in, but I have in mind, say, increasing your EPR to 3 and your fixed pressure to 8.

You could certainly try using a pressure range instead of a fixed pressure. My suspicion is that the pressure will be driven up by the flow limitations without doing you much good, but then again you won't know unless you try it.

[Dog Slobber]

I would:

1. Switch over to APAP mode
2. Set the pressure range to 6 - 20. We want to reestablish your minimum pressure. Don't worry about the machine going too high, with your numbers, I doubt it will go much higher.
3. Optimize your pressure, likely by increasing your minimum.
4. After you're happy with your numbers, try setting your EPR again. EPR is primarily a comfort thing, but can influence centrals with some people. I like EPR set to 3 for me
5. Try EPR for a few days and see what you like.
6. We may need to have to re-optimise your minimum after changing your EPR.

Given how few centrals you are having, I don't think they're worth worrying about.

[philo-br]

Thank you all. That's very helpful -- and a lot to digest. I will look into these adjustments.

I guess my challenge now is to persuade the CPAP provider to do them (it seems that in Ontario, Canada, we are not allow to set the machine ourselves). But I will try to talk to them.

Just a couple of more follow-up questions:

1) Do EPR makes central go down or up? Or is it personal?
2) Also, when should I start worring about centrals? I seem to have 1 to 4 per night that are captured.
3) Are there advantages/disadvantages to a nasal mask? I will start trying one today.

I imagine I should refrain from changing multiple things at once, so I will try the land the mask over the next few days and then follow-up with these other adjustments.

Thank you again.

[slowriter]

1) Do EPR makes central go down or up? Or is it personal?
2) Also, when should I start worring about centrals? I seem to have 1 to 4 per night that are captured.
3) Are there advantages/disadvantages to a nasal mask? I will start trying one today.

1. often, it increases centrals, but there's only one way to find out
2. maybe when you average 3 or more per hour?
3. one pro is there's less places to leak, but the con is you then have to worry about potential for mouth leaks

[Dog Slobber]

Thank you all. That's very helpful -- and a lot to digest. I will look into these adjustments.

I guess my challenge now is to persuade the CPAP provider to do them (it seems that in Ontario, Canada, we are not allow to set the machine ourselves). But I will try to talk to them.

Just a couple of more follow-up questions:

1) Do EPR makes central go down or up? Or is it personal?
2) Also, when should I start worring about centrals? I seem to have 1 to 4 per night that are captured.
3) Are there advantages/disadvantages to a nasal mask? I will start trying one today.

I imagine I should refrain from changing multiple things at once, so I will try the land the mask over the next few days and then follow-up with these other adjustments.

Thank you again.

You most certainly can change it yourself, you just don't know how.

I'm in Ontario, and manage my own machine.

My supplier, didn't like it, my Sleep Dr. fully supports it.

1) EPR may influence centrals for some people. For me, none.
2) 1-4 centrals a night is nothing. And they may be false positive, or while you were awake.