What causes spontaneous arousals?

[Jake B]

Hi all, I'm not sure where to get info about this topic but I have posted on this forum before so I decided to get some more opinions.

I'm officially a CPAP/BiPAP dropout. After using different machines, trying multiple masks, adjusting pressures, etc. it never made any difference to how I felt even though my numbers were near perfect. There may be some additional info about this in my previous threads if needed.

Something I've done recently is looked over my 3 in-lab sleep studies (2 initial studies, 1 titration study - all done at different labs) and made a table comparing some of the key stats. The two main things I have discovered that may be my issues: 1) I have a high number of 'spontaneous' arousals and 2) my REM and 'deep' sleep percentages are well below average. I'm sure these two go hand-in-hand, since in theory each time I have an arousal that would revert my back to light sleep and restart my cycle. Here are some key numbers:

Study A:
36 respiratory arousals
104 spontaneous arousals
0 limb movement arousals
REM Cycle - 16.1% total sleep time
Deep Cycle - 19.5% total sleep time
2.4 AHI

Study B:
0 respiratory arousals
56 spontaneous arousals
8 limb movement arousals
REM Cycle - 8% total sleep time
Deep Cycle - 4.2% total sleep time
12.1 AHI (mainly hypopneas)

Study C (titration):
2 respiratory arousals
78 spontaneous arousals
0 limb movement arousals
REM Cycle - 4.2% total sleep time
Deep Cycle - 13.6% total sleep time
1.3 AHI
*Oxygen levels never dropped below 90% for all three studies.

In regards to the sleep cycle...some quick research indicates my Deep sleep (N3) cycle should be 10%-20%, and REM should be 20%-25%. As you can see above mine are well below average.
As I noted before, I'm assuming it's the high spontaneous arousal numbers that are not allowing me to get to the deep stages as much as needed.

My question is...what can cause these? I have some nasal issues that I hope to get corrected soon (mainly nasal valve collapse), but would this cause arousals without being classified as a breathing event?

Let me know if I can provide any more info. My sleep docs never mentioned 90% of what is in my sleep studies and would probably have downplayed any of my concerns anyway, so any opinions are appreciated!

[Miss Emerita]

Arousals don't necessarily mean you have to start a sleep cycle all over again, but having a lot of them can certainly result in poor sleep architecture. I don't know whether your nasal valve collapse issue would result in events scored as "spontaneous" or as "respiratory-related," and that's certainly a good question to ask a doctor.

Do you have pain at night that might explain arousals? Are you aware of frequent wake-ups? Do you feel a need to change position frequently? And how are you doing on following these guidelines?

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

Finally, I wonder whether you'd benefit from Cognitive Behavioral Therapy for Insomnia (CBTi). It helps some people who need to consolidate their sleep. More information here:

https://www.sleepfoundation.org/insomni ... y-insomnia

[Jake B]

Thanks for the reply. I don't have any pains at night that keep me awake. I typically sleep through the night, besides one or two bathroom trips and a few tosses and turns.

All the "sleep hygiene" guidelines have never really worked for me. The majority of these I do regularly, and others I've tried in the past with no difference.

The insomnia link you posted is interesting, however I've never had any problems getting to sleep. My issue is that when I'm asleep, something is causing these arousals and fracturing my sleep cycles. I'm fairly certain that it's not apnea related, because my numbers were not too terrible to begin with and the PAP machines (in theory) cleaned up any respiratory issues I was having, or at least that's what the numbers and charts indicated.

[jimbud]

An explanation:


https://doctorstevenpark.com/spontaneou ... leep-apnea


Probably not a lot you can do about it.

I have them too, I just live with it.
All in all, much better than it used to be

JPB

[Miss Emerita]

The insomnia link you posted is interesting, however I've never had any problems getting to sleep. My issue is that when I'm asleep, something is causing these arousals and fracturing my sleep cycles.

CBTi can help with fragmented sleep, which is, or contributes to, a form of insomnia where people have difficulty maintaining sleep. You may or may not be aware of the arousals. More information about fragmentation:

https://www.sleepfoundation.org/sleep-d ... pted-sleep

[palerider]

My question is...what can cause these?

Unfortunately, by definition, spontaneous arousals are those that occur without any known (respiratory) cause. Many of us, as we get older, have more spontaneous arrousals caused by aches and pains. noises, lots of possibilities.

I know that's not what you want to hear, but, looking up Grannie's recurring posts on sleep hygiene would be a good path to pursue.