Definition of "Arousals" in the overnight study?

[johntee]

Hi all. I'm wondering if anyone can explain to me what exactly the term "arousals" means in the context of the overnight sleep study. Is it related to the respiratory monitoring (i.e., some roughness in breathing, not as severe as an apnea or hypopnea), or is it sleep-stage-related (i.e., a movement of brain waves out of deeper sleep into shallower sleep)?

In a related vein, has anyone ever been given access to their overnight data that shows the respiratory monitor's data, or is it so voluminous that I'd never be able to get/decipher it to investigate whether my arousals might be being triggered by RERA- or UARS- types of events?

(My last overnight -- to see why the 6cm pressure I'd been using for a year hasn't relieved my fatigue -- showed great results - 2 centrals (during the entire night), no obstructives, 2 hypopneas during the entire night, but 37 arousals -- 6.6 arousals per hour. Ten of the arousals were during REM, 27 during Non-REM.)

Thanks for your help!
John

[Fredman]

Hi all. I'm wondering if anyone can explain to me what exactly the term "arousals" means in the context of the overnight sleep study. Is it related to the respiratory monitoring (i.e., some roughness in breathing, not as severe as an apnea or hypopnea), or is it sleep-stage-related (i.e., a movement of brain waves out of deeper sleep into shallower sleep)?

In a related vein, has anyone ever been given access to their overnight data that shows the respiratory monitor's data, or is it so voluminous that I'd never be able to get/decipher it to investigate whether my arousals might be being triggered by RERA- or UARS- types of events?

(My last overnight -- to see why the 6cm pressure I'd been using for a year hasn't relieved my fatigue -- showed great results - 2 centrals (during the entire night), no obstructives, 2 hypopneas during the entire night, but 37 arousals -- 6.6 arousals per hour. Ten of the arousals were during REM, 27 during Non-REM.)

Thanks for your help!
John

Hi John many of us pull data from our machines on a regular basis. Some daily, some weekly, or even monthly. If your machine is data capable, there often is software for some of the machines. Resmed and Respironics have software for viewing data as recorded nightly on your machine.

A lot of the veteran cpap'ers here are very good at providing you with some of their insight to your data. Generally people save the data to flickr or photobucket for viewing as we are not able to post them on the forum.

I am not sure what machine you have, it looks like a Respironics unit and I am not sure what model...? I suggest that you change your profile instead of the pictures choose the text option. The pictures look pretty good, but for folks to give you good advice if you choose the text version, they will be better able to provide you with a satisfactory or more accurate answers.

[johntee]

Hi Fredman... I found this forum before I got my machine (and learned alot) and I've been looking at my Encore Pro data since pretty much the beginning (almost 2 years ago).

I was actually looking for info on what they term Arousals in the Overnight Sleep Study...

(Since there had been no clues in the EncorePro data as to why my CPAP usage wasn't curing my fatigue, I had finally cajoled them into doing another overnight sleep study -- using my standard 6cm pressure -- to see what was really happening. As I mentioned, those results were "beautiful" (to use my Sleep Dr's word), except now I'm starting to wonder about the possible effects of the 6.6 Arousals per Hour they recorded.

Thanks!
John

[TSSleepy]

From the wiki page on Polysomnography:
'Arousals' are sudden shifts in brain wave activity. They may be caused by numerous factors, including breathing abnormalities, leg movements, environmental noises, etc. An abnormal number of arousals indicates 'interrupted sleep' and may explain a person's daytime symptoms of fatigue and/or sleepiness.

[iricoboy]

I had a sleep study with my resmed on a few weeks ago, just to see how is my sleep quality with the respiratory machine. i didn't go to fetch the results, my mother went to the doctor for my result instead, and told me the doctor said my sleep quality was good, and it's convenient that i go on using the machine. but when i took a look at the result paper myself, my arousals was as high as 279 in the entire night, i jsut slept a few hours(i couldn't go to sleep very fast in the hospital room), does that mean my sleep quality is very bad? o there are other factors i should look into, which affect my sleep.
i don't think 279 arousals is a good number, o indicates something wrong with my sleep, i don't know how the doctor explain this, i think i would go there myself and ask him why sometime later.

so, it's very useful this forum, thanks to the creator of this site, to whom i'm very grateful for this so helpful and interative place!!!

[jnk]

. . . I'm wondering if anyone can explain to me what exactly the term "arousals" means in the context of the overnight sleep study. . . .

Well, since your question is about "in the context of the overnight sleep study," I believe that if you were to ask four different techs to define "arousal," you would probably get five or six different answers.

My personal definition of arousal in the context of sleep in general is this: "An arousal is a change during sleep that the brain recognizes as a significant disturbance, but the person doesn't remember as a conscious awakening." I'm sure some would disagree with that definition, but that is what it means to me in my broad overly-simplified way of looking at things.

When it comes to the technical process of SCORING, or recognizing, arousals, there are many different ways of measuring, differentiating, and contextualizing "arousals," and those ways vary from tech to tech, from lab to lab, from doc to doc, and from year to year, so that there is a lack of clarity in the industry as far as recognizing REM arousals and non-REM arousals--just as there is a worldwide problem with defining hypopneas, for that matter. There is a history to how arousals are scored. There are different ways of scoring them now. And there likely will be different ways of scoring them in the future. That is why, for me, the point is often more a matter of whether a patient responds well to PAP therapy than it is why the patient does.

Some techs and docs may think that the technical aspects are all very obvious and clear (maybe it is, to them), while others may be confused and afraid to say so, and still others may be able to grasp the overall spirit and purpose of what is being looked for during a PSG, and why, and have the judgment to make that work for different patients, with different problems, on different days (or, nights, actually).

And that is part of why I think the people who do PSG work and do it well deserve a lot of credit and respect.

jeff

[StillAnotherGuest]

. . . I'm wondering if anyone can explain to me what exactly the term "arousals" means in the context of the overnight sleep study. . . .

Well, since your question is about "in the context of the overnight sleep study," I believe that if you were to ask four different techs to define "arousal," you would probably get five or six different answers...

When it comes to the technical process of SCORING, or recognizing, arousals, there are many different ways of measuring, differentiating, and contextualizing "arousals," and those ways vary from tech to tech, from lab to lab, from doc to doc, and from year to year, so that there is a lack of clarity in the industry as far as recognizing REM arousals and non-REM arousals--just as there is a worldwide problem with defining hypopneas, for that matter. There is a history to how arousals are scored. There are different ways of scoring them now. And there likely will be different ways of scoring them in the future.

Actually, the definition of arousal, will, to a man (or woman) working in the sleep field will be recited to a word with a precision that can be compared to the Pledge of Allegiance (including the phrase "under God"):

Score arousal during sleep stages N1, N2, N3, or R if there is an abrupt shift of EEG frequency including alpha, theta, and/or frequencies greater than 16 Hz (but not spindles) that last 3 seconds, with at least 10 seconds of stable sleep preceding the change.

Scoring of arousal during REM requires a concurrent increase in submental EMG lasting at least 1 second.

SAG

[jnk]

. . . I'm wondering if anyone can explain to me what exactly the term "arousals" means in the context of the overnight sleep study. . . .

Well, since your question is about "in the context of the overnight sleep study," I believe that if you were to ask four different techs to define "arousal," you would probably get five or six different answers...

When it comes to the technical process of SCORING, or recognizing, arousals, there are many different ways of measuring, differentiating, and contextualizing "arousals," and those ways vary from tech to tech, from lab to lab, from doc to doc, and from year to year, so that there is a lack of clarity in the industry as far as recognizing REM arousals and non-REM arousals--just as there is a worldwide problem with defining hypopneas, for that matter. There is a history to how arousals are scored. There are different ways of scoring them now. And there likely will be different ways of scoring them in the future.

Actually, the definition of arousal, will, to a man (or woman) working in the sleep field will be recited to a word with a precision that can be compared to the Pledge of Allegiance (including the phrase "under God"):

Score arousal during sleep stages N1, N2, N3, or R if there is an abrupt shift of EEG frequency including alpha, theta, and/or frequencies greater than 16 Hz (but not spindles) that last 3 seconds, with at least 10 seconds of stable sleep preceding the change.

Scoring of arousal during REM requires a concurrent increase in submental EMG lasting at least 1 second.

SAG

I believe you, Muffy-SAG/TPFKAS.

So are you claiming that all techs actually read and understand the suggestions of the AASM?

May one day that very religious consistency within the industry keep you from ever needing to ask anyone for their raw data!

jeff

http://www.binarysleep.com/phpbb2/viewt ... &start=105

[StillAnotherGuest]

I believe you, Muffy-SAG/TPFKAS.

Oh, right, I mean

oxoxoxoxoxo

[-SWS]

An oldie, but this article may help give readers additional understanding of arousals and other scored sleep events:
http://www.sleepreviewmag.com/issues/ar ... -04_07.asp

I mean

oxoxoxoxoxo

Anybody missing a scoring grid up there?

[jnk]

That total desturation in the first epoch may be too far from the absence of flow in the third epoch. We'd better look that up before scoring anything!

[-SWS]

Well call me an avid hobbyist or just a clinician-wannabe... But I'm pretty sure I know how to score these things correctly:

That event scored in the upper right corner represents a cross-over from one sleep stage to the next. And that left-of-center event clearly depicts a complete sleep cycle finally coming full circle.

I know these things because I saw that same scoring sheet out in the PSG control room---right after my own professionally-conducted sleep study.

[jnk]

. . . that left-of-center event clearly depicts a complete sleep cycle finally coming full circle. . . .

Or maybe that's how the effort channels look when a belly dancer dreams of doing the hula.

I may send my next study to get scored in Korea: http://www.sleepnet.or.kr/workshop/2008/0955.pdf

[elader]

I think arousals are measured by the EEG (sleep stage)

My daughter does not have apnea but does have arousals from something called 'alpha wave intrusion'. My sleep doc gave me my entire report. Yours should give yours to you.

Hi all. I'm wondering if anyone can explain to me what exactly the term "arousals" means in the context of the overnight sleep study. Is it related to the respiratory monitoring (i.e., some roughness in breathing, not as severe as an apnea or hypopnea), or is it sleep-stage-related (i.e., a movement of brain waves out of deeper sleep into shallower sleep)?

In a related vein, has anyone ever been given access to their overnight data that shows the respiratory monitor's data, or is it so voluminous that I'd never be able to get/decipher it to investigate whether my arousals might be being triggered by RERA- or UARS- types of events?

(My last overnight -- to see why the 6cm pressure I'd been using for a year hasn't relieved my fatigue -- showed great results - 2 centrals (during the entire night), no obstructives, 2 hypopneas during the entire night, but 37 arousals -- 6.6 arousals per hour. Ten of the arousals were during REM, 27 during Non-REM.)

Thanks for your help!
John

[-SWS]

...scored in Korea: http://www.sleepnet.or.kr/workshop/2008/0955.pdf

Starting at page nine of that Korean document, we can see a summary that distinguishes ordinary isolated arousals (these ordinary arousals commonly recur and are of various origins), from frequently-recurring arousals that are specifically Cyclic and Alternating in Pattern (thus CAP arousals---with various proposed biologic origins still under investigation by sleep science).

Ordinary arousals in that first category, but specifically those of undetermined or environmental origin, are often scored as Spontaneous Arousals. Respiratory Effort Related Arousals ( or RERA's) are arousals of that first category as well. They most often occur because of how much respiratory effort is required to overcome airway resistance.

Elader, alpha wave intrusions are very often associated with fibromyalgia or pain. My sister has fibromyalgia but has elected to pass on a sleep study. Regardless, she seldom sleeps well and is very often tired because of her fibromyalgia.