I am a little confused about the stages of sleep.  I had always had the impression that REM sleep was what you aimed for, however when I read about the different stages, stage IV seems like a deeper sleep (so I would presume more restful) than REM.

I believe that I spend very little time in REM (7.9%) but a lot of time in Stages 3/4 (40.1%).  I figure my body is not so stupid as most of the apneas occured in REM!

Any enlightening words?

Thanks, Judy

Hi Judy!
Stage 3 and 4 sleep collectively is known as slow wave sleep (SWS) or delta sleep.  It's where the body gets truly restored.  It should be about 20% of the night, that you have twice the amount has to be put into context (was this part of the CPAP titration?)  The amount of REM sleep has to be put into context as well.  Normal REM is about 20%.
sleepydave

The numbers are from the original study.  I just got scheduled for my titration.  I didn't go into REM for a very long time either (198 minutes).  Anyhow, as Stages 3/4 are actually deeper sleep than REM wouldn't it be preferable to be in them rather than REM?  I had realized that the number was rather high and REM low from other things that had been posted.

Hi back!
Wow, that's a lot of SWS for a pre-CPAP!  Are you tired during the day?  REM and SWS bump out the lighter stages of sleep, so the choice isn't between either SWS or REM, nice to have both.  Any medications that limit your REM? How 'bout the rest of your results?
sleepydave

One of the reasons I am studying others results so much is that the copy I was sent of my sleep study -- the headers of the columns are unreadable.  I am trying to get a better copy.  Maybe you can figure out what some of them are -- it is frustrating.  My pulmo said next time I see him we will go over it, but I don't have any appointment with him at the moment.

The interpretation was that I have "mild overall obstructive disordered breathing (RDI 13) that is associated with moderate fragmentation of sleep continuity and oxygen desaturations to 86%.  The disordered breathing was most significant during REM sleep.  The patient cycled through all stages of sleep and there was mild intermittent snoring noted throughout.  Sleep efficiency was significantly reduced"

I like the progression from mild, to moderate, to significant, though obviously the sleep efficiency looks like a mess.



Sleep Efficiency is 56
Sleep Onset  28.5
REM Latency  198

Stage I            18     8.9    3-9%
Stage II           87.5 43.1    47-87%
Stage III/IV      81.5 40.1    3-21%
REM                 16     7.9      20-29%

(I am gathering that the last numbers are probably the norm, the first the minutes, the second the percentage above)

Arousals                           66    19.2     <40
Awakenings                         3    .9        <7
Arousals+Awakenings         88    20.1


                                   Jerks                       6   1.8   8   2.4
                                   Jerks, No Arousal      6   1.8   8   2.4
                                   Jerks, Non-REM         6   1.9   8   2.6

(These were the only jerks categories that had any results -- guess I don't jerk much!)

(I have no idea what these numbers are)
1   0.0        0.0  0.00    364.5     203.0  20   5.9  24  7.1  13  68  20.1




Apneas, NREM                7           23          18-31
Apneas, REM                  13         22          15-26
Apneas, TOTAL               20         22          15-31


Hypopneas, NREM            18         23          22-29
Hypopneas, REM                6         24          22-31
Hypopneas, Total             24          24         22-31

Apneas, Total                 20       5 .9            20     5.9         -------      ---------
Hypopneas, Total            24       7.1             22     6.6          2                .6
Events                           44       13               42     12 .4       2                .6

Total Sleep Time                                 81  122  122
Percent Time to TST                            39   80.1  60.1
NUmber of Events                                20   24    24
Number of Apnea                                        10    10
Number of Hypoapneas                        10     14    14
Apnea Index                                        7.4    4.9   4.9
Hypopnea Index                                  7.4     6.9   6.9
Apnea + Hypopnea Index                      14.8  11.8  11.8

(As RDI was 13, I guess that is different from the AHI)

SaO2 Mean Wake      98
SaO2 Minimum          86
SaO2, Range             86-97
SaO2  Mean               94

(These numbers are higher than I expected, I have a pulse oxi at home and rarely see it higher than 96)

Heart Rate, Wake                      152
Heart Rate, Steady Sleep Avg     140

(I was in atrial fibrillation during the study, and am tachy with it, though these numbers seems high.  It does stay high during sleep and oddly seems to increase the SaO2, so maybe that is why those numbers are higher than I expected)

PAC  events              ----------
PVC  events              ----------

Shortest R-R           .4     .4
Longest R-R            .5     .5

(What does R-R mean?)


Then there were a bunch of graphs.  It looks like perhaps the Min SaO2 -- saturation measures at 40 (or less that is the bottom of the graph) during apneas I gather -- anyhow it shows it bumbling along at a fairly steady 92 or so and then dropping down rapidly)


You asked whether there were drugs, etc. that could be affecting it -- as I say I was in afib (atrial fibrillation) and I think I sleep worse in afib.  At first I just didn't sleep at all as the high heart rate kept me awake, but I have adjusted.  I take some drugs to reduce the heart rate (obviously with limited success!) and control the rhythm (with no success).  These drugs (according to the fliers) can make you drowsy -- but perhaps only if they work, who knows.

My pulmo sent me for the study as apnea can cause heart rhythm problems and he thought perhaps that was figuring into the equation.  I am very anxious to see whether I am better on the CPAP, though actually was hoping for a worse apnea rating giving me more hope that was the problem with the afib.  I would far rather sleep on a CPAP than take the drugs and have the uncontrolled afib.  Essentially I cannot do much while in afib as my heart rate goes so high.

I am tired all the time, but I had associated that with my afib.  I will actually fall asleep reading the morning paper which drives me nuts.  Anyhow, I never complained about any of that as symptoms as I was busily writing everything off to the afib and the drugs associated with that.  Actually the doctors have me so messed up by now I have no idea which end is up.

Well, that was a lengthy post in response to a short question!

Judy

judyb:

I'm new and have been spending a good bit of time researching our sleep problem.  One area I have researched is defining AHI and RDI.  Frankly, they both have all kinds of definations depending on where you look.  However, I am on medicare and medicare has a defination for AHI so I use that.  In researching RDI I find most sources use RDI and AHI interchangably.  However, most sources that do define them differently add another figure to the AHI index such that the resulting RDI number is HIGHER than the AHI.  

Yours is the first and only instance that I have encountered where the RDI was lower than the AHI.  

I am very hopeful that someone on this board can clarify that so my search for definations can continue.

Frank

judyb wrote:

I am a little confused about the stages of sleep.  I had always had the impression that REM sleep was what you aimed for, however when I read about the different stages, stage IV seems like a deeper sleep (so I would presume more restful) than REM.

I believe that I spend very little time in REM (7.9%) but a lot of time in Stages 3/4 (40.1%).  I figure my body is not so stupid as most of the apneas occured in REM!

Any enlightening words?

Thanks, Judy

Hi Judy,

The National Sleep Foundation have launched a new multimedia family called The Doze Family. Worth looking at on their site as it covers the various sleep stages, among other things.

Daniel


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

On the RDI vs. AHI question.  I found a site that said that some people (negative implications as to their habits) calculated a RDI by apnea + hypopnea +RERA (awakenings not by other two).  That would explain why RDI is usually higher than AHI -- however, not why my RDI is lower!

I'll check out the sleep stages if I can find it (no link given).  It could be that the reason that REM was considered so good is that perhaps people know somewhat that they are in REM and not in stage IV -- i.e. they know they dream.   So, it could just be something that you can tell as to whether you are getting any sound sleep.

I would love it if someone would post what Medicare does re: insurance.

Judy

http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=240.4&ncd_version=2&basket=ncd%3A240%2E4%3A2%3AContinuous+Positive+Airway+Pressure+%28CPAP%29+Therapy+For+Obstructive+Sleep+Apnea+%28OSA%29

I can see this is going to be exciting with Medicare.  I have a feeling I am about to be torqued again!

Hi Judy!
No, Medicare shouldn't be a problem, cause your AHI is 11.8 or 14.8 (yeah, it'll help to get the column headers to interpret all that stuff) and if the MD documents your EDS (which you obviouly have) it shouldn't be an issue.
BTW the R-R interval is the time from one heartbeat to the next.  An R-R of 0.4 therefore gives you a heart rate of 150.
Thre's still chunks of stuff missing, but if that night represents a pretty "normal" night for you, then right now it looks like simply not enough sleep is a big part of that.
Only AF drugs?  I was looking at the reduced and delayed REM, that can be affected by medications.  We can look to see if the ones you're on can cause sleep disruption.
How many desaturations were there?  A sudden steep drop in the O2 sat could be artifact, like when you moved or got up.
CPAP may help, but I think there's at least one other issue in there somewhere.  
sleepydave

Ha -- well it is nice to know what the R-R is.  I had never heard that term before.  I also didn't realize that changing positions would make you desat -- doesn't seem like that should happen if your wires don't come loose. I have seen some low saturations at home too so that isn't surprising to me, I was surprised that it wasn't lower actually, but afib generally raises the saturation levels it seems (go figure).

The medications are:  propafenone (rythmol, or is it rhythmol), diltiazem, warfarin (coumadin), lasix (heart failure due to afib), potassium (due to lasix), toprol.  I don't believe any should disturb your sleep, most have a possible side effect of making you drowsy, though perhaps drowsy translates into all that stage 3-4.  Diltiazem and toprol are to lower your heart rate.

The reason that I was concerned about Medicare is that the link says AHI of 18 and if CPAP is just to avoid surgery.  The second case that they will allow it is you have eschemic heart disease (afib isn't actually heart disease so I'm not sure about that -- obviously it is heart difficulties) and without CPAP would need surgery.  I don't understand this about Medicare, the care doesn't seem to be there.  What do they want you to do, wait until all this drives you into a stroke?  It seems like CPAP is preventative to me, and why they would want to wait until more serious effects have happened I do not know.  Now, of course, I am hoping that CPAP will help my afib as that has absolutely changed my life and is clearly causing me additional health problems.  Anyhow, it seems like Medicare should care about getting me out of afib too.  I guess they would approve a pacemaker, but that is not an ideal solution either.  One would love to find a cause, and take care of the cause.  Besides, I want to feel the energy that all of you describe after CPAP therapy!  (Guess Medicare definitely doesn't care about that, as that is just quality of life).

Judy:

I have afib, take tikosyn and counadin.  I have a pacemaker along with sleep apnea and high blood pressure.  The tikosyn is a fairly dangerous drug but that is what I am on.  It keeps the afib in check, but about twice a year the heart does it's own thing.  The pacemakers advertise that they have an afib algorithim, but my doctor and I cannot find that it helps even the slightest.  I have the pacemaker because my heart sometimes just stops for a period of time.  Perhaps it is the apnea which causes that because I got the pacemaker before I got CPAP.  For a long period of time I have taken and recorded my blood pressure each morning.  I am currently trying to evaluate the CPAP and blood pressure to see if the CPQP lowers the pressure.

I have never been able to determine a good figure for my blood pressure or pulse rate when I am in AFIB.  It just seems to run away.

I guess the point I am trying to make is that all of these things seem to be related and it is difficult to determine which is cause and which is effect.

I'm having no problem at all with medicare and any of the above problems.  If you read the medicare site I posted carefully, the thing that you need for medicate is a prescription from your doctor.  My doctor advised me that surgery was almost useless and I have a AHI which is less than yours.

I don't think there will be a problem with the doctor writing a prescription.  He is the one that brought up the whole subject as he hopes that treating the apnea (which he just suspected at the time) might help my afib.  I am in afib about 70% of the time now (I had an ablation 4 months ago, I was in it 40% of the time before the ablation).  Actually, I just cut down my rythmol and I am in afib less than when I was on the prescribed amount.

I just worry about insurance as I have ended up with very hefty bills so far and the way I read the medicare site was that it only was approved if it kept you out from under the knife. I am used to insurance using any means to keep from paying.  

I have a pulse oximeter which is the only way I get a pulse rate when I am in afib (a stethoscope works sometimes).  I have had some very strange blood pressure readings in a fib also, sometimes quite low, sometimes extremely high.  I just hope it is the equipment not me!  

I was interested in the algorithms -- I have a feeling the technology is not quite there yet.  I know of someone else who has a pacemaker and they play with the algorithms, so far to no success.  My heart also "pauses", but so far it has not been too bad.  

It is disappointing that treating the apnea hasn't taken care of your afib, but perhaps that is why you aren't in it nearly so much as I am and it is doing good from that standpoint.  It does make sense that stopping breathing would shock the body considerably, and low sats can drive you into afib also.

Anyhow, thanks for the info --

snip <It is disappointing that treating the apnea hasn't taken care of your afib>

I have had no afib since I started CPAP, but I have only been on CPAP for a couple of months.  AFIB usually only happens a couple of times a year, but after it lasts for two days the Doc takes me to the emergency room and shocks me back into rhythm.  For some reason, the last time that it happened it started with a substantial drop in BP.

Frank

PS a few mispellings in my last post.  Needed to re-read.