Increasing Stage 3 and REM sleep

I have been on a CPAP for 13 years. My "sleep professionals" deploy technology. They have never talked about sleep.

My first sleep study was in Oct 2019

Stage N3 0% Stage REM 20% AHI 25.3

Then a titration (mask fit) later in Oct 2019

Stage N3 0% Stage REM 9.6% AHI 2.6

So they fixed AHI way back then but I didn't notice about N3 and REM Watching a series on Brain Heath and the important stages are N3 and REM.

Over the years had 4 different masks, had trouble holding the seal, and occasionally get to 5 or below on AHI.

New sleep study Feb 18, 2024. I was congested so it might have been an invalid study Stage N3 0% Stage REM 0% AHI 65.1

At the end of the year I asked the sleep doctor how to increase REM. She didn't know how. Since I had lost weight she thought a new sleep study was needed and lowered the pressure. I might not need a CPAP at all she said.

I realize that the sleep study on 2/18/24 was probably corrupted because I was congested. But, but, I don't know how to work with this doctor to get good Stage 3 and REM sleep because this involves problem solving which I have not yet seen. There is a company that provides a FITCHECKER that I am going to use to get the best mask for me, but I don't know what to do about the quality of my sleep.

Question: Is it common to see State 3 at 0%? Is it common to see REM decrease during titration/mask fitting?

Comments and suggestions are welcome.

Welcome to the forum,

Some questions for you to clarify where you are at:

1. What CPAP are you using?
2. Does it give you a breakdown of the AHI into central, obstructive, and hypopnea events, and if so what is your typical breakdown?
3. Have you tried using OSCAR to do an analysis of your detailed data from your CPAP, assuming it supports your machine? Most of the popular ResMed and DreamStation machines have a SD card that captures detailed data for analysis.

The breakdown of AHI is very important as a CPAP is most effective in reducing obstructive apnea events because they are caused by the airway closing down, and the pressure can open it. If they are mainly clear airway or central events then more pressure can make the event frequency increase instead of decrease.

Hi Sierra, Thanks for the reply.

1. I am using AirSense10 Respond

2. This the first time I have looked at the data. In the 2009 study _ Hypop 65, Obstruct 65, Central 10, Mixed 0, Apneas 75

AHi/Hour Hypo 25.3 Non-REM 25.7 Ren 23,5 (I am not sure about the Hypo score: it is a column with 3 numbers added up to get 25.3

1. I have never heard of OSCAR.

This initial contact is very helpful because my "sleep doctor" never discussed these issues with me.

I am 81 years old, weigh 160 lbs. and the only prescription I have is for the CPAP. Lifestyle progress in last year got me off 4 prescriptions.

The 2/18/24 report is 7 pages with an introductory letter of 3 pages.

I was congested with drainage to my stomach. I think that that made the entire study invalid.

Here is my attempt to provide you the data. The table titled "Respiratory Events" The first row is "counts" and here are the columns for "Count" Cen. Apneas 16, Obs. Apneas 190, Mxd. Apneas 5, Hypop 9, Total Apneas 211, Apnea+Hypop 220, RERA 17, All Resp Events 237

The 2009 study was 2 pages long.

Final question. I am considering using the service of FitChecker for advice on the best mask fit. They are at maskfitar.com. I heard of them from a Dr. Talks series on sleep that ended recently.

I hope that I came close to providing what you were asking for. Sincerely Don

I am so happy to be able to discuss these issues.

1. I am using Resmed AirSense 10 Respond. My current mask is AirFit 30i which covers the mouth and extends to the underside of the nose

2. This is the first time I have looked at this data. Hypop 65 Obstr 65 Central 10 Mixed 0 Apneas 75 from 10/13/2009

Ces Apneas 16 Obs Apneas 190 Mxd Apneas 5 Hypop 9 Total Apneas 211 RERA 17 All Resp Events 237 from 2/18/24

Stage 3 0.0 REM 20.0 Study 10/13/2009 Stage 3 0.0 REM 9.6 Titration 10/20/2009

Stage 3 7.6 REM 28.1 Titration 3/9/2017

Stage 3 0.0 REM 0.0 Study 2/18/24

I noted in the original mail that I didn't think this study is valid because of chest obstruction. The primary doctor said that she reviewed the test results and said that they are valid. My hunch is that the purpose of the test is to set the stage for the next action, titration scheduled for May.

1. This is the first time I have heard about OSCAR.

Final question. I think that the 0.0 scores for stage 3 and REM prove that the test is invalid.

Thank you Don

Thank you again for the help. And thank you for this community. Here is an update.

I was really upset about sleep issues and the realization that my "sleep doctor" was just a technician with a CPAP tool.

When the sleep test came back with 0.0 for both Stage 3 and REM I freaked out. These are the two most important scores for cognitive decline.

As noted earlier, I thought that the sleep test was invalid because of congestion in the chest. I attempted to find out the meaning of these scores.

I realized that they don't pay attention BECAUSE there are two tests. The initial test and the titration, the second test is when they fit the mask.

They had a SUCCESSFUL initial test because it yielded a score of 60 AHI which justified the second test and the titration. They don't care about the details. They offered me a chance to come in and speak with the big cheese sleep doctor but I know she won't be of any help because a few years ago when I brought up the book "Why We Sleep" she freaked out. A challenge to her authority or something.

Looking for another sleep doctor so far has failed. I am looking for a doctor who works with lifestyle and supplements.

I have settled down from my high levels of concern and will go for titration study in May. They sure aren't in a hurry!

I have not downloaded OSCAR and begun looking at the data in my machine. I will do that in a couple of weeks when I have more time.

Again, thanks for the help.

When you get organized, just post a typical Daily Report like the one below. This was one from when I was first getting started and did not have my settings optimized. I can give you my thoughts on where you are and what improvements can be made.

Have you checked to make sure there is a SD card in your machine? If not, then all detailed data is being lost...

There is a RESMed SC card in my AirSense 10. I loaded it into my desktop and listed the files for each day.

As mentioned earlier, I will not fire up OSCAR because getting ready for a week long trip. Will do it then.

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Hi Sierra,

It has been more than a month and I finally loaded OSCAR today. I loaded it directly from the card. OSCAR recommended locking the card and I did.

I have a years data. AHI for the year is 6.77. The last month it was 9.41.

The original question involved Stage 3 and REM sleep levels. Maybe the color codes on the graphs will tell the story but in the short time I have looked at it if doesn't jump out.

The doctor signed me up for a titration in May so I have some time to work on things.

A couple of years ago I had trouble with leakage and switched to a foam cushion full face mask that covered mouth and nose, and rested on the bridge of the nose. It worked OK for a couple of years. Then the pressure went up and to keep the leak under 20% I tightened the straps and ruined the flesh at the bridge of my nose.

Over the life of masks, 13 years, they have always been medium.

I am now using a Resmed F30i which is considered a full face mask. It covers my mouth and nose.

An online offering, MaskFit, cost $10 and recommended three masks. They asked demographic questions and took a scan of my face and my nasal openings. Their three mask recommendation were all large. And they are all nasal only masks.

#1. Fisher & Paykel Eson 2 #2 Phillips Respironics Pico #3 Resmed AirFit N20.

I have had trouble for years on the leak rate. I have been on the F30i for most of the year. My yearly leak rate is 22 and I though it was worse because almost everyday on the screen of the Airsense 10 it comes up red (failure to keep below 20%)

I have taped my mouth for over a year. Leave space to breathe.

Take a nap a couple times per week.

I would appreciate your thoughts.

Sincerely

Don Utter

Hi again. I looked at the video information for OSCAR and looked at daily data. My current max pressure is 13. The first day I looked at maxed out at 13! In other words, I need to increase the upper limit. I will set it for 16 this evening and look at my OSCAR report tomorrow.

All the days I looked there was no snoring.

One of the days the AHI was over 11.

The sleep technician said not to worry about numbers like that. She sees numbers in the hundreds. When I went in for my sleep study in Feb at 5' 9', 160lbs the other patients were obese.

I am trying to really improve my health. The goal is AHI less than 5 and lots of Stage 3 and REM sleep.

OSCAR sure provides a lot to play around with.

Don

Hi Hi I just found leakylefty27 on youtube. He has a video that leaky mask can cause wake up which messes things up. The other thing is the variable pressure.

Feel free to send me to various links to learn more.

It makes me angry that the medical system hides tools like OSCAR which allow people to be responsible for their own health. Making money and a prestige job seem to be what is important.

Don

A leaky mask used with a variable pressure machine, such as an APAP, etc. can result in soaring pressures. I found myself trying to exhale against what felt like a hurricane. My normal average pressure was about 11, but it went to 18 with a bad leak. That will wake you up for sure, and probably many times a night.

So, the first order of business is to get the best fitting mask you can find, and eliminate mask leaks. People often have to try five or six to get one that works optimally. You also have to eliminate mouth leaks, so use a chin strap, if necessary.

However, there IS something else that can be done: optimize your pressure settings. Your sleep lab can adjust the pressure settings to a narrow band around your average pressure. That way, even if you experience a bad leak, the upper range of the variable pressures will stay within reason, and you will avoid the feeling of trying to exhale against a hurricane.

Finally, assuming your machine has the expiratory assist setting feature, make sure it is turned on. In general, you should study your user’s manual and familiarize yourself with your machine operations and settings.

Finding is good mask that suits you is difficult. I use a ResMed AirFit P10 nasal pillow mask. It is a very minimalist mask and is comfortable. If there is a weakness, it is the headgear. Fairly recently they have come out with a somewhat improved headgear for it. I believe it is the most popular mask used. But if you open your mouth in your sleep, it is best to use mouth taping. I mouth tape every night.

With the ResMed machine events are not reported when the leak rate of the mask exceeds the redline of 24 L/min. If evens are flagged during a high leak period they should be identified as Unclassified Apnea (UA) events, and the machine does not respond to UA events. So, pressure should not increase while the mask is leaking. You can confirm that by looking at the OSCAR pressure graphs to see what the pressure does when you are having a large leak - there will be grayed out areas of the graphs when the leak exceeds the redline.

If you want to post a typical OSCAR Daily Report screen here I can take a look at it to see if there is anything obvious that can be done. To do that on a PC make the Daily report full screen with a full screen window and press F12. A box will pop up asking where you want to save the screenshot image. Save the file. Then with a full width post here, find the file with File Explorer, left click on it, and then drag it into the post here. It should upload.

Based on what you report your AHI readings do seem fairly high. What is the average breakdown of the various components of the AHI? You should be able to see that on the Statistics page. AHI, OA, H, and CA events are the important ones. The 95% pressure is also a useful number. If you have imported a year's data there should be some good averages there.

However, I can tell you the most if you post a Daily report screenshot for a typical night. I posted an example of one in an earlier post.

Hi Sierra, After finding out yesterday that my pressure was maxed out, I changed the upper limit to 16. I am going to try pasting the first page of my report from last night. This is my first attempt. Don

I made the suggested changes. EPR = 3 Max Pressure = 12

I don't tape my mouth completely closed. Last night it was a open too much. Tonight I will be shut more.

I use standard surgical tape.

The lankylefty27 recommends not using auto sense. That may be something to try in the future. Try different pressures at different nights.

I am now going to take a walk in the sun. Exercise seems to help my sleep. But there are so many changes that I can't tell.

The bedroom is dark. The temperature is low with window open a little. My wife does charge cell phone and hearing aids in the room. Is it because I shaved? What I ate? When I went to bed? So much variation that I know something is not working.

Yes leakage has been a problem, probably for over 3 years. The doctor stopped commenting on it so I have not focused on it. Now that I learned that leakage can set off the machine and/or wake me up, and your comment that various measurements are compromised with poor seal, this will be a priority.

You + OSCAR have already given me 5x, or 10x more information than the "doctors" in 13 years. They have a racket. I am on Medicare advantage with 80% coverage. I feel sorry for people paying retail price for this equipment.

After thinking about your OSCAR screenshot a little longer I realized that if you are using mouth taping, you must not be using a full face mask. The machine should be set to match the type of mask you are actually using. Setting the wrong type of mask can make the leakage rate less accurate. However if you have it set to full face and are using a nasal mask the error would be in under reporting your actual leakage rate. Each type of mask has a calculated vent flow which is subtracted from the total flow to give the leakage rate. The full face has the highest vent flow and the nasal pillow the least. So if you have it set for full face and are using a nasal pillow then air leakage will be under reported.

Amazing night last night! Thanks for the suggestions!

I taped mouth shut but by morning the tape was loose and allowed a small opening. I had never taped mouth shut before: always left a small opening.

I was using a reasonably hard foam pillow with indents thinking it was a CPAP pillow. I changed to a feather pillow.

Feel great this morning. Maybe didn't realize how much sleep has been lost with the CPAP attacking me because of leaks and mouth breathing.

The machine is set to full face.

my F30i is full face but it only covers mouth and nose. It does not go up to bridge of nose.

The humidity is set to 6 and tank was empty this morning.

I realized that I had scrolled down on the daily report and posted the end. Here is a new image of the top scales. I also scrolled down on the information on the left to display the settings on the machine.

I changed EPR to Full Time. I changed the humidity level to 4. I will not use tape this evening or as long as I have a full face mask.

How long have I been causing problems for myself? Like taping with full face mask?

Given my past sleep, last night was outstanding. It sounds like it will get much better as I follow your suggestions.

I went back through several days and found days with apnea over 10 minutes. And found days with mask leak problems over 20 minutes. And even the second graph, the flow rate, is now heavier and concentrated more in the middle. As I looked at this and other graphs I saw that they changed dramatically day by day. That could be the reason for the grasping at straws trying to figure out what was going on.

Are there any particular graphs that I should follow?

Also, as I recall it was OSCAR, who warned about changing the memory card to locked because of potential problems that the computer would overwrite the data. I an using off the shelf WIN 11 and I don't think it will be a problem if I always leave the card unlocked.

Again, thanks so much! Don