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Zeo monitor and slow-wave sleep
My last two sleep studies tweaked my CPAP pressure but clearly show that I get no deep (slow-wave) sleep. No wonder I've been getting dizzy since January! I'm using Gabapentin and feel better, but still am woefully sleepy. Two sleep docs have run out of ideas. I'm thinking of trying the Zeo sleep monitor. Here's my hypothesis.
I'd like you-all to poke holes in my plan, if you would, please.
I have found that 'an hour of sleep before midnight is worth two hours of sleep after midnight' ever since college days. Recently I find that I feel much better if I turn off the light and go to sleep around 9pm. That is socially not very appealing to my wife, however, who likes to sleep in. (I waken at 5am no matter how dizzy I feel or when I go to bed.)
I use an ADAM circuit http://www.cpap.com/productpage/adam-circuit-headgear.html and a Puresom Ruby chin strap (mounted upside down - so that it pulls my chin up instead of back) with my CPAP. I think that I could squeeze another headband in there somewhere, allowing the Zeo sensor access to my forehead. (It is a bit hard to get a good side view with all that stuff on my head.)
In theory I don't see why the Zeo monitor could not read the brain waves and give nearly as good a readout as the professional sleep equipment. My breathing is controlled now, but my sleep is not restful.
I figure that monitoring my brain waves and manually recording how I feel in the morning, plus any other relevant observations might lead me to better quality sleep.
Views: 393
Replies to This Discussion
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Permalink Reply by Banyon on
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Jim Ludden said, "But the machine is doing its part."
How can you tell if you are asleep?
We can make subjective judgments about how we feel the next day but we can be fooled badly by subjective judgments. I went through this with my own basic CPAP and convinced myself I was feeling great. After some months I began to realize something wasn't right then I got a data-capable machine and the software showed me the therapy was ineffective.
The software produces a "Daily Details" report that has a timeline showing every apnea, hypopnea and snore and the amount of mask leak and pressure level.
Have a look at the Respironics PR System One REMstar Auto CPAP Machine with Encore Viewer software. http://www.cpap.com/cpap-machine/respironics-pr-system-one-remstar-...
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Let me add that only after getting a machine with software was I able to figure out what was wrong and makes changes to get an effective treatment. It could not have been done with the three nights I spent in the sleep lab - took a few weeks at home with data to measure effectiveness.
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Permalink Reply by Renee on
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Hello Jim ~
Yours is one of few, if any, postings that I’ve read oabout not NO SWS. I have had 4 sleep studies taken at 2 different labs over a period of a few months that showed that I also don’t get SWS – my last sleep titration indicated 2.8% SWS and zero REM. All of the test showed that I fall asleep real quickly but that I have a great deal of alpha intrusion which continues to keep waking me up throughout the night - although I think I am sleeping right ‘til morning – probably something like people being woken up by OSA events but not realizing it. Rock Hinkle investigated this THOROUGHLY with me over a lengthy period and I think we both gained a great deal of insights in the process – and I can’t thank Rock enough for all his interest, support and the sharing of his extraordinary knowledge and efforts on my behalf.
I do use CPAP but remain tired. I haven’t been posting, or even checking in, on SG for about the last 3 months ‘til today because I’ve been so tired that I have to carefully choose how I use my energy and waking time – and it has been very limited. In my case, I have visited with, now a 3rd, sleep specialist and this doctor is not only a top specialist but, so far, seems very considerate and respectful of my condition and my input and seems to be really concertedly trying to help me. He has prescribed several RX at night: Gabapentin – wasn’t effective; Lunesta – wasn’t effective and I wound up having one of the serious side effects which required me to stop taking it and Gabitril. Gabitril at 4 mg worked wonders – within just the 1st day or 2, I was already “awake” during the day – but it caused cognitive problems and confusion and, at a lower dosage – 2mg, it wasn’t effective. I had not wanted to take Nuvigil or Provigil during the day until some RX was proving to work at night because I figured that even if Nuvigil or Provigil helped me “feel” somewhat more awake during the day that it would be masking the fact that I still wasn’t getting SWS / restorative sleep at night and I wanted my health – not just a daytime boost – and the doctor I’m seeing now is accepting of my judgment about RX and worked on find a night time RX that would help. But, since his arsenal has just about run out, I have recently tried taking Nuvigil – 150 mg during the day. It didn’t help at 1st and it also had the side effect of causing me TOO much stomach pain and illness, so I had to stop that also. But, I have now re-started Nuvigil at 75 mg and I am not sick AT ALL – and it may even be helping me be more awake during the day – case in point, I checked in on SG today.
But he has also made arrangements for me to take the last available night time RX. It is Xyrem and it can only be prescribed by some doctors. He is authorized to prescribe it and it has taken about a month to get processed but I am contemplating starting it soon. The company that produces it has the rights to it tied up ‘til 2020 so tightly that it can’t be purchased at a pharmacy – it is instead FedEx’d to one’s home and you have to be there when it arrives in order to sign for it in person – and it can’t be prescribed until every possible RX has already been tried and failed. Most insurances don't cover it and it can cost $2,500 - $3,000 per month - WHEW - my insurance had given the OK for me to take it and they will cover it with a co-pay. So, should I start taking Xyrem - which is likely, it is the last possible night time RX to be tried..
Although, fyi, I have read that Trazadon helps people have increased SWS but most doctors don’t seem to know about it. Since all the other night time sleep RX are generally known about by good sleep doctors, and you likely know about them yourself, I’ll just give you some info that I have researched about Trazadone since it seem to be such an unknown quantity in the sleep profession . . .
TRAZODONE – DESYREL – INCREASES SWS & USUALLY DOES NOT DECREASE REM
The most frequent used off-label sleep aide in the U.S. is trazadone (Desyrel);
Trazadone is an antidepressant; it is a triazolopyridine; trazadone increases slow-wave sleep;
it does not usually alter REM sleep; its half-life is 6-9 hours; side effects of trazadone include priapism (1 in 10,000 to 40,000 cases), constipation, and hypotension
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Nearly all selective serotonin reuptake inhibitors, mixed serotonin/norepinephrine reuptake inhibitors, and tricyclic antidepressants cause sleep abnormalities to some extent.
These antidepressants have marked dose-dependent effects on rapid eye movement (REM) sleep, causing reductions in the overall amount of REM sleep over the night and delays the first entry into REM sleep (increased REM sleep onset latency / ROL), both in healthy subjects and depressed patients.
The antidepressants that increase serotonin function appear to have the greatest effect on REM sleep. The reduction in REM sleep is greatest early in treatment, but gradually returns towards baseline during long-term therapy; however, ROL remains long. Following discontinuation of therapy the amount of REM sleep tends to rebound.
Some of these drugs (i.e., bupropion, mirtazapine, nefazodone, trazodone, trimipramine) appear to have a modest or minimal effect on REM sleep.
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Since, in my experience – not getting SWS does not seem of interest to most doctors at sleep labs – who, instead seem inclined to have a tech conduct a test and then produce a report and then prescribe an OSA RX and let it go at that. I found, at both sleep labs that I went to, that they did not want to help me with the lack of SWS and REM. The 1st lab that conducted 2 tests (and I’ve read the reports showing my major lack of sleep) did not even tell me about it. At the 2nd sleep lab, the doctors were very concerned and, therefore, conducted 2 tests, 3 months apart, in order to confirm their results. I was then told that, although I should use CPAP for OSA that I should expect to remain very tired because of the extreme alpha intrusion and lack of SWS and REM – and to come back in 3 years for my next sleep titration. And, with that, the doctor couldn’t close the door fast enough behind me – whence I began my 3rd search for a sleep professional who was knowledgeable, qualified and actually interested in helping. By the time I met with him, I was a knowledgeable patient having done a ton of research and learned heaps from Rock. - ( Thanks again Rock ! )
About the ZEO - from what I've read, most people seem to buy it to help them wake up during a light stage of sleep in the morning and to, maybe, chronicle how stress, what they eat, etc. affects their quality of sleep. I haven't read of people being interested in their various stages of sleep - but, like you, I AM ! However, since I use a fullface mask, I don’t have the space available to place the ZEO on my forehead but I’ve found devices that you can wear on your wrist. I am thinking about getting one myself. Here's some websites on the possibilities that I've found . . .
aXbo Sleep Phase Alarm Clock – about $349
http://www.activeforever.com/p-4915-axbo-sleep-phase-alarm-clock.as...
http://www.digitalreviews.net/reviews/miscellaneous/axbo-sleep-phas...
http://www.atruereview.com/accessories/axbo-sleep-phase-alarm-clock...
The Sleeptracker PRO Watch – $99 or $179
10% discount at this site - http://pavelfatin.com/sleeptracker-pro-review/
http://www.digitalreviews.net/reviews/miscellaneous/sleeptracker-pr...
http://www.sleeprequired.com/2009/05/sleeptracker-pro-review-a-watc...
WatchPAT – 100 – $10,995 ! WOW !
http://www.itamar-medical.com/WatchPAT.html
WatchPAT – 200 – call for price ! WOWWEEEE !
http://sleepgroupsolutions.com/modules/tinyd3/index.php?id=5
And, of course, ZEO – $249 and $349
With the clock, 2 wrist bands are provided so 2 people can use it. And I seem to recall that 1 of the reviewers thought the clock wrist band could perhaps provide more reliable info than the watch wrist band. But, I don’t know about these devices except what I’ve read online. It could just be a preference of wanting to use a watch or a clock along with price – from $99 for 1 version of the Sleeptracker PRO Watch up to $10,995 for the WatchPAT 100 and "call for pricing" for the WatchPAT 200 !
I know this is a long post but I wanted you to know about the various RX that I have found through research - and tried all but Trazadone. And to let you know that I do commiserate with your difficulties. I hope some of this info will be helpful to you in your adventures along with your doctor and your own initiatives. -- And I wish you much success !
My best and wishing you some good SWS sleep,
Renee
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