Thank you so much for your website. I'm really new and thisis helping me alot.

My sleep report says something about WASO. What does this mean?

I was also curious about the REM informaion. What should the latencys be?

Thank you in adviance

You are quite welcome for the site.

WASO on your sleep report stands for Wake After Sleep Onset. During the recording your night technician should have run through some Bio-Calibrations (look left, right, blink eyes, open eyes, close eyes, hold your breath...etc). Once these bio-cals are complete, they should wait until you're settled in a comfortable position and then note on the recording "Lights-Out".

From "lights-out" to when you fall asleep is your sleep latency or, in normal people speak, how long it took you to fall asleep. "Sleep-onset" is a marker just like lights-out. It's just one moment in the time during your sleep study.

Once you fall asleep you will eventually wake up. Wake After Sleep Onset is the time in minutes from when you initially fell asleep until the you first woke up. Quite honestly this is a somewhat useless term and doesn't offer much, if any, information about your quality of sleep.

The REM latency can be very useful though. Normal REM latency should be between 90 and 120 minutes. The first REM period usually only lasts 5-10 minutes.
There is evidence that a REM latency of 60 minutes or less is an indicator of depression. An REM onset close to Sleep Onset is sometimes an indicator of Narcolepsy, thought only and MSLT can diagnose that.

Probably too much information, but let me know if that doesn't answer your questions.

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So what about people like me who don't go into REM in our sleep tests? Criminally insane?

Are you a criminal?

Insane...absolutely!

I really don't know the answer to this. Some medications inhibit REM, but sometimes when people don't have REM I'll check their medication list. They won't have any reported meds.

I often wonder if it's the environment of the sleep lab that prevents it from excessive disruptions.

The other possibility is that it's missed by the scorer. I would hope that this is rare though.

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My long-suffering husband would probably agree about my insanity! At any rate, I don't want to invest in a Zeo so I will just forget about REM sleep. Hopefully all will work out...

Just flip a coin. It's almost as accurate as the Zeo.

Hi and thank you for your informative web site with its associated videos. I have seen the terms "periodic breathing" and "Chene-Stokes respiration". In the write-up of my last sleep study the analyst noted that "an irregular pattern of breathing was present during this portion of the study but was not typical of Chene-Stokes respiration. How do the two differ?

You can reference this page. http://www.freecpapadvice.com/Central_Sleep_Apnea.html The upper left picture is more like periodic breathing. You'd see these in long series typically without arousals. The examples of Cheyne-Stokes is a very clear waxing and waning pattern to it. It looks like a bunch of eggs or footballs lined up when looking at a 2 minute window or more.

They're both treated very well with an ASV. My uncle had this problem and they tried to treat him with a BiPAP ST. No good....the ASV works like a charm now.

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Lefty, thanks. I can see the waxing and waning in the graphic for Cheyne-Stokes breathing. My last sleep study (Dec 2011) showed an AHI of 61.9 mostly central using a CPAP set to a pressure of 11. I was prescribed The PR System 1 ASV and my average AHI over the last 360 days has been 2.1. Pretty amazing to me. Just as amazing is to see the size of the machines go from shop-vac size down to the little cubes they are today.
Another question, although I don't know where it belongs in the forum - I use the SleepyHead software to look at my SD Card data. Under the "Mask Pressure" graph I can see a sawtooth waveform that repeats itself regularly. Looks like a rise time of about 2 minutes and a fall time of about 1 minute. Any thoughts on this? Thanks again

You can post it right here if you want so I can see what you're talking about.

It doesn't really matter where these things are posted to me quite honestly. I've been trying to figure out the code with another forum I have (that nobody visits ) so that there really are no categories.

Every time I make a change I have to restore the previous version.

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OK. Let me see if I can figure out how to post an image....
The first graphic is from December 3rd, 2012

The second one is from last night.

I'm trying to figure out what the "mask pressure" graph is telling me.

Thanks again!

That's very unusual. Just because it looks like it lasts a couple of minutes I have no idea what it is.

Some of these are pretty close to what could be wake times...beginning and end. Do you feel any increases in pressure?

Maybe it is detecting increases in pressure if you're adjusting the mask? I really have no idea. They seem to be much to uniform to be something you're doing. Very weird.

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I do feel the pressure increases sometimes but not very often. I usually sleep through them.

Another "weird" question... Does an ASV machine cause the respiration rate to increase above what the individual's normal would be? (assuming there were no apnea events)

It shouldn't. The ASV sets the rate based on a 4 minute moving window of your own breathing. The only caveat to this is that respiration does increase (rate, not amplitude) naturally during REM. I would think that the ASV would pick up on this and try to match it.

There is a sort of "grace period" before it forces a breath though.

Does that make any sense?

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Yes it does make sense. It just seems that my respiration rate seems higher (to me) than it used to be. Incidendentally, I did look at my Jan 2 data using Encore Basic rather than Sleepy Head and saw the same mask pressure variations indicating it's not a software analysis issue.

Just out of curiosity, why are the settings on your machine so restricted? ASV's are designed to be left open ended. It's like placing a governor on a sports car and killing the performance.

Did your doctor or the DME tell you why? I'm wondering if this is part of the answer.

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I never realized it was restictive. I graduated from a CPAP that was set at 9. I visited the sleep clinic last month (Dec 2012) and they said all was well. So I have had the same perscription since Dec 2011. Looking at AHI over the last year, the numbers look good I think. AHI =2.08, CA = 0.17, OA = 0.01, H =2.05.

Machine Max pressure is set to 16 and the graphic does not appear to approach this level.

You may very well be correct. I'm looking more at the EPAP range of 6-10cmh20 as a max and min. That can be set higher if t needs that much to resolve any OSA above that....you're probably right that its not needed.

Then the pressure support is typically set to 15. Your numbers are certainly good, I'm just trying to make sense of the strange mask pressure graph. Strange to me anyway.

With an ASV the range will go all over the place during the night.m yours looks like its set to straight Bilevel. 10/6.

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I was prescribed the ASV machine because of a high number of events (AHI 61.9), the majority being central episodes while on a CPAP during my latest sleep study. The CPAP did keep oxygen saturation above 90% with a low of 92%. So here is a question/assumption? The ASV machine is supposed to prevent or mitigate central episodes I think. Since my AHI is below 2.1 for the last 368 days can it be assumed that the machine is operating as it should by mitigating any central apneas and therefore there are no wildly varying pressure levels? Any thoughts on this? Thanks by the way for all your answers.

Yes, that is definitely a safe assumption! Really the only times that a central waveform is going to able to sneak through would be false. Using a nasal only mask with a mouth leak, or if the mask is pulled away from the face.

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