Saturday, June 18, 2011

Wanted to share this with you...

I see lots of unusual presentations of the different sleep disorders, and lots of subtle variations on some of the same more common disorders.

But I wanted to share this one with you from a patient I saw last week that I was really excited about. It shows straight forward Severe Apnea, and how great an improvement one can have after CPAP is applied.

First, this person is undergoing a Split Night study, so they are sleep just like they do in home in the first part and then with the CPAP placed, AFTER the bright green line that I drew in. In the middle panel, you can see that "CPAP/Bilevel" (For this person, just CPAP) doesn't start stair-stepping up until after the bright green line. The various types of respiratory events are in the top panel, and you can plainly that there are a bunch of them before the green line and the very VERY few after the line/after CPAP is applied. They went from VERY SEVERE APNEA to completely normal breathing! WONDERFUL. And the needed CPAP pressure was actually quite low.
You can even see below that the "Arousals" we are following, remarkably improve as well to a normal level after the green line as well. So we know they are finally able to truly rest.

Now this next part of their Sleep Study is also really interesting.
Note that in this picture, REM sleep (Rapid Eye Movement/Dreaming Sleep)is the bottom stage on this picture, with a bold maroon color.

What you see here is what happens when they start to get a good night's sleep AFTER the CPAP is put on. Everyone gets a little REM sleep (Dreaming Sleep) as the night goes on. But in the first part of the night, they are so busy briefly waking up throughout, that their brain can't rest enough to get into dreaming sleep. BUT, in the back half of the night, AFTER they can rest properly because they're using their CPAP, you can see the huge chunk of REM sleep that they get.

We call this REM Rebound. Their REM rebound lasted over an hour. I wonder what they dreamt about for so long.