5-HTP : Modes of Action?

I've previously conducted two experiments with 5-HTP: 

5-HTP and its effect on my AHI and sleep in general (link)

5-HTP and its effect on my snoring profile (link) 

Both gave encouraging results. In fact they were so encouraging and surprising that I really would like to know more about how it has the effect that it does, and would it work for other people?

My studies are so small (as I am only experimenting on myself) and the potential for a pharmaceutical solution to Sleep Apnoea and Snoring so attractive that I would love to see further research and a larger trial for 5-HTP as it poses so many questions:

• Does it work for anyone other than me?
• Is it only effective for Mild Obstructive Sleep Apnoea?
• How dose-dependent are the effects? Does too high a dose limit the effectiveness (as with Melatonin)?
• Does the positive effect fade with long-term use?
• Are there any negative effects?
• Are the co-factors that I've been taking with this brand of 5-HTP (label from manufacturer's website here) partly responsible for the effect?

Although I can't find the results of any direct studies looking at AHI or snoring, there is a fair amount of medical literature relating to Serotonin (which 5-HTP is an immediate precursor to, that is 5-HTP is metabolised into Serotonin by the body).

From the existing literature I've tried to piece together possible mechanisms for the effects that I've observed.

THE EFFECTS OF SEROTONIN ANTAGONISTS IN AN ANIMAL MODEL OF SLEEP-DISORDERED BREATHING

By blocking serotonin activity in a breed of dog prone to obstructive apnea, it was possible to induce snoring whilst they were awake along with a collapse of the upper airway, which was reversed when serotonin activity was allowed to return.

Veasey SC, Panckeri KA, Hoffman EA, Pack AI, Hendricks JC
http://ukpmc.ac.uk/abstract/MED/8564132

"Veasey et al" blocked the action of serotonin (5-HT) in Bulldogs while they were awake (using agents known as 5-HT Antagonists). Daytime snoring was observed. Furthermore using live CT scanning a collapse of the upper airway was observed. These effects were reversed when the action of serotonin was unblocked.

This gives a clear indication that serotonin is essential for maintaining the muscle tone of the upper airway.

So, why does this tone drop off during sleep? During sleep (and especially during REM sleep) muscle tone is reduced. In REM sleep we undergo muscle atonia (deactivation of most muscles - this is also the cause of sleep paralysis). It is also shown that Serotonin activity is at its lowest during REM sleep. So a greatly reduced level of serotonin activity leads to a greatly reduced level of muscle activity during REM sleep.

It doesn't seem that simply activating certain Serotonin receptors can undo this muscle atonia. This is a bit of a leap on my part, but it seems that 5-HTP excites all types of serotonin receptors rather than just a few that are excited by various other pharmaceutical methods. Maybe this is because that by allowing the body to convert the extra 5-HTP to serotonin you are allowing natural metabolism of 5-HTP to 5-HT rather than just a localised or specific 5-HT receptor activity.

There are papers that support the fact that 5-HTP has an effect where 5-HT has none (albeit in motor function).

5-HT PRECURSOR LOADING, BUT NOT 5-HT RECEPTOR AGONISTS, INCREASES MOTOR FUNCTION AFTER SPINAL CORD CONTUSION IN ADULT RATS

Y. Hayashi, S. Jacob-Vadakot, E.A. Dugan, S. McBride, R. Olexa, K. Simansky, M. Murray, &  J.S. Shumsky

Exp Neurol Jan 2010

We conclude that selective 5-HT or 5-HT receptor activation was not effective in improving 2C1A hindlimb function after incomplete lesions. In contrast, the 5-HT precursor 5-hydroxytryptophan (L-5-HTP), which activates all classes of 5-HT receptors, increased both %WS and hindlimb activity

http://ukpmc.ac.uk/abstract/MED/19840787

In the following paper by Ling, Bach & Mitchell it is shown that 5-HTP has the ability to reveal and activate a latent pathway in the spinal cord in hemisected rats (similating an incomplete spinal injury).

SEROTONIN REVEALS INEFFECTIVE SPINAL PATHWAYS TO CONTRALATERAL PHRENIC MOTONEURONS IN SPINALLY HEMISECTED RAT 

Liming Ling, Karen B. Bach, Gordon S. Mitchell

Exp Brain (June 1994)

These results indicate that serotonin converts ineffective crossed phrenic pathways in the spinal cord to effective pathways. It remains to be determined whether serotonin is both necessary and sufficient in this modulatory process, or if it is a nonspecific result of increased phrenic motoneuron excitability.

http://ukpmc.ac.uk/abstract/MED/7843300

5-HYDROXYTRYPTOPHAN-INDUCED RESPIRATORY RECOVERY AFTER CERVICAL SPINAL CORD HEMISECTION IN RATS

Shi-Yi Zhou & Harry G. Goshgarian

J. Applied Physiol (June 2000)

Because experiments were conducted on animals subjected to C2 spinal cord hemisection, the recovery was most likely mediated by the activation of a latent respiratory pathway spared by the spinal cord injury. The results suggest that serotonin is an important neuromodulator in the unmasking of the latent respiratory pathway after spinal cord injury. 

http://ukpmc.ac.uk/abstract/MED/11007592

So we have two potential mechanisms by which 5-HTP could work: 

1. By loading with 5-HTP it allows the body to metabolise it to 5-HT activating all classes of 5-HT receptors thereby reducing the effects of muscle atonia in REM without completely inhibiting REM atonia.
2. By possibly activating a dormant pathway in the spine to the phrenic nerve (increasing breathing effort). 

As we've seen by my sleep-study results, my sleep apnoea is obstructive in nature, so it is unlikely that increasing breathing effort would reduce my AHI as I still make breathing movements but they are rendered ineffective by the obstruction in my upper airway.

If 5-HTP does work in these two ways then it's possible that 5-HTP may have a positive effect on both Obstructive and Central sleep apnoea as item 1 above relates to OSA while item 2 relates to some forms of CSA. 

Sleep Onset Apnoeas / "Throat Closing"

One of the search terms that people find this blog with surprised me by how frequently people search for it, there are several variations but these two sum things up well:

• Throat closes as I go to sleep
• Choke as I fall asleep

I hadn't really considered this before but I really should have done because it happens to me, and one of my parents. Normally when I experience those throat-closing moments they are accompanied by the first snore / cluck / snort of the night, a flash of whatever broken dream images were going through my mind and the knowledge that I'll soon be asleep. I guess it's something that a lot of us experience but don't really talk about it because it sounds a little strange.

Polite and usual "sleep chat" is usually along the lines of "Did you sleep well?" and not much deeper than that which is a shame because it's such a fascinating subject that few of us speak about because many (wrongly) consider sleeping to be a waste of 8 hours and some even see it as a weakness ("Sleep is for wimps" etc etc).

I've been using CPAP for a month or so now and have been adjusting my own pressures based on the sleep study data that I record each night. When I reviewed each night's data, one of the things that stood out about breathing as we drop off to sleep was how it changes at sleep onset (the moment that a sleep lab would declare that we are now asleep).

This becomes more pronounced with CPAP (or at least for me as a relative newcomer to using CPAP for myself) because when I first switch the machine on at night I instantly become aware of my breathing and try to control it. Oddly, consciously controlling our breathing is something that we don't do very well and it is best left when our bodies do it for us automatically. Can you imagine the chaos that would result if we had to consciously take every breath or control every heartbeat?

The following is a few minutes of data representing my breathing as I was dropping off to sleep whilst wearing CPAP. It's taken from Resmed's ResScan software (click for a larger version).

The breathing on the left is when I was awake, it is clearly different to the smooth regular breaths on the right side of the graph. Falling asleep is what brought about the change as I "forgot" to consciously breathe and my body took over.

So far so good, but on several nights I noticed that the handover from from awake breathing to asleep breathing wasn't so smooth... 

Notice how there are gaps in my breathing? This is from a night where some apnoeas were still occuring; I remember that as I was falling asleep I experienced at least two of those "throat closing" moments. The apnoea briefly woke me as left me realising that a moment before I was asleep, which also seemed to shift the hypnagogia into my conscious mind and then into my memory because this night was also a night that I remembered a lot of it.

Several different images and phrases came and went as I drifted off to sleep. The Zeo recorded that I briefly entered REM as I fell asleep (possibly causing a loss in muscle tone resulting in apnoeas)...

This is something that I see on many nights when I look at my Zeo data, but in the interest of accuracy, Zeo do point out that if your sleep is generally healthy with 7-9 hours per night and no feelings of tiredness during the day that this brief period of REM could be wake being misinterpreted as REM. It could be that N1 sleep mixed with brief periods of wake (from my respiratory arousals) were interpreted as REM by the Zeo (as wake is so similar to REM). 

The following night my sleep looked very different and I achieved a lot more REM along with no apnoeas or hypopneas recorded at sleep onset, intriguingly the Zeo data doesn't show me passing through REM as I fell asleep. So this could actually be REM, although this could also be because there were no respiratory related arousals during the transition from wake to sleep.

With the Black Shadow Sleep Monitor I've seen that less significant respiratory events are linked with altered REM sleep, in my case a series of hypopneas leading to a Lucid Dream. This raises an interesting issue that may provide some insight into dream formation.

I used to be comfortable with those throat-closures before I knew I had Sleep Apnoea as they had become so familiar to me. I used to use them as a way of knowing that I'd soon be asleep. In a strange way I will be sad if they go because after each "cluck" or snort I'd briefly wake and commit the partial dream or hypnagogic image to memory and would be able to study sleep as I drifted off.

Famously people have used a technique that relies on waking from hypnagogia in order to remember it which involves napping in a chair whilst holding a metal spoon over a metal tray or plate. Once you drop off to sleep you automatically release the spoon, causing a clattering sound which then wakes you allowing you to recall what you saw and heard.

I see my sleep onset apnoeas as such a system, alebit a naturally occuring one. I think that during the times that I want the best of both worlds of having the apnoeas at sleep onset but sleeping safely for the remainder of the night that I will experiment with setting a RAMP on my CPAP which delays the maximum pressure by up to 45 minutes, giving me time to explore the hypnagogic world.

Knowing that I have obstructive sleep apnoea and that the first apnoeas of the night are usually at sleep onset, I would suggest that anyone who experiences these throat-closures at sleep onset should at the very least be aware that they could have Obstructive Sleep Apnoea and look out for other symptoms. The best thing to do it get it checked professionally as it could also be a sign of another condition such as Acid Reflux (GERD) or Laryngospasm.

Snoring Remedies? Introduction and Positional Therapy Results

Snoring occurs when the tissues of the airways relax during sleep causing the air to vibrate as it passes over them, in a similar way that deflating a balloon causes the balloon's neck to vibrate and make that familiar raspberry sound.

This can be illustrated by the following airflow waveform taken from my snoring using Stowood's Black Shadow Sleep Monitor.

What should have been nice smooth breaths like these... 

...ended up becoming jagged saw-toothed breaths like these...

...resulting in a rasping snore.

To give you an idea of what the Visi-Download software allows me to see (and how the vibrations above actually sound) I've made a short video of a few snores that I recorded on one of my baseline nights:

Snoring can simply be just that - a noise, it can be a nuisance if it's too loud as it can wake others in the house, if it's loud enough it can actually wake the sleeper! However, it can also be much more than just a noise. Besides being the cause of much nocturnal anger and maybe even the cause of a relationship breakdown, it can also be a sign of a greater health issue such as sleep apnoea.

I snore. In fact my snoring is sometimes so loud that I hear it in my dreams.

If only that were as as serious as it got, but my snoring is actually due to sleep apnoea. As documented in many posts on this blog, I have mild sleep apnoea.

I've found some ways to bring the apnoea to acceptable levels with a typical AHI of between 1 and 3, (an AHI of under 5 is considered normal if it doesn't cause symptoms such as daytime tiredness etc). The way that I did this was to keep off my back when I slept by using a Rematee belt. This also had a knock-on effect of reducing my snoring, but not eliminating it.

On the nights that I've recorded while using the Rematee to keep me off my back, my AHI has been stable and my snoring has reduced (the residual respiratory events are mainly hypopneas, although the lowest that my oxygen saturations drop to has improved, it still drops to around 79%).

Besides looking for other ways to bring my AHI down even more, I want to go further and eliminate my snoring. I guess that my long term quest is to see if it's possible to have the much hyped perfect night's sleep.

Many snoring remedies (and there are many) say that they are not suitable for snoring that is caused by sleep apnoea, so with my new found side-sleeping "normal" AHI and some residual snoring I now find myself in a good position to put them to the test.

Quantifying Snoring 

The problem is that snoring is hard to quantify. Yes, you could ask a partner, but that answer would be fairly subjective. You could judge by how you felt in the morning, but again that is subjective. You could even place a Dictaphone beside the bed to record your snoring but besides but again, how do you score the recording?

One of the channels that Stowood's Black Shadow sleep monitor measures is snoring, and it does this via a calibrated microphone, allowing you to quantify how loud each snore actually is. It also derives a second channel from the sound to identify individual snores, thereby allowing you to actually have a snore-count. From there it calculates a snore-index (a number of snores per hour, grouped according to volume).

So, my method is this:

By keeping off my back I am essentially apnoea-free, leaving only the snoring to be addressed, so to ensure this and to eliminate the effects of a variable sleep position on my snoring (and to bring my AHI to normal), I'll be wearing the Rematee belt whilst putting a different snoring remedy to the test each night hoping to eliminate my remaining snoring.

I'll record sleep data for three nights per selected remedy and calculate the mean snoring profile for each by graphing each remedy according to:

• Hourly snores between 55db and 65db
• Hourly snores between 65db and 75db
• Hourly snores greater than 75db 

This "Snore Profile" will not only allow me to see if the total snores have been reduced, but it will allow me to see if the remaining snores are quieter.

This graph shows the mean snore profile for my Supine Baseline, Free-to-Move Baseline (calculated from the same nights), and my Rematee baseline. 

The majority of my snores are louder than 75db regardless of whether I sleep on my side, back or am free to move around! Not unexpectedly then, it follows that the next largest chunk of my snoring falls between 65 and 75 db with hardly any under 65db.

The "Remedies"

There are plenty of "remedies" available. Some of these are traditional remedies (using the term loosely), and some are more modern commercially available remedies.

• Positional Therapy - (Tennis Ball / Rematee) already shown above

It's clear to see the positive effect that side-sleeping has on reducing my snoring. It reduces my snoring by over 50%, so it is likely that this in itself will be a clear leader in the remedy league table. I suspect that for many snorers (where their snoring is not caused by apnoea) that the Rematee and side-sleeping could eliminate snoring completely.

• Mandibular Advancement Devices
• Nasal dilation
• Snore Spray
• Humidifier by the bedside
• Anti-Snore Ring (Acupressure)
• Anti Snore strip (on roof of mouth)
• Drinking a glass of water before bed
• A night time garlic gargle
• Toothpaste under the nose
• Electric snore-shocker devices
• Nasal irrigation

 I also want to explore the following to see if they have an effect on my snoring.

• 5-HTP
• Melatonin
• L-Tryptophan
• Blood sugar levels
• Large dose of vitamin B6

I'll pick from this list (avoiding some completely) and put them to the test for three nights to get a mean snoring value. To avoid creating a very long post I intend to create a separate post introducing each remedy (and how well it performed). When I've finished I'll then chart the results together. 

Besides bringing my AHI to an acceptable level to address the residual snoring, part of the reason for staying on my side for the entire night is that it will allow a fair comparison of snoring in all sleep stages (I typically spend around 2h10 minutes in REM and 45 minutes in Slow Wave Sleep). I'll also be keeping an eye on my Zeo stats to see if any of the methods have an effect on my sleep composition. I expect that the methods that rely on disturbing you during snoring episodes may have a negative effect on REM or Slow Wave Sleep.

Update on Saturday, May 19, 2012 at 1:08PM by Hypnagogia Blog

5-HTP Results

Using the method detailed in this post I decided to see if 5-HTP had any effect on my snoring.

I was keen to try out 200mg of 5-HTP first, given that it had previously had such a positive effect on my AHI.

My thinking was that if 5-HTP had been able to reduce the gross movements of my airways that are responsible for obstructive sleep apnoea, then maybe it would also be able to reduce the smaller movements that are responsible for snoring. However, I suspected that as it hadn't been able to completely prevent airway restrictions that it wouldn't have an effect on the smaller movements. 

It seems that I was wrong. The results were promising to say the least. 

5-HTP was able to reduce my snoring further than that offered by just sleeping on my side.

Given that from my data alone there are two indications that 5-HTP is beneficial to sleep (AHI reduction and a reduction in snoring) I would love to see a larger scale experiment or trial take place, after all I am just "n=1".

Prior to taking 5-HTP I researched it in medical literature with regards to dosage and possible side-effects. After seeing my results I went back to the literature and started looking for a possible mechanism or explanation as to why 5-HTP might have this effect.

I'm working on a summary of what I've found and will post it in the near future.

For the future:

• I'm curious as to whether the 5-HTP would reduce my supine snoring index, given that my snoring is at its loudest and most frequent when on my back so I will record a three-night mean of 5-HTP sleep when I will be free to move and produce supine and free-to-move snoring indexes via the Visi-Download software.
• I'm also curious to see what different doses would achieve, so I'll carry out three night mean trials of side-sleep + 50mg, 100mg and 300mg of 5-HTP and measure the effect on my AHI, snoring profile and sleep stage data.

Sleep Paralysis as a Result of Nocturnal Disturbances and Respiratory Events?

A few years ago I had three instances of sleep paralysis in the same night, leading to finally meeting "The Stranger In The Room". Since then I haven't been afraid of sleep paralysis, in fact I've welcomed it as it's a fairly easy way to initiate a lucid dream.

The other night I experienced sleep paralysis which progressed to an Out of Body Experience (OOBE) then to a Lucid Dream, and it's given me more of an insight into a possible mechanism, which seems to fit with the episode that occurred a few years ago, only this time I was wearing 2 sleep monitors so I've been able to "capture" some elements of it and piece together my theory of the events.

This has led me to realise that there are common factors in the events leading up to sleep paralysis and the subsequent spontaneous lucidity.

I'll begin by describing what happened several years ago. I'm well aware that it didn't happen literally, but bear with me as I think it's best to describe it as it appeared before taking it apart scientifically. I've put the account in a quote-box, so if you really can't bear hearing other people's dreams you can easily skip over it...

I briefly mentioned in this post that as far as getting over the fear of sleep paralysis goes, the turning point for me was a night several years ago when my son had a chest infection causing his nocturnal oxygen levels to drop lower and more frequently than usual meaning that I had to carry out assisted coughing and nasal suction several times. Needless to say our night was very disturbed and we were both very tired. This was the second such night in a row.

On three occasions when I returned to my bed I suffered from sleep paralysis. It was something that I'd grown used to because it had been occurring roughly once every couple of months from the age of around 13.

I'd be laying in bed listening out for his oximeter alarm, then I'd get the familiar whistle in my ears, a crackling noise, then my body would feel crushed and each muscle would feel as if someone had deflated it squashing me further into the bed. Then the familiar (but still frightening) feeling of someone watching me as I lay there struggling trying to talk but only managing a throaty "uugh" noise.

By the third time I almost found it funny (maybe because it had never happened to me so frequently, so this time it felt familiar, almost to the point that I knew I was safe). I kept telling myself that my body was effectively asleep. "Okay, so my body is asleep but somehow I (whatever makes me me) is awake, so that 'me' is going to get up".

"I" then rose above my sleeping self about a foot or two, rolled left (now facing the wall), then floated to the foot of the bed and ended up standing on the floor looking back at my sleeping-self.

This all seemed normal at the time. 

It was then that I could finally see the person that had been watching me. He was standing next to me at the foot of the bed. He stepped aside, smiled and gestured towards the mirror at the end of my bed. Then I passed through the mirror, through the wardrobe and then through the wall into my son's room next door. A few moments later I was back in my bed, awake and able to move.

The feeling was incredible, even if it did leave me a bit confused as to whether I was really awake this time. From that moment on I have not been afraid of sleep paralysis.

Now here's a brief account of the episode I had the other night, then I'll draw some parallels between the two nights...

I'd had little sleep the previous night as I had to be awake around 3am for a journey to Manchester. When I got home I was tired, so after dinner I made a point of not staying up late (bed by 9pm). Keen to carry on my experiments with 5-HTP I took 200mg of 5-HTP, connected some channels of the Black Shadow sleep monitor (SPO2, Pulse, Airflow, Body Movement and Sound), put the Zeo headband on, started to record the raw Zeo data with ZeoScope and went to sleep. I was also wearing the Rematee belt (as is normal for me now).

I was asleep within 6 minutes (a fair indicator of sleep-debt). Another indicator of sleep-debt is the fact that I was briefly in REM sleep within 9 minutes of getting into bed!

At 4:02am (I know this from the raw data) I was woken from REM by a noise near my bedroom window. I woke suddenly thinking that I had an intruder. I shuffled round the bed a bit listening for more noises and then lay there replaying the noise in my head trying to make it fit with a known noise. At the time I also considered that it was a hypnagogic noise. It was a multiple banging noise, and I imagined it was probably a picture falling off the wall and bouncing on the wooden floor.

I'd spent around 10 minutes trying to work out a cause of the noise as I dozed in and out of sleep, then the familiar whistling noise of Sleep Paralysis stirred me. I got excited and tried to turn it into an OOBE by pushing "myself" from my head, but that just stopped the noise so I stopped too. Then the whistling returned and I tried rolling "myself" out of my body. It worked, I sat on the edge of the bed and felt sad that I'd actually woken myself up. It turned out to be a false-awakening because I then floated to the end of the bed, realised that I was still dreaming, and from that moment on was in a lucid dream (albeit of the out-of-body variety).

I went to my bedroom door, floated out into the hallway (something I've never been able to do before as doors usually take me to the wrong place).

It was dark, so I put my hand into the adjacent room and tried to put the light on except there wasn't a switch, just a lump of plastic. Again, this prompted me to stay lucid. So I went to the front door (in search of the cause of the noise). As I got to the front door I hesitated because I really wanted the door to take me outside and I was afraid that it would take me to the wrong place (despite the earlier door working correctly), so I "poured" myself through the letterbox and ended up outside on the driveway.

It was still dark outside, and I had trouble seeing, I imagined that this was because I knew that my eyes were shut because I was asleep, so I took my dream-hands and prised open my dream-eyelids in a way that only someone who has ever had conjunctivitis will know. Then it became daylight.

On my driveway was a postman in a bright red fleece. Instantly I was standing next to him and he acknowledged me. I was confused because I knew that this was a dream so expected that I was ghost-like and he wouldn't be able to see me. (I didn't realise it at the time but I was losing lucidity and becoming the observer of the dream again rather than the creator).

The postman apologised for the noise and said that he'd been trying to get a large parcel through the tiny letterbox.

I thanked him, took the parcel and opened my front-door, only to find myself back in bed and waking up.

I then pressed then event-marker on the Black Shadow Monitor and recorded what I remembered of the dream before getting out of bed.  

There are a few key similarities that I think are worthwhile extracting from these accounts, and some I've only become aware of in light of the lucid-dream I had the other night.

• Sleep debt from previous night
• Disturbed Sleep that night
• Waking and being fully alert during the night before returning to bed
• Remaining alert for an anticipated noise
• Sleep Paralysis leading to a dream which became lucid ending with me going off in search of the source of the noise.

In the morning I was keen to playback the audio recording of the night's sleep to see if the sound was real, or hypnagogic in nature. I also wanted to see what the various monitors managed to show of this experience.

It turned out the sound was real and the Black Shadow's microphone was sensitive enough to capture it. It was possible to hear a car driving past the house (causing me to stir) followed 6 seconds later by the sound that I heard: it sounded like a rat-a-tat-tat on the letterbox but I still couldn't identify the noise.

The first sound is much clearer through headphones or good speakers.

The next morning when I went to my car I found the cause of the noise. The passing car had lost a plastic hubcap which had hit the front of my house (my bedroom wall) and spun on the concrete before settling down, in a similar way to a spinning coin running out of energy on a tabletop.

Looking at the graphs from the Black Shadow and the Zeo, it became fairly clear that this wasn't the trigger for the dream, but it was a very important factor because it caused me to wake up fully. I was very alert as I listened out for the cause of the noise, I was anxious and to be honest a little afraid. This likely put me in a state of heightened awareness and self-consciousness, which on some level carried over for the next few minutes into the dream.

I've annotated the 30 minutes covering the noise and finally waking from the lucid dream (click for a larger version).

The raw single-channel EEG data is displayed at the top. I've selected the point that I first woke after hearing the noise. This section aligns with the marker in the brainwave frequency lines (coloured as indicated by the key). 

The hypopneas were the likely cause of the sleep paralysis. I suspect the third one was the trigger as body movement is shown after the first and second along with the noise of bedclothes moving, so sleep paralysis had not set in by then.

I suspect the evening went something like this:

1. Initial car and hubcap noise occurred
2. I woke suddenly causing a rise in delta wave "noise" as I moved.
3. My heartrate more than doubled to 101 bpm (startled and fear) (in line with the delta increase)
4. I lay in bed listening for further sounds until...
5. I drifted to sleep and quickly went into REM
6. My respiratory issues are exacerbated by REM so hypopneas followed (yellow blocks)
7. I had micro-awakenings due to the hypopneas (shown by the blue blocks and reduced pleth)
8. Due to my heightened state I failed to go back into normal REM and became aware that I was asleep.
9. Possibly the final hypopnea ended the dream.
10. I laid still for a few moments before dictating the contents of the dream into the microphone

So I suspect that to reliably induce sleep paralysis and/or lucid dreaming two factors are required;

1. True wakefulness in the night, not just snoozing a 4am alarm
2. A cause of micro-arousals / micro-awakenings.

Wild speculation...

I was hoping for a clear indication of something on the EEG and frequency tracings.

The brainwave frequency analysis in more detail with the purple section believed to be the dream.

If I had to be pushed to look for a trend then I'd say that there was a slight increase in Alpha waves (blue) during the time identified as the dream-period also becoming nearly equal to the Theta wave activity (green) at one point, which declines as I wake, but that is possibly stretching things too far at the moment. However, this overlapping (or meeting) of Theta and Alpha occurs in other places in my sleep (and wake) without any memory of lucidity, so I imagine that finding a simple pattern from a single EEG site is unlikely as things are likely a lot more complicated than that.

For the future

I hope to record the events surrounding more sleep paralysis / lucid dreaming episodes and document any trends that arise rather than just basing my hypothesis on one night.

I'd like to learn to signal to the Zeo that I'm dreaming using eye movements, so that I can further pinpoint when lucidity occurs. Maybe this signal could be on a regular basis (or as regular as the dream permits) to help pinpoint when lucidity begins and ends and normal dreams take over.

 Links

The Stranger in the Room / The Presence / The Dweller on the Threshold / Guardian of the Threshold in literature, religion and folklore

Sleep paralysis and psychopathology - Mume & Ikem "Sleep paralysis occurs frequently after arousal from REM sleep""

Sleeping Position - Supine AHI: A Baseline Measurement

Looking at my previous data for my 5-day mean AHI, you can see some variation on the day-by-day AHI measurements. 

It makes sense that each night will be slightly different but I still wanted to identify and eliminate some of these variables. Now that I know that my sleep-apnoea is positional (mainly when supine) I can attribute some of the night-by-night changes to my sleeping position.

Using the Black Shadow sleep monitor, I am able to automatically record my body position during the night. This is a recording of my sleep position for a single night.

 AHI = 9.30

As you can see from the above chart I spent a fair chunk of the night on either my right or left side. Those short spells on my back are when my sleep apnoea kicks in (or the snoring is so loud that it wakes me up). The reason that they are only short spells is that the apnoeas briefly wake me causing me to move onto my side for an hour or so before ending up on my back again (and beginning the cycle again). Towards the end of the sleep I remained on my back despite the apnoeas causing repeated micro awakenings (micro-arousals).

Prior to having access to accurate sleep position data I was aware that sleeping position (and other variables) could affect my AHI, so in my previous experiments I tried to eliminate its effects by recording 5 consecutive nights and calculating a mean AHI. Solely recording one night could have given a falsely low AHI because if by sheer chance I managed to spend the majority of the night on my side then my AHI would have been lower. This lower AHI would actually be masking my problem.

A recent paper by Sunnergren, Broström & Svanborg shows that "Position–dependent obstructive sleep apnea (POSA) was common both in subjects that by American Academy of Sleep Medicine classification had obstructive sleep apnea as well as those without. The severity of obstructive sleep apnea, as defined by American Academy of Sleep Medicine, could be dependent on supine time in a substantial amount of subjects".

This hints that people are slipping through the net and missing out on a diagnosis and treatment. 

It is for this reason that a sleep-study conducted in a sleep-lab or a hospital tries to have at least part of the night recorded with the patient sleeping on their back (and with some REM sleep too).

The Visi-Download software allows me to include/exclude portions of the night based upon custom criteria, so I manually selected only the times that I slept on my back and re-ran the analysis.

Using this method, my Supine AHI for the 9.30 night shown above was actually 12.73, for which I snored at a level of above 55db for 95.5% of the time! For the record, my lowest oxygen desaturation took me to 79%.

Using this method, my supine AHI is more stable, (although not completely the same every night) this demonstrates that this is actually a more consistent method of calculating my night-time AHI, although for others with non positional apnoea it may well be a different story.

I plan to carry out some further monitoring without the Rematee, so this is the method I will use to ensure a fairer compaison between nights.