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.

Lucid Dreaming

 

Imagine that as you read these words you hear a voice from nowhere telling you "You're dreaming..."

You may even tell yourself that you just imagined it, but what if you listened to the voice?

What if you then looked around and saw clues that all was not as it seemed?

What if you then realised that you were actually dreaming? You'd realise that you were essentially a character in a story that your sleeping brain was dreaming up.

As the author of this dream you'd them be able to control aspects of it. You'd be able to communicate with your sleeping-self and in essence become a god in a universe that you created.

Crazy? Maybe. Impossible? No.

This happens to people, and it happens to me...

I was dreaming. I couldn't remember how I got there but I was trapped in a room with no doors and no windows. There was, however, a large mirror on the wall. 

Something changed: I stopped worrying about getting out and instead tried to work out how I'd managed to get there in a room without an entrance in the first place.

"It's got to be a dream", I told myself.

"Well, if it's a dream then I should be able to walk through the mirror and escape."

So I tried - face first...

... and after a bit of pushing I found myself in a stairwell on the other side of the mirror. "Yep, definitely a dream" I thought as I became aware of the other me - the "real me" asleep in my bed.

"Wow! I'm dreaming". I did the obvious thing and tried to fly my way to safety; slowly I was hauled upwards by the shoulders and flew for about 300 yards. As I get more involved in the story I somehow started to forget that it was a dream and after a few more episodes of realising and forgetting that I was dreaming it settled back down into a normal dream.

Sounds familiar? "The Matrix"? Pretty much, although it's an older idea in the world of philosophy. It's essentially a scaled down version of Gnosticism. In Gnosticism our world is the dream-world and there is a "real world" in which our awareness exists watching us play our parts in the "here and now". Like a set of Russian Dolls, we are also able to create a fake world in which we can lose ourselves in the experiences that it offers.

For some people these dreams happen spontaneously, meaning that they don't have to prepare or practice in order to get to hame them. Others can only dream of having a dream like this (poor choice of words really). The idea of a normal dream is mind-blowing enough when you think about it: every night we go to sleep and lose our sense of identity. We lose sense of the passage of time and we forget that we are The Dreamer Dreaming, we actually feel as if we are the character in the dream...

...but with a lucid dream we adopt a dual consciousness: our real-life identity returns and we can watch the dream from the vantage point of that identity from the comfort of our bed knowing that whatever happens we are safe, we can take more risks in the dream, we can have fun with the story rather than fear it, we can even shape the dream-world, yet we can also simultaneously adopt the vantage point of the dream characters and get involved in the story. You are both the Dreamer Dreaming and the Dreamed.

My first lucid dream was a spontaneous one and it happened on the night that I had three episodes of sleep paralysis. The sleep paralysis was the trigger that told me that I was dreaming. From that moment on I was in the dream, but still able to reason with the dreamer part of me.

Lucid dreaming isn't just an interesting sleeping-habit, it has actually been used to help people control re-occurring nightmares.

How can you make lucid dreams occur?

If you aren't one of the lucky ones that have had lucid dreams spontaneously (or you want to able to increase the frequency with which they occur) then there are a few things that you can do to help turn a normal dream into a lucid one:

Dream worlds seem to be comprised of disjointed scenes with the brain doing its best to link them together in a narrative, as such the rules that govern the dream world can differ from scene to scene, hence if you check, you may have 10 fingers one moment, then the next moment 11 when you check again. This sort of clue should be enough to alert you to the fact that something isn't right and that you are in fact dreaming.

Most people talk of performing "reality checks" where throughout your waking day you constantly check whether you are awake. You can simply ask yourself if this is a dream, or you can perform some checks to see if you are really awake.

These sort of "Reality Checks" don't really work for me, instead I question my surroundings. Do this during the day and it should carry over (sometimes) into your dream.

The big pointer to me is a lack of continuity, such as the night when I entered REM sleep as soon as I closed my eyes (confirmed by Zeo)...

 (Click for larger image)

...I was suddenly in the back of a car that was being driven along a mountain road, I had the sense that we were late for something and possibly being chased but my first thought was, "...but I was in bed a moment ago, how did I get here?". That questioning was enough to shatter the illusion and I became aware that I was still in bed (even what position I was sleeping in), and yet I was still in the dream. So Chitty-Chitty-Bang-Bang style I was able to make the car fly to the meeting that I was late for.

When you wake from a normal dream, you may well kick yourself because something in the dream was so odd that you should have realised that it was just a dream. These are the sort of things that you can look out for to act as a prompt for you to question your surroundings.

Question everything:

• How did you get where you are?
• Who are you with? 
• Why are you there?
• Is time flowing as it should - were you older a short while ago?
• Can you fly?
• Do doors take you where they are supposed to? Actually walk through a doorway rather than assume you have just walked through it. (For me, doors usually take me onto the roof of a building).

Other things to look out for are sounds that don't belong there. I've had several lucid dreams that have been triggered by noises that make their way into the dream. Examples of that are:

• During the summer I slept with the window open one night. I dreamed that I was standing beside a really busy airport runway with planes rushing by every few seconds or so. As I listened to the noise I realised that they weren't planes but they were actually cars going by my house. This triggered a lucid dream.
• I was dreaming that I got out of my car, then I heard myself growling... "Oh great, now I'm a werewolf", I thought to myself. I then listened more to the growling that I was making and realised that it was actually snoring, from there it was an easy jump to realise that I was actually dreaming and could hear myself snoring. The dream became lucid from that point.

Several devices make use of this principle.

I've already mentioned Dan's ZeoScope software elsewhere in this blog. This works in conjunction with the raw data from the Zeo Bedside unit. When you have been in REM sleep for a certain time, ZeoScope plays your choice of mp3 to you. This then "leaks" into your dream as a signal to you.

There are also several iPhone apps that do something similar, although they only guess at when you are likely to be in REM as they have no way of telling. DreamWaker and Dreams Controller are both good examples of this. Dreams Controller also goes to the lengths of prompting you to perform reality checks whilst you are awake. The first time I tried these apps I became lucid, and a certain school of thought says that is likely due to the "beginners luck" effect where your anticipation and expectation of a lucid dream causes it to happen.

To a degree, the principle of a stimulus leaking over from the real world to the dream world also applies to sights as well as sounds.

The NovaDreamer is a device that looks like a sleeping mask, but with red LEDs built into it. An infra-red LED detected when your eyes are moving (hence you are in REM sleep) and then flashes the red LEDs to alert you. In your dream these red lights can become anything from a police car to a volcano. Your job is to realise that anything flashing red in your dream is a signal that you are dreaming. 

I've had limited success with the NovaDreamer and a similar device called the REM Dreamer, although I found that they often woke me up.

Other tips:

• No alcohol - If you do achieve lucidity then (for me) it is always short lived and usually becomes an episode of sleep paralysis.
• As you drift off to sleep really be aware of your surroundings. Note your bedroom, your position in bed etc
• REM deprivation helps. Maybe this is because when you next achieve REM it will be much nearer to the start of sleep meaning that you can carry the awareness mentioned above over to the dream.
• If you become lucid, don't get too excited otherwise you'll wake up.
• If you become lucid, keep reminding yourself that you are dreaming otherwise you'll forget.
• Read about lucid dreaming before you go to sleep, surprisingly this can help as you may dream about lucid dreaming (which will then be a pointer to you in your dream)
• Set an alarm for around 3am. Wake up and actually get out of bed, don't just doze, you need to be fully awake. You could read for a short while (maybe an article on lucid dreaming would help), then return to bed. This time of the morning is when REM sleep is increasing. This time awake should allow you to enter REM pretty quickly, almost with a vengeance.

Supplements to aid lucidity?

Pills and potions to aid dreaming are nothing new; many works of art such as this fantastic watercolour by John Anster Fitzgerald painted 1857-1858. I have a copy of this on my wall, and yet I am not certain of the name. I suspect that, like Fuseli's work, it is called "The Nightmare", but I've also seen it listed as "The stuff Dreams Are Made Of", although  I think that name may relate to later versions where the bottles (probably containing opium) have been omitted.

Opium aside for obvious reasons, there are a number of nutritional supplements that have an effect on sleep and consequently dreams.

I've tried a few supplements to try to reliably encourage lucidity, with some partial success. It's partial because nothing seems to do this on it's own but with a little preparation they seem to help, but proceed with caution (don't treat anything you see on the internet at automatically safe - my words included. Look both ways before crossing, chew your food etc etc), and research any supplements for yourself before you decide to use them. 

A short word on dosage

Melatonin: the dose given in the BNF is deemed to be the most effective dose. I am well aware that I am taking more than that, although singles doses as high as 10mg are on sale and studies of daily doses of up to 75mg have been conducted (MacFarlane et al.).

Vitamin B6: Although 200mg doses are on sale in the UK, it is not recommended to take them on a long term basis as they can cause side effects which appear to reverse when the dose is stopped

Yesterday (in the real world) I was driving for 350 miles and listening to audiobooks discussing consciousness, quantum physics and Gnosticism. I realised that this stuff would be floating around my head during sleep as my brain processed the events of the day, so I thought there would be a good chance of lucidity that night. 

This is the routine that I've found seems to help:

45 mins before bed: 5mg time release Melatonin
30 mins before bed: 200mg Vitamin B6
When in bed:  1mg Melatonin (not time release)

It is known that too much Melatonin will be counter-productive and cause you to wake up. I think my method actually makes use of this effect. The British National Formulary sets 3mg of time-release Melatonin as the correct dose for an adult over the age of 55 (Not usually prescribed for people below 55) Generally 0.25mg of instant release is enough to initiate tiredness and hence sleep - the sustained release version ensures a trickle dose throughout the night. 

I usually find that I wake up fully after a few hours. This is when I then take a further

1mg Melatonin (not time release)...

...which sends me back to sleep within about 20 minutes. That's it. I normally find that will give me lucidity or sleep paralysis (which can be converted to a lucid dream which may even take the form of an OOBE - Out Of Body Experience).

It's not a guaranteed method, but on the nights that I've tried it (a few times a month for several months), usually something has happened, even if the effect was short lived. I suspect that lucidity would last longer if I were calmer when I realised I that it was a dream. 

Update on Saturday, March 17, 2012 at 2:51PM by Hypnagogia Blog

I had some experience of the "Wake & Back to Bed" method of inducing a lucid dream.

http://hypnagogia.squarespace.com/blog/2012/3/17/lucid-dreaming-wake-back-to-bed.html

Update on Friday, May 11, 2012 at 10:15PM by Hypnagogia Blog

Lucid Dreaming via a disturbed night...

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

During one lucid dream I was able to signal to my monitors that I was actually in a lucid dream...

Lucid Dreaming - Sending a Signal to the Waking World

Vitamins, Minerals & Breaking the REM Barrier

Like a car, the body seems to need the correct fuel to run optimally. It seems that I may have been "running on empty" as far as sleep-related vitamins and minerals are concerned...

I ended my last blog-post regarding REM rebound with several questions, all pretty much along the line of "Where is my missing REM?"

Although typically the amount of REM that I have each night is within limits (at the lower end of typical) it was often broken by either periods of wakefulness or light-sleep.

It bothered me that I couldn't seem to achieve the expected REM rebound that conventional wisdom says should occur. What was wrong? Was it the equipment, the method or was it me?

I finished that post by wanting to increase the amount of REM that I have and also by trying to get rid of these periods of being awake.

Not an easy task considering that I can already probably attribute some of these awakenings to temperature drops and apnoeas!

I'd already found a way to decrease the number of apnoeas and hypopneas (AHI) that I had using 5-HTP which left me thinking that maybe I was lacking in other vitamins / minerals / hormones that are essential for sleep.

It was suggested to me that I try Vitamin D3 which is formed when we soak up sunlight during the day. This made sense to me as I am not a fan of bright sunlight (I was sun-burned badly as a child). So it was not outside the realms of possibility that I was lacking in D3.

I took this for a few nights without it seeming to make a difference to my sleep staging (as scored by the Zeo sleep monitor). Maybe I should have given it longer as I like the "scientific method" of only changing one variable at a time, but with the range of vitamins and minerals and other various supplements claiming to improve sleep I decided to go for an "all or nothing" approach.

During the time that I tried to find supplements to help with lucid dreaming (another reason to want more REM) I found many forums where people spoke about their "Sleep Stack" which refers to the stack of pills they take before sleep.

So, the question was: what to include in my "sleep stack"...

A brief look around the internet for supplements to improve sleep will pretty much turn up results for everything and yield many wild claims without much backing. Many refer to studies without citing them using phrases such as "Studies have shown" etc etc. This makes it hard to know where to begin when looking for supplements as science and advertising seem to blur into one.  

Getting to sleep isn't a problem for me (far from it), so I didn't include Melatonin or Valerian (although I've had good experiences with inducing sleep with both).

My chosen regime was:

Morning: Vitamin D3, Multi-vitamins & minerals with Iron

Bedtime: ZMA (Zinc, Magnesium and Vitamin B6)

Occaisionally I added 200mg of 5-HTP to the bedtime regime with the thinking that a reduced number of respiratory events would reduce the awakenings during the night.

My reasoning behind the choices (click for brand and detailed info):

Vitamin D3 (1000 iu / 25 ug)
I took this for the reasons already mentioned. In addition to that, D3 is linked to our Circadian Rhythm, which seems logical, considering it is produced by the skin in sunlight. For that reason I decided to take this in the morning as it seemed that is when it would normally be produced.

A safe dose seems to be 4000iu or 100ug according to Vieth, Kimbell et al (2004) so I didn't see a problem with taking 25ug or even 50ug. 

Multi-Vitamins & Minerals with Iron

I deliberately chose a blend with a high Iron content as Iron is essential for haemoglobin (used in gas transporation around the body). Low iron levels are also associated with Periodic Limb Movements which can cause awakenings during the night.

I also wanted a blend that had B vitamins because I have previously taken Vitamin B6 at night to help with sleep and dreaming. I found that B6 helped, although in a dose that is not recommended for the long term. B6 is also used in the production of serotonin, which links back to my 5-HTP post, so this seemed like an essential one to have.

B12 is also known to have an effect on Melatonin. Mayer, Kröger and Meier-Ewert (1996)

Magnesium may have an effect on Periodic Limb Movements Hornyak et al

With these seeming to be comprehensive multi-vitamins and minerals, I thought I pretty much had any possible deficiencies covered although I did add ZMA in the evenings...

ZMA (Zinc, Magnesium and B6)

This is found in the bodybuilding section of the health food shop. ZMA is to be taken at night (which sounded promising for sleep). It is also discussed anecdotally in body-building forums as having a positive effect on sleep. I thought that an additional boost of B6 and Magnesium (for the reasons given in multi-vitamins) would be useful at night. The Zinc seemed to be an added extra, although it does seem to have a role in regulating hormones and neuro-transmission

I am pleased with the result. A quick look at one of my typical Zeo hypnograms confirms why: 

Aside from how I felt, my criteria for deciding whether I'd had a decent sleep used to be if the amount of wake was less than the amount of deep as the two were usually similar in duration!

This is a graph from a week or so after taking the supplements mentioned above.

So I slept better on that night (despite a higher "sleep stealer" score), but what about the rest?

This is from a couple of weeks later:

Although there are still awakenings, they are relatively short (total of about 5 mins a night, well under the average for my age) my weekly average graphs show that the story of higher REM is repeated nightly along with less time spent awake:

(I started taking the D3 on the 19th of December and the additional supplements on the 23rd of December) 

That seems fairly conclusive to me. I hope that the pattern continues. This is all the more impressive as I haven't been doing anything more than taking the supplements. Some nights have been early, some late, some with a couple of drinks etc etc).

I intend to carry on with the regime with some additional monitoring - I'd like to see if the supplements also bring my AHI down, what the effect of 50ug of D3 is and what the combined effect with 5-HTP would be.

I'd then like to try the REM Rebound experiment again now that I seem to have broken my REM barrier.

We are all unique, and all I can say is that this works for me. I would be interested to know if anyone else has had a similar effect.

Circadian Rhythms & Temperature

Due to a bit of an erratic week, I haven't been able to reliably measure (and experiment with) my apnoeas, so instead this was going to be a blog post about "Circadian Rhythms" (the daily sleep/wake cycle).

Given that we inhabit a planet with a 24 hour day, it is no surprise that our bodies have become roughly linked with the day/night cycle, with various hormones being released at certain stages in the rhythm enticing us to sleep or wake.  

               (Combined photos from my Sky-Watcher and solar telescopes)        

Not everyone's rhythm is the same, some people have theirs shifted (such as when you are jet lagged). Even a skew of an hour or two can make a huge difference to how easily you are able to wake up for work in the morning, or how late you can stay awake.

There are a couple of online questionnaires to help you determine your own circadian rhythm:

http://www.philips.co.uk/c/circadian/178344/cat/
http://www.bbc.co.uk/science/humanbody/sleep/crt/

Both of these decided that my rhythm was skewed, so I decided to make my own measurements and chart them here but after seeing the first 24 hours of data, something interesting emerged...

This is a normal circadian rhythm taken from the Philips website. 

In fact, this is a simplified rhythm, because it is normal to have a small dip in the energy levels around mid afternoon, hence the reason for many countries having an afternoon siesta, and the reason why we tend to slump at our desks in the mid afternoon and reach for a cup of coffee.

This dip can be seen in my graph from the BBC circadian test.

Core body temperature is a good way of charting your own rhythm because energy levels are reflected by our temperature. Our body temperature is not a static 37.5 C, in fact it fluctuates throughout the day inline with our circadian rhythm. Of course, it is also affected by ambient temperature and how active we are.

So, all it would take to chart my own rhythm would be a decent thermometer.

I decided to get a data-logging thermometer, so that I could see what was happening while I was asleep.

I ordered a thermometer capable of recording every 10 seconds (to weed out anomalous readings), and was expecting the probe to be a small thermocouple-type sensor that I could stick to the skin under my arm, but the probe was more like a bullet and wasn't adhesive plus the logger turned out to be a lot bigger than it looked in the photo!

I'd gone this far, so in the name of science, I shaved under my arm and fixed the probe there with Melonin (low adhesive dressing) and Tegaderm (a clear waterproof adhesive dressing). I then wedged the cables into my suit and went off to work.

After 24 hours (and a few weird looks) I downloaded the data to a computer. I noticed that generally the pattern was the same as that belonging to "normal" people, but that it had a few fairly severe drops in temp during the night.

I repeated this over several days.

On the graph below, the dip is around 1:30pm and again at 4:00pm. I suspect the 1:30pm dip is my normal afternoon energy dip whilst the 4:00pm dip is environmental because I was working outside at 4:00pm. 

I repeated this the following day and the dip was much more pronounced again early at around noon, but I ended the recording early as it was becoming awkward to carry the data-logger around with me, so I can't show a full 48 hour graph.

It's also interesting that the temperature drops around 8pm. That's pretty much when I start to look forward to sleep! It plateaus at 10pm for a couple of hours in a similar way to the one produced by my answers to the BBC link. This may have been because I was already asleep by then!

The first 24 hours...

Those drops in temperature during sleep are severe. When I first saw them, I suspected that they were erroneous readings, but the probe was stuck so tightly to me that there was no way that these were due to poor contact (after all, if that were the case, why didn't this happen during the day when there was more movement?). However, as the data rate on the logger was so high (240 recordings an hour), these were clearly not erroneous as they slowly crept back up to the plateau level of around 36.5°C.

I wasn't happy with this result, so I repeated it the following night. The drops in temperature were still there.

On the second night, to eliminate the possibility that these variations were due to environmental changes, my room temperature was monitored with another probe, and it was a surprisingly constant 18°C  for most of the night, so there were no corresponding dips in room temperature. I don't like my bedroom to be too warm so I switch the heating off at night.

I took a look at my sleep-stage data using the Zeo, and was surprised that the seemingly random falls in temperature coincided with awakenings from REM! (Shown as orange "wake periods" on the coloured graph, but as REM/Wake on the detailed graph. Light green = REM, Dark green = slow wave sleep, grey - stage 1 & 2 sleep. For the sake of simplicity I won't show the detailed graph, but you can see one on the blog post "My Baseline AHI").

So what's going on?

Along with the muscle paralysis that comes with REM sleep (to stop us acting out our dreams), there is also a decrease in the body's ability to regulate its temperature (thermoregulation). 

So, it seems that my temperature was dropping, causing me to wake in order to regulate my temperature, pretty much in the same way that my apnoeas cause me to wake during REM.

If this is true then it means that in order to be able to stay asleep during REM I now have two issues to deal with: apnoeas AND temperature!

During REM this decrease in ability to regulate our temperature causes us to be largely "Poikilothermic" (meaning that our temperature is governed by the temperature of our environment). So the key to eliminating this issue is to regulate the temperature of my bedroom better.

I repeated this for two more days, and then concentrated on the nights and gathered more data (total of 5 nights). It seems that these overnight drops in temperature aren't always correlated with REM sleep (sometimes they are just before and sometimes just after), so until my more accurate thermometer arrives, I decided to calculate the mean temperature from the week's recordings to get a better idea of my rhythm and to try to eliminate the overnight drops.

This gives a much nicer picture and goes some way to reducing the environmental effects. The data fits well with how I feel throughout the day. I tend to get a bit tired at 1pm, then start considering bed around 8-9pm.

Compared to the BBC graph, it lines up fairly well, although my "energy drop" happens earlier in the day at a more accurate time.

I'm not comfortable with this experiment as there is much that could be improved on:  

• Better temperature sensor (on it's way)
• Eliminate environmental temperature effects (maybe on a day where I stay at home)
• I still am not convinced whether these changes in temperature are an effect of activity. After all, it stands to reason that when we are more active our bodies produce more heat, so it would be interesting to do this on a day where I forced myself to do nothing, stayed at home and forced myself to stay awake past my usual bedtime, that way I could see whether these changes are still evident on the graph. That said, some of the nights were recorded with an 11pm bedtime although my temperature still dropped as usual around 8pm, so it could be accurate.

One thing that it has shown me is that it is essential to have your sleeping environment just right for you...

A good sleep routine involves making sure that your bedroom is the right temperature. It should be cool but not cold. In days gone by, the outside temperature dropping in the evening acted as a cue for our ancestors' bodies to sleep. Of course, in days where our homes are heated, this confuses the body and can lead to poor sleep.

The same is true with light. Nowadays we have artificial light filling our homes and offices, and that also interferes with our sleep/wake cycle as we don't receive the nighttime cues.

So sunlight during the day and a cool, dark bedroom goes some way to remedying this.

Update on Friday, December 9, 2011 at 8:46AM by Hypnagogia Blog

My new monitor arrived. It's able to record temperature, blood pressure, ecg trace, heart rate and oxygen saturations together.

I still saw temperature drops, and they still correlate with REM sleep.

The following screenshot (combined with the Zeo hypnogrm) shows the temperature drop along with changes in heart-rate during a REM period.

Key

Zeo hypnogram
Oxygen saturations
Pulse rate
 Temperature

5-HTP, Serotonin and Sleep

 

For the last 5 days I've been taking 5-HTP.

5-HTP is a precursor to serotonin (that is, it becomes serotonin once metabolised by the body).

I've previously used 5-HTP for experimenting with my sleep composition, and to try to reliably trigger lucid dreams. The dosage that I was taking then was 50 - 100mg at night.

This time I tried a brand that contained "co-factors". These are associated vitamins and minerals that help the body to metabolise the 5-HTP into serotonin. 

I decided on 200mg each night about 10 minutes before getting into bed. 100mg is the recommended maximum daily dose of this brand, although I have seen others that give a maximum daily dose as 300mg.

I have also seen medical literature that cites doses of 150mg-300mg as a daily dose (as a trial for treating depression), so toxicity at this dose seemed unlikely.

Why did I take 5-HTP?

The rather lazy answer is that (as I mentioned above) I've taken it before without ill effect, and that it is mentioned to have a positive effect on sleep, even being cited as having a positive effect on a severe case of insomnia 

A rather cheeky and over-simplified answer is that I have already shown that a depressant (alcohol) increases my AHI, so I wondered if something that has antidepressant properties would have the opposite effect and reduce my AHI.

I have also seen medical literature that suggests a link between depression and sleep apnoea (both as a cause and effect of sleep apnoea). 

Depression is more complicated that just having low serotonin levels, but low serotonin does play a part. Serotonin is a neurotransmitter (it is used in the body's sending and receiving of nerve impulses), so I wondered if increasing my levels would mean that I would have stronger signals to breathe during sleep and that the muscle tone in my airways would be that much "sharper".

Okay, so how did the 5 days go?

I noticed the following effects (sleep related and non-sleep related):

• I wasn't as tired in the evenings, so went to bed later
• I found it easier to wake up
• I didn't feel as hungry during the day, generally ate once at 2pm, then didn't eat in the evening.

Throughout these experiments, I go to bed when I am tired.

I calculated my average bedtime using the Zeo data. As I am doing these 5-day comparisons on weekdays (except the alcohol test - see separate blog for that), the time that I had to wake up was the same each day, hence later to bed meant less time in bed, which oddly with the 5-HTP didn't feel like a bad thing.

 

I wondered if my body "needed" more sleep, afterall I am used to roughly an extra hour (and still crave more), but on two mornings of the week (Fri and Sat) I can have a bit of a lie-in if I need to but I didn't want to lie in when taking 5-HTP at night (It's Saturday and I'm typing this at 7am, after waking up at my normal weekday time of 6:30am)!

It is known that some anti-depressants can decrease the amount of REM sleep that you have, so I suspected that my percentage of REM would decrease.

As percentages, the figures do not show this. In fact they show an increase in the percentage of deep sleep, along with a slight increase in REM and wake...

However, as REM is more abundant at the end of the night, it follows that the less time one spends in bed, the less opportunity there is for REM sleep, hence my actual 5-day-mean time in REM fell by 11 minutes from my baseline of 98 minutes, although it put it more inline to the average for my age of 90 minutes.

My actual time in slow-wave sleep (deep) rose by a mean of 3 minutes.  My mean deep sleep (34 minutes) is still way below the average for my age (69 minutes) but within limits, so I am pleased with this small increase.

I'm not sure if these changes are actually significant, perhaps a longer trial may reveal more?

So, even if 5-HTP didn't affect my AHI, it still had positive effects on several aspects of my sleep composition. 

However, it did have a positive effect on my AHI and it was much more noticeable... 

I've graphed my 5-day-mean AHI alongside the other 5-day-mean AHIs for alcohol and my baseline.

It brings my mean AHI down to a level that puts me in the "normal" category (<5 AHI = normal). Maybe this is the reason for not wanting to sleep so early and finding it easier to wake in the mornings.

For the sake of showing that this is a consistent effect, I also graphed the data on a night by night basis... 

For now, this seems too good to be true: 

• Lower AHI
• Normal bedtimes
• Less time in bed
• Increase in slow-wave sleep

So what now? Keep on taking the tablets?

Based on my limited data, I wouldn't dare go so far as to claim that this is a effective treatment for mild (very mild) obstructive sleep apnoea, nor would I suggest that it would work for others, but it is intriguing and does need looking at further.

It leaves me wanting to know more about the mechanism behind this effect. Yes, it's good that it has helped me as far as my AHI is concerned, but I want to know how. In a previous post, I noted that my sleep apnoea seems to be REM related. Serotonin related activity drops dramaticaly during REM sleep, so maybe the higher levels due to 5-HTP reduced that effect?

Is my pseudo-science hypothesis correct, or is there more to it than that?

I'd be interested to see if this effect carried on, or if my body got used to the 5-HTP and the effect faded.

I'd also like to try this with a lower dose of 5-HTP (after all, why take a high dose if you don't need to)? I'd also like to see if sustained-release 5-HTP is more effective.

I was planning to try the mandibular advancement device next, but after such a positive effect, I think I'll stay with 5-HTP for a while and see if I can improve on the results even more. I'd like to bring my sleep latency (time to sleep onset) down.

Yes, this is good news but I can't help feeling a little like Lizzy in "Drop Dead Fred", she knows that she's taking a pill that will stop her seeing things that others can't. Will taking 5-HTP, increasing my serotonin levels and bringing my AHI down stop me from having sleep paralysis, lucid dreams and seeing/hearing the sleep-wake border imagery that I have grown so used to? 

I hope not.

I'll explain how and why I came to like sleep paralysis in an upcoming blog-post. Hopefully it may be of use to anyone that fears it as I used to.

I have to say that this is a test with a tiny sample size, and of limited duration. I am not suggesting that anybody should try this, and certainly not use it in place of recognised treatments. 

Update on Saturday, May 12, 2012 at 7:54PM by Hypnagogia Blog

I've also found that 5-HTP helped reduced residual snoring after lowering my AHI with positional therapy.

Snoring Remedies? Results for 5-HTP