CPAP & FitBit sleep measurement accuracy

[RichardMW]

I do not see much deep + rem activity in my FitBit.

I am starting to suspect that the fact that I am using a CPAP mask results in FitBit missing deep sleep & rem recognition.

Have any other CPAP users seen this lack of deep & rem sleep?

Do you think that there is something wrong with the FitBit sleep algorithms for people who use CPAP?

Example:

Last night I went to bed at 11:45 PM and woke up briefly 3 - 4 times and woke up at 9:10 AM.

In the morning I woke up feeling as if I had gotten a good night's sleep.

FitBit Premium said I had 7 hr 27 min sleep.

Deep sleep = 9 minutes

Rem = 19 minutes.

Light sleep = 6 hr 59 minutes.

I am fairly certain I had more rem sleep since I woke up during the night remembering dreams. That typically happens at the end of REM.

I also think that I had more than 9 minutes of deep sleep based on the fact that I felt rested after waking up.

I am 77 years old in reasonable health.

I use a Versa 2. I have a FitBit Premium subscription.

My CPAP machine is a Phillips Respironics with a Dreamwear mask.

Last night the CPAP said I had an AHI of 5.4. That means that the CPAP is working well.

[SunsetRunner]

Hi @RichardMW - You say:  

I do not see much deep + rem activity in my FitBit.

I am starting to suspect that the fact that I am using a CPAP mask results in FitBit missing deep sleep & rem recognition.

That has not been my experience with my CPAP and Versa 2. My reports have been a good mix of REM, Light and Deep sleep. You can read more about how Fitbit calculates sleep and sleep stages, and also read tips for a better sleep here.  You may also want to check how tight or loose your Versa 2 is on your wrist. The wristband should be snug but not constricting, a tight wristband restricts blood flow, potentially affecting the heart-rate signal ... which affects how sleep stages are interpreted. 

Hope this helps.

[RichardMW]

Thanks Carol,

I have had the Versa 2 fairly snug on my wrist.

I will loosen it and see if that makes a difference.

[RichardMW]

Carol, 

I loosened the strap one notch. No changes.

I loosened another notch. Still no deep sleep recorded.

If I loosen it more, it will slide along arm.

Maybe the fact that I do not see deep sleep is a combination of the fitbit algorithm for sleep stage detection and me personally. I usually sleep on my back. I will sometimes fall to sleep on my side, but I always wake up on my back.

[SunsetRunner]

I’m sorry the trouble shooting did not work for you, @RichardMW . You are very methodical. A question - Does your heart rate appear to be working correctly? Try carefully cleaning the contact points. Instructions are here. 

If you have not already done so, you may want to check out the Fitbit Help documentation regarding the estimated oxygen levels and the Help data regarding sleep stages-  how they are calculated, and how to interpret your results. 

Finally, it never hurts to restart your Versa a couple times. Wish I could suggest more. Maybe other CPAP users will chime in with their experiences. 

[PacificaN]

I had given up on my CPAP for close to a year.  When I started looking at my nighttime oxygen levels (a LOT of orange spikes), I got it out and started using it again- WOW! only a couple spikes in over a month. 

-how is that reading for you?

(I have a charge 3)

[RTVM]

I recently started using a cpap with the same equipment. I'm experiencing the same issues... I wondered if others were experiencing that too.

[Otdk]

Thx for this post, I am in the same boat. Have been through several smart watches discovering various levels og insufficient deep sleep levels and now just started using fitbit. 

[RichardMW]

Otdk,

I am now using a Resmed 10 with a Phillips Dreamwear mask.

Phillips issued a worldwide recall last May for all their CPAP machines. They warned users to immediately stop using them.

There was a big problem with sound reduction foam breaking down if used with a ozone cpap cleaner.

Smaller problems for non-ozone users.

[Carebear11]

Yes! My sleep tracking rarely shows REM or deep sleep when I have my bipap on. I also have days where I wake up feeling like I slept well when wearing it but my fitbit show under 30 minutes of rem. 

[Drumbob]

I have severe sleep apnea and am using a bi-pap machine. I was recording very little deep sleep. I'm 68 and have recently lost a lot of weight but still very little deep sleep. Rem and light sleep has been in the benchmark for my age group. I read about taking 3 mg of melatonin a couple hrs. before going to bed. It's helped. Took a few days but I'm recording much better deep sleep. Last night I had 1 hr. and 12 min. deep sleep. That's great for me and within the benchmark. Give it a try, might help.

[JJinMO]

Two years late to the discussion but I wondered the same thing (which is of course how I came here :-). I have had a couple different Fitbit models and have had the same experience. I have compared nights I wore my CPAP and nights I didn't. I definitely see less deep sleep reported by my Fitbit when I wear my CPAP and maybe less REM as well. I also see lower reported estimated oxygen variation, tossing and turning, and sleeping heart rate.

[AZLemur]

I have been experiencing this as well!

I've been wearing a Fitbit to measure sleep for years (currently using a Sense), and my sleep scores were pretty good - averaging in the mid-80s and sleep stages within normal benchmarks. However I was feeling more and more exhausted during the day, in spite of these pretty decent scores. The HR and breathing variability numbers were spiking most nights so I underwent evaluation for apnea and found I have moderate obstructive apnea. 

I've been using a ResMed 11 CPAP machine since mid-August -- I find it very comfortable and have no trouble wearing it all night long. I have gone from 16 apnea events per hour to ZERO using this CPAP device, and I feel a million times better when I wake up and during the day, the difference in how I feel compared with before the CPAP is really extraordinary. 

However, my Fitbit scores rarely break 80 now, mostly due to reduced time in deep and rem sleep. It does appear to be correctly tracking HR and respiration variability, because am not seeing any orange spikes any more like I did before the CPAP.  I experimented with setting the sensitivity to high vs normal, but it hasn't made a noticeable difference.  It really seems like wearing the CPAP is interfering with how the Sense tracks sleep stages. 

It's puzzling and a frustrating, and has led me to cancel my Premium Fitbit service, since I don't have confidence in the metrics anymore, given they don't seem to relate to my actual experience.  I am sorry others are seeing this too, but it is a bit of a relief as well - I though I was going nuts. 

[Drumbob]

Hey @AZLemur , congratulations on getting zero ahi. That's huge. Isn't it amazing when you get a good nights sleep using the cpap? I felt so good when I got my cpap dialed in and was getting ahi's of 2 and below with some 0 event nights. I knew I was dragging during the day and for me headaches but had no idea how much better I could feel. I have to remember my Fitbit device is not a medical device and a cpap machine is, so I don't put much stock in my Fitbit over my cpap. ( but I still want to get a good score, lol.) I found my Fitbit is a great motivational tool for me and if I'm heading in the right direction re active minutes, steps etc. Take care.

[Lindy99]

Yes!!  I’ve only been using my CPAP for 1 week and my sleep data is worse that before!   Like you, my CPAP is showing a good record of sleep…. 
I use a Sense Fitbit and my oxygenation spikes are low but my overall oxygenation % for the night is super low…

[BarryMasters]

So, since I have been using the CPAP machine my sleep has been better and I feel much more awake and energetic during the day. I am also much more positive, but my Charge 5 has no idea how to record my sleep. Since using the CPAP, my Fitbit records between 1 and 3 hours of sleep maximum per night, whereas I allow for 9 hours and I am asleep for at least 7 of them.

For clarity, my bedtime routine has not changed and previously Fitbit recorded between 6 and 8 hours per night. Now that I sleep better, the results are absolutely useless. Is anyone else experiencing this?

[BarryMasters]

Yep, mine just shows 30min of sleep in total

[CANYINNJILMI]

Something I'm wondering about is whether my BiPaP machine's cloud feature may be interfering with my Fitbit getting an accurate reading. I have a Versa 4 and a Resmed Airsense 10 BiPaP ST and get full results some days and sleep duration only on others. Like someone above, I also sleep on my back, but in my case it's the whole night.

Another complicating factor to my Fitbit getting a good read on my heart rate is I'm in A-fib on an ongoing basis (have detector for this turned off), but that wouldn't explain the variability, unless, which I just thought of, the nights it can't get a reading are ones my heart rate is indeed more variable than usual for me. I'll have to compare the tracings for that with the sleep record ok vs problem days.

[RichardMW]

CANYINNJILMI,

I have a Versa 2 and a Resmed 10 CPAP. I tried a Versa 3 with same problem.

Fitbit NEVER identifies all my sleep. I have to sync, then delete the sleep log. I then edit a new record.
There is not a great correlation between how I feel in the morning and the sleep report and score.

[PLeeC]

We are traveling abroad for business and my husband had symptoms of a cold which I did not want to catch so I wore a mask to bed. Today no sleep stats are registered even though I know I slept at least a few hours last night.