help with what keeps waking me up

[tarah]

Hello everyone,

Thank you so much for all you do.  I posted a few years ago when I was getting started with CPAP and it helped me greatly with the transition.  

The past few months, I have been waking up alot throughout the night.  It very much affects how I feel the next day.  I did have some allergy testing done and will start shots soon to hopefully clear up some of the nasal congestion.  I use a full face mask so I should be able to just breathe through my mouth, but something else is still going on because I am still waking alot and feeling like crap alot of days.

I am going to try to post some images and hope that someone can help me with any ideas of what's going on.  I feel exhausted today, woke up early and also woke up at around 2/2:30 in a panic and ripped off my mask.  The previous night (7/21) was a pretty good night and I felt good the following day.

[tarah]

To add a bit more information, I was dx'd with UARS about 5 years ago after a BRUTAL few years of severe insomnia, depression, anxiety.  My mom, dad, and sister were also diagnosed with severe apnea within a few months.
The APAP was hard to adjust to, but I was able to get used to it and come to love it and its association with sleeping well.  The past few months, I've had trouble with waking up alot.  Got into an ENT and they started me on nasal antihistamine, tested me for allergies, found alot of seasonal allergies and told me to start on allergy shots.  I am going to be starting those soon.  In the meantime, I switched to a full face mask, but I am still waking so, so much some nights.  It makes me feel so horrible the following day.
I am taking doxepin (depression), ambien (insomnia), nasal antihistamine, and using a net pot several times per day.  I sleep up on several pillows which is the only way I can get a reasonable amount of air through my nose.  I hate that I take so many meds but I want to be alive to be here for my small kids.
My sleep doctor claims that the machine is treating everything it can, but I am skeptical because when I look at the graphs, I can see that I am waking alot at certain times and those are directly correlated with FL's and increasing pressures.

[Melman]

I see nothing in your data that explains why you are waking up frequently. You have few pressure increase but they are only about 4cm of water which isn't much. You did have pretty consistent low level leakage the first night which may have disrupted your sleep but very little on the second night. If you know the times you wake up post a chart showing a 2 min period of your flow chart just before awakening. It may not show anything but it's worth a try. Hopefully someone else will have some ideas.

[Sleeprider]

Let's zoom in on the flow rate to 2-minute segments. This is where we can see the shape of individual respiratory flow waves. Try to find areas where you think your sleep is disrupted, and we can try to interpret what we see. It will be most helpful if we can see the moments leading up to arousal, but not the disrupted arousal itself.

[tarah]

This is right around 2:30, when I woke in a panic last night and ripped everything off. 
Is it possible that I am waking every time I am having even a bit of flow limitation?

[Sleeprider]

I can see the flow limitation leading up to this event, and the arousal at 02:29:30. Looks like you kept the mask on, and at 02:29:45 the FOT is pulsing. Looks like recovery by 02:30:15. I think this is definitely an arousal, but I have no idea how to deal with it with your current machine. I think some additional pressure support might head-off the flow limitation. You are at minimum pressure here, so perhaps increase that to 8.0 and see if you have fewer arousals.

[tarah]

I definitely ripped everything off, so it must have been earlier.  This looks to be it.  So many wakeups, so tired, its hard to keep track of the times.
thanks much

[Sleeprider]

That looks particularly nasty! New on me. It looks like all exhale and no inhale.

[mesenteria]

Where is the 'large leak' showing in the table at left?  I don't see it in the timeline in the graph.  Did it happen earlier, later...?  I never get any large leaks, so when I see any hint of it in another person's data, I begin to look to educate myself about what else is associated with it.

I wonder if you are getting squiffs of air over a period as you attempt to breathe and then exhale, which is all the machine registers.  Positional problems?

Also, this is approximately at your first REM for the night. Could that be something to bear in mind?