[CPAP] Low AHI but waking up some nights and/or high sleeping heart rate

[cupcakechinchilla]

On some nights I am asleep but my Fitbit shows my heart rate about 15-25 points above my typical sleeping rate. Sometimes I wake up, other times I don't. As you can see, my AHI is very low but I still am not getting good sleep because of this. When I don't have these issues, I feel good the following day, but the bad nights make for miserable days. 

I have adjusted my CPAP pressure several times over the past few months (7-11, 9-13, 10-12, 10-13, 11-13, 11-14). I use a nasal pillow mask and when pressure gets above 13 I start getting major leaks, so I've stuck around 13. I've tried EPR both off and on.

I had a heart scan a few weeks ago and they found no issues, so this is something that just happens overnight during my sleep. I'm still a few months away from being able to meet with a sleep specialist.

I'm hoping someone with some experience can help me determine what might be going on.

I have attached three screenshots from last night. Note the major leak around 4am is not typical, but when I do see those, I wake up with a very dry mouth. As you can see, just a few minutes later I woke up and turned up the humidity level. Any help would be greatly appreciated!

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[Sleepster]

On some nights I am asleep but my Fitbit shows my heart rate about 15-25 points above my typical sleeping rate. Sometimes I wake up, other times I don't. As you can see, my AHI is very low but I still am not getting good sleep because of this. When I don't have these issues, I feel good the following day, but the bad nights make for miserable days. 

Have you tried waiting until the next night to look at your fitbit data? See if your heart rate went up the previous night unbeknownst to you, followed by a day that wasn't miserable.

The elevated heart rate could be due to a REM sleep cycle. It's possible that a flood of stress hormones causes both the elevated heart rate and the next day's miserable feeling. When you look in the morning at your fitbit data and see that you had an episode during the night, the looking causes the stress hormones to spike and brings on that miserable feeling. That's why I suggest the experiment described in the first paragraph above.

We likely had sleep apnea for many years or perhaps decades before we got our first CPAP machine. Our bodies got used to dealing with the apnea. The heart rate elevates during an apnea, and it takes the body awhile to realize that it doesn't need to respond that way anymore because the CPAP machine is preventing the apneas.

[cupcakechinchilla]

Have you tried waiting until the next night to look at your fitbit data? See if your heart rate went up the previous night unbeknownst to you, followed by a day that wasn't miserable.

The elevated heart rate could be due to a REM sleep cycle. It's possible that a flood of stress hormones causes both the elevated heart rate and the next day's miserable feeling. When you look in the morning at your fitbit data and see that you had an episode during the night, the looking causes the stress hormones to spike and brings on that miserable feeling. That's why I suggest the experiment described in the first paragraph above.

We likely had sleep apnea for many years or perhaps decades before we got our first CPAP machine. Our bodies got used to dealing with the apnea. The heart rate elevates during an apnea, and it takes the body awhile to realize that it doesn't need to respond that way anymore because the CPAP machine is preventing the apneas.

Thank you. I have anxiety meds for use as-needed. Sometimes the overnight and next day issues happen even while taking them. It seems the higher my daytime HR gets, the worse my night is. Then a vicious cycle to a bad morning. The anxiety meds don’t seem to make much of a difference other than helping me deal with it a little easier.

I’ve used a cpap for about 20 years. This seems to have started sometime during the pandemic.

You are correct, most of the awakenings and high heart rate are happening during REM sleep (per Fitbit data and the fact that I always remember the current dream very vividly). 

Any clues from the OSCAR data for what might be causing the wake-up’s during REM as opposed to any other time? Does the data show anything meaningful?

Is my pressure too low, or too high? Am I mouth breathing? Could using EPR make this worse?

[Sleepster]

I would stop checking the fitbit data and the CPAP data so often. It's just adding to the anxiety.

I don't see any changes you need to make to your therapy, but I'm no expert. You will have to organize your OSCAR charts and post them again. http://www.apneaboard.com/wiki/index.php...ganization

I'd like to see your leak rate graph.

[cupcakechinchilla]

I would stop checking the fitbit data and the CPAP data so often. It's just adding to the anxiety.

I don't see any changes you need to make to your therapy, but I'm no expert. You will have to organize your OSCAR charts and post them again. http://www.apneaboard.com/wiki/index.php...ganization

I'd like to see your leak rate graph.

Thank you! I have added two nights worth of data at the higher level, let me know if you need any zoomed in views. I know there was a large leak on one of them, that is not typical as I had an issue with a new strap that night.

   
   

[staceyburke]

You are doing fine. You can see your pressures remained better the night your EPR was set to 3. Less increases which should mean a better nights sleep.

[cupcakechinchilla]

You are doing fine. You can see your pressures remained better the night your EPR was set to 3. Less increases which should mean a better nights sleep.

Thank you. I noticed I'm hitting 12.9 pressure, should I set it to 14 to give it some headspace? Is it better to have a narrow range (11-13) or a wider range (such as 10-14)?

One last question, any suggestion as to why I'm waking up during REM (see highlighted section of this screenshot): 
   

[staceyburke]

On July 11 it looks like you had a large mask leak that woke you up.

If you use EPR 3 I don’t think you need to raise pressure.