[Diagnosis] On cpap for 3 years with low AHI..but still waking at least 8+ times (Oscar Data)

[Metalsymphony]

Hello everyone! So long story short, I've been using my cpap for around 3 years. And while it does help a little and my AHI is usually really low, I still wake up at least 8+ times a night. My pulmonologist see's the myAir Data and what the Resmed 10 says and claims my stats are great but honestly some days I feel like it barely helps at all, or that I'm really not getting truly deep, restful sleep. I usually have a lot of different dreams in a night and can clearly remember almost of all them usually, so I suspect there's something else at play here. And while I understand it's normal to wake up a few times a night...it can be so excessive sometimes. I'm talking upwards of 15 times occasionally. Luckily I have a big data sample on my SD and imported it into OSCAR, so hopefully someone can shed some light or give guidance. I chose a random day and have the overall statistics after a few years. Thanks!

[sheepless]

most sleep docs are useless for anything other than diagnosing obstructive sleep apnea. imo you're on your own.

there are many things that could be waking you. I wake to the point of masking off between 3 and 9 times a night and wake enough to roll over probably twice that. leaks and fluctuating pressure tend to wake me. my wife's snoring wakes me. the barking dog wakes me. I can ascribe 2+ full awakenings to my periodic limb movements.

scrutinize your oscar charts to look for clues. scroll through them at a 10 minute view scale and again at about a 3 minute view. if you mask off, look especially at the minute or two before that. if you don't, try to leave a marker for oscar to report like a quick large leak or a giant breath when you wake up. audio/video recording might reveal something. also consider keeping a journal of some kind noting daily things like food, drink, meds, stress, etc., anything that might influence sleep. keep a notepad or voice activated recorder nearby to note how you feel as it happens. anxious, sweating, urge to pee, nightmare, noise, panting, pain, whatever. dig deep into your full report of your sleep study, looking for arousal/awakening statistics. see if there are any explanations. movement is probably the most common. 'spontaneous' is meaningless imo but indicative of something awry that bears investigating.

paying close, systematic and critical attention may reveal why you wake up so often.

[Metalsymphony]

Thank you for your response. I have been going over the data and trying to find some trends day by day, and man from the looks of it I'm all over the place. I most commonly have an equal mix of hypopneas and centrals, followed by occasional RERAs and least common, Obstructives. The hypops and centrals *seem* to follow when I have high leaks, which luckily isn't too often. Other than that, I'm having a hard time seeing any common occurrences and it's so random for myself when events happen. I do tend to toss and turn a lot and I sleep like a furnace. I'm also a mouth breather ( Deviated septum ), and a side sleeper. I hope that helps shed a little more light on my problem.

[sheepless]

I hear you. in 4 years I've discovered some of what wakes me but not everything apparently. I still have trouble sleeping longer than 2-3 hours at a time but that's a big improvement over not being able to sleep more than 30 - 60 minutes at a time when I first started papping.

based on your last description, I'd start by trying to figure out what makes you such a hot and restless sleeper. that's pretty vague but that's kind of the point. if it was obvious, it wouldn't be a question. it's up to you to systematically try new things and eliminate others to try to narrow the possibilities. sleep hygiene practices are a good place to start.

[Metalsymphony]

Sorry I should of clarified. I'm normally a hot sleeper (I thought my apneas might of been the reason) but have been okay for a while now. I live in FL and have to use just a sheet and keep my ac at 65° in order to stay cool enough. I do think I practice sleep hygiene fairly well. Completely pitch black room, no blue light an hour before bed, .5mg melatonin to help and no caffeine past 12pm. And working out at least 4 times a week. I feel you, it's been a struggle to figure out and try to find how to get the best sleep I can as well. 

I did see some other threads on here and reddit stating that the EPR setting at 3 can cause more centrals in some, which get a fair amount of. I think I'll try 2 for a bit and see how that goes. Also I see that I could of formatted my OSCAR images better according to the wiki. So I'll collect and post those after a few days, properly. Hopefully that'll give some better insight.

[SarcasticDave94]

The CA you're referring to is the treatment emergent variant. As you've stated you've been on PAP for 3 or so years, that type of CA should not apply to you. The .12 CA average your OSCAR data shows isn't worth editing the EPR.

[Metalsymphony]

Okay, I think I understand what you're saying. Sorry I'm still new to getting a deeper understanding of all this. And that's a relief (pun definitely intended) because last night on EPR 2 was pretty awful. To add to everything, I've never had a in lab study done. It was just the take home kind. Would that be worth looking into? I've had bad sleep since I can remember and the CPAP definitely helps, but I still can't recall a truly restful nights sleep even with my AHI at .02-.05 most of the time.

[SarcasticDave94]

Unless there's aspects that only a lab test reveals, mostly now that you've got a PAP machine, it's going to be a waste of time and money.

[Metalsymphony]

Okay gotcha. You seem very knowledgeable so I have another question. So I have a deviated septum. Now during the day I breath through it pretty often despite the deviation, and I've used breathing strips before which definitely help. Do you think the pressure from a nasal mask would "open" it up more and allow me to breath better? I was prescribed a FFM from my doctor but it's probably because I told him that I'm a mouth breather and I've wondered if one would help me get more restful sleep.

[Crimson Nape]

Based on your statements above, I suggest that you look into the Resmed F30 or F30i. The only difference between the two is the F30 uses a front hose mount and the "i" model uses an overhead connection. Both are listed as FFMs but are actually hybrids. They have a mouth enclosure, but employ a nasal pillow for the upper area. This provides the pressure expansion enjoyed by a nasal pillow and, at the same time, allows for the patient to mouth breathe without degrading their therapy.