[CPAP] Low AHI but waking early still

[SunnyGC]

Hi - fairly new to CPAP after being treated now since May 2015 where I started with an AHI of 27 during my study. However during REM this increased to >50 - mostly Hyponeas.

I'm still having trouble with early morning waking and feeling very tired during the day for no apparent reason other than the Apnea. i.e. no depression etc.

My AHI moves around from approx. 3 to 6 over the days and weeks and my therapist says its technically OK. I downloaded Sleepyhead this week to look at the data for myself.

What I found is that during the early morning hours of 2-4am ish my AHI is often much higher than 5.0. It varies between 6.0 to 18.0 and probably averages 10. I suspect this is why I am waking up. Now its either the result of apnea related wakings or the machine pressure which increases sharply waking me up. Once I'm awake I find I tend to sleep very lightly but will often fall asleep only to wake up again shortly after.

Has anyone else experienced the clusters of apnea in the early morning that wakes them up?

[woozie38]

What I found is that during the early morning hours of 2-4am ish my AHI is often much higher than 5.0. It varies between 6.0 to 18.0 and probably averages 10. I suspect this is why I am waking up. Now its either the result of apnea related wakings or the machine pressure which increases sharply waking me up. Once I'm awake I find I tend to sleep very lightly but will often fall asleep only to wake up again shortly after.
Has anyone else experienced the clusters of apnea in the early morning that wakes them up?

Yes - this is me & I suspect many other PAPers too. I believe it could be because after having reclined on our side/s for some 4~6 hrs, we finally turn onto our back. This is the last thing we would want to do, but our bodies demand the relief & since we are asleep, are powerless to stop it. Almost immediately our airway begins to restrict & sometimes block off completely causing a rise in OA's, FL's & Hypopnias. Subsequent respiratory effort will cause awakenings. In the 15 some years I've been PAPing I have not found a solution. There are many suggestions on this forum that could work for you. There is a belt you can wear. You can even sew tennis balls into the back of your PJ jacket. My numbers are similar to yours & vary very little night after night. Try all suggestions put forward here & good luck.

[trish6hundred]

Hi SunnyGC,
WELCOME! to the forum.!
Hang in there for more answers to your question and much success to you with your CPAP therapy.

[TyroneShoes]

My original prescription was 5-20. Wide open ranges are often prescribed for new patients, until the APAP data can reveal what the range should be, especially if titration does not occur in the PSG or is inconclusive.

I found that the machine "ran away" a couple of times and went up to about 18, which would wake me. I then looked at voluminous SH data and determined that on other than those two occurrences, my pressure never rose above 13, so I lowered the top limit to 14, and it has not risen above 12-13 since, and not awakened me.

Raising the low limit also can help. The APAP (ResMed, anyway, they are all similar) raises 1 cm at a time, 1 cm per obstructive event or FL event, so if the pressure you need at a particular time of the night is 12, and your low setting is 6, it will take a minimum of 6 events that you must endure first to reach that pressure. If the low limit was 10, it would take just two events to get there, so you've lowered your AHI for that stretch by as much as 66%.

But raising the low limit too much is not good either; it can cause more CA events and more preponderance for leaks.

Leaks, in fact, may be why my S9 "ran away". Sometimes leaks confuse it and it raises thinking there was an event to respond to. So the first thing to do is look at your leak rate during these periods, and try to get that under control going forward.
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[SunnyGC]

Thanks for the advice thus far. I have been on the phone to my sleep tech and with some persuasion they agreed to make some adjustments. So low pressure has been increased to 7 for the next few days to allow some adjustment (small steps) and in the next phase they will start to decrease my upper pressure from 20 to reduce the sudden pressure increase which is also waking me up. My 95% pressure is around 8-9. Leaks are very low overall but there have been some leaks that coincide with apneas and pressure increases in the AM hours. I have an appointment late next week and am hoping that there are some positive changes prior to that.

[TyroneShoes]

...low pressure has been increased to 7 for the next few days to allow some adjustment (small steps) and in the next phase they will start to decrease my upper pressure from 20 to reduce the sudden pressure increase which is also waking me up...

Yes, that is the safest way to do that; a small step each week or so. My apologies for not suggesting that. It's always implied, but you are new. Err only on the side of caution.