Help preparing for first doc visit in 4 years

[Dormeo]

It's good to know you're headed toward CBTi and working on some issues in advance. I think it'd be a good experiment to try greater PS and see whether that makes any difference to you.

It's pretty common to wake up after REM sleep. The question is how long it takes to get back to sleep. If it's just a minute or two, the post-REM wake-ups aren't much of an issue. Your sleep cycles will move along normally and you'll get enough sleep over the course of the night. But longer wake-ups deprive you of needed sleep and can reduce the number of cycles you have per night.

Thanks for letting us know how things are going. Keep us posted.

[fishfinderG]

I've got another follow up appointment with my sleep doctor in a few weeks.  I'm still dealing with waking up too early and being tired during the day and evening.

Over the last few months I've done a Cognitive Behavioral Therapy for Insomnia program available as a mobile app.  I've also started seeing an in-person Therapist.  The CBTi program and Therapist have given me some techniques to use that do help me avoid insomnia when I first get in bed, but I'm still waking up during the night a few times, and still waking up after only 6-7 hours of sleep feeling tired but unable to fall back asleep.

The therapist is asking me to very seriously reconsider if the reason I'm waking up has to do with my sleep apnea.  She doesn't believe that stress is waking me up early.

So... Sleep Doc says it's probably just stress.  Therapist says it's probably sleep apnea


I guess I'm back to scrutinizing my therapy and trying to discern if my cardioballistic laden flow chart is somehow obscuring flow limitation or other signs that my breathing is still to blame for waking up early.


Two interesting things that I figured out by reviewing my last 3+ years of data:

1. The day before I get stuffed up from a sinus infection I have my lowest flow limitation nights.  My sinuses get dried out, painfully so, and while I'm dried out I seem to be able to breath better in my sleep.  I also see that when I first lay down at night I have a few minutes with pronounced flow limitation until my nose clears from the humidity and pressure. Maybe I should ask for a consult with an ENT? Basically all my remaining events are a snort followed by an arousal so this could just be a congestion issue in my nose?


2. Static pressure around 9.6 + ample humidity + EPR=3 does seem to increase the chances that I make it through most of the night with only a few wake ups.  It's not perfect but those settings appear to be better than anything else I've tried.  I'm tempted to try higher pressures again but don't think I can make that work without a BiPAP to combat aerophagia.  I can bring this up with my doc but I have a hard time seeing them let me just try out a BiPAP for fun.

[Dormeo]

The clash of opinions between the therapist and the sleep doctor is not so helpful, is it!  I do think it'd make sense to see an ENT; of course you'll want to explain your sleep and PAP situation.  You might ask the ENT whether a referral to an allergist could be helpful.

Do you have a reason to think that higher FLs are correlated with worse sleep?  If you don't, try keep a notebook in which you make a brief daily note about what the previous night seemed like to you and how rested or unrested you were during the day.  Also note your hours in bed, your FL data, and your AHI.

After a couple of weeks, it should become clearer to you whether the FLs are part of your sleep problem.  If they are, and if the FLs are originating in your nose, then a bilevel machine is unlikely to help, since the inside of the nose is not going to be pushed back (opened up) by PAP pressure.  But if the FLs originate in your pharynx, a bilevel machine definitely could help, since an increase in PS can really reduce FLs.  I've posted a typical FL graph from my Airsense 10 Autoset days and another from my VAuto with PS of 5.  (Note that I customized the Y-axis for both.)

[fishfinderG]

Thank you again, Dormeo. Your post encouraged me to step back and consider if perhaps I've been trying too hard to get flow limitations to 0 even though I don't have any proof that removing all flow limitation is important to my sleep quality. 

The wiki says that flow limit 95% under .1 is great.  I've been under .1 for a long time but kept slowly increasing pressure to try to get lower since I believed that flow limits were waking me up in the absence of some other explanation.

I've gone back to a range to reduce risk of aerophagia and leaks. Also trying EPR=2 instead of EPR=3 since that appears to make my REM sleep more stable, even if it does lead my flow limit 95% to be .01-.04 higher.

CBTi therapy still isn't helping with waking up early but my insomnia during the first part of the night is a lot better.



I'm going to give these settings a week and see if any patterns emerge in sleep quality and potential triggers that are still causing me to wake up early.



   

[Dormeo]

I'm glad to hear that the first part of the night is going better for you. And giving new settings some time before trying to assess them is an excellent idea. I think for you the main way to assess settings should probably be how you feel the next day, rather than data gleaned from Oscar. So again, you may want to try keeping notes. If you're anything like me, it is otherwise hard to keep track of what correlates with what.