Am I waking up because of too much or not enough pressure?

[JamesD0079]

Hi everyone,

I've been on CPAP for over a year now and over that time my experience has been improving incrementally thanks to a bunch of changes i have implemented, many thanks to the advice I have received on this forum!

However, one thing that continues to happen and affects my tiredness levels greatly is that I wake up pretty much after every sleep cycle, sometimes I'll get through two, but often it's only one and I'll wake up. I find I am generally on my back when I wake up, but usually go to sleep on my side, but I'm also able to go to sleep on my back.

Based on my data below (last 2 nights), my questions is: Am I waking up because I am receiving too much pressure, or not enough pressure?

Please let me know if you need a close up of the data at any spots. Any help is greatly appreciated.

Thanks!

   
   

[DaveCar]

Do you use any pressure relief like EPR ?

[JamesD0079]

Hi... thanks, yes, EPR set to 2.

[EddyDee]

In your previous threads on this forum (it's best to keep all your therapy questions in one thread), has the issue of your flow limits come up?

Your machine is responding to flow limits by raising the pressure, sometimes substantially, in a very short time which may be causing you to wake up. I will defer to experts on this forum, but it looks like this could be related to the waking that you are experiencing.

I can't say if the flow limits are related in some way to your sleeping position or something else. Has this come up in the past?

[Sleeprider]

James, I am divided between recommending you set a lower maximum pressure, or use EPR 3 which would lower the flow limits that are driving pressure. Let's do both:
Mode: Autoset soft or for-her
Minimum: 7.0
Maximum: 9.0
EPR: Full-Time Setting 3.
This should provide less pressure variation, while allowing better control of flow limits and should resolve the sleep disruption from pressure fluctuation.

[mper6794]

Hi, James
_ just to share: I am a UARS (OSA only during REM) and RLS sufferer. I am some 6.0 years using a Bilevel aircurve Vauto. NIght after night with no OSA (< 2.0) or flagged FL (zero both columns). And yet, waking up only during REM sleep (at the very begginning or at the end truncated cycles; together with nightmares, which I have been trying to work out with Dreamwork when I wakep up)
_ tough remaining issue to work out! after several back and forth adjusts: currently ResMed AirCurve 10 VAuto PAP Mode: VPAPauto PS 4.2 over 8.6-14.2 (cmH2O). and Clollar. Slowly increasing EPAP up to some 10.
_ I have been managing and doing rather well with clonazepam 0.5 and those settings. Always trying to improve, however...
_ your sleep looks similar to mine. I would interpret that you, like for hundreths of people on these forums, you have trouble to run smoothly to REM stages (waking up, going to toilet, etc...)
_ Currently I think a Bilevel, ASV (much less a APAP) could resolve those wake ups. They might be related with a very sensitive, reactive to very minor flow restrictions nervous system, and so on.

All hte best and good luck

[JamesD0079]

Hi Sleeprider,
Thank you so much for your help and suggestions, i made the changes you suggested (EPR to 3, Autoset to soft - started at 6.6-9.0, moved it to 7.0-9.0 towards the morning) and overall had a better night, but still waking up during the REM stages, although definitely not as intensely. My sleep apnea is somewhat weird in that I often wake up before I even have an apnea, so it's really hard to tell whether it's the pressure or the lack of airflow that's waking me up. The previous couple of nights I had been waking up feeling quite dizzy and feeling this during the day, not as much today I thnk although I've just woken up, so I feel like that might be an indication of too much pressure, I dunno? I've recently been strenthening my airways with singing exercises and given up dairy which has made a massive positive difference to my airways, so maybe I don't need as much pressure... so hard to tell. (I am going to post a thread about my experiences with these soon).

Anyway, I've posted my chart from last night below and would be so grateful for your thoughts... I see someone has also posted a reply who has had similar experiences and i will reply to that also, as I think they may have some good points... they point out the nervous system thing, there's definitely something going on there I think, there has been a level of trauma  that my nervous system has had to endure through the last many years related to this sleep stuff, and it's very sensitive so I'm interested in exploring that a bit more..  thanks again for your help, I'm so grateful!

Last nights sleep
   

Previous two nights sleep
   
   

[JamesD0079]

Hi mper6794 ,
Thanks so much for your post and hearing about your experience and suggestions. i think you are right about the nervous system thing, as mentioned to Sleeprider, my nervous system has been through a lot with this sleep stuff (I would call it a level of trauma), that it's incredibly sensitive to even the slightest lack of airflow. Earlier in the piece I wouldn't even be able to fall alseep if there was a the slightest level of restriction in my airway (not a blockage mind you) and as you can imagine that was a perpetuating cycle and not much fun. I've made some really positive gains over the last year, I wear a soft collar also, use an Intake nasal dillator, have given up dairy, do singing exercises every day, avoid TV before bed, stretch and relax before bed etc. etc... all those little things have added up to make a massive difference (although it is quite consuming!) and like you, I guess I'm trying to resolve this waking up at the end of a REM cycle, which is kind of the last piece I hope... the nightmares thing for me is there too... however, last night was better from that point of view with the pressure turned down, so that's interesting... still weird as f$%^ dreams that had a strange edge to them, but not the intense nightmares that I often get... I was taking CBD oil at one stage which did definitely help me sleep through a lot better, but my understanding is that it affects your REM sleep which might not be great in the long term, but I'm keen to give it another go again to see if I can put together some decent nights... I will look into the Bilevel, ASV... I don't know much about them, thank you for this suggestion. Anyway, again, I really appreciate your feedback. I hope that you are also able to sort your remaining issue out... I'd be keen to see your chart if you feel like sharing.
Thanks again and take care!
J
p.s. I posted my chart from last night in my reply to sleeprider.

[mper6794]

_Hi, James
_ hereinbelow, you would find my last night, which looks indredibily good and rare (let us confirm during the my day), when I have only two wake up and trip to toilets, a 3;10 (truncated at the very start up of a REM cycle)....and at around 6;10, another REM truncated at after some 9 minutes after beginnning...the REM around 7;40 was followed by remembered vivid nightmares (just wake up and did Dreamwork, with EFT, etc)
all the best

[mper6794]

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