Inexplicable fragmented sleep

[koy23]

I wrote few posts here on the board, but i decided to make this in a post on its own because all the other posts i wrote were not the main issue.
The main issue is i can't have a good night sleep because i keep waking up 4-5 times a night ( always in rem cycle, i wake up remembering the dream)
This sleep quality makes me feel like a zombie all day.
This has been ongoing since August 2018, i developed LPR (inflammation in the larynx) because of prolonged acid exposure from the stomach GERD.
i did a sleep study and it showed :

Total number of awekening > 2 epochs : 44.0
Sleep latency: 60.5mn
N1: 12.4 %
N2: 72.6%
N3: 10.1%
REM: 4.8%
Stage shifts: 191.0
REM Latency: 146.0 mns

22.8 Arousals/HR
0.0 arousals/hr were PLNs related
12.9 arousals/hr : apnea/hypopnea
6.5 RERA/hr
3.4 arousals/hr spontaneous

Sleep continuity : 2.6 mns.
Delayed REM onset.

Sleep quality: avergae moderately restless
Apnea and hypopnea index(REM and NREM) : 16.8/hr
apnea and hypopnea index (REM) : 42.6/hr
apnea and hypopnea index (supine) : 17.6/hr
RDI (REM and NREM) : 23.3/hr
baseline O2 saturation : 95.4 %
lowest O2 saturation : 88%
number of O2 desaturation : 20.0
duration of O2 saturation less than 90% : 0.4

After that i got an APAP REsmed 10 autoset, i tried all possible variables for one and half month but i was still waking up.
here is the SD card data :
https://drive.google.com/file/d/19sS3NE2...sp=sharing

my notes are : 
i can't tolerate higher pressure because of aerophagia (> 10)
i wake up with rapid large increase of pressure.
i have lower OA pressure when i sleep on my side which i started after Jan 18 in the files using tennis ball.
I think i need a high pressure to overcome RERAs but can't do it because of aerophagia, so i switched to bipap auto : Aircurve 10 vauto.

Here is my first night :
my notes is : i had almost no aerophagia with ps 4, epr 5, and ipap 9 to 13.
i woke up more times than normal ( every 2 hrs, i marked only 2 awekenings by resetting power, but not the rest )


I almost feel like i tried everything, i saw a similar post here for someone with 14 pages of post, with weird airflow curves, who also tried everything and did not have a solution from the board.

I wonder if there is help , i used to sleep 8 hrs straight before august and for the rest of my life.
I am 39 years, male, 6'1" and 210 lbs, just lost 10 lbs with low acid diet to fight reflux, i am not taking ANY medication do not some or drink alcohol.

thank you

[JJJ]

[quote pid='283908' dateline='1548890916']
The main issue is i can't have a good night sleep because i keep waking up 4-5 times a night ( always in rem cycle, i wake up remembering the dream)
This sleep quality makes me feel like a zombie all day.
This has been ongoing since August 2018, i developed LPR (inflammation in the larynx) because of prolonged acid exposure from the stomach GERD.
I did a sleep study and it showed:
my notes are:
i can't tolerate higher pressure because of aerophagia (> 10)
i wake up with rapid large increase of pressure.
i have lower OA pressure when i sleep on my side which i started after Jan 18 in the files using tennis ball.
I think i need a high pressure to overcome RERAs but can't do it because of aerophagia, so i switched to bipap auto : Aircurve 10 vauto.
Here is my first night :
my notes is : i had almost no aerophagia with ps 4, epr 5, and ipap 9 to 13.
i woke up more times than normal ( every 2 hrs, i marked only 2 awekenings by resetting power, but not the rest )
I wonder if there is help , i used to sleep 8 hrs straight before august and for the rest of my life.
I am 39 years, male, 6'1" and 210 lbs, just lost 10 lbs with low acid diet to fight reflux, i am not taking ANY medication do not smoke or drink alcohol.

[/quote]
I have suffered from fragmented sleep like you but with some differences. First let me explain the differences and then I will tell you what I tried, and what worked and what didn't.
My first sleep study was at the end of March, 2012. I was diagnosed with severe sleep apnea (~60 events per hour on my back and ~40 per hour on my side. In the meeting with the sleep doc after the study she said that I was 'all over the bed,' but that restless leg syndrome was not indicated. She prescribed a Philips Respironics System One APAP with a pressure range of 5 - 15 cm.H2O. When I was younger - up to about my middle 50s - I slept all the way through the night. But then I started having awakenings, first just one per night, and only occasionally, but over several years increasing to four or five per night. For a long time before the 2012 sleep study I had suspected sleep apnea, so the diagnosis of severe sleep apnea wast not a shock. In the pre-study meeting with the sleep doctor I mentioned the awakenings and she said that they were no doubt caused by the apneas, and that after I had it controlled with a PAP I would go back to sleeping the whole night through.
I picked up the machine and started educating myself, eventually learning how to change the settings and much more. By the end of the first month I had changed the pressures from 5 - 15 to 12 - 18 cm.H2O and my AHIs were finally averaging only a little over 2, and never over 5. But the awakenings continued as before. Thinking that it might take a little longer for the benefit to make a difference I stuck with the machine for another month. But when I still saw no change in my awakenings I went to see the sleep doc again. She offered a referral to a psychologist, on the theory that my awakenings were caused by mental issues. I did not follow up with the psychologist. I went home and continued with my PRS1. Over the next several years I continued, changing once to a Resmed machine, and eventually setting the pressures to 15 - 20 cm.H2O. I just put up with the awakenings.
In late March, 2018 my Resmed machine crapped out (motor bound up) and I had to get a replacement. By then I had Kaiser Permanente (an HMO), and they offered a Dreamstation APAP for ~$300 co-pay, so I took it. (A couple weeks ago I traded it in for a Dreamstation BIPAP, currently set at 15 - 25 cm.H2O.) Shortly after getting the first Dreamstation I made an appointment with the KP sleep guru (an NP, not an MD, but he really knows sleep apnea). I brought up the awakenings, and he ordered a new sleep study. I had another meeting with him after the sleep study, and he said that they had definitely observed restless leg syndrome. And then he said that restless leg syndrome can cause awakenings. He gave me a prescription for gabapentin (Neurontin) to stop the RLS. After a few weeks it made no difference, so I went back and he changed the prescription to pramipexole (Mirapex). After three weeks I went back to see him again because the pramipexole also had no effect. He changed it to ropinirole (Requip), and I tried that for several weeks, but still no change in the awakenings. When I went back to see him again he suggested that we stop with the RLS drugs and just try a plain sleep medication. He wrote me a prescription for trazadone (Desyrel), and it finally worked. That is, it changed me from having four to six awakenings to two to four. He had given instructions to start with 25mg and go up to 50mg if necessary, but he pointed out that trazadone is also used as an antidepressant, with very much higher doses. When I discovered partial success with 25mg I went up to 50mg, expecting even better results, but I was still having awakenings, so eventually I went up to 100mg, and I still have awakenings. From my experience it seems like trazadone is one of those 'diminishing returns' druges, e.g., you take 25mg and you get X amount of benefit; but if you double the dose you don't get 2X of benefit, maybe only 1.5X, and if you double it again maybe you get only 1.75X. But note that is pure speculation on my part. 
I have a meeting with my sleep guru in a couple of weeks, where trazadone will be the topic. I'll keep y'all posted on my continuing saga.

[stanleydean]

Hi koy,

While my therapy seems, as far as I can tell, to be working very well and I am satisfied with my overall sleep experience I have learned over the years that a lot of outside factors can impact my quality of sleep. For example my right knee is totally shot and replacement is not an option for several reasons. Some nights there are times when no position is comfortable for that knee. That effects my quality of sleep. I do need a bathroom break once or twice a night but at one time it was more often and really impacted my sleep. A couple of minor prostate procedures and a RX for Flomax helped there. So if you do have any outside factors that may be contributing to your situation try and lessen or remove them. Hopefully some of our more competent members will be giving you helpful input on your machine settings etc.

Wishing you the best on your journey,

Stan

[Ockrocket]

A totally sideways step.... 

I started using eye masks when sleeping at night, even found one that works over the nose part of the F&P Eson nose mask, now I sleep totally undisturbed most nights.
It turns out that my eyelids are thin, and I'm super-sensitive to even low level light when I'm asleep (and I can see well in the dark, guess I was a cat in a past life   )

[Hydrangea]

I wrote few posts here on the board, but i decided to make this in a post on its own because all the other posts i wrote were not the main issue.
The main issue is i can't have a good night sleep because i keep waking up 4-5 times a night ( always in rem cycle, i wake up remembering the dream)
This sleep quality makes me feel like a zombie all day.

my notes are : 
i can't tolerate higher pressure because of aerophagia (> 10)
i wake up with rapid large increase of pressure.
i have lower OA pressure when i sleep on my side which i started after Jan 18 in the files using tennis ball.
I think i need a high pressure to overcome RERAs but can't do it because of aerophagia, so i switched to bipap auto : Aircurve 10 vauto.

I had a somewhat similar experience, so I'll share what worked for me.
Aerophagia
- I started sleeping at a more inclined angle.  I put a pillow under my shoulders, and then another under my neck/head.  So basically I sleep on 2 pillows (thus elevating my head & shoulders). 
- If I need to sleep on a side, I do not sleep on my left side.  I had read that on here somewhere, that the air gets stuck if you're on your left side, but can more easily come back up and out if you're on your right; and I've certainly found that to be the case.
- I lowered my max pressure.  Once I got the aerophagia under control, I've slowly raised the max pressure.
Waking up with large increase of pressure
- I lowered my max pressure, but made sure my AHI was still under control.
The ResMed causes me what you call "inexplicable fragmented sleep", but the DreamStation does not.  I've finally whittled it down to the more aggressive response of the ResMed - it disturbs my sleep.  DreamStation's "softer" response to apnea events does not interrupt my sleep.  Once I figured that out, I tweaked the ResMed's response to be "soft", and that has helped.  I've decided I'm a candidate for ResMed's "For Her" machine, since my body responds better to a "softer"/less "aggressive" response to my apnea events.

[koy23]

I wrote few posts here on the board, but i decided to make this in a post on its own because all the other posts i wrote were not the main issue.
The main issue is i can't have a good night sleep because i keep waking up 4-5 times a night ( always in rem cycle, i wake up remembering the dream)
This sleep quality makes me feel like a zombie all day.

my notes are : 
i can't tolerate higher pressure because of aerophagia (> 10)
i wake up with rapid large increase of pressure.
i have lower OA pressure when i sleep on my side which i started after Jan 18 in the files using tennis ball.
I think i need a high pressure to overcome RERAs but can't do it because of aerophagia, so i switched to bipap auto : Aircurve 10 vauto.

I had a somewhat similar experience, so I'll share what worked for me.
Aerophagia
- I started sleeping at a more inclined angle.  I put a pillow under my shoulders, and then another under my neck/head.  So basically I sleep on 2 pillows (thus elevating my head & shoulders). 
- If I need to sleep on a side, I do not sleep on my left side.  I had read that on here somewhere, that the air gets stuck if you're on your left side, but can more easily come back up and out if you're on your right; and I've certainly found that to be the case.
- I lowered my max pressure.  Once I got the aerophagia under control, I've slowly raised the max pressure.
Waking up with large increase of pressure
- I lowered my max pressure, but made sure my AHI was still under control.
The ResMed causes me what you call "inexplicable fragmented sleep", but the DreamStation does not.  I've finally whittled it down to the more aggressive response of the ResMed - it disturbs my sleep.  DreamStation's "softer" response to apnea events does not interrupt my sleep.  Once I figured that out, I tweaked the ResMed's response to be "soft", and that has helped.  I've decided I'm a candidate for ResMed's "For Her" machine, since my body responds better to a "softer"/less "aggressive" response to my apnea events.

Thanks that was super helpful, how did you tweak response to be softer ? By limiting the range ?

[Hydrangea]

I had a somewhat similar experience, so I'll share what worked for me.
Aerophagia
- I started sleeping at a more inclined angle.  I put a pillow under my shoulders, and then another under my neck/head.  So basically I sleep on 2 pillows (thus elevating my head & shoulders). 
- If I need to sleep on a side, I do not sleep on my left side.  I had read that on here somewhere, that the air gets stuck if you're on your left side, but can more easily come back up and out if you're on your right; and I've certainly found that to be the case.
- I lowered my max pressure.  Once I got the aerophagia under control, I've slowly raised the max pressure.
Waking up with large increase of pressure
- I lowered my max pressure, but made sure my AHI was still under control.
The ResMed causes me what you call "inexplicable fragmented sleep", but the DreamStation does not.  I've finally whittled it down to the more aggressive response of the ResMed - it disturbs my sleep.  DreamStation's "softer" response to apnea events does not interrupt my sleep.  Once I figured that out, I tweaked the ResMed's response to be "soft", and that has helped.  I've decided I'm a candidate for ResMed's "For Her" machine, since my body responds better to a "softer"/less "aggressive" response to my apnea events.

Thanks that was super helpful, how did you tweak response to be softer ? By limiting the range ?

On my ResMed 10 Auto (I forget the official name of it), in the clinician settings, you can change the response from normal (I forget what they specifically call it) to "soft". Sure enough, it helps me sleep much better!

[MitchS]

I had a somewhat similar experience, so I'll share what worked for me.
Aerophagia
- I started sleeping at a more inclined angle.  I put a pillow under my shoulders, and then another under my neck/head.  So basically I sleep on 2 pillows (thus elevating my head & shoulders). 
- If I need to sleep on a side, I do not sleep on my left side.  I had read that on here somewhere, that the air gets stuck if you're on your left side, but can more easily come back up and out if you're on your right; and I've certainly found that to be the case.
- I lowered my max pressure.  Once I got the aerophagia under control, I've slowly raised the max pressure.
Waking up with large increase of pressure
- I lowered my max pressure, but made sure my AHI was still under control.
The ResMed causes me what you call "inexplicable fragmented sleep", but the DreamStation does not.  I've finally whittled it down to the more aggressive response of the ResMed - it disturbs my sleep.  DreamStation's "softer" response to apnea events does not interrupt my sleep.  Once I figured that out, I tweaked the ResMed's response to be "soft", and that has helped.  I've decided I'm a candidate for ResMed's "For Her" machine, since my body responds better to a "softer"/less "aggressive" response to my apnea events.

Thanks that was super helpful, how did you tweak response to be softer ? By limiting the range ?

On my ResMed 10 Auto (I forget the official name of it), in the clinician settings, you can change the response from normal (I forget what they specifically call it) to "soft". Sure enough, it helps me sleep much better!

I find this mode helpful as well. It is located at: Clininal Menu> Therapy > Mode. 

It will still work within the pressure range you have set. It will not be as aggressive when changing pressures. ResMed’s soft mode is not the same as Resporonics’ apap treatment. I found the pressure pulses my DreamStation uses to be disruptive to my sleep. The ResMed soft mode is much better.

I have also come to the conclusion that EPR disturbs my sleep, as well.

[Hydrangea]

I found the pressure pulses my DreamStation uses to be disruptive to my sleep. The ResMed soft mode is much better.

I have also come to the conclusion that EPR disturbs my sleep, as well.

That's interesting. I've been wanting to experiment (now that I've figured out that - with the ResMed - I respond better to its softer mode), but I haven't had a time where I had consistency in my life, and an opportunity where I don't mind risking being more tired & brain fogged.

I've definitely had to decrease the EPR in order to get rid of the daytime clicking and popping in my ears.  I've pondered fully eliminating the EPR, since I've found it distracting while falling asleep. So now I'm going to have to experiment with this as well!!!!

[rbellamy]

Hello Koy:
I'm new here and read your January post with much interest as we appear to have similar stories re: fragmented sleep.  Before diving into my history, I was wondering how things were going and if you'd since identified possible causes or remedies.

Thanks,
Bob