[CPAP] Still Waking up in the middle of the night

[rdrivas]

Hello everyone - I have been using a CPAP machine for about 6 years now. Two years ago I have a second sleep study done because I was still waking up in the middle of the night (2 - 3 am) and had a hard time falling back to sleep. The second study showed central apnea events and the doctor prescribed the ResMed AirCurve 10 ASV machine, which I'm currently using. He has changed the pressure settings multiple times in the last 2 years and he said that my data looks pretty good on paper, but not much has changed in regards to my main concern (waking up in he middle of the night). I see my doctor every year now.

I will appreciate if someone would take a look at my charts and pressure settings and maybe provide suggestions to improve my sleeping. I posted an image on Imgur at http://i.imgur.com/b7Pyu57.png

Hopefully I followed the steps to upload the image correctly. Otherwise please let me know. Thank you,

[DavePaulson]

It does look pretty good. Do you have any pain issues that could cause arousals?

[chill]

Assuming that this is related to sleep apnea may be distracting your focus from other possibilities.You may be trying to solve something that is normal, not a problem, see Biphasic Sleep History.  It is a rare night that I don't wake up mid-way through for while, though I am usually awake for a short time than you report.  You may also have sleep maintenance insomnia.

[rdrivas]

No pain. But I seem to have vivid dreams most nights.

Also, I fall asleep pretty fast when I go to bed around 10:00 pm

[trish6hundred]

Hi rdrivas,
WELCOME! to the forum.!
Hang in there for more answers to your question and good luck as you continue CPAP therapy.

[ajack]

It's actually very normal, to wake up several times a night at the end of REM. Even if we aren't aware of it every time. Vivid dreams may be because you are now getting some REM sleep.

I'd google sleep hygiene and look in that area and perhaps a specialist in that field.
I don't look at the time, I can't change it and it becomes an issue of regular looking and it further wakes me up and frustrates me. The alarm will go off when it's time to get up.
I read a book with incandescent light till I get sleepy again. Most people work within a 90 minute cycle. Stay away from blue light, TV, phone/ipad etc.
http://www.med.umich.edu/painresearch/pa.../Sleep.pdf

[vivaldi]

Sleep hygiene is very important as ajack mentioned.  I would first try doing some of those things as a first step if you haven't been doing them already.

Secondly there are some prescription drugs your doctor can prescribe that help you stay asleep throughout the night, rather just knock you out like Ambien and other hypnotic drugs do.   Try talking to your sleep doc about these newer alternatives.

Thirdly there are some natural supplements that may help you sleep.  There's probably twenty or more different ones you can get from most online supplement stores.   I personally take 1000 mg of Niacinamide time release (it's a form of B3, like niacin, but it's not niacin.  You don't want to take niacin at this dose as it would cause flushing and it would be dangerous, whereas Niacinamide is generally regarded as safe at that dosage, talk to you doctor to make sure).   The niacinamide doesn't help me get to sleep quickly but it does help me stay asleep throughout the night.  I also take a time release melatonin at a small 1mg dose an hour or two before bedtime to help me get to sleep.    Everyone is different so these may or may not work for you.

[robysue]

rdrivas,

Welcome to the forum.  I am sorry to hear about your problem.  

In looking at your data, there are some questions that come to mind, but mostly they're not about the machine's therapeutic settings.

On the night you posted the data for, you turned the machine on and went to sleep at 21:05 (or 9:05 PM for those of us in the US). There's a clear wake at 1:15ish where you turn the machine off and back on after about 5 minutes.  Bathroom break perhaps?

Question 1: Did you have trouble getting back to sleep after that 1:15 wake?  (Given the evenness of the flow rate data, my guess would be that you had little or no trouble getting back to sleep, but it's still worth asking.)

And after that 1:15 wake, you wake up and turn the machine off for good around 4:45 AM. And I assume at this wake you got up.  So you used the machine for a full 7.5 hours.  

Question 2: How much sleep do you think you got during the 7.5 hours of usage?

Question 3: How rested (or unrested) did you feel when you got up at 4:45am? And what did you do after that early morning wake?  Is this your normal waking time?

Question 4: What is your desired sleep schedule?  When do you want (or need) your bedtime to be? When do you want (or need) your wake up time to be?

Finally about your data: Most of the night is exceptionally clean.  As in there's absolutely nothing going on that we can see, although what you posted does not contain data about so-call machine-triggered breaths vs. patient-triggered breaths, and that might be useful since central apneas were why the ASV was prescribed in the first place.

But there is one cluster of events: There are 3 hypopneas and 5 apneas scored between 3:50 and 4:10. As I recall, your machine doesn't try to determine whether an apnea is central or obstructive in nature. And while the usual assumption about Hs is that they're obstructive, if the primary problem is central apnea, it's possible for the Hs to be central hypopneas.  But any way you look at it, 8 events in a 20-minute period is quite a few events---if you were sound asleep at the time they were scored. So that raises the next question:

Question 5: Were you sound asleep, lightly dozing, or awake when that cluster of events happened? Or do you just not know whether you might have been awake during that cluster?

If this were data from a typical obstructive sleep apnea patient, it would be tempting to blame that cluster of events on a bit of back sleeping or a bit of REM sleep or a combination of the two. But I'm not sure we can do that here.  Which brings me to my final question:

Question 6: How often do you see event clusters like the ones in this data? Every night? Most nights? A few nights every week? A few nights every month?