[Symptoms] Good until 3am, then awake sadness

[AvocadoSniffer]

Hi folks - I was diagnosed with mild sleep apnea (AHI 5.4) late last year after years of poor sleep and daytime fatigue. I started use of a CPAP at a low pressure (5 - I have experimented with 4 and 6) which has successfully reduced my measured AHI to 0.8. I understand that this will never be 0 and that this is a great success. However, I still wake repeatedly in the night. While many nights I will wake up several times, typically I sleep soundly until about 3:20am, then have many awakenings after this time. It is not uncommon for me to have non-acid reflux during this awakening (I am on a PPI, so there is no acid, but material travels up the esophagus and is uncomfortable). This never happens when I am awake, even when lying down for long periods, and my sleep medicine doctor has speculated that this may be because of negative pressure due to apnea events "pulling" stomach contents up the esophagus.

I have included OSCAR screenshots from a representative night, as well as the content of an Wellue O2Ring.
   
   

I have observed that when I zoom in on the graph, I see a very stable heart rate and breathing pattern in the beginning of the night. However, at a certain point in the night, there is a very sudden change in breathing, which becomes somewhat sinusoidal, and I start having heart rate spikes. I typically do not have much if any apnea before this point.

   

I do not have any trouble getting to sleep, and typically can get back to sleep within 20 minutes after one of these awakenings (unless it is after 6:30am, in which case I cannot). I suffer from frequent migraines and low energy, palpitations, and generally still feel like dirt (though I have more daytime energy than pre-CPAP) - I am relatively certain the sleep disruption is to blame, as it was a major migraine trigger for me before these sleep problems developed. I am writing this in hopes that the experts on this board can shed some light onto what might be going on, and how I might make progress. Any insights or advice would be very much appreciated - this has severely damaged my quality of life; every night is a struggle.

[HalfAsleep]

Have you tried raising the head of your bed by 6-8 inches, so the bed slopes? This is typically a GERD solution, but maybe it would help with your non-GERD reflux. The docs thought I had reflux, so they urged me to try this. Turns out, I don’t have any reflux, but now I’m used to a sloping bed. I used leftover pieces of 2x4’s and 4x4’s and went with 6 inches total extra height. My bed is not very long, so that’s all the tilt I went with.

At any rate, perhaps you can separate out the reflux and sleep issues, so they’re both easier to address.

[AvocadoSniffer]

Yes, I have tried this, both with a foam wedge and an adjustable mattress raiser at a variety of heights. No impact from either.