[Symptoms] Waking up 15min after falling asleep - new insights

[McPhearson99]

I'm still having the issue where I wake up 15-20 minutes after falling asleep at the beginning of the night or after 6 hours of sleep. I think this is due to a combination of having a narrow airway/UARS, suffering from flow limitations when I go into REM sleep or initially fall asleep, and having a sensitive throat. I noticed that on days where my throat feels irritated, I'm more likely to end up in sleep-wake cycles. If I manage to stay asleep past the 20 minute mark, I usually will continue asleep for at least 6 hours.

When I take some sort of sleep aid (Benadryl, Trazodone, alcohol) I consistently fall asleep and stay asleep.

I started turning off my APAP and turning it back on whenever I have one of these events so that I have a way of accurately recording on my charts when I woke up. I've attached an overview of last night when I started doing this along with a zoomed-in view of the flow graph just before I turned the machine off. I'm making this post in hopes of getting feedback or insight on the following points. Currently I am using an AirSense 10 with pressure 12 to 18 and EPR 3 but I also have an old VPAP III BiPAP available for use.

• Is there a way to manage REM sleep associated flow limitations? Would switching to a BiPAP help and if so, how should I start and adjust my therapy?
  
• Do the flow graph details show anything unusual? I noticed that there seem to be 2 peaks in each breath on top of the usual inspiratory flow limitation waveform.
  
• What else can I do about my sensitive or irritated throat? I've already deep cleaned every container I use to drink water and my CPAP mask and tubing.
  
• Is there any other information I can provide that would be helpful for you to help me?
  

Thank you in advance.

[staceyburke]

I see high flow limits that may have caused your wake up. The Cpap raises pressure when it finds FL, you can see the pressure rise each time FL increase. They look like they caused a mask leak and that could be the reason.

We try to limit FLs using EPR and you have yours turned off. To turn them on you need to do two things.

Then EPR to full time

Set EPR to 1, 2 or 3

I would start at 3 and go down if there are problems.

[McPhearson99]

I could've sworn I already had EPR turned on, thank you for catching that.  I'll turn it on and see if there's improvement.

In case anyone else is having similar throat irritation issues, I found a drug cocktail that has a high success rate in keeping me asleep: 400mg ibuprofen, 50mg trazodone or diphenhydramine, and 1 or 2 cough drops (I use Halls).

[McPhearson99]

Better results with EPR but still had various wakeups before finally falling asleep after taking trazodone.
I'll keep EPR on since the charts look better but it doesn't look like it's the answer to my problem.

[McPhearson99]

Between trazodone and general exhaustion, I only woke up once today. However, I ended up swallowing a lot of air during the night. Overall, ended up being a decent night.
I've attached a zoomed in screenshot of the flow graph. Judging from the waveforms, I'm still getting inspiratory obstructions and that's what's causing me to wake up. I don't know why such a minor flow limitation is waking me up.

I'm also thinking of trying the BiPAP with a low EPAP and PS, something like 7 EPAP and 8-10 PS. I generally have very few obstructive events even at low pressures but a lot of flow limitations during REM sleep.

[McPhearson99]

Stayed on the APAP this night. Did not take trazodone or Benadryl, tried instead using a menthol/benzocaine spray. I think this has promise as I didn't wake up during the first half of the night but by the second half my throat was irritated by a second application of the spray. Might try a benzocaine only spray since I suspect the irritation was the menthol's fault.

Overall I think this experiment supports my theory that whatever is causing me to wake up just after I'm falling asleep is a sensitivity or irritation issue on top of my narrow airway. Awful night of sleep but at least for something.

[staceyburke]

I would lower the min to 8. Higher pressures can cause waking

[McPhearson99]

Lowering the pressure didn't seem to change much. I ended up taking trazodone around 23:30 and was able to finally fall fully asleep an hour later. I also tried using a soft cervical collar but it didn't seem to make much difference and I took it off at the same time I took my trazodone and went back to my chin strap.

[staceyburke]

You still have almost no obstructive events at min 8.  What I would try and see how a constant pressure and no EPR does.  

Min 8
Max 8
EPR off

And on the next OSCAR be sure we can see the flow limits as flow limits are controlled with EPR.

[McPhearson99]

I changed my APAP to CPAP mode at 8cmH2O. I had 3 wakeups before finally falling asleep and surprisingly very few flow limitations. I think that my APAP isn't picking up on subtler limitations because if I zoom in on the flow rate waveform I think I can see flattening and double peaks.
Am I just spectacularly sensitive to flow limitations and that's what's causing me to wake up with a jolt of adrenaline?