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

[McPhearson99]

At this point, I think I will give my old BiPAP another try to eliminate the RERAs that prevent me from falling asleep.
My plan is as follows:

1. Starting from a low EPAP of 7, find the highest PS I can tolerate without CAs.
   
2. Increase IPAP and EPAP in tandem, keeping the PS constant, until I can fall asleep consistently without waking up every 20min.
   
3. If I have a particularly bad night, use trazodone the following day to recover and try again the day after that.
   

Since the arousal I'm trying to avoid happen 15-20min after I fall asleep, I can iterate quickly to find the settings that work for me.

[McPhearson99]

One night, I decided to see how high of a pressure was necessary to stop my wakeups with an EPR of 1. I got to 18cmH2O and instead of falling asleep and waking up, I felt some sort of click or twang in my throat. I tried falling asleep again and I noticed that I also had to burp after the noise. Given these two facts, I think it's my epiglottis collapsing that is causing the noise and is also probably causing my other issues.
From what I've read on epiglottis collapse, it doesn't respond to CPAP well and increasing pressure exacerbates the collapse. This seems aligned with what I've experienced.

My current apnea is controlled with a combination of trazodone to avoid the 20min after falling asleep wakeups and a pressure of 10cmH2O with EPR of 2. I would like to eventually only need my APAP but until I can get a drug-induced sleep endoscopy to confirm epiglottal issues or pinpoint what other structural defect is causing my wakeups, my current setup is good enough.

[Jay51]

Thank you for posting that. I also hear a noise similar to the one you are describing.  It is more like a very soft "gurgling" sound.  This is  when air gets past my esophageal sphincter and goes into my stomach.  I don't have to burp afterwards, but that is what is happening.  
I have learned to ignore it, even though I have some lower abdomen stomach distention in the morning when I wake up.  Doesn't hurt much and leaves when I eat something.  
Lowering pressure decreases aerophagia.  Can try lowering pressure and see if it still occurs.  But you need high enough pressure to keep airway open, etc.  
It may be something different though.  And getting an endoscopy sound like a good plan IMO to check it out.  Especially if it keeps waking you up at night.  I hope you find a solution to this problem.

[ancheero]

I've got a very similar issue. Before cpap, it happened within 5 minutes of falling asleep - it happens whether I'm on my side or on my back, so it doesn't seem positional. I'd get caught in loops where I'd doze and wake up with adrenaline and feel/hear a sort of "clunk"; doze back off and it would repeat a couple times until I stayed asleep. 

I just started with my cpap this week and have noticed it's still happening, but thought I just would need to keep adjusting. I'll track it more closely now - it's really helpful to see a thread on this.

[McPhearson99]

Counterintuitively, if you are in fact suffering from epiglottal collapse like I suspect I am, raising the CPAP pressure will only make it worse. If the rest of your apnea is controlled by a lower pressure, keep it there.
I've found only two reliable ways of consistently falling and staying asleep: exhaustion or a sleep aid. 50mg of trazodone one hour before bedtime has helped me tremendously. I've also tried positional therapy, a cervical collar, and a chin strap but none helped with this issue.
Other things that I've found that helped (but not reliably) are proper hydration to avoid a dry throat and Advil. I do not now why the Advil helps. It may be the fact that I take it with water or it may be reducing inflammation/irritation in my throat.

If you find something else that helps, please let me know!

[gainerfull]

Have you tried optimizing your leaks at all? Not terrible but given how prevalent they are it could cause an arousal.

How'd it work out on bipap? What does your median, 95% and 99.5% inspiration times look like?

[McPhearson99]

The leaks usually don't coincide with any of the arousals that I'm tackling here. Mine usually happen once I'm fully asleep and I haven't noticed them so far.
I wasn't able to get my hands on a good BiPAP, only an old VPAP III. So, I don't have any hard numbers unfortunately. Subjectively, it didn't seem to change much compared to an EPR of 3, except that at higher PS settings (>5) I woke up from a few CAs. One thing I just realized I didn't try was setting a PS of 4-5 with the lowest EPAP the machine could provide, so that may have worked better for me.

In 2024, once I'm settled in to my new place and the holidays are over, I'll sit down with a new sleep specialist or pneumologist and see what they recommend. I will update accordingly with their recommendations and my outcomes. I will also update the thread if I figure out anything else that's helpful.

[McPhearson99]

I apologize for reviving an old thread, I'd like to share my solution to my waking up problem in case anyone else is having the same issue.

I finally figured out what was causing me to wake up shortly (i.e. 10-15min) after falling asleep: some sort of soft palate inflammation or irritation of uncertain cause. I haven't managed to pinpoint the true root cause but icing my soft palate for a while before going to sleep has reliably prevented the dreaded wakeups. I just bring a handful of ice cubes to bed with me and suck on them and push them against my palate while I read in bed. I suspect that electrolyte/hydration levels, what I've eaten during the day, and air pollution all play a role in triggering the inflammation that lead to waking up.

Now that I'm not waking up soon after falling asleep, my CPAP can do its job properly at 8cmH2O and I'm feeling much better. I'm not sure why my body reacts this aggressively against my soft palate relaxing when I first fall asleep and never at any other point during the night, I'm happy I found a reliable solution after this long.