[Treatment] Disturbances later in sleeping period

[Greenbean]

                       
For as long as I can remember I have been on a quest for the golden chalice holding eight hours of refreshing sleep. When I find it I will win the Powerball, lose 30 pounds, grow three inches and age backwards for 20 years. I am halfway there. Meanwhile I am hoping for some help with my cpap.

I sleep well for the first 4 +/- hours but then have disturbances which often don't bring me fully awake but arouse me enough that I know I've been disturbed. I futz around with my mask but it seems ok.  Very ocassionally I pull it off just in case I will sleep better without it. Indeed, SleepyHead says I don't have any concerning leaks.  Sometimes it's just to shift position a bit due to creaky bones. Sometimes I just don't feel great when I awake, and looking at SleepyHead shows stuff happened.

I see flow limitations but I don't know how to interpret any of the fine SleepyHead charts or what might be the cause. I am attaching a few charts with some of the areas in question and will provide more if it would be helpful. I would appreciate any suggestions you might have. Thank you.

[Reznik]

I am not an expert by any means, but my understanding is that as you get past 4 hours of sleep, the length of your REM cycles go up quite dramatically, and REM sleep is often associated with breathing disturbances, including apnea.  I often find that I wake up at 5-6 hours with an AHI <2, and then I go back to sleep and wake up with an AHI that has jumped up dramatically during the last two hours of my sleep cycle.

Since you have a Respironics Autoset machine, every time that you have an apnea lasting > 10 seconds, you get a pressure pulse that the machine uses to detect whether you're having a central apnea.  Those pulses may disturb your sleep and even wake you up, especially when you have several in a row.  Imagine your wife/spouse/partner grabbing your mask and bouncing it everytime that you have an apnea, and you'll get the picture.  You might want to try a machine that doesn't do central apnea detection.  Without those pulses, you may find that you sleep better during the last few hours.  I know that I do.

Finding a machine that doesn't send those pulses isn't easy.  Resmed's machines actually send MORE pulses - they start at 3 seconds into the apnea and continue until you start breathing again.  Only the entry level Resmed CPAP and the entry level Respironics CPAP machines send no pulses.  The Resmed AirStart 10 CPAP ($349 at Supplier #1) Commercial Link Removed also sends no pulses.  However, all of these machines are bricks - they give no detailed data at all.  And the AirStart gives NO data, not even a summary showing AHI at the end of the night.  

The Resmed AirCurve 10 VAUTO can be configured NOT to send the pulses (in S mode with Easy-Breathe Off).  I use that and love it, but I hate that I had to pay double the price of a CPAP machine just to turn off the pulses.  I believe that ST and ASV machines also do not send the pulses, but they're even more expensive.  These machines do give both detailed data AND summary data, but they are all super expensive.

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[Greenbean]

Thank you, Reznik. I'm sure insurance wouldn't cover a different machine if for no other reason than that I'm getting very good AHIs with this one. If this is from normal/typical sleep changes maybe I can train myself to ignore them like I've pretty much trained myself to stay on my left side. Also, maybe I should try getting up after the four or so hours (that is still more sleep than I've gotten for years) instead of drifting in and out to get closer to the supposed ideal of eight hours. I was hoping there were some settings tweaks I could make. I will lower my expectations and appreciate the improvement I've gotten.