[Treatment] Fragmented sleep all night

[foxmt58]

I would be most appreciative if someone could help me with my fragmented sleep
at night.  I'm not taking any medications for sleep.  Here is the machine I'm on:
 
ResMed AirCurve 10 VAUTO
 
Settings:
 
VAuto mode
Min EPAP 12
Max IPAP 20
Pressure Support 4
Ti Max 2
Ti Min .3
Trigger Medium
Cycle    Medium
ResMed Medium Quattro Full Face Mask
Auto Climate Control
 

The problem is that my respiratory rate is about 15 BPM for about an hour then the rate increases to about 20 and is very erratic for about 20-30 minutes and then I wake up.  This happens from 6-8 times each night which wrecks my sleep.  The problem is that this often happens when there are no leaks, no flow limitations, no detected apneas and the pressure range is still 12-16.  When there is clearly an apnea or flow limitation the pressure range increases to 14-18 and sometimes this restores normal flow but often it does not work and I wake up.  I think that after about an hour the muscles supporting the tongue have completely relaxed which results in partial or complete blockage. Are any of the settings wrong and if so what should be changed?  I know the Min EPAP and Max IPAP could be increased but this might just cause more leaks. Thanks for any help you can provide.  If needed I could supply some data after I figure out how to do that.

[Walla Walla]

It would help if you could download sleepyhead software and posted a chart. The links are below. Normally if there if there is some blockage it would show up as flow limitations and that would trigger a pressure increase. It sounds like you may be dreaming during the REM stage of your sleep and it's causing the increase breathing. But just guessing without anything to go on.

[Sleeprider]

The most useful data, and easiest to post would come from #Sleepyhead. Organizing and attachment instructions are in my signature.

From your description, I think slowly raising pressure support may suppress flow limitations. It seems your apnea rate is low, and you don't say if events are obstructive or clear airway.

[foxmt58]

I am a little lost in how to post a Sleepyhead image. I will try to do that a little later.

[foxmt58]

[attachment=9173]

As you can tell I'm new to the Sleep Apnea Board.  Hope this helps.

[Sleeprider]

Good job on the chart. Nothing stands out as being related to the therapy breaks, and AHI is very low. My impression is your pressure may be higher than you need, and could see you dropping EPAP min to 9.0.

[foxmt58]

Thanks for the input from you and the Advisory Member.  I really appreciate it because I just
couldn't understand what was going on.  I did some checking and as you mentioned REM sleep
(where most of your dreaming occurs) does raise heart rate and respiration rate.  Every
time I wake up I usually have a strong memory of a dream and it could be that since I'm
close to waking up at the end of a REM cycle the pressure, which may be too high, just
brings me to being full awake.  I will try lowering the pressure and see what happens.
Thanks again.

[mesenteria]

It seems to be fairly common with later-in-life sleepers that they awaken after a dream.  This also takes place late in a position of repose that has lasted for as much as an hour without a turn-over.  So, there might be some discomfort, or sleeping limb syndrome, creeping in and becoming annoying enough that we don't really complete the dream to the extent the story could run, but we awaken, turn over, head to the John, go get a glass of water, let the dog out...whatever needs doing.

I have always dreamt, even prior to the discovery that I have severe apnea.  But I seldom remembered them unless I had one just prior to the six-hour point which is about where I would awaken naturally.  Now, undergoing therapy, I dream more, almost much more, and I do sometimes awaken.  Fortunately, if it's prior to 0300, I can go back to sleep.

Anyway, this isn't about me...I just wanted to let you know that what you are experiencing is not all that uncommon generally as we age, and that quite a few people complain about this problem early in their PAP therapy, probably because the slightest little thing can vex us and make it seem as if PAP is what is to blame since it is the most salient 'thing' in our health lives in the early months.

[foxmt58]

Thanks for your input.  You are probably right that all sleeping problems are
not necessarily connected to APAP machines.  Aging, no doubt, plays a role.