[Treatment] Treating frequent awakenings

[marre]

Hello! I'll give a short rundown of my sleeping issues: I have a lot of common symptoms of sleep apnea like snoring, peeing at night, waking up a lot, feeling very tired and so on. I recently did one of those basic at home sleep studies and I only slept for 3 hours, and my AHI was 5 (10 on my back and 1 on my side). I had a sh**ty CPAP from before and wanted a Resmed 10 and I was gonna get one from the healthcare system (Sweden) but I also wanted to speak to a sleep doctor and they made me choose between CPAP and speaking with a doctor so I bought a Resmed 10 myself while I'm in the queue to see the doctor which sucked... Anyway rant over.

My CPAP often shows very low AHI but I still feel as bad as usual. I usually have physical awakenings throughout the night, first one about 1-2 hrs after falling asleep and thereafter about 5-10 every night, is what i would approximate. I have not had a night of sleep without several physical awakenings in years.

I have not used my CPAP a lot and as I mentioned I recently bought the Resmed 10 which is so far way better, quieter and better everything, which is making using my CPAP more comfortable which is nice. I'll attach a picture of last night from OSCAR which shows how i woke up after about an hour of sleep like usual, is there anything odd with my flow rate? I'll also attach SleepHQ links from that night and the one before where I used my CPAP the whole night.

I'm a man, early 20's. Also wondering if there is anything you people think I should bring up with my sleep doctor when I see him (in a few month unfortunately) seeing as my low AHI with CPAP and how I still feel horrible. I am convinced my frequent awakenings is wrecking my well-being, I just don't know why I'm waking up so much.

Appreciate it, let me know if I'm missing something.  

Slept and woke up after about an hour with CPAP (night of attached OSCAR data)
sleephq .com/public/8db66662-9f30-4f16-8db4-c94019fd1402

Another day where i had the CPAP the whole night
sleephq .com/public/e937191b-5048-426e-b3c6-7735189847cc

(There is a space in the links I don't have enough posts to post full links)

[staceyburke]

You left off the left column so I can't see many things I would want to see.  Use the F12 key for a screenshot in OSCAR, it will format it correctly.  

Looking at your other attachment it shows a large amount of flow limits.  Flow limits are apnea just like oa and H events.  FL can cause you to wake up or not get into deep sleep. We try to control flow limits by using EPR.

I would try the following

EPR on FULL time
EPR 3

And see how your sleep is.

[marre]

Hello, here's the formatted picture, also for the full night one i posted from SleepHQ

[Sleeprider]

You are using your Autoset at 7 to 10 pressure, and we're about to make it a lot more comfortable and effective because your CPAP is actually a BiPAP. The 7-hour night looks pretty good. 95% flow limits are 0.07, and we're going to make them go away by using EPR (exhale pressure relief) which is the bilevel therapy I mentioned. This will give you lower exhale pressure and higher inhale pressure with up to 3 cmH2O difference, corresponding to the setting. Let's go ahead and try the full 3-cm EPR and see what it does for you. Set minimum pressure at 7.0, maximum pressure 12.0, EPR On, Full-Time as Setting 3. Your therapy looks very good for a new user with very low leak rates and few events. The OA event you zoomed to shows an arousal at 22:50:30 followed by an inhale and breath-hold. I suspect you shifted position and this was not actually an obstructive apnea. The zoomed image also shows some oscillations during the exhale phase that your CPAP is misinterpreting as start of inspiration. Those bumps are most likely Carcinogenic oscillations and are normal. Explanation here: https://www.apneaboard.com/wiki/index.ph...cillations

Between the us, I think you made the right choice to go with the machine rather than the doctor.

[marre]

Hey thanks for the responds. I'll try turning EPR on 3, and I understand the 7 hour night may look good but i had the same amount, probably 5-10 physical awakenings as always where I open my eyes and think "ok just woke up again" and then usually fall asleep quickly again. Which is why I asked if there were any ideas anyone had as to what I should communicate to my sleep doctor in a few months when I get to see him, since he might also just see that my stats are good and I still feel terrible :/ I'll see what the EPR can do for me though

[Sleeprider]

If you want to focus on arousals, look for the flow spikes like the one at 00:12 on your June 12 chart. Also at 23:25, 00:10, 01:25, 01:40, etc. Those suggest arousals. The only question is are they spontaneous, or respiratory related.

[HalfAsleep]

From experience, it takes a while to get used to CPAP therapy and sleep through the night. It took me 2 months.

[marre]

Hey guys.

Since my post I turned on EPR to 3 and have used my CPAP almost every night, and I can see on OSCAR my flow limitation did go down, usually it's almost 0.00 95%. My setting are 8-20 on pressure (since it pretty much always maxes out at around 10 I didn't bother to set it to max 12 since it never goes that high). However, I still don't feel any different from before I was using it, waking up just as much, and I am still waiting to see my sleep doctor (I'm on the waiting list).

I kind of convinced myself I have UARS but I guess I really don't know, I can't really tell anything from my OSCAR charts but I though maybe I should just try increasing the pressure 0.2 every night (I get Aerophagia if I raise it too fast and don't get used to it) to just see if it helps, and then ask my doctor for a sleep study that scores RERAs, what do you guys think? And maybe ask for a BIPAP if I need much higher pressures but maybe I'm just getting ahead of myself? I guess it could be something not respiratory related like Sleeprider said a while ago.

Also I thought I would ask for a Modafinil prescription, since I'm having a hard time in school and in life, but I'm in Sweden and from what i can tell EU delisted Modafinil for Sleep Apnea patients some time ago so it would have to be a off-label prescription and I very much doubt I would get it.

Or if anyone else has any other suggestion I can try or anything I should ask of my sleep doctor when I see him? Maybe I should bring my SD-card, however I don't know how many doctors use OSCAR or the like. I plan to write in and ask how long until I can see him and ask if any suggestions I get here can be acted upon.

I'll attach a recent night where I used the CPAP and attach the link to it on SleepHQ in case anyone wants to look.

Cheers  

https://sleephq .com/public/a80b3f46-4ee1-4ae6-9a30-1503fdeb45da (remove space between sleephq and .com to open)

[Sleeprider]

We can only optimize the CPAP therapy, and this is looking very good. I don't see evidence of UARS with a 95% flow limit of 0.00, however your inspiration time is longer than expiration on the statistics, so we would need a zoomed image to sort that out. The volumes and AHI looks good. There is one cluster of OA and a CA cluster at 09:30. If the time on the machine is correct, it looks like you are sleeping in daytime to evening which would present all kinds of circadian rhythm problems. Arousal can occur for many reasons outside of therapy, and I have had many problems this year staying asleep, waking up in the middle of the night for several hours, or early in the morning. Last night my sleep time was only 5-1/2 hours according to the Apple watch. I know it has nothing to do with my PAP therapy, but with other stresses in life as we are in the process of relocating from PA to FL. I have no means of evaluating what stress, or sleep schedule, sleep hygiene and other factors may affect your sleep, but it doesn't look like arousals originate from therapy. Very steady pressure, low leaks, and consistent looking results

[marre]

I thought it could be UARS since I have signs of smaller airway like bite marks on my tongue, smaller lower jaw, snoring and the 10 AHI when sleeping on my back, and I have seen others with the same thing of good CPAP stats but wake up throughout the night like me, but of course I don't know this.

I would guess the CA flags are from when I have woken up like I always do and with CPAP I the breathing is more manual so when I'm awake I sometimes gets CA events.

My circadian rhythm is definitely scuffed I really can't fall asleep at the same time every night even after months of "good sleep hygiene" it's not like my circadian rhythm resets like for a normal person when my sleep is so terrible. Now it's summer and I'm a student so I have just gone to sleep when I have felt like it, which is the only way I don't spend hours trying to fall asleep. When I had a physical job I would sleep for 13 hours of terrible sleep most days and wake up throughout the night just as much and going to pee and stuff so I understand sleep hygiene is important but there is definitely something physically wrong with me but it could be something else than breathing.

I guess if I get sleeping drugs I would have to be on them for life which doesn't sound great but if it helps my quality of life I guess it would be worth it, I would be happy if I could find a reason for my problems though. Not a sleep drug, but Modafinil seems like a drug that could improve my quality of life with not that many side effects, and maybe even improve my sleep if I can go through the day without naps and stuff.

"Inspiration time is longer than expiration", is this bad? I'll attach some zoomed in pictures I took them from the SleepHQ link above since I'm not home right now but could do OSCAR if its better as well later, from soon after I fell asleep:
   

Later into the night:
   

Anyway I appreciate the help, it's good to know there's nothing wrong with my CPAP therapy at least so now I can skip the months of getting a CPAP from the hospital and further delaying other help when I know a CPAP won't cure my problem