Waking up in the middle of the night

[SelfLoadingCargo]

am very grateful for this forum.  I've received some terrific advice and insight, and I feel very fortunate for this spot on the internet.

Thank you in advance for reading about my woes and for any feedback you may offer.  Attached is a screenshot from SleepyHead with my most recent "decent" night's sleep:

I have a ResMed AirSense 10 AutoStart w/ humidifier and P10 nasal pillows.  Default settings except ramp time set to zero.  For roughly five months I had really good success - sleeping through the night, no acid reflux, and the associated benefits you'd expect.  However, over the past 30 days or so, I've been waking up in the middle of the night, anywhere from 1am to 4am, with a feeling of being out of breath.  I've tried reseating the nasal pillows, and turning off and then back on the machine, but it's very rare where I can make use of the machine for the rest of the night.  Accordingly, I feel like I'm going backward - very tired during the day, occasional acid reflux, and very restless sleep without the machine, including snoring.  Everything I experienced before starting the therapy.

I just received replacement hardware - long hose, and the pillows/frame/short-hose assembly.  I clean the humidifier tank 3x/week, the hoses 2x/week, and I use wipes on the pillows nightly.  I replace the air filter every two weeks.

Any thoughts on what I can do to get back on track?  Thank you again for your time and energy.

[DeepBreathing]

G'day SelfLoadingCargo. Welcome to Apnea Board.

Looking at your chart there seems to be a lot of really heavy / ragged breathing from about 03:00 onwards. Your average respiration rate is also reasonably high and your inspiration / expiration times are a bit too close (exhaling is usually substantially longer than inhaling).

Can you zoom in on that ragged breathing - say a three minute sample around 03:45 - so we can see what's happening in more detail?

As a general rule your minimum pressure should be a bit less than the median reported by the machine, so try setting the minimum at 7.0. This will reduce the pressure swings which might also be disturbing you.

[SelfLoadingCargo]

Thanks so much for the quick response and your expertise.

I'm having a hard time with the app right now - the daily chart now shows a different duration and only extends until 1:50am on 11/29. Let me try to reload the data and see if I can bring up the ragged breathing detail you mentioned. More soon...

I'll try raising the minimum pressure as well. After reading here about three weeks ago, I tried that before, but it seemed to make things worse. However, that was before I got my new hose & mask. Perhaps an important detail I failed to mention in my original post above - for the first few nights after receiving the new hardware, I slept great. But just as I was thinking the problem was solved, it started happening again.

Thanks again...more detail to follow soon.

[SelfLoadingCargo]

Well, shameful for an IT guy to admit, but I can't figure what happened to the data.  I reloaded from the SD card, and those few hours were still missing.  Sorry about that.

Attached are two shots from 11/26, showing the whole time period and a zoom when some of the trouble seemed to start.  I'll also post last night's brief window where I was able to connect without feeling like I was suffocating.
I've reached my attachment quota - guessing this related to my low post count.
Other variable...bought new pillows today.  Reaching at straws here.  

Thanks again for the help.

[SelfLoadingCargo]

Data from last night...thanks in advance for your time and expertise.

[OpalRose]

Hi Jerry,
This is one of those cases where a low AHI doesn’t equal a restful sleep.  

Your machine is set at the default range of 4-20 with an EPR of 3.  

It looks like the pressure is driven upwards by snores.  A low minimum pressure of 4 can feel suffocating, and the pressure zooms upward pretty quick.  Look at your graphs and take note where your 95% pressure is.  Your minimum should be approximately 2 to 3cm below that.  

You may have a more comfortable night by inching your minimum pressure up.  Try moving it to 8 or 9 and bring your max pressure down to 16.  I would also change the EPR to 2.

This will narrow the pressure range and keep your pressure more steady, as the pressure swings could be waking you.

[Sleeprider]

Completely agree with OpalRose. A machine set to 4-20,but that has a median pressure at nearly 11.0, is not optimized. Your minimum pressure should be moved to 9.0 cm. Everything else will fall into place with that change.

You are having mostly hypopnea, and that is happening because your minimum pressure setting is too low, so your machine tries to reduce pressure resulting in flow limits and hypopnea. This happens over and over. In spite of your good AHI, your pressure frequently drops below optimum, and this can be disruptive. You're fortunate to be using the Resmed Autoset as the Philips would not maintain pressure even this well.

[SelfLoadingCargo]

OpalRose & Sleeprider, my thanks to both of you.

I'll make the changes today and will report back.

Thanks again!

[Sleep2Snore]

This might have nothing to do with it, but I caught myself with my arm over the mask vent, I have caught myself doing this twice now. My partner said I was doing this for almost 10 minutes one night (She is now aware that I should be nudged) and there was not a lot of air getting past my arm. There must have been enough or I would not be here. Just in case you are doing the same and building up Co, I did wonder why I had headaches! I have maybe done this more than has been noticed, it does make you short of breath when you wake up!
This might not be the case with you, but keep it in mind. I might have done this when I had the CPAP, but I was on a much higher pressure with it and if it couldn't get out of the vent, it would just leak out the sides.

[OpalRose]

This could also be an issue for those that claim to sleep with their faces mashed into their pillows.  
It's always a good idea to be careful not to obstruct the exhaust vents.