ewriter - therapy thread

[ewriter]

I need some help understanding why I wake up after only 2 hours or so. This is a change in my therapy and never happened before. I am concerned about what is
causing it.

I am using a Respironics BiPaP Auto (never use the Bipap settings as i felt i couldn't breath) and have used it for 11 years (mostly compliant). I also have a ResMed Aire 10 for Her (i am a guy but the clinic couldn't give me a guy's or a gender-neutral machine).

I have no idea why i can't sleep through yet. Any suggestions?

Also, can anyone help me see if my settings are the most optimal (12.5 or 13 for CPAP, no FLEX (i read in another forum that turning this on causes central apneas).

A couple of months ago i was sleeping through and not waking up. I then did some major floor sanding in my house, unfortunately without adequate ventilation/masking (and the Polyurethane was very noxious). A few days after the floor was done, an old "flutter" started coming back. I was afraid i had done some damage and panicked. I upped my beta blocker by 100% then 200%, which was unwise. What followed is two months of night terrors and anxiety; ok, that's more like 1 month. I get the night terrors from several symptoms:

1. "mild flutter/palpitation"
2.  Racing heart when i fall asleep without using the CPAP;
3. PVCs when i don't take enough Propranalol (currently on 80 mg a day but was only needing 40 or even 20 before i did the floor).


Does anyone have ANY idea what would make me wake up? The doctors are mystified.

[Jay51]

Hello ewriter.  I want to thank you for this post and for your post in MickTravis's thread also.  That post helped me.  I have 2 goals in posting:  1.  to help you figure out your question of why you are suddenly waking up after 2 hours and then unable to fall asleep for quite a while; and 2.  share more of my experience and medical history with you in an attempt to better understand the "buzzing".  

Do you mind reposting your OSCAR chart here in your thread?  I am no expert at interpreting OSCAR charts, but a few things from your chart jump out at me.  The chart only shows some hypopneas and few obstructive apneas.  This could possibly be solved by something as simple as using a soft cervical collar.  The SCC could help prevent chin tucking and the obstructions in your airway that are showing up on your OSCAR.  My AHI was 42 from a home Lofta WatchPat sleep study (severe obstructive and mild central apnea).  My polysomnography showed 32 AHI, but 2/3rd of my apneas were now central (with the use of cpap, bipap, and ST).  Just sleeping on my side instead of my back reduced my AHI to 20 (based on the Lofta WatchPat) study.  When I slept in a recliner the 1st time, it went down to 5 (based on ODI from my own oximetry testing).  Just some things to try if you feel like it.  

You have what looks like about a constant 16 cpap pressure.  I think I read where you don't like bipap.  To me this could actually be positive.  At least you don't have any central apneas yet.  Your cpap at 16 may be pretty close to correct.  Possibly posting another OSCAR or 2 could give more details.  There are specific links on how to post OSCAR with specific instructions here on this site.  A 3 minute strip of your flow rate when asleep could reveal something.  Turning off the pie chart on the left side would help also. 

I read where you have had 3 sleep studies already. If there was any way you could get a copy of one or all of these and post them here (with personal info redacted) something major could be revealed from them.  When I posted my sleep studies here, I received a wealth of valuable interpretation and suggestions.  

The "buzzing" - I read where Vancenase corticosteroid basically cured your buzzing.  I see that it has been discontinued.  Could you get a derivative or newer version of it and see if that helps again?  I plan on trying to get it for myself after reading your post.  From my research, this works on dopamine, epinephrine, etc. receptors in the body to regulate nerve impulses, etc.  Parkinson's disease is caused by decreased dopamine I think.  Just mentioned that because I had a grandmother that died of Parkinson's.  Anything else in your medical history that could contribute to the "buzzing"?  I have also had a few concussions playing football, been involved in 2 major motor vehicle accidents, My mother had Myesthenia Gravis (but this is an autoimmune disease that occurs spontaneously).  I have been diagnosed with hypothyroidism, but my thyroid levels are normal now when I take medication for it.  

You believe your "buzzing" is caused by disordered breathing.  I think you are correct.  You say that you are very sensitive to environmental pollutants.  I grew up on a cotton farm.  Was around diesel fuel and diesel exhaust (the tractors).  Where I live we can get blowing dirt and dust in the air.  Also I live in an oilfiled community - can smell the oil in the air.  I usually start coughing and sneezing from dust, etc. but it doesn't trigger the buzzing in me personally.  I took the Pulmonary Function Tests and actually just  barely failed them (they showed COPD).  But when the Pulmonologist saw me the 1st time, he said, there was an error in you testing.  This can't be right.  You don't have COPD.  He wants me to retake the tests sometime in the future.  Both of my sisters (who grew up on the same farm, etc. now have Asthma - one uses an inhaler.  

3 (or 4) things make the buzzing worse in me I have found:  the more physical activity I do during the day, the more likely and intense the buzzing.  Extreme cold or hot can trigger the buzzing in me.  These all increase my metabolism.  The by product of an increased metabolism is CO2.  Also extreme stress can trigger it I have found.  2 things that have reduced it:  1.  Being upright (not lying down).  It is worse on my back, gets less when I sleep on my 45 degree angle upper body wedge, and has never occurred when I am awake standing sitting or walking.  

I have read 3 posts within about a week that have all used the term, "buzzing".  Yours, MickTravis's, and Daniel (Morgannon)'s threads.  The cadence of the buzzing to me is very fast:  like trying to knock on your door with your knuckles as fast as you can.  Or better yet, a drummer doing a drumroll.  Probably 80 to 90% of it occurs when I wake up from sleep during the night.  I take a couple of breaths and it is usually gone in less than 5 minutes.  It I get upright it disappears.  Only about 10% I get it just as I am falling asleep.  I completely stop breathing just before I fall asleep as per my polysomnography.  It gets slower and shallower and then stops.  It is interesting each us of have a different guess as to what causes it.  My RT has another guess.  She thinks CO2 accumulates in the bottom of my lungs after I sleep for awhile.  The thinks this excess CO2 causes an irritating or inflammatory response in my lungs and my windpipe, etc.  Anatomically this is where I feel the buzzing:  chest area and back of head and neck.  I get rid of the excess CO2 and it disappears.  I had an arterial blood gas draw that actually showed I a greater than normal amount of O2 in my blood rather than CO2.  I have failed several tests that show I exhale too large a % of CO2 at night while asleep.  It was 66% lying on my back, but decreased to 33% at the 45 degree angle sleeping.  Normal is 25% or less during sleep (ETCo2).

I hope this helps.