Sudden wakings - have you solved this?

[mkirkwag]

About 3am I wake up. I go back to sleep - no problem...and jerk awake a few seconds after I drop off. This goes on for one to two hours. Dozing off on my side reduces the effect, but is a painful position and *that* wakes me. Sounds like apnea, right? The thing is, it happens whether I have my mask on or not. Before I go off to the doctor and start spending zillions on pressure adjustments, etc., I'd like to know if other people have had this experience while wearing a mask, and if you solved it. Thanks for sharing!

[Snoredog]

the hypnic jerk is normal when transitioning from wake to sleep. 1 or 2 is normal, but if that cycle repeats they are probably onset sleep events. The difference is a shock or startle of the upper torso vs more of a leg jerk.

The best way for me to describe them is I get fully relaxed (too relaxed it appears) and I basically forget to breathe. Going along fine not breathing then my body says hey you are not breathing and it startles me back to a fully wake state with heart racing. For me, I'm sleeping on my side when this happens so the chances of it being my tongue into the back of the throat is low. Some nights I'll have only 1 or 2 of these, others it seems 20 or more and anxiety starts building the more you have.

I found just understanding what they are and using the machine on low pressure seems to help the most.

The above is just what happens when falling asleep, as to the main part of your question?

Sudden wakings at 3AM? if you were sleeping prior to 3AM what woke you up?

My guess: Leak or inadequate pressure.

Mask leak and/or mouth breathing: If you start to mouth breathe before 3AM your CPAP pressure can escape from the mouth and loses its ability to splint your airway. This is more likely to happen during REM, if there is no pressure due to mouth breathing and/or a large leak you can experience an apnea which then can easily wake you.

-observe your machine leak reports and compare to mask flow rate at your given pressure.

Pressure may be too low: is your pressure high enough to clear obstructive apnea during REM? If not you may experience a apnea in REM as a result of pressure NOT being high enough. During REM sleep you are closer to being awake than other non-REM periods, meaning it doesn't take much to bring you back to a wake state. This is why it is important for the machine pressure to keep your airway splinted.

-observe AHI more specifcally AI indice. If AI is high, could mean your pressure is not high enough, try increasing pressure by 1 cm.

[Goofproof]

About 3am I wake up. I go back to sleep - no problem...and jerk awake a few seconds after I drop off. This goes on for one to two hours. Dozing off on my side reduces the effect, but is a painful position and *that* wakes me. Sounds like apnea, right? The thing is, it happens whether I have my mask on or not. Before I go off to the doctor and start spending zillions on pressure adjustments, etc., I'd like to know if other people have had this experience while wearing a mask, and if you solved it. Thanks for sharing!

You have not taken the time to fill in your profile (in Text). so let me guess. You use a "Nasal Mask", possibly you are mouthbreathing, loosing you treatment out of your mouth, and are having apnea events that are waking you up with a start. Also you have no data collecting ability or program to tell you aren't getting the treatment you need. This is just my uninformed guess, but odd's are it's what is going on. Jim

[mkirkwag]

Well, not quite. I didn't want to get into the details because I didn't want to sidetrack from the subject of having these events when I have the mask on - that was the part that mystified me. Here's the whole story:

I used a (goofproof called it) swift II with a resmed cpap with c-flex more or less successfully for about a year. Two things were a problem: 1) my AHI never got below 12 and was more commonly around 17 and 2) I'd wake up with a frozen nose and take my mask off. Thus began "the quest." Mask after mask - nothing worked - they all leaked and made me nuts. I ended up back at the swift with the iguana cable attached to my hose with a hose cover over it and resmed m auto-pap. With this configuration and the humidity all the way up, my nose doesn't freeze. In fact, when it's hot, I actually turn the humidifier off. My AHI came down to 8. The problem? I can't stand to wear it any more. The buckle in the back of my head - what were they *thinking*??? So I've been trying to do what I did before when I was learning to wear it - go to sleep without it, and when I wake up, put it on. I'm sleepy enough then to go to sleep. Works about once a month. But I at least expect it to provide some relief when I *do* put it on.

I don't think I'm sleeping with my mouth open - I went through all kinds of falderol training myself not to do that, and I'm pretty sure I'm successful. My husband checks me, and it isn't open when I jerk awake. Also my leak level is way down from what it used to be. As to why I wake up...I'm hot. We have a memory foam topper which helps a great deal with all those pressure points, but it retains heat like crazy, and in the summer I wake up hot. Although it could just be apnea and I notice I'm hot once I'm awake. My husband's sleep doc is against auto-machines - he says that there's a pause before it kicks in, thus allowing apnea. I'm not sure that's the problem, given that my AHI came down so much when I started using it.

I thought when I lost weight (I was somewhat overweight, but not at all obese) it would all go away, but . I weigh 110lbs and apnea R me. I'm thinking that maybe I should try turning off the c-flex?

And no, I don't have software. Last time I checked it was over a $100, and I flat don't have the money. I make do with what my machine tells me.

[Goofproof]

You must have a Remstar "M", not a Resmed. Now it comes down to finding which model you have, The APAP and the PRO are DATA capaple, others are not. As far as your Doctor not likeing APAPs it's because he doesn't have a clue on how to set them so they respond to apneas in time for them to work. You have Apnens while asleep it's hard to see if you are mouthleaking while you are asleep, the software give you the clues by showing your leaks in real time, it can also give you a clue why you were awakened. C-Flex is a comfort setting, it had little effect except to make exhale easier. Being too hot can cause poor sleep, I keep my "Cave" at 64 degrees year around and bury myself in old Bear Furs to keep warm. Let us know what machine you really have, maybe we can help more. I'll still guess mouthleaking. Jim

[mkirkwag]

Sorry - you're right. I get resmed on the brain. It's a REMstar Auto M Series with C-Flex. I've read about people getting a suffocating sensation from c-flex - what it really does and what if feels like subjectively are often two different things. I'm grasping at straws here.

I'm pretty sure I'm not mouth breathing. Having done it quite a bit, I'm very familiar with the signs. Also, I'm only out a few moments (feels like seconds) - not really time to fall into a deep enough sleep to start that. Most telling was the falling leak rate. However, I just checked and my leak rate is way up again. Not sure if it's caused by a couple of incidents with button confusion - failure to turn it off - or if I *am* mouth breathing again. Really don't think so. You're all right about it definitely being *incidents.* My AHI is back up to 23.

Maybe I should figure out how to tweak the max pressure up a notch? If the leak rate increased, I'd know for certain that I was mouth breathing.

BTW - He's not my doctor - he's my husband's, so no worry there. It was just a conversation they had - and in fact, it may have been a PA.

[JeffH]

I've solved this. First, NEVER take the mask off unless you are getting out of bed....EVER!

Before I go to bed, I seal my mouth so it doesn't leak. I don't "think" I "know" whether or not I'm mouth leaking, I seal it with polident strips to make sure I DON'T mouth leak. Next, I put a terry cloth head band around my mouth so I don't suffer the blow-fish effect that can wake us up also. I run my machine on straight CPAP because APAP's pressure changes were waking me up and I'd rather sleep at night. This also lowered my AHI.

I do a couple of other things that are eye related, so I won't go into that.

I make sure my nose is free of skin oil by cleaning it with Seabreeze. I put my mask on and do a few mental exercises that I've learned and usually only wake up once, maybe twice a night.

Good luck

JeffH

[Snoredog]

Well, not quite. I didn't want to get into the details because I didn't want to sidetrack from the subject of having these events when I have the mask on - that was the part that mystified me. Here's the whole story:

I used a (goofproof called it) swift II with a resmed cpap with c-flex more or less successfully for about a year. Two things were a problem: 1) my AHI never got below 12 and was more commonly around 17 and 2) I'd wake up with a frozen nose and take my mask off. Thus began "the quest." Mask after mask - nothing worked - they all leaked and made me nuts. I ended up back at the swift with the iguana cable attached to my hose with a hose cover over it and resmed m auto-pap. With this configuration and the humidity all the way up, my nose doesn't freeze. In fact, when it's hot, I actually turn the humidifier off. My AHI came down to 8. The problem? I can't stand to wear it any more. The buckle in the back of my head - what were they *thinking*??? So I've been trying to do what I did before when I was learning to wear it - go to sleep without it, and when I wake up, put it on. I'm sleepy enough then to go to sleep. Works about once a month. But I at least expect it to provide some relief when I *do* put it on.

I don't think I'm sleeping with my mouth open - I went through all kinds of falderol training myself not to do that, and I'm pretty sure I'm successful. My husband checks me, and it isn't open when I jerk awake. Also my leak level is way down from what it used to be. As to why I wake up...I'm hot. We have a memory foam topper which helps a great deal with all those pressure points, but it retains heat like crazy, and in the summer I wake up hot. Although it could just be apnea and I notice I'm hot once I'm awake. My husband's sleep doc is against auto-machines - he says that there's a pause before it kicks in, thus allowing apnea. I'm not sure that's the problem, given that my AHI came down so much when I started using it.

I thought when I lost weight (I was somewhat overweight, but not at all obese) it would all go away, but . I weigh 110lbs and apnea R me. I'm thinking that maybe I should try turning off the c-flex?

And no, I don't have software. Last time I checked it was over a $100, and I flat don't have the money. I make do with what my machine tells me.

Sounds like you have quite a few issues going on with therapy, they don't go away with denial. You need to write them down no matter how trivial and address them one by one. Just from your posts here I see:

1. You dislike the Swift mask, it is cold and uncomfortable, you wake up and take it off, you don't like the cold incoming air so you turn your humidifier up to compensate for the cold air, when its warm you don't use the heat.

answer: Well that is not surprising, Swift is crap in my opinion, so is Nasalaire, so is the Breeze. Find another nasal mask, but if you stick with those same flimsy pillow style interfaces like the Swift, known in advance they ARE going to be cold and noisy, there is no getting around that. If the incoming air is too COLD, increase room temperature or get a heated hose, not a covered hose, a heated hose. Heated hose pays for itself in energy savings by not having to turn up the thermostat. Humidifier heat will never warm the incoming air enough without first causing excessive rainout and/or causing your nasal passages to shut down from too much humidity. Congestion will make the incoming air seem warmer.

2. You continually deny you are mouth breathing, yet you indicate machine reports higher leak. There are NOT a lot of complaints about leaks going on with the Swift and it is not like you are using a Full Face mask that are prone to leaks, but leaks clearly CAUSE a higher AHI. Even the lowest AHI you mention is nothing I'd want to write home about. It is very difficult if not impossible for a partner to determine if you are mouth breathing throughout the night. The data on the LCD tells a more accurate story.

answer: One way of determining where the leak is coming from is by taping the mouth for a night. IF the leak rate drops way down you have your answer, if leak continues high as before you are leaking elsewhere such as the nasal pillow or externally between the humidifier tank and the machine or you have a hole in the hose from a cat claw.

3. Your AHI is too high no matter what is going on, even the lowest of 8 you mention is too high. But in order to address that, you first have to get the leak under control before you can address the AHI aspect with pressure. As mentioned before, loss of pressure from leak allows apnea to show up especially during REM sleep when apnea is more likely to show up, that is 3AM to 6AM.

But if you are going to ask questions then discount and/or deny every suggestion ever made then well maybe you should consider other treatment options as you will never resolve your problems denying them. Ask anyone, success with this therapy is all about addressing all the little issues you may have with it and solving them one-by-one. Pretty soon you find you eliminated all the issues you had and finally get some needed sleep and not just once a month. If you are only getting relief once a month I wouldn't consider that therapy at all.

From my read you seem reluctant to consider the possibility of mouth breathing and/or inadequate pressure. Sorry, but there are not a lot of things left to consider. But if you have a machine that reports data on the LCD it should be a lot easier to get things under control.

For that to happen, you need to:

1. Adjust room temp or use a heated hose so the incoming air is comfortable, I would avoid turning the humidifier up to compensate.
2. Adjust or switch to a better more comfortable nasal mask, a ComfortGel, UltraMirageII or Soyala are 10 times better than the Swift, the Soyala is silent by comparison. These masks diffuse the incoming air so you don't have that direct cold air blowing directly in your nares.
3. But first order has to be to determine where the leak is coming from, machine will give you leak rate, look up the flow chart for your mask and pressure then compare, if it is not leaking externally, it has to be coming from the mouth, tape can determine that. If leak is being reported higher than 45-50L/m then consider it impacting your therapy.
4. Observe the LCD AHI, that avg. number will include both Apnea and Hypopnea. You don't want either one, so AHI heading down is what you want to see. The only way it can change is by elimination of leak and/or increasing pressure. You first have to have leak under control to establish a baseline. That is done by observing the leak rate getting it normal then observing the AHI. IF AHI is still >8 then you need to increase pressure by 1cm. If pressure is already a problem you enable the Ramp feature found on the machine with a lower pressure setting so it does not impact falling back asleep and is more comfortable to tolerate.

If machine is an autopap, put it in auto mode for a few nights and let it find your 90% pressure, then input that found pressure in the CPAP mode. Only other option you have is increasing it manually by 1 cm and observing the AHI on the 7-day display. If you erase that data on the LCD it will give you a "daily" value, doing that it does not erase the data on the SmartCard.

But you need to understand these issues don't go away with denial, if you continue to do that, you will be back months from now with the very same issues.

[mkirkwag]

Well, one night isn't much of an indicator, but my leak rate was only .3 last night, so my best guess from what you all said is that the maximum pressure needs to be increased. I didn't have any of those jerking awake incidents, but I did wake up with a headache, so something isn't working. Does anyone happen to know how to raise the pressure? It's set so I'm not supposed to be able to do it.

[Wulfman]

Well, one night isn't much of an indicator, but my leak rate was only .3 last night, so my best guess from what you all said is that the maximum pressure needs to be increased. I didn't have any of those jerking awake incidents, but I did wake up with a headache, so something isn't working. Does anyone happen to know how to raise the pressure? It's set so I'm not supposed to be able to do it.

You still haven't told us which machine of filled in your profile. From the leak rate you quoted, I'm guessing a ResMed "something".

Some of them can be found at this link.

http://www.cpap-supply.com/Articles.asp?ID=130

Den

[marshaeb]

Ask anyone, success with this therapy is all about addressing all the little issues you may have with it and solving them one-by-one. Pretty soon you find you eliminated all the issues you had and finally get some needed sleep ...

Wow. I've been "on the hose" for about a week and a half and have been putting off posting questions, both because I figured others would crop up in these early days and also because I vaguely remembered seeing things that were already posted and didn't want to bug anyone unnecessarily. (I finally got smart and now have an "xpap-future reference" file.)

Snoredog, you've put me in a very tough position. I may have to actually forgive you for that nagging women crack. (drat) This is excellent. I'm sure I've read one version or another of each of your points, but this pulls it all together. For instance, I knew one of you had said what to do in order for those without the software to see their daily stats, but I couldn't remember who said it or when and have spent LOTS of time looking. Delighted to give up that quest. This answers every question on my list and some that weren't there, and it does so in a way that's so easy to understand. Kudos. Thank you.

I don't know who does it or how it's done, but could this be put in "Our Wisdom" -- maybe as its own heading called something like "The Basics About Machine Settings"? I think it would end up being perfect if you could also add target levels (AHI should be < 5 & 0 is best, etc.).

Thanks again, Snoredog. Great job.

Marsha

[Goofproof]

Well, one night isn't much of an indicator, but my leak rate was only .3 last night, so my best guess from what you all said is that the maximum pressure needs to be increased. I didn't have any of those jerking awake incidents, but I did wake up with a headache, so something isn't working. Does anyone happen to know how to raise the pressure? It's set so I'm not supposed to be able to do it.

You still haven't told us which machine of filled in your profile. From the leak rate you quoted, I'm guessing a ResMed "something".

Some of them can be found at this link.

http://www.cpap-supply.com/Articles.asp?ID=130

Den

She has me thinking she has both, Remstar and Resmed, and every other post the Sleep Fairy changes machines on her, maybe it a Hybrid, a Resmed "M" APAP with EPR, very confusing. Jim

[jnk]

No, it's definitely a RespirMed.

[Snoredog]

No, it's definitely a RespirMed.

LOL troublemaker!!

[jnk]

LOL troublemaker!!

Who? Me?