Total hours alseep; apnea events while asleep vs awake

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Dyssomniac
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Total hours alseep; apnea events while asleep vs awake

Post by Dyssomniac » Sun Feb 01, 2015 10:04 am

I've been noticing a big uptick of logged events at the beginning and end of nights when I'm more awake than asleep, and would be interested in any thoughts on this. First, some background:

I've now been using my machine for about three months. The first thing I noticed is that my AHI is very high when I sleep on my back, and reasonably low when I sleep on my side. So the first thing I did was to focus on sleeping on my side. I got my overall number for each night down to the 0.5 to 1.5 range. This is with the machine at 4 to 20 cm variable pressure as set by the sleep clinic tech. A typical night might include about 20 RERA events, 5 hypopnea events and 3 or 4 flow limitation events.

Last night I decided to bump up the minimum pressure to 6 cm to see what this would do. During the approximately five hours of the night when I was fully asleep, the machine logged 3 RERA events, 1 hypopnea event and 2 flow limitation events. For this part of the night, the AHI was shown as being pretty close to 0. However, I was partially or fully awake for the first 15 minutes of the night when the machine was running, as well as the final 80 minutes in the morning before I turned it off. During these time periods there were quite a few additional events (primarily hypopnea and clear away) that caused the hourly AHI to rise to 8. Overall the AHI for the night was shown as 2.68.

I feel quite alert during the day, though I still have a tendency to want to nap after lunch. This may be out of habit, but it may also reflect the fact that I'm only getting about 6-1/2 hours of sleep overall (and only 5 hours of really asleep sleep) per night. I've cut my caffeine use to very low, with none after 3 p.m. I'd like to avoid having to use any kind of sedative to get more sleep.

So two things I'm wondering. One is, do you worry about logged events at the beginning and end of the night when you're not fully asleep if the rest of the night is looking good? Second, any suggestions on extending my sleep without having to medicate?

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Re: Total hours alseep; apnea events while asleep vs awake

Post by Pugsy » Sun Feb 01, 2015 10:26 am

I always totally omit any awake flagged events from any of my evaluations of my therapy. They are awake events and have absolutely no bearing on therapy effectiveness.

Prolonging actual sleep hours is tough. Anything special going on when you do wake up and can't go back to sleep?
Like I might wake up on my back ...which causes me to have a lot of back pain and it's likely the pain that is waking me up.
When this happens during the night I can normally get right back to sleep but sometimes I wake up around dawn and I simply can't stand to lay in bed in any position comfortably enough to go to sleep.

Sometimes there's no physical reason for the wake up to the point we can't go back to sleep even though we really wish we could. 5 hours of sleep out of 6 to 7 hours in bed is going to be less than optimal for regenerating the needed daytime energy supply. It can be a form of insomnia that is difficult to fix because it's difficult to isolate a cause and sometimes even if the cause is known it is difficult to fix.

Is this a problem for you that was going on long before starting cpap therapy in November?

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Re: Total hours alseep; apnea events while asleep vs awake

Post by Jay Aitchsee » Sun Feb 01, 2015 10:30 am

Dyssomniac wrote:So two things I'm wondering. One is, do you worry about logged events at the beginning and end of the night when you're not fully asleep if the rest of the night is looking good?
No.
Second, any suggestions on extending my sleep without having to medicate?
Consider eliminating caffeine consumption (in all forms) even earlier, say before noon. Depending on the amount consumed, and on the individual, the effects of caffeine may linger longer than most people realize. Watch out for "decaffeinated" beverages. Usually it means reduced caffeine, not caffeine free.

Try to avoid naps and practice good sleep hygiene. Google for advice.

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Re: Total hours alseep; apnea events while asleep vs awake

Post by Sleeprider » Sun Feb 01, 2015 10:45 am

I think any therapy under 6.0 cm is not enough to hold open an airway, so increasing the minimum pressure was probably needed anyway, and you might chase the few Hypopnea and flow limitations with just a touch more. As far as any events while awake, it has been discussed on the forum a lot. Search for sleep wake junk SWJ.

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Re: Total hours alseep; apnea events while asleep vs awake

Post by Dyssomniac » Sun Feb 01, 2015 11:39 am

Thanks for all the comments. Sleeprider, I appreciate the mention of sleep wave junk, I'll search on that.

Jay, I did detect that I became more sensitive to caffeine when I started cpap therapy. It's possible I may need to cut it out entirely, and the naps as well. Both are just longstanding habits. Sleep hygiene recommendations (such as here) look like good ideas.

Pugsy, even before starting cpap therapy I rarely slept more than 6-1/2 hours or so, though I offset it with daytime naps. The issue is only at the end of the night: I begin to wake up around 4:30 or 5 and find I can't get back to sleep. I do work an early schedule -- most days I get up at 5:45 a.m. to get to work by 7.

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Re: Total hours alseep; apnea events while asleep vs awake

Post by Dyssomniac » Sun Feb 01, 2015 11:44 am

One side question about "compliance." A couple of weeks ago I missed one night entirely due to a mask malfunction, and one or two nights the machine has been on a bit less than 6 hours. But SleepyHead still credits me with 100% compliance since I started cpap therapy three months ago.

Exactly how much per night and how consistently does the machine have to be used for it to call it 100% compliance? Does all software report it the same way as SleepyHead? I'm just wondering if my sleep clinic might ever ask to see the SD card and come up with some difference compliance interpretation.

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Re: Total hours alseep; apnea events while asleep vs awake

Post by Pugsy » Sun Feb 01, 2015 11:51 am

If you are taking naps during the day it's entirely possible that your body just doesn't feel the need to sleep longer.
It's a hard habit to break though....been there myself.
If I take a nap during the day it totally messes with everything...my usual get sleepy time along with how long I stay asleep.
That's why I really try to avoid naps whenever I can because I know it sort of creates a new bad monster where I have trouble falling asleep and then staying asleep so that I end up with less hours of sleep which will in turn really make we want to nap the next afternoon. Nasty little circle happens and it can be hard to break that cycle once it gets started.

Compliance requirements....usually 4 hours a night for 70% of a 30 day period will satisfy most insurance companies. That is what Medicare wants and most insurance companies go by Medicare's standards.

Not sure why SleepyHead isn't seeing a night with no cpap use unless maybe your nap time was using the machine and that got added into the hours of use for that 24 hour period.

SleepyHead lets you set the "hours of use to whatever you want for compliance standards)...the other software programs go by the industry standard of 4 hours of use within a 24 hour period and that 4 hours doesn't have to all at one time.

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Re: Total hours alseep; apnea events while asleep vs awake

Post by Dyssomniac » Sun Feb 01, 2015 12:11 pm

Thanks. So my new goal for the month is to eliminate naps, and minimize or eliminate caffeine, to make my nighttime sleep longer. Hygiene-wise, no food within 2 or 3 hours before bedtime and possibly throwing in a warm shower before sleep seem like they might help.

Actually I was wrong about SleepyHead. I thought it was giving me 100% compliance November through January, but when I look now in the Usage area under Overview I see that it does report 0 low usage, 1 no usage out of 31 days for 96.8% compliance for January. So it did catch the missed night. It's helpful to know that 4 hours per night is the minimum for insurance purposes. For some reason I thought it was 6 hours; now and then I was forcing myself to stay in bed with the machine running when I was fully awake and unable to sleep just because I thought I had to log that number of hours. Under those circumstances I now know I can get up (though obviously the long-term goal will be to extend the sleep period).

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Re: Total hours alseep; apnea events while asleep vs awake

Post by palerider » Sun Feb 01, 2015 1:03 pm

Sleeprider wrote:I think any therapy under 6.0 cm is not enough to hold open an airway,
do you have any data to back that up, or is it just your opinion based on the fact that the majority of people need higher pressures?

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Re: Total hours alseep; apnea events while asleep vs awake

Post by cathyf » Mon Feb 02, 2015 10:47 am

palerider wrote:
Sleeprider wrote:I think any therapy under 6.0 cm is not enough to hold open an airway,
do you have any data to back that up, or is it just your opinion based on the fact that the majority of people need higher pressures?
Sleeprider could have phrased that a little more precisely -- of people who meet the diagnostic criteria for cpap, it's probably pretty rare for us to get any benefit below 6cm. Now the general population where 80% of people don't have apnea, that's a different story. It wouldn't be hard to test if anybody cared about our data enough to pay attention to it -- if an autopap wants to lower your pressure below 6cm and keep it down there for awhile while you are asleep, then it thinks you don't need more, at least for that period. Have any of us ever seen that?

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Re: Total hours alseep; apnea events while asleep vs awake

Post by Sleeprider » Mon Feb 02, 2015 11:30 am

palerider wrote:
Sleeprider wrote:I think any therapy under 6.0 cm is not enough to hold open an airway,
do you have any data to back that up, or is it just your opinion based on the fact that the majority of people need higher pressures?
Good call. Almost nothing is absolute and there may be some small fraction of people that achieve effective therapy at less than 6.0 cm. Most of us benefit from eliminating ineffective pressure ranges, and I should have avoided an absolutism. Seems applicable to the O.P. and hopefully the rest of my response was more helpful.

thanks

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Re: Total hours alseep; apnea events while asleep vs awake

Post by Dyssomniac » Mon Feb 02, 2015 12:14 pm

cathyf wrote:if an autopap wants to lower your pressure below 6cm and keep it down there for awhile while you are asleep, then it thinks you don't need more, at least for that period. Have any of us ever seen that?
When it was set for 4-20 cm, my machine would spend anywhere from 1/4 to 1/2 of most nights at 4 cm. Quite often it will stay there for long stretches, but will have these little "sawtooth" spikes every 15 minutes or so where it goes up to 5.5 cm for a minute or two, but then goes right back down. But it may spend an hour or more flatlined at 4 cm. Apart from accidentally turning to sleep on my back, I think most of the nights when the pressure gets much higher than that are nights when my nose is really clogged up.

Going back to the topic of sleep/wake junk, I had one other question. In SleepyHead, is there a way to zoom in on just the "truly sleeping" part of the night (leaving out the "junky" periods at the beginning and end of the night) and get it to report overall statistics such as AHI, RERA, etc, just for that time period? I know how to click and drag in SleepyHead to highlight any part of the night, but the overall statistics always appear to be the numbers for the entire time the machine was on that night, including the "junk" periods.

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Re: Total hours alseep; apnea events while asleep vs awake

Post by Jay Aitchsee » Mon Feb 02, 2015 12:20 pm

After you click and drag, look at the numbers above the Flow Rate chart for one instance - there may be others

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Re: Total hours alseep; apnea events while asleep vs awake

Post by Pugsy » Mon Feb 02, 2015 12:30 pm

Dyssomniac wrote: is there a way to zoom in on just the "truly sleeping" part of the night (leaving out the "junky" periods at the beginning and end of the night) and get it to report overall statistics such as AHI, RERA, etc, just for that time period? I know how to click and drag in SleepyHead to highlight any part of the night, but the overall statistics always appear to be the numbers for the entire time the machine was on that night, including the "junk" periods.
No way that I know of if you are wanting to permanently change all the statistics to omit the awake take...except for one but it would involve your turning the machine off and back on briefly before you go to sleep so that a separate session is created since with SleepyHead we can actually turn off an unwanted session and that should remove that session data from any statistics.
I haven't tested it to confirm though.

Example...you start the machine and lay there for a period of time and sleep just doesn't come and you know you are causing some awake events to be scored then you think you are starting to finally get sleepy enough to fall asleep...at that point turn the machine off and on and that second "on" will start a new sleep session in SleepyHead and the first session can be turned off.
Easier said than done because it requires the presence of mind to reach over and hit the on/off button.

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Re: Total hours alseep; apnea events while asleep vs awake

Post by palerider » Mon Feb 02, 2015 12:38 pm

Sleeprider wrote:Good call. Almost nothing is absolute and there may be some small fraction of people that achieve effective therapy at less than 6.0 cm. Most of us benefit from eliminating ineffective pressure ranges, and I should have avoided an absolutism. Seems applicable to the O.P. and hopefully the rest of my response was more helpful.
as I understand it, there are a few people that need very little pressure, just like most people don't need over 20, most people probably need more than 6... but there's always the edge cases

there's even one manufacturer that goes down to 3cm... so one one figure SOMEONE can go with the low pressures.

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