Newbie, but oldie with frequent night awakenings

[Julie]

Sending you a PM...

[SleepyToo2]

Joannebc, others will talk about the details of what you need to adjust. My message is don't adjust too much too quickly. I, and a lot of others, have found that it can take more than one sleep session with new sessions. A "good" setting may actually give you not good readings the first time. No need to go a full month between changes - many sleep docs will say they need this level of information. This will apply even more when you start to narrow things down. It might also be worth keeping a diary of what changes you made, on what date, and how you felt as well as your numbers.

[Wulfman...]

Gosh there is a lot of information on this thread. I printed it and will try to learn as much as I can.

Below is last night's data. Restless for 136 minutes, 14 x. I had two "major" periods of uninterrupted sleep 11:09 - 11:54 and then from 2:35 - 3:34. There were a couple of others, but less than 40 minutes each. I did go to an ENT before the sleep lab. The ENT didn't see any blockages or obstructions. I do wake up with dry nose and the feeling of needing to cough. I have the humidifier on 5.

I know I am up when the fit bit marks restless sleep because I get woken up by something. I don't look at the clock unless I use the bathroom, or feel I cannot go back to sleep and wonder how close I am to the time I have to get up.

In the last 2 months, I've been to an ENT, a retina specialist (lack of sleep is giving me tunnel vision), had an MRI on my brain and orbits, ultrasound on my carotid artery, all tests are normal. No one can explain the sleep problem. I was referred to an insomnia specialist who is booking 6 months out... I can't go another 6 months. The thought of that is incredibly depressing. I'm 48, normal weight, had a total hysterectomy 6 years ago, my gall bladder removed 4 years ago, but other than that healthy. I teach and cannot remember my students names. I get lost in my thoughts.

I will adjust CPAP to 7 tonight. What do FLOW LIMITATIONS mean and how do I normalize them?

Why are you changing your pressure again after only one night?

When I've increased my pressures (although very seldom), it has taken me a couple of nights to get used to the new one.
We don't sleep the same every night.
And, I thought you mentioned earlier that you thought your previous pressure might have been a little low.
Overall, you're still at fairly "low" pressures, but your reports look pretty good.
I'd give it a few more nights for evaluation.

I think "robysue" covered the flow limitations very well. Lots of breathing scenarios can appear to be something that the machine might "think" it needs to increase pressures when it actually doesn't. And, some people just have issues with their breathing (nasal structures) that are adverse to using ranges of pressure.

But, regarding this:

A good example is Pale Rider and Wulfman, who have somewhat opposing views on Flow Limitations and APAP. Both are right and both are wrong. It depends on the individual being addressed.

I wouldn't say that we're both "wrong", but rather we look at these situations in different ways. From my perspective, I look at the "quality" of sleep first and reducing "events" secondary.......and finding a happy medium. If a person spends too much time in the lighter stages of sleep, the AHI numbers can look great, but they aren't getting the deeper, restorative sleep stages if they're getting bumped out of their needed, restful sleep stages. On the other hand, any number of people don't seem to be bothered by the changing pressures and seem to sleep just fine.
Before therapy, we spent years being suffocated in our sleep with AHIs of 10 - 100+. Some people get really good sleep with this therapy at 5.0 and below. Some need and feel that lower is better. And, that again goes to an individualistic nature of this therapy. We each have to have an open mind about what works best for us and try to tweak our therapy as best we can......and hopefully have a fully data-capable machine and software to monitor it.

One thing about this therapy and hanging out on a forum like this is that we can learn so much more about our sleep, breathing and lots of other things that can go with all of this (like many other health issues we've never even thought about). It's (literally) a never-ending learning curve. And, that's a good thing.


Den

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[joannebc]

Hi Den,

I think Robysue suggested 7. I can leave it where it is. I am looking for a block of quality sleep that will make me feel refreshed, less exhausted. I may have jumped the gun on changing it because I am hoping if I make a slight change, things will correct themselves.

I'm also unsure if I should continue the trazadone. Will stopping it make things worse?

As for the flow limitations, I wondered if I can do anything to adjust it In a way that will produce a better result.

My sleep hygiene is good. On the insomnia index I'm a 26.

I appreciate all information. Please bare with me.... My thinking abilities are greatly impaired.

[Wulfman...]

Hi Den,

I think Robysue suggested 7. I can leave it where it is. I am looking for a block of quality sleep that will make me feel refreshed, less exhausted. I may have jumped the gun on changing it because I am hoping if I make a slight change, things will correct themselves.

I'm also unsure if I should continue the trazadone. Will stopping it make things worse?

As for the flow limitations, I wondered if I can do anything to adjust it In a way that will produce a better result.

My sleep hygiene is good. On the insomnia index I'm a 26.

I appreciate all information. Please bare with me.... My thinking abilities are greatly impaired.

I guess I missed robysue's comment about the pressure.

Can't answer that question about trazodone. I would suggest reading this link about it though:

http://www.drugs.com/trazodone.html


Den

.

[robysue]

joannebc,

I just wrote a long response and the damn CAPTCHA ate it.

I don't want to take the time to retype everything, so ask questions if I don't give enough detail.

Gosh there is a lot of information on this thread. I printed it and will try to learn as much as I can.

Below is last night's data. Restless for 136 minutes, 14 x. I had two "major" periods of uninterrupted sleep 11:09 - 11:54 and then from 2:35 - 3:34. There were a couple of others, but less than 40 minutes each.

and

I know I am up when the fit bit marks restless sleep because I get woken up by something. I don't look at the clock unless I use the bathroom, or feel I cannot go back to sleep and wonder how close I am to the time I have to get up.

So those very precise times for when you were asleep are coming from the fitbit or the clock?

Some comments:

1) The habit of looking at the clock when you are wondering how close it is to when you have to get up may be making your insomnia problem worse.

2) Your breathing pattern in the flow rate graph starts to look like regular sleep breathing by 10:10 or 10:20. (Although I'd really need to see a close up of the flow rate for the period between 9:50 and 10:15 to confirm this.) But if you managed to fall asleep as early as 10:15, then the first way at 11:54 is most likely a normal post-REM wake, and the CA scored around that time may well be a sleep/wake transitional CA.

3) I assume you went to the bathroom around 2:15-2:20 when you turned the machine off for about 5 minutes. And then you fell pretty soundly asleep within 15 minutes of returning to bed. Any chance the 3:34 wake was caused by the small leak that abruptly ends around 3:30 or 3:35?

4) I use a fit bit myself to track sleep among other things. Which fit bit? And what are the sleep settings? Are they set to sensitive or normal? I ask because it may be that some of what your fit bit is scoring as restlessness or wake may in fact be fairly normal Stage 1 or light Stage 2 sleep for you.

5) Do you look at the fit bit data first thing in the morning to determine how good or bad your sleep was? If you see a lot of "wakes" or "restlessness" in the fit bit data, does that tend to get you down and make you feel worse than you already feel when you get up?

I did go to an ENT before the sleep lab. The ENT didn't see any blockages or obstructions.

Did the ENT say anything about your mallampati score?

I do wake up with dry nose and the feeling of needing to cough. I have the humidifier on 5.

Does your nose dislike windy days? Does your nose dislike sleeping under a fan?

Because you are waking up with a dry nose, I would increase the humidifier setting. As I recall, a setting of 5 is not the maximum on a Resmed machine.

You may also want to consider getting a ClimateLine (heated) hose. That might let you increase the humidity without risking rainout.

In the last 2 months, I've been to an ENT, a retina specialist (lack of sleep is giving me tunnel vision), had an MRI on my brain and orbits, ultrasound on my carotid artery, all tests are normal. No one can explain the sleep problem.

If I were a gambler, I'd place my money on a future diagnosis of "idiopathic insomnia", meaning you have insomnia, but there's no identifiable cause. Idiopathic insomnia is most commonly treated with either cognitive behavior therapy or prescription sleeping pills or a combination of the two.

I was referred to an insomnia specialist who is booking 6 months out...

What's the background of the insomina specialist? Is s/he a sleep doctor? a psychiatrist? a psychologist? What s/he will recommend is very dependent on his/her background.

I can't go another 6 months. The thought of that is incredibly depressing.

In the meantime there is a lot you can do to try to manage the insomnia on your own.

I would start by reading a book called Sound Sleep, Sound Mind by Dr. Barry Krakow. This is a self-help book for insomniacs. The first part of the book has a lot of information about what kinds of things insomniacs do that tend to make their insomnia worse as well as lots and lots of varied techniques to try to avoid each of the "bad" behaviors. There are a lot of good tips that go beyond the standard "Use good sleep hygiene" advice. The second part of the book concerns the role of untreated sleep disordered breathing in causing insomnia as well as some information about how PAP works to treat OSA. Be warned, however, that Krakow has some very unorthodox ideas about UARS and how to treat UARS with ASV machines. I'd take his advice that UARS patients need to be treated with ASV machines with a very, very huge grain of salt. As in I think he's probably wrong on the UARS & ASV stuff.

Next, I'd keep a sleep journal for 2-4 weeks (or more) that is based on how you actually feel each morning before you look at either the fit bit data or the CPAP data. In the journal, you need to jot down the following things based on nothing but your memory of the night:

• Time you went to bed
• Time you got up for the morning
• Estimated time it took you to fall asleep at the beginning of the night. Do NOT look at the clock to try to figure this out. Do NOT cheat by basing your answer on the fit bit data. Do it only on how long it seemed to you that it took to fall asleep.
• Estimated number of wakes you remember. Do NOT cheat and base this on the fit bit data. Do it only on what you actually remember.
• Estimated total sleep time. Do NOT base this on the clock. Do NOT base this on the fit bit data. Do NOT base this on the CPAP data. Just make a guess on how long it feels like you actually slept during the night.
• A few notes about how you feel on waking and anything "interesting" that you actually remember from during the night. (In other words, notes like, "I woke up once from a dream and twice from masks leaks" is more than enough detail.)

Note that you should NOT try to track every wake. And you don't need to write down the time of any of the wakes that you remember.

The goal of the journal is to establish what your sleep subjectively feels like to you. It also will give the insomnia specialist some baseline data on what your insomnia looks like. (The first thing a lot of insomnia specialists ask their patients to do is to keep a sleep log for at least a couple of weeks.)

If you do start trying some of the suggestions you find in Sound Sleep, Sound Mind, the sleep log is also a way to deterimine whether they are doing some good: Learning to manage insomnia is usually not a "quick fix" type of thing, and the log can let you see how minor steps forward start to add up over the course of several weeks or several months.

What do FLOW LIMITATIONS mean and how do I normalize them?

A flow limitation is technically a string of misshaped inhalations in the flow rate curve. The particular way(s) the inhalations are misshaped can indicate that the upper airway is slightly compromised and may be at higher risk of collapsing or partially collapsing. The usual hypothesis is that a flow limitation in the flow rate curve has a high chance of corresponding to increased respiratory effort (as measured by the belts on a PSG). Increased respiratory effort means that your body is working harder to inhale the same amount of air as in a regularly shaped inhalation.

If the respiratory effort caused by a flow limitation becomes great enough, it can trigger an EEG arousal, in which case a RERA is scored on a PSG. The RERAs scored on your machine are based on looking for a series of flow limited inhalations followed by what appear to be "recovery breaths" that indicate an EEG arousal very likely did occur.

As for how to normalize them: The usual way flow limitations are "treated" is by increasing the pressure. But if the flow limitations scored by your CPAP are not real, more pressure won't eliminate them and may cause more of them.

In your case, you've got some activity in the flow limitation graph, but on the straight CPAP nights, it's really not very much activity. On the APAP night, it's a bit more and the most extreme FL value is much higher. That's some evidence that your FL are not responding well to more pressure, which may indicate that they are not "real" flow limitations after all.

My own advice to you is this:

Rather than worrying about tweaking the settings to somehow "improve" your already excellent efficacy data in an effort to fix your sleep problems, you need to step back and realize that CPAP/APAP doesn't fix bad sleep. CPAP/APAP fixes sleep disordered breathing and nothing else. Your excellent efficacy data indicates the CPAP is doing its job. So your sleep remains bad for other reasons. And until those other reasons are addressed, your sleep is likely to remain bad.

So here's what I think you should do:

1) Pick the setting that seems the most comfortable to you and stick with it for at least a week or two: I suggested straight CPAP at 7 since I'm a big believer in using only as much pressure as is needed because I get really bad aerophagia when my pressures get too high. But if you're more comfortable breathing at 8 cm, stick with that. Once you settle on a pressure setting that seems most comfortable to you, stick with it for at least a week or two before contemplating another pressure change. And only change the pressure setting if you know what problem you are trying to fix with the pressure change.

2) Work on increasing your comfort while using the CPAP as much as possible. You need to "fix" the dry nose problem since it is waking you up. More humidity should help. You might also find lots of Lanisoh nipple cream in and around the nose at night may help. The use of saline nasal sprays and/or a saline nasal rinse an hour or two before bed might help.

3) Start working on managing the insomnia. Try keeping the journal I suggested. As hard as it is, try to NOT let the fit bit data influence how you feel about your sleep. Jot down the notes in your journal in the morning when things are fresh in your mind. Look at the fit bit data in the early evening and see if it resembles what you remember or not.

[robysue]

I'm also unsure if I should continue the trazadone. Will stopping it make things worse?

Was the tazadone prescribed as a sleep medication?

If so, I would NOT discontinue it without talking to the doctor who prescribed it.

If the trazadone was prescribed as a sleep medication, but you don't believe it is working, you need to contact the prescribing doctor and set up an appointment to discuss whether you should continue taking it. And if you and the doctor decide that you should discontinue it, talk to the doctor about how to taper off it if need be.

As for the flow limitations, I wondered if I can do anything to adjust it In a way that will produce a better result.

Your flow limitation graph is "good enough" for now. While there is activity in it, it's relatively minor: The peaks are all pretty much below .33. And focusing on tweaking the settings in an effort to get a near perfect Flow Limitation curve is not likely to fix your real problem of frequent night time awakenings.

My sleep hygiene is good. On the insomnia index I'm a 26.

I'm not familiar with the insomina index you are talking about. Can you provide a link or tell me more about it?

[joannebc]

Robysue - Thank you so much for the reply! I didn't see it until now. I am trying not to dwell/obsess on sleep. I feel better the last two or three days, but by better I mean not as awful as I did... still not energized though. I've kept the CPAP on 7.

I will look for the book you recommend.

I use the fitbit flex and only look at the clock when I get up to use the bathroom. I have it on sensitive mode. For grins I turned it to normal mode for a couple of nights and the difference was astonishing. Restlessness went down to 7 minutes. Last night I put it back on sensitive and I was restless for 190 minutes. The times I listed in the previous post were times noted on the fitbit and yes, I do look at it first thing in the morning. I do recall waking numerous times during the night and often have great periods of being up. When I am up I typically focus on breathing, but just switched that up to thinking about being at the beach. I just recently started to dream. My dreams seem brief, but I have no true way to measure that.

Do you know why there is such a difference on the fitbit sleep settings? I do practice good sleep hygiene, and will keep a journal. I thought of that, but want to only think of sleep as a positive and was worried writing it down would make it.

I've reread this post a few times... I'm sorry I'm not clearer. It is hard to think and be smart at the same time... This is a recent issue for me. One I hope goes away quickly.

[robysue]

I use the fitbit flex and only look at the clock when I get up to use the bathroom. I have it on sensitive mode. For grins I turned it to normal mode for a couple of nights and the difference was astonishing. Restlessness went down to 7 minutes. Last night I put it back on sensitive and I was restless for 190 minutes.
...
Do you know why there is such a difference on the fitbit sleep settings?

I really don't have any idea why there's such a big difference in the two settings. My guess is that the sensitive setting may be so sensitive as to pick up any kind of movement when you are asleep, including such normal movements as turning over in bed or kicking the covers off in your sleep when you get hot. It may also be sensitive enough to pick up any kind of coughing, sniffling due to allergies, or the kinds of movements that can be related to apnea related arousals. Whereas the normal setting may be set to only pick up really large movements that are more indicative that the person really has woken up or is very, very restless. In other words, the sensitive setting may pick up a lot more "sleep-wake-junk" noise that is probably not all that important to a person who wakes up feeling good every morning.

I too have my fitbit set to sensitive mode, but I'm also aware that it may overestimate the wakes and restless periods. (The regular mode, however, may underestimate them, and I'd rather deal with an overestimate than an underestimate.)

The times I listed in the previous post were times noted on the fitbit and yes, I do look at it first thing in the morning.

You do need to not let the fitbit data control what you think about your sleep for the night. What I mean by that is trust your body more than the fitbit data. If you are feeling pretty decent in the morning and the fitbit says you woke up a whole lot, don't let the fitbit data ruin how you're feeling.

I do recall waking numerous times during the night and often have great periods of being up. When I am up I typically focus on breathing, but just switched that up to thinking about being at the beach.

Does thinking about the beach allow you to get back to sleep relatively quickly? That's what I think you need to work on: Teaching yourself how to get back to sleep once you are awake. It's not always easy to do, but if you can decrease the time it takes to get back to sleep after each wake, your sleep efficiency will go up. And once the sleep efficiency is consistently around 90% or above, the wakes really won't be much of an issue and you'll probably start feeling much better.

I just recently started to dream. My dreams seem brief, but I have no true way to measure that.

You don't need to measure the amount of dreaming you are doing. Once you are sleeping at least 90 minutes at a time consistently, you can assume that you are getting full sleep cycles and the wakes are normal post-REM wakes.

Also do keep in mind that most people with normal sleep patterns do NOT remember their dreams on any kind of a regular basis. The dreams we remember most vividly are the ones that we wake up in or the ones we wake up right after having them.

I do practice good sleep hygiene, and will keep a journal. I thought of that, but want to only think of sleep as a positive and was worried writing it down would make it.

A journal can actually be a good way of focusing on the positive aspects of your sleep rather than increasing the worry about it.

When I was fighting the First War on Insomnia with primarily CBT-I techniques, the sleep journal was a major positive tool that let me see I was making some real progress even if it did still feel like I was not sleeping very well. In the journal I was told to write down the following information every morning right after getting up:

• Time to bed. I was allowed to look at a clock and I think I did write this down each evening just as I went off to bed. However, if I forgot, I just used the timestamp on the CPAP.
• Time out of bed. I was allowed to look at a clock for this.
• Estimated time to get to sleep at the beginning of the night. The estimate was NOT to be based on looking at the clock. Accuracy in the actual time to sleep was not important; rather I was supposed to just write down how long it felt like it took me to get to sleep since one of my goals was to get to where I could fall asleep quickly with the CPAP on before it irritated me into a WIDE AWAKE and angry state.
• Estimated number of wakes during the night. I was specifically told to NOT try to track the number of wakes with any objective sense of accuracy by looking at the clock and trying to remember when they happened. Rather I was told to write down my best guess about the number of wakes during the night. I was also told that it was fine to write down a range of values (i.e. 4-6 wakes) if I wasn't sure how many had occurred.
• Estimated total sleep time during the night. Again, this was not to be based on a critical analysis of the night or to be based on watching the clock all night. Rather I was told to just plain estimate or guess roughly how much sleep I thought I got. And ranges of values were acceptable. In other words, on a bad night, I would write something like 3.5-4 hours (or even 3.5-4.5 hours). On a good night, I usually had a better grasp of how long I'd been asleep because there wasn't a whole lot of wake time in bed.
• Estimated sleep efficiency. Technically I was not told to track this, but I found it a very useful piece of data to track. Sleep efficiency is just (estimated total sleep time)/(time in bed). For example, if my estimated sleep time on a very bad night was 3.5-4 hours and I spent 6.3 hours in bed, then the estimated sleep efficiency is between 3.5/6.3=55.5% and 4/6.3=63.5%.
• A brief note or two about how you feel when you first get up Are you still tired? Sleepy? Ready to get up? Sort of refreshed? Sort of rested?
• A brief note or two about anything unusual about the night (optional). In my case I needed to tease out how many of the wakes were really coming from aerophagia vs other things. I wound up writing far more than I should have on this in retrospect, but with where I was at the time, I think I needed to put my frustrations down on paper so that I could then forget about them during the rest of the day.

If you decide to keep a sleep journal, it also helps to have at least one measurable goal that can be worked on and tracked. In my case the goals changed with time, which is ok. In my case, the first goal was to establish just how bad the problem was. The next two goals were working on reducing my sleep latency at the beginning of the night and increasing my overall sleep efficiency using a variety of CBT-I techniques (and the occasional use of Ambien at the time). The journal was a way of measuring whether the changes I was making in my lifestyle were actually improving the sleep or not.

[robysue]

joannebc,

I thought I'd also take the time to do some analysis of the data you presented in terms of your stated problem of frequent night awakenings with not feeling good in the morning. While our machines only have one channel of data, namely the flow rate, variations in the flow rate can be correlated to either REM or wakeful/restless periods during the night.

Based on the variation in flow rate that is visible at this scale, here's my best guess as to what's going on each night. I'd love you to tell me whether my analysis of the possible restless periods corresponds at all with what your fitbit data indicates. The following is organized one night at a time.

3/20:
Fell asleep by 21:40, which is about 20 minutes after going to bed. You also turned the machine off for about 10 minutes before you fell asleep. Any ideas on why you turned the machine off? What did you do in the ten minutes before turning the machine back on at around 21:30? It looks like you fell asleep pretty quickly after you turned the machine back on.

Potential restless/wake periods or possible REM periods are

• 23:30-23:50 There's an obvious wake around 23:30 where you turn the machine off and back on. Bathroom break? It looks like you don't get fully back to sleep until 23:50. Given this is wake is about 80 minutes after you first fell asleep, it may be a normal post REM wake, and after waking you decided to go to the bathroom. But it did take you a while to get back to sleep after returning to bed.
• 1:10-1:40. It's hard to figure out whether this is REM variability or a restless period. The timing fits a possible REM cycle since this starts about 90 minutes after you fell back asleep after the bathroom break. But a 30-minute REM cycle this early might be unusual. (REM cycles typically increase in length as the night goes on.) It could even be a combination of REM and then a post-REM wake with restlessness afterwords. What do you remember and what does the fitbit data say about this stretch of time?
• 1:55-2:05. This could just be a continuation of the above period. Or it could be this is the post-REM wake. Or it could be this is real restlessness or a wake. What do you remember and what does the fitbit data say?
• 2:45-3:35, when the machine was turned off. Which begs the question: Did you get up for the day at 3:35 or did you take the mask off and go back to sleep for another couple of hours?

3/21
Fell asleep by 22:10, which is about 60-70 minutes after going to bed. You turned the machine off and back on twice during this time frame. Was the machine making you uncomfortable? Was it keying you up in any way? A sleep latency of 60 minutes is very long and that can be enough to make one feel tired in the morning even if the rest of the night is good.

Potential restless/wake periods or possible REM periods are

• 1:05-1:15 There's an obvious wake around 1:05 where you turn the machine off and back on. It looks like you get fully get back to sleep around 1:15
• 2:05-2:45 The timing is not right for this beginning of this period to be REM. So that makes it more likely that this really is a restless/wakeful period. What do you remembe and what does the fitbit data say about this period?

3/22
Fell asleep by 21:50, about 20-25 minutes after going to bed. Again, you turn the machine off and back on before you are clearly asleep. Why? Are you having some kind of comfort problems when you are trying to get to sleep at the beginning of the night?

Potential restless/wake periods or possible REM periods are

• 0:20-1:15. It's not clear what might be going on here. It's really not quite the right timing for the first REM cycle, particularly since the OA at around 23:40 has just a tiny bit of variable breathing around it and THAT little bit of variable breathing + the OA does have the right timing for a first, typically short REM cycle. My guess is that you probably were a bit restless between 0:20 and 1:15. Maybe dozing in and out of sleep? What do you remember and what does the fitbit data say about this time frame?
• 1:30---there's a 5 minute long wake centered around 1:30 where you turned the machine off and back on. This is the bathroom break for then night? Did you finally get tired of lying in bed and not sleeping and then decide to get up to go to the bathroom? Or did you wake up and immediately go to the bathroom? If you had been lying in bed awake for a long time before deciding to go to the bathroom, you might have done better to just get up and go. Because it looks like you fell asleep pretty quickly after returning from the bathroom break.
• 2:30-3:00. This is only an hour after you fell back asleep. It could be a REM cycle, although it's a bit early. Or it could be a restless period. What do you remember and what does the fitbit data say?
• 4:20-5:00 when you turned the machine off. How long do you think you were in bed awake before getting up for the day? Note that many people do go through an extended period of light (Stage 2) sleep before they wake up for the day and it is possible to do some moving around in Stage 2 sleep.

3/23
Fell asleep by 22:05, about 40 minutes after going to bed. Again, you turn the machine off and back on before you fully get to sleep. Why? Comfort problems leading to the machine making you less sleepy and more wakeful?

Potential restless/wake periods or possible REM periods are

• 0:45-1:15. This could be the second REM cycle. (There's a bit of variability in the flow rate curve at around 23:20-22:30 which is better timed for the first REM cycle.) Or this could be some real restlessness. What do you remember and what does the fitbit data say?
• 1:50-1:55 There's an obvious 5 minute long wake here where you turned the machine off and back on. Bathroom break? At any rate, it looks like you got back to sleep pretty quickly after the bathroom break.
• 2:35-3:35 This starts way too soon after the last wake for a typical REM cycle. So my guess is that this probably does represent a real wakeful/restless period. What do you remember and what does the fitbit data say?

3/24
Fell asleep by 22:10, about 15-20 minutes after going to bed. Notably you fell asleep last night without the need to turn the machine off and back on. Were you more comfortable (or at least "less uncomfortable") lying in bed with the machine on while getting to sleep last night than you were on the previous nights?

Potential restless/wake periods or possible REM cycles are

• 0:45-1:50. The timing is right for the beginning of this bit of irregularity to be the second REM cycle. Whether the whole 60 minute period is REM is a different question since second REM cycles are usually not that long. So it could be this is a REM cycle with a post-REM wake and you had difficulty getting back to sleep after the post-REM wake. What do you remember and what does the fitbit data say?
• 3:10-4:20. It's a bit early for the third REM cycle, but not that much too early. But again, the variability lasts for over an hour. It's getting late in the night, so it could be this is all REM. Or it could be REM plus a post-REM wake where you have trouble getting back to sleep after the wake. Or it could be an extended period of wakefulness/restlessness that happened before you got back to REM. There's really no way to tell for sure. What do you remember and what does the fitbit data say?
• 4:20-4:35 There's an obvious 5 minute long wake here where you turned the machine off and back on. It's not clear if this wake is an extension of a very restless period from 3:10-4:20 or whether you were in REM during 3:10-4:20 and this is just a post REM wake up where you decided to go to the bathroom after waking up. But you do seem to get back to sleep shortly after turning the machine back on. You may not have stayed soundly asleep for very long however, because there's another potential restless period that starts at 5:00
• 5:00-5:20 when you turn the machine off. Again, this could just be typical Stage 2 sleep where you are starting to move around because you're getting ready to get up for the day.

Having written all of that, I'd like to ask a couple more questions that may help make sense out of what's going on.

1) How accurate or off base is my analysis? If my comments seem really disconnected with your memories of these nights and/or your fitbit data for these nights, please let me know.

2) What time do you usually get up for the day? Do you use an alarm?

3) What's going on when you go to bed and turn the machine off and on one or more times before you manage to finally drift off to sleep?

[Guest]

Hi again! I'm sitting in traffic, so I'm going to quickly address some of your questions, then later will carefully respond to the others. Because I am a newbie with the CPAP machine my doctor advised me to run it half hour to 45 minutes before turning in to go to sleep I order to get used to it. Every time I turn the machine off it is only to go to the bathroom. The mask is not uncomfortable. Upon waking when I feel the need to go to the bathroom I usually go right away. Sometimes I hesitate and think about it to see if it's an awakening or a true bathroom neccessity.

[joannebc]

Hi Robysue -

Since getting the CPAP, I've been going to bed around 8:45 and turning the CPAP on and wearing it to get use to it. Doctor's advice... The time I usually go to sleep is between 9:30 and 10:15. If I turn the machine off before then it is because I have to use the bathroom, no other reason. The mask is not uncomfortable.

Unfortunately I only have fitbit data for last night's sleep, because on the other nights this week I either turned off the fitbit altogether to not focus on it, or switched it to normal mode. I used normal mode twice this week. One night I had my boyfriend use it to see how it tracked his sleep. Of course, he sleeps like a baby!

I don't specifically remember each time I am up, because I am having a very hard time remembering anything, but I do know I'm conscious about being up, I turn over or move and just try to focus on breathing to get back to sleep. When I'm restless it's either tossing and turning, or dozing -- and just when I think I should be asleep, I'm awake again.

My normal routine is to go to my bedroom just before 9:00. I watch TV, it helps me fall asleep (really)... I'm typically asleep between 9:20 and 10:15, depending on how tired I am. I have the blue light turned off on my phone. My alarm clock faces the wall, on the dimmest light. I only look at it when I return from the bathroom. It is set to go off at 5:30. M-F I typically am up before that. I recently installed room darkening curtains. I've tried tweaking my schedule to stay awake until 10 or 11:00, but it is SO HARD TO DO. I'm so tired by 8:00 it is hard to keep my eyes open. Adjusting that time does not change any of the outcome. I go to bed on the weekends around 9:30.

In general, if I wake up having to go to the bathroom I almost never wait. If I have to go, I go. Also, in general, I have no trouble falling asleep (initially). I have trouble staying asleep.

I've been visualizing the beach instead of focusing on breathing for just under a week. I believe it has worked, except for last night. Not sure why.

On 3/20 - I got out of bed around 3:45 because I was tossing and turning and could not get any more sleep. I don't remember if I tried visualizing the beach or not that night. I just remember it was pointless to lay there. If I'm up, and not feeling that heavy sedated feeling... I get out of the bed and move to another room if I can't fall back to sleep.

On 3/24 (last night) I turned on the mask when I was ready for sleep (which was different from all other nights). According to the fitbit, I slept from 10:07 - 11:17, 11:28 - 11:46, 11:56 - 12:23, 1:14 - 2:48. I was pretty much up in between those times and after that. I only had three additional periods of sleep after 2:48 that were about 10 minutes each time. I recall being woken and tossing and turning. I am much more tired today than yesterday. Actually, yesterday was a decent day for me comparatively speaking...

What should I know about REM periods and restfulness? I'm going to do some research. - - -

Lastly, if I added you as my friend on FIT BIT, could you see my data? I would love that, if you wouldn't mind. Thank you so much for your time and assistance!

[kteague]

I just wrote a long response and the damn CAPTCHA ate it.

OUCH! That used to happen to me when I typed too long and it logged me out. One night I accidentally back arrowed and to my surprise my composition was still there. Don't know if that's the case these days or not. But I feel your pain. Or just a bit of it. You put a lot of time and personalization in your posts. That would hurt.

[robysue]

I just wrote a long response and the damn CAPTCHA ate it.

OUCH! That used to happen to me when I typed too long and it logged me out. One night I accidentally back arrowed and to my surprise my composition was still there. Don't know if that's the case these days or not. But I feel your pain. Or just a bit of it. You put a lot of time and personalization in your posts. That would hurt.

Yep. I know all about the back arrow trick. It's helped in the past. This time? Nope.

Yeah, it's a pita. But I've relearned the lesson of "select all, copy" before hitting that "preview" or "submit" button when things get long more than once.

[joannebc]

First, thank you all who have taken such time to help me understand what is going on. I appreciate you beyond words.

I have kept the CPAP on the setting of 7. I did move to my daughter's room on the off chance that my BF's snoring keeps me up when I am restless. He ordered a mouth guard... Until he gets use to wearing it, I'm going to find another place to sleep. Despite the change in location, I am still experiencing numerous night awakenings. I believe I am getting better at falling back to sleep quicker, but the quality of my sleep could still be so much better. I am sending some recent screen shots. BTW, Saturday night was the BEST NIGHT EVER. I woke up Sunday ready to run a marathon and felt that way ALL DAY. I was happy, energized, tuned in to my life!!! I want that again. Is there a reason Saturday night was better? Nothing on my end was different, with the exception of since this is Spring Break, I am going to be a little later, and if I'm still asleep, I am sleeping in.

I still get up to go to the bathroom -- will that need ever go away???
One night I woke up because of a leak. I don't think the head gear is on optimally, but I'm adjusting it as first put it on to see if I can find the best fit.
Lately, my belly is getting filled with air. I have to belch or pass air in other places, which I'm happy to do if I get the sleep I need, but is that a symptom of a problem?
My most pressing question is how do I reduce the restless/wake periods? Or is this something that will get better gradually over time.

Time to bed - Between 10 and 10:30
Time out of bed - Usually 5:30, althought since it is spring break, if I can sleep longer, I let myself
Estimated time to get to sleep at the beginning of the night - Relatively quick, less than 10 minutes always
Estimated number of wakes during the night - 6 that I remember. Fitbit shows 20-30.
Estimated total sleep time during the night - can't tell
Estimated sleep efficiency - can't tell, but way less than I need
A brief note or two about how you feel when you first get up - I am still sleepy, BUT more rested than I was feeling before I moved into my daughter's room. BUT not energized, refreshed or ready to go (except for Sunday)