Pressure too high?

For the last few weeks I, with a few exceptions, can't sleep more than six hours; often just five. This began around the time I lost some weight. I have lowered the pressure down from a high of 20 to 11, though my charts say I spend a lot of time at the high end. Even so, could I still be at a too high pressure and that wakes me early or keeps me from deeper sleep? Does it even work that way?

What does your software (SH?) say?

Julie wrote:What does your software (SH?) say?

Last night's AHI was 1.27, with 7 hours use (but I would say I slept from 6 to 6.5 hours). I feel like either I didn't get enough sleep or didn't get enough deep sleep. It says my pressure was under 10.98cm 95% of the time.

Noctuary wrote:

Julie wrote:What does your software (SH?) say?

Last night's AHI was 1.27, with 7 hours use (but I would say I slept from 6 to 6.5 hours). I feel like either I didn't get enough sleep or didn't get enough deep sleep. It says my pressure was under 10.98cm 95% of the time.

It's probably more likely to be that the pressure isn't high enough, rather than too high. Do you have any graphs?

I'm envious of your AHI. I'd kill for an AHI of 1.27!

OK, maybe not kill. I'd do violence... no, not that either.

I'd say rude words for an AHI that low!

We can't see the complete pressure graph. Are you using the Ramp ... if so shorten it and/or raise its starting pressure. If it were me I would raise both the lower and upper pressure by 1 cm. If you were awake for the first 30 min you can through out all that (as pugsy says SWJ )

grayghost4 wrote:We can't see the complete pressure graph.

Noctuary, Here's Pugsy's instructions on posting Sleepyhead images - viewtopic.php?f=1&t=104876&st=0&sk=t&sd=a&start=30

Noctuary,

The far right side of your flow rate and pressure graphs are cut off for some reason---even when I click on the link and look at the graph over at Imgur. In other words, I can't see what's happening between 9:30 and 10:17.

But---the rest of the night looks very good. Yes, there's a small cluster of events---including a bunch of CAs between 3:08 and 3:30. But that looks to me to be sleep transition stuff that I personally wouldn't worry about. By the end of that cluster, it looks like you were asleep at least for a while. There's evidence of avpotential microarousal just before 4:00 and the flow rate looks like you might have been a bit restless between 4:00 and 4:45. There's another potential microarousal at one point between 5:30 and 6:00 (the huge, sudden and brief increase in flow rate), but you seem to have gotten right back to sleep after that one. There are two more probable micro arousals between 6:30 and 7:00, one of them even has a CA, but again it looks like you probably got right back to sleep. My guess is that CA scored around 8:20 is SWJ or caused by the transition between sleep and wake. By 8:30, it looks like you might be getting restless or just transitioning to a real wake that occurs around 9:10. You turned the machine off and back on around then as well. Did you turn the machine back on out of a belief that you needed more sleep? How well do you think you slept the time you turned the machine back on and 10:17, when you decided to just get up for the day?

You say you slept for between 6 and 6.5 hours. It looks like your "Time in Bed" was around 7.15 hours (Wake-Sleep = 7:09). If you only got 6 hours of sleep, that's a sleep efficiency of 6/7.15 = 84%, which ain't bad, but it also isn't real great. If you did get 6.5 hours of sleep, the sleep efficiency is 6.5/7/15 = 91%, which is pretty good. If you had to choose one of "I slept 6 hours" or "I slept 6.5 hours", which would you pick?

A few more questions, some of which I know are going to sound strange:

1) Did you feel better or worse at 9:10AM when you chose to turn the machine back on rather than just get up than you did when you finally did get up at 10:17?

2) How long would you estimate that it took you to get back to sleep after the 9:10 wake? Were you awake for quite a while? Or did you fall back asleep pretty quickly?

3) How much sleep do you think you actually got between 9:10 (when you turned the machine off and back on) and 10:17 when you chose to get up for the morning?

A final comment: Something other than events is causing the pressure to increase. Since no events are being recorded, that something must be either snoring or flow limitations. We've talked about this in the past in other threads. When you had the max pressure set higher, there was real evidence that the higher pressure spikes were causing some serious restlessness. You do seem to be sleeping more continuously with the maximum pressure capped at 11cm than you had when the pressure was allowed to go much higher. Your overall AHI is about the same as I recall. It's possible that either snoring or flow limitations may be causing some problems that are subtle enough to not show up in the flow rate graph as obvious potential arousals. The important question for you is: Are any sleep related problems due to snoring and flow limitations more or less disruptive to your overall sleep quality that the pressure-related problems you were running into when you had your max pressure set much higher at 20cm.

In other words, at this point finding the "sweet spot" as far as the max pressure setting is concerned may involve a delicate compromise between setting the max pressure high enough to minimize sleep disruptions from snoring/flow limitations and low enough to minimize sleep disruptions caused by the pressure being high enough to cause spontaneous arousals of various sorts. Finding that delicate compromise for the max pressure setting can only be done through continued experimentation on your part.

Note to others: Noctuary has experimented with a number of different max pressure settings. At one point he had his max pressure set to 20cm, but he was waking up a good deal of the time and most of the events being scored were CAs. (See I'm not getting enough sleep now.) By lowering the max pressure setting, he has been able to get more sleep and his AHI has gone down mainly because the CAI has gone down. (See Latetest SleepyHead report.) Unfortunately even though Noctuary is sleeping more hours now than he was back in early May, he's still not feeling particularly rested when he gets up.

At 9 am I was awake. I tried for a time to go back to sleep, but could not. I cannot say whether I slept for 6 or 6.5 hours.

Noctuary wrote:At 9 am I was awake. I tried for a time to go back to sleep, but could not.

So from 9:00am to 10:17AM you laid in bed trying for over an hour to get back to sleep, but failed to do so?

Lying in bed trying to get back to sleep for over an hour and then getting up leaves me seriously exhausted. As in a whole lot worse than if I'd just got out of bed when I first woke up. It's a lesson that I've learned the hard way. And so now I'm very reluctant to lie in bed for any length of time in the morning after I've woken up and its after 8:00am---regardless of when I went to bed.

Have you considered just getting up when your body naturally wakes up instead of trying desperately to get a few more Zzz's? Particularly when you have already gotten at least 6 hours of sleep?

Noctuary, I really think its worth trying to just get up when your body is done sleeping. And yes, I know that's a hard thing to force yourself to do. But its still worth trying.

I cannot say whether I slept for 6 or 6.5 hours.

So you got all (or almost all) of your sleep before the 9:00AM and you went to bed around 3:08. So for the first 6 hours of the night (from 3:08 to 9:00), you were pretty much asleep the whole time. And the vast majority of the wake/restless time was between 9:00 and 10:17?

So from 9:00am to 10:17AM you laid in bed trying for over an hour to get back to sleep, but failed to do so?

I counted backward from 100 and didn't trip.

Have you considered just getting up when your body naturally wakes up instead of trying desperately to get a few more Zzz's? Particularly when you have already gotten at least 6 hours of sleep?

I want to try to feel good.

So you got all (or almost all) of your sleep before the 9:00AM and you went to bed around 3:08. So for the first 6 hours of the night (from 3:08 to 9:00), you were pretty much asleep the whole time. And the vast majority of the wake/restless time was between 9:00 and 10:17?

Yes. I still don't feel rested. I don't have a stellar life that I can't wait to get to, so I just want to not feel bad in my day.

Noctuary wrote:

So from 9:00am to 10:17AM you laid in bed trying for over an hour to get back to sleep, but failed to do so?

I counted backward from 100 and didn't trip.

Have you considered just getting up when your body naturally wakes up instead of trying desperately to get a few more Zzz's? Particularly when you have already gotten at least 6 hours of sleep?

I want to try to feel good.

That's actually my point: You might feel better if you just go ahead and get up when your body says it is done sleeping for the night.

There's such a thing as trying too hard and you may be doing that with regards to trying to squeeze out just a bit more sleep in the morning. And trying too hard can leave you exhausted and feeling miserable. Because in addition to being worn out from working hard at trying to get back to sleep, you also have a sense of failure to contend with as well.

It sounds corny, but attitude does matter, and a sense of failing to accomplish a goal (getting back to sleep) is a bad way to start the day off. And that's part of why I think you might do better to just get up when you wake up after 6 hours of sleep.

Noctuary wrote:

So you got all (or almost all) of your sleep before the 9:00AM and you went to bed around 3:08. So for the first 6 hours of the night (from 3:08 to 9:00), you were pretty much asleep the whole time. And the vast majority of the wake/restless time was between 9:00 and 10:17?

Yes. I still don't feel rested. I don't have a stellar life that I can't wait to get to, so I just want to not feel bad in my day.

Here's the thing: You didn't feel rested when you woke up at 9:00. But you felt just as unrested (maybe more unrested) when you finally decided to get up at 10:17. And so in addition to feeling unrested, by 10:17, you were already focused on just how lousy you now felt since you not only woke up earlier than you intended, but you also failed to get back to sleep as well. In other words, the failure to get back to sleep likely added to how bad you felt when you finally did decide to get up and face the day.

Yes, it's hard to force yourself to just get up. I don't have a steller life either; I certainly don't wake up ready to bound out of bed because of all the interesting and wonderful things that await me. (Indeed there are a lot of mornings where I don't particularly want to get up because of the long list of "things I must do that I'd rather not do today".) But I know that I have a simple choice each and every morning when I first wake up and it's clear my body is done sleeping for the night:

I can get up, stumble downstairs and hope hubby is willing to make me some decaf, and focus on waking up, eating breakfast, and realizing that even if I'm still tired, I'm not exhausted. And after breakfast I usually start to feel pretty decent. And after being up for a while, I tend to notice that I'm not as tired or exhausted as I thought when I first got out of bed.

Or I can lie back down and try desperately to get more sleep and usually fail. And as I lie there getting more frustrated, the BiPAP inevitably triggers some aerophagia and/or anger. And I toss and turn and silently curse the fact that it's so difficult to get back to sleep. And I maybe doze a bit and sometimes catch myself starting to snore, so the pressure goes up, which aggravates any aerophagia that I have from using the BiPAP all night long. And eventually I get up 40-60 minutes later feeling more tired and more mentally exhausted than I felt when I first woke up. And I still stumble down the stairs hoping hubby will make me some decaf. But after breakfast I don't usually feel as good as I would have felt if I'd just gone ahead and gotten up when I first woke up.

So for me it's clear: If I chose to lie back down after waking up and I'm not sound asleep within about 10 minutes, I'm far better off just getting up and admitting that the body is done with sleeping for the night.

It really doesn't make a difference in how I feel during the day whether I get up or not. I know as soon as I awaken how I will feel.

Attitude, sleep hygiene, etc. make no difference for me. But thank you for your post.

I don't think a maximum pressure of 11 is enough.
It's hitting 11 and possibly wanting to go higher.