Machine says all is well, but i keep waking up... why?

16 days on the machine, pressure of 11 (starting ramp at 4). Took 3 days to get used to the swift nasal pillows, I wear the contraption all night. Added a chin strap on night 3, which reduced the leakage and helped me adjust to everything. I wake up 6 to 12 times a night, but fall back asleep fairly quickly. Wife does not wake up, so I doubt that some noise is the culprit.

As usual (for the past year) we have a fan running in the room on low and a white noise generator. Mattress is fairly new (memory foam), so that probably isn't it.... i don't drink, don't use caffeine, go to bed around the same time each night. Have tried warm baths, etc.

I was so hopeful that the machine would help me feel rested. Not so far.....

Any ideas or help would be great...

Oh_2get_some_sleep wrote:16 days on the machine, pressure of 11 (starting ramp at 4). Took 3 days to get used to the swift nasal pillows, I wear the contraption all night. Added a chin strap on night 3, which reduced the leakage and helped me adjust to everything. I wake up 6 to 12 times a night, but fall back asleep fairly quickly. Wife does not wake up, so I doubt that some noise is the culprit.

As usual (for the past year) we have a fan running in the room on low and a white noise generator. Mattress is fairly new (memory foam), so that probably isn't it.... i don't drink, don't use caffeine, go to bed around the same time each night. Have tried warm baths, etc.

I was so hopeful that the machine would help me feel rested. Not so far.....

Any ideas or help would be great...

Got a copy of your Sleep Study? Drag it out, look for CA or MA events, spontaneous arousals, PLMD etc. These are other disorders which can impact your sleep assuming OSA is taken care of by CPAP. CPAP only addresses one aspect of sleep disorders, obstructive events. Your sleep study should identify those other items.

Don't have a copy of your sleep study? Ask for it. Ask for the exact report sent by the sleep lab to the doctor, not your doctors summary of it. You have a legal right to a copy of it once the results of that test have been delivered to you by a Licensed doctor.

Also you could tell more if you had the software and reader, the LCD doesn't tell all. Jim

Wow, fast replies. You are awesome.

I've been thinking about the software, just wondering if it was worth the expense. I've been reading the posts here and can't decide...

My sleep study says AHI of 21, REM AHI of 42, Oxygen nadir of 85%, EEG arousals 38 per hour.

128 events in 372 minutes. 19 obstructive apneas, 12 central apneas, 5 mixed events, 92 partial apneas/hypopneas.

Still a rookie, so not sure what all that means. Sleep doc wanted a followup in 6 weeks (bring my card in) but I'm going to schedule something at 4 weeks....

Thanks for your help.

It means you aren't getting the benefit of the treatment, and I personally would put that down to the mask fitting badly, maybe not the one for you, or else the fact that you may be a mouth breather and unaware of it, in which case you'd need either a full face mask (which isn't what it sounds like, it's just a bit longer than the nasal one and covers your mouth), or possibly a nasal mask (I found the Swift to be very ineffective) with or without mouth taping, which many people do.

Just another opinion, but it could be you are just getting used to things. 16 days really isn't very far into this. Yes you may finally be getting a good seal and the straps aren't as noticable, but you are also adjusting to a different noise (no snoring). Also your sleeping is different in order to accomodate the hose. Slight tugs when you turn or movement of the mask agaisnt your pillow will be enough to arouse you.

Take the other's advice regarding adjustments, but also realize you are learning a new way to sleep and that takes time. Pretty soon you will be able to ignore things and really sleep. But even then don't be suprised if you wake up after jsut a few hours sleep. Often when the therapy is working you are getting as much rest in 4 hours as you were when you slept a full night before. Over time you will overcome this too.

Obviously, the card reader and software will give you alot of information, but the LCD on the M Series Pro will give you some.

Are you accessing the LCD info? You might have alot of mask leaks that you aren't aware of.

If you don't know how, here's the info:

You just need to press either of the arrows on the control panel to scroll through the LCD data. It will show average pressure, AHI, leaks, hours of use, etc.

You are right, it has only been 16 days. I do intend to keep at it.

The first few days i had leaks, and my mouth was open, so i got a chin strap, which solved the problem. I do check the LCD every day, and i saw the mask leaks drop way way down once i got everything adjusted.

If the nose pillow things shift, I get a leak and it wakes me up. I've got the adjustments on the headgear figured out,and i rarely wake up with the mask leaking. I just wake up, everything seems fine, and in a few minutes I'm asleep again. But waking up every 45 minutes is a drag!

Maybe it is me moving and the hose is tugging on the mask... I keep some slack in the hose and the rest I put between the pillow and the headboard to keep it from flopping around....

Thanks again you guys, I really appreciate this forum. I can see how support from folks like you can keep us rookies on track.

What numbers is the LCD showing for a typical night? What's the AHI?

AHI is hovering around 2.2

Oh_2get_some_sleep wrote: I've got the adjustments on the headgear figured out,and i rarely wake up with the mask leaking. I just wake up, everything seems fine, and in a few minutes I'm asleep again. But waking up every 45 minutes is a drag!

waking up every 45-minutes could mean when you reach REM and that the pressure on your machine is NOT high enough. The Centrals and Mixed apnea probably had some bearing on the final pressure finding that ended up on your machine.

They probably had to send you home with a pressure that avoided the centrals seen, that means that same pressure can also allow some apnea to go left untreated. Since most apnea usually occur during REM sleep state which you may go through every 60-90 minutes. So it could be when you hit these REM periods pressure isn't high enough to completely eliminate the apnea therefor it causes an arousal.

On the flip side, the arousals that are waking you are some of those centrals seen on your PSG. Central apnea will take you back to a wake state, you may even wake up in a panic. The machine you are using won't be able to accurately track those type of events.

So you are left to assume:

1. That CPAP will eliminate all the "obstructive" events seen on your PSG.

2. Once those OSA events are eliminated that all other non-OSA events seen on your PSG also subside and don't interrupt your sleep. CPAP generally does not address central apnea events in fact most machines will try and avoid any response to them as increased pressure can make them worse in frequency.

So once you are sure your OSA is under control, and/if you are still waking and/or not feeling rested you need to ping your doctor about those other items seen on your PSG and not let them go unaddressed.

Most people don't, most don't even know those other items exist and so they play with pressures up and down and never really resolve the underlying issues interrupting their sleep.

Those CA & MA events seen on your PSG may make your case more complex to resolve. It all depends on what was actually seen during the titration portion and how you responded to cpap pressure. Other items not to overlook are spontaneous arousals, those can leave you tired during the day also. If you are having 27hr of spontaneous arousals, those can be the same as a AHI=27 per hour, just that there is no SAO2 desaturations associated with them, but they can destroy your quality of sleep just as well as OSA can.

Oh_2get_some_sleep wrote:AHI is hovering around 2.2

That's very good. Any AHI under 5.0 is considered "normal", so you're doing well.

I agree with mikemoran that the frequent wakeups are probably still part of learning this new way of sleeping with a mask on your face. As Mike pointed out, "Slight tugs when you turn or movement of the mask against your pillow will be enough to arouse you."

Slight leaks hitting your face occasionally can do the same thing. It can take quite some time for some people to get used to all the equipment issues that can obviously or even subtly affect sleep.

As Goofproof mentioned, having the software to get a better look at each night's leak rate (as well as other nightly details about your treatment) would be more informative than having to rely on the LCD weekly/monthly "averages." If you find that mouth leaks may be a problem after all, Julie's post has some good suggestions for working on that. Mouth leaks can be a waker-upper for some people while others sleep through them.

Sounds like you're slowly but surely getting the pieces of the puzzle together. As you get more comfortable with a mask that suits you and the whole rig, it does get easier. Good luck!

I've been at this about three weeks now.. Maybe four. So I'm not too far off from you in that regard.
I also am using the swift mask, and our machines are similar (except that I got the auto).
I also wake up 4-6 times a night. So far, I don't mind. I am feeling MUCH better, so I really am not worried about it.
I suspect that my tossing around is knocking the swift loose. I don't strap it too tight, but it's not ideal for side-sleeping.
I look forward to trying the twilight np, but it'll be five months before my insurance will pick up another mask, and my finances don't allow for doing it out of pocket.

At this point, it's working, and I'll do whatever it takes to keep it working. I need this therapy.

Keep the faith,
LyleHaze

Do you take any meds? There are some that actually cause fragmented sleep which appears to be what you are experiencing. Also, look for hidden caffeine in pain meds, chocalate and etc. Caffeiene really wreaks havoc on my whole system for many hours after I have any. Sugar also keeps me awake at night. Take a look at what you are eating and see if that is the problem.

If none of those are the problem and your AHI is within the normal range, then perhaps you are just have some difficulty adjusting to the machine.

I'm lucky that i am med free. I only take (daily) a multi vitamin, vitamin E, and a omega 3 fish oil capsule (the spouse's idea....).

It may be that the mask tugging is causing me to wake up. I'll stick with it and see what happens.

My real hope is to feel rested enough so i can exercise in the morning, because i hear that regular exercise is great for good sleep. Plus, if I lose some weight, I will feel better and have more energy....

Looking to start that upward cycle of getting good sleep, exercising, losing weight, getting better sleep, exercising more, ......

Thanks for all your replies. I'm humbled by how helpful u all are.