Are AI's during the first hour of sleep unusual?

Hey friends,

I appreciate everyone's help in assisting me on this journey. The last two nights I have noticed that all of my apneatic events have occurred in the first 15 minutes of sleep. Two nights ago I had 3 Apneas, ranging from 12 to 26 seconds in duration and all within 12 minutes of each other with a my minimum pressure set on 11. Then last night I had 4 Apneas ranging from 10 to 17 seconds in duration and all within 5 minutes of each other with my minimum pressure set on 9. (Some of you suggested not monkeying with the pressure so often so I put it back down to where I had it before. Either way, I got the same result with Apneas occurring in the beginning of my sleep. And remember, these all occurred within the first 15 minutes of falling asleep with Hypopneas throughout the night but no more Apneas.

So my questions are:
1) Is it unusual for Apneas to occur at the beginning of sleep? I thought that it was more likely during REM stage 5 sleep.
2)Any idea what it means when they are in the beginning? Is it my body adjusting to a different kind of breathing? If so, would I benefit by taking something to help me sleep?
3)Should I be concerned about Apneas lasting that long? I know that it has to last 10 seconds or more to be an Apnea, but 26 seconds seems like a long time.

Thanks again for the help from all who have been there for a while.

I don't have the answers, but I am anxious to hear some from our more knowledgeable members. I have experienced the same thing for at least the last two months (I didn't have a data capable machine for the two years prior to that). Mine last anywhere from 10 seconds to 45 seconds each. I might have some sporadically later in the evening, but right off the bat, in the first hour, I usually have several close together.

I am using EPR of 3. Don't know if that has any bearing on it or not.

I think they can happen anytime. Yes, they are more likely to occur during REM sleep because it is often a very deep, relaxing sleep, but they don't occur only at this time. I wonder if it is at all related to your sleep position. If you sleep on your back you are more likely to have an apnea because gravity and the human anatomy are working against your airway. You could try sleeping on your side or stomach to start and see if that makes a difference.

spookydoo wrote:Any idea what it means when they are in the beginning?

Are you using the ramp?

LoQ wrote:

spookydoo wrote:Any idea what it means when they are in the beginning?

Are you using the ramp?

Exactly what I was thinking! If I happen to have an off night where I can't fall asleep within 30 minutes (rare for me), if I check my numbers they are horrible! When I check them in the morning, they're usually pretty good with an apnea cluster happening (or at least being recorded that way) at the beginning.

I am using the "Ramp". It's actually called "Settling" in the APAP mode. But it's set on 5 minutes because I fall asleep so fast. And 2 nights ago I set the minimum pressure 2 points higher because of this reason, but it didn't make any difference. Thoughts?

As far as sleeping positions, yes I sleep on my back. I start on my side but that only lasts a few minutes. And of course if I slept on my stomach...well no CPAP for me! Actually I did take a nap today without a CPAP today on my stomach and seemed to have no problems. However, I'm just not sure I could pull that off every night for 6-8 hours.

Still looking for an answer as to why so many Apneatic events in the first hour as opposed to later in the night. Anyone out there know or experience the same?

Tossing and turning can cause you to briefly hold your breath. You mention you start on your back, but quickly turn on your side. It may be that your moving around is registering as apneas or hypopneas. These apneas will not respond well to pressure, as they are basically central in origin. Also, not everyone has the most apneas in the REM cycle. My sleep studies showed my apneas were more likley to happen outside of REM.

I do not use the ramp. In fact, I haven't used the ramp feature except for the first month or so after I began therapy 2 years ago.

I do fall asleep on my back and some nights I do wake up changing positions from my side to my back. I'm assuming that from the posts so far, that the reason for this is mainly sleeping position? I'll try falling asleep on my side for a few nights and see what happens.

I sleep on my stomach or side or combination of both. I have noticed the last couple of nights that I am having apneas before I go to sleep. It's not so much a blockage as it is just not breathing. I always have been a shallow breather, but feeling the pressure ramp up really makes me aware of it. I usually fall asleep within a short time.

I had a very interesting meeting with a Neurologist who specializes in sleep disorders at Vanderbilt Medical Center today. I showed her my Resmed software report over the last several days and asked lots of questions. The information I gleaned was very valuable and I thought many of you would like to hear some of the things she had to say.

As to why my Apneas are primarily occuring in the first hour of sleep, she said that I should take those with a grain of salt. She said that everything from sighing to moving around can create Apneas on the software. She said that people sigh a lot when they first lie down to sleep. And she said that when you sigh, you stop breathing for longer than normal. She's right. Try sighing and see how long you go before taking another breath. She also said that any kind of turning can create an Apnea, which some of you have implied on your posts about this topic. I asked her if it came from my body moving into a slower type of breathing. She said no. I find it hard to believe that she would know definitively that there are no Apneas when slowing down your rate of breathing. Seems it would be more reasonable to say "It's not likely". But she wasn't arrogant by any means. She took lots of time with me and answered all of my questions and really tried to help me in my journey to better sleep.

APAP vs. CPAP-She said that they prefer a straight CPAP mode as opposed to APAP mode because you have to experience Hypopneas or Apneas before it will Titrate upwards, and then it Titrates down again only to have to go back up again only if you have more Apneas; and the goal is to eliminate Apneas. She said that if you can find a pressure you can live with that is also effective (try 3-4 nights at each pressure before deciding), then you will most likely have better results in a constant CPAP pressure. She wasn't against APAP and certainly understood the comfort factor, but she liked the results better with CPAP.

Central Apneas causing Death-She was emphatic about this. She said that Central Apneas do not cause death. Now this surprised me. One of the reasons I wanted the sleep study was because I wanted to make sure that my Apneas were not from Central Apneas. She said that with all types of Apnea you do wake up. And that spouses who lie awake at night worrying that their spouse will die from cessation of breathing should go back to sleep because they will NOT die from Apnea. She said the way Central Apnea kills people is that it causes heart arrythmias and that is what eventually kills people. I mentioned Reggie White and she said that that was from the heart arrythmia issue. (BTW, I had a sleep study 7 years ago and was diagnosed with Severe sleep Apnea-64 per hour. My AHI now ranges from 2-10 AHI each night
and I'm trying to get it below 5. So far it seems like I'm getting much better results with the Resmed s8 Auto II than with the Respironics M Series A-Flex.)

As to my daytime dizziness-She acknowledged that CPAP can cause dizziness because of the pressure it creates in the ears. However I have been using APAP and am not sure if it's with APAP and CPAP or just CPAP. She was a little perplexed by the dizziness thing however. After having just gone through their Balance Disorder clinic and having all tests negative, I decided it could be Apnea problems. And I told her that last Sunday when I had NO Apneas during my sleep, I had NO dizziness the next day, NO fatigue, NO brainfog and felt incredible. Don't know what the magic was that day, but man do I want it back. I have read from many of your posts that you just have to hang in there and it will get better over time.

While I know the doctor is not God, she has a lot of good data and has seen a wide variety of sleep disorder patients. Unless someone has some facts to the contrary and can show supporting data or share conflicting advice from another good sleep specialist M.D., I'm going with what she told me. Just as a side note, I started switching my healthcare over to Vanderbilt-a teaching and research medical center and have gotten superior results compared to the other local hospitals and doctors in town who whisk me in and out of their office in no time flat. At Vanderbilt, they are never in a hurry, are very thorough, are not afraid to run tests, are generally more curious, and do their best to get to the bottom of the problem. So, I say if you aren't getting the satisfaction you desire, go to a teaching medical center if you're near one. Hope this info is helpful to someone who has lots of questions like me.