Why do I still wake every 2-3 hours?

curtcurt46 · Post by **curtcurt46** » Sun Oct 08, 2006 4:52 pm

Dear Capers forum wide.
I am looking for ideas on how to solve my waking every 2-3 hours(3 times per night). I have improved from a high of 5+ times per night. I sleep with the Auto Bipap with Biflex in the auto mode setting of 5cm to 20cm, based on the rx from doctor.
Here are the typical numbers for a night:
AHI: 4.7
OA: 1.9
H:2.9
VS: 1.9
FL:0.4
NR:0.0
25.87 lpm with activa mask, no large leaks and no mouth leaking.
I have been compliant 100% of the time for the past 60 days using the cpap 7.5 to 8.5 hours per night. This is absolutely the best I have ever done, even better than when the doc had me trying Ambien to help me maintain sleep with cpap. Before that it was hit and miss and my old numbers showed it. I was less than 50% compliant over the previous 18 months. I finally decided that I have to make this work and have had steady improvement during the last 60 days.
I am being treated for PLMD with requip 1mg. A recent sleep study identified a PLMD index of 100 and a PLMD arousal index of 10. My doc thinks the PLMD may be waking me.
Does anyone have any thoughts on things to consider to improve my situation. I will be discussing with my doctor the end of the month. I know it's a process of elimination with educated guess work.
Thanks in advance and I appreciate any insights provided.

cflame1 · Post by **cflame1** » Sun Oct 08, 2006 5:03 pm

I know what worked for me... dunno if it'll work for you.

I raised my bottom number to 7.5... 7 or above could possibly work. Then again if I push it too high I wake up then too.

curtcurt46 · Post by **curtcurt46** » Sun Oct 08, 2006 5:45 pm

Raising the bottom to 7-7.5 was a thought I also had. Thanks.

Wulfman · Post by **Wulfman** » Sun Oct 08, 2006 5:55 pm

What do your charts from Encore Pro say?
At what pressure are your apneas and hypopneas occurring?
Are they showing a number of pressure increases during the night?.....and at the approximate times you're waking?

Den

Guest · Post by **Guest** » Sun Oct 08, 2006 7:00 pm

Wulfman,
My pressure usually runs from 7-9/10 with hypopnea's and 10-11 with apnea's. My IPAP starts at 7 and that's were I spend the majority of the time. My minutes were 7@266min., 8@53min., 9@76min., 10@7min., and 11@80 min. 9 was the cpap setting from the sleep study and that was increased to 11 because of snoring, but i had a UPPP and my snoring is very quiet and not very often.
It's rare to see any event just before waking. Of three wakings on the night of the 7th only one could you see an OA followed by H just before the waking.
The wakings usually do occur when the pressure is up or has been up, but not always.
Curtis

curtcurt46 · Post by **curtcurt46** » Sun Oct 08, 2006 7:51 pm

Wulfman,
The above response from guest is cuctcurt46. Must have been signed out and didn't know.

JeffroDoe · Post by **JeffroDoe** » Sun Oct 08, 2006 7:58 pm

curtcurt46...waking up in 2 or 3 hour intervals may be the result of something as simple as a heated humidifier setting.

If you don't get enough humidity, your mind will sense it and pull you out of a deep sleep. If you are using heated humidity, try bumping it up a notch and see what kind of improvement, if any, you experience. I'd try that before making changes to your pressure.

Snoredog · Post by **Snoredog** » Sun Oct 08, 2006 8:11 pm

My opinion based upon your numbers/reporting:

1. You are on the wrong machine (based upon your pressure report).
2. Min. pressure is too low (reason you are still having FL's and HI's).
3. You should have another PSG or EEG/ECG to see if the requip medication is actually addressing your PLMD.

UPPP surgery is NOT going to prevent your tongue from falling into the back of the throat (cause of most obstructive events). Only thing that is going to help or address that is sleeping on your side or stomach and/or considering a GGA that pulls the tongue forward. But there are no long term studies indicating weather or not your tongue may not just grow larger and do the same thing again.

I think your doctor first needs to find out if the arousals seen on the EEG are still present with medication (i.e. if the medication is working). If the arousals seen on the EEG are still present they should also see if they are associated with the arousals that bring you back to the wake state. Only other arousals that take you back to a wake state are central type events, if the latter is the case then you don't need to be on that machine with a range of 5cm to 20cm. You should be on a straight cpap at 9cm pressure maybe with cflex at a setting of 2. 9cm w/cflex=2 is easy to breathe against, there is no justification for the Bipap at that pressure.

GGA procedure:
http://www.sleepsurgery.com/genionglossus.html

Since you have had the UPPP, you may have some flabby tissue remaining that flaps in the wind that triggers the machine into thinking your are snoring, if that is the case you don't want a machine that triggers heavily off snore.

If you want an inexpensive way to determine if the tongue is the problem, consider the $150 tongue retaining device Snork tried (suction cup thing that pulls your tongue forward). Most people cannot tolerate it for more than a week but if you try it and feel better you'll know the tongue is the cause of your problem and you can take steps to address it. I'll try and find the link to that device, but they also make a dental appliance that pushes the tongue out of the airway (doesn't pull the mandible forward like the TAP devices). Search for TRD or Tongue Retaining Devices.

Wulfman · Post by **Wulfman** » Sun Oct 08, 2006 8:16 pm

Curtis,

From reading your posts, I've been wondering if your pressure changes have been disturbing your sleep, too.....and that's still the impression I'm getting.

You didn't mention your EPAP pressure.....

Is there a pressure where you do NOT (seem to) have any apneas and/or few hypopneas?
I'm thinking that if you could find a fixed IPAP and EPAP to try for awhile....you might have better results.

Den

curtcurt46 · Post by **curtcurt46** » Sun Oct 08, 2006 8:44 pm

Snoredog/Wulfman,
You both have given me a lot to think about and consider. I do believe my epap and ipap start pressures are low.
There is no pressure looking over my charts long term where I don't have H and OA. The pressure has gone as high as 16cm, but that was when I didn't understand leaks. Here lately my highest pressure has been 13cm.
I plan on discussing with the doc how we are going to determine if the requip is working for PLMD. I believe the only accurate way if PSG testing. One other thing that might be occurring is that my sinuses get congested off and on. I have been changing my humidity each night to see how I respond. I may breath better but I still have the waking. I am going to focus on the comments from Wulfman and Snoredog and try to do the process of elimination. Thanks much for your comments. I will sleep on them and develop a plan of attack to get it right. Thanks Again.

curtcurt46 · Post by **curtcurt46** » Sun Oct 08, 2006 8:54 pm

Wulfman,
I didn't answer your question about EPAP. The machine is set at 5. I do think this is to low. I am think this might need to be kicked up to 7cm. Any thoughts.

Wulfman · Post by **Wulfman** » Sun Oct 08, 2006 9:09 pm

Curtis,

You can configure your Bi-PAP to run like a straight CPAP by setting the IPAP and EPAP to the same pressure.....you could try 9 cm. as Snoredog suggested.
You could still have the C-Flex, too (which is called BiFlex on that machine).

Anyway, that's my 3 1/2 cents worth.

Good luck and let us know how things go.

Den

curtcurt46 · Post by **curtcurt46** » Mon Oct 09, 2006 10:39 am

Wulfman/Snoredog,
I have made a list of those items that I need to investigate as a process of elimination to solve my wake problem. Here is my list:
^Mouth leaks/dry mouth/mask leaks: under control.
^Nasal congestion: under control with humidity and flonase.
^Events (apnea, hypopnea): don't see waking on daily data, may contribute to arousals. Need to get AHI as low as possible. See pressure settings below.
^Event (central apnea's): don't think I have had any, but it's worth having my last couple of PSG reviewed for centrals, just to make sure.
^Event(PLMD): need to make sure medication is working. work with doctor. maybe I can do an at home EEG/EMG? Long term need to determine if PLMD is primary or secondary to OSA. If secondary is determined then when can meds be eliminated as CPAP therapy eliminates the PLMD.
^Pressure settings: raise EPAP to 7 or 7.5 or 8. Try for a week to see if any improvements waking and AHI.
^Pressure settings: set EPAP and IPAP to 9cm and flex of 2, see if improvements.
^Have doctor involved in the process.
^Report results to forum.
What have I missed, that should be on the list?
Thanks for the great advise and particularly your time contribution.
Curtis

Wulfman · Post by **Wulfman** » Mon Oct 09, 2006 11:13 am

Curtis,

Sounds like a plan, to me.

I'm not sure about the following one if you're going to set the IPAP and EPAP at 9 though......this one may not be necessary.

^Pressure settings: raise EPAP to 7 or 7.5 or 8. Try for a week to see if any improvements waking and AHI.

Good luck,

Den

curtcurt46 · Post by **curtcurt46** » Mon Oct 09, 2006 11:31 am

Wulfman,
Thanks
I may try both but agree with you. Guess I am curious as to what will work.
Thanks,
Curtis[/quote]