Please help. Low AHI but still wake up all the time.

[Pugsy]

90/95 % numbers....it's NOT an average
It's where you were at OR BELOW for 90/95% of the time.
90/95% numbers are easily skewed to the high side with just a brief episode of higher whatever. For that reason the 90/95% numbers are just numbers.

If more pressure causes more leaks and more leaks disturb sleep...then that's what I meant by making a compromise.
We have to decide which devil is the worst devil...the FLs or the leaks.
At this point we don't know for sure that the FLs are a factor in your sleep quality. They are a maybe factor.

[CarpeNoctum]

Personxyz,
You mentioned leak issues and lanolin. Many use mask liners that help with leaks. Worked well with my FF mask. Just a thought...
CN

[Jas_williams]

Lanolin is used to treat a sore nose not to help the mask seal, infact use too much and the mask will slide all over (ask Pugsy she ended up with her Nasal pillow in her ear I am sure I have read)

[nicholasjh1]

I consistently have an AHI below 2, sometimes even under 1 but I wake up 5-6 times every single night. I thought when I had my sleep apnea under control these frequent awakenings would stop but that hasn't happened.

Is there any part of the sleepyhead data that may give more insight into why I wake up so often? Could I zoom in on a time period where I know I woke up to try to see what triggered it? Which charts would be worth looking at in more detail if I did this?

I feel I'm within touching distance of getting really great sleep. My AHI numbers are really low, if I can stop the frequent awakenings I will be in a truly great position.

For me it was related to mouth leak. I wasn't breathing out of my mouth, but air was bubbling, or just flowing (decreasing total pressure) So this would actually keep my apnea's low because I was basically waking up everytime I got to a deep sleep, so I never got to the stage with high apnea's. Taping helped with this, but drool would mess up the seal, and I also got bad aerophagia with a good tape. The ultimate chin strap has worked for me. Sleep is dramtically deeper, my apnea's actually went up after the strap, I believe because I am going into a deeper sleep stage, but upping the minimum a bit helped with that. The chin strap also brought my leaks to 0 at the 95%, and they were between 8 and 24, telling me that there must have been a huge amount of mouth leak. I would suggest that, or others use a combo of chin strap and tape, or a cervical collar and/or tape. To me the ultimate chin strap is best because it covers the mouth without causing the problems of tape and you can adjust the chin strap part just right.

[Personxyz]

Last night I turned the machine off for a brief period every time I awoke so that I had a record of exactly when it happened. My mind was racing a little yesterday and I think that's why I ended up awakening 9 times. I only stopped the machine 8 times because on the first awakening (which happened around midnight) I forgot to turn the machine off.

I've been learning about sleepyhead in the past 24 hours, particularly to do with the flow rate graph in an attempt to find out why I keep awakening. I've attached screenshots for each of the 8 awakenings below where I have zoomed in to try to find out what happened. I'm only a beginner at analyzing data but I can't see why I'm waking up.

There are no pressure increases just before I wake up and there is barely any flow limitation at the awakening times (on some there is zero). The flow rate graph for most of the awakenings stays consistent right up to awakenings. It looks like I was perfectly asleep and then woke up out of nowhere. I checked the leak rate at the time of each awakening and it was at roughly 2 in 7 out of the 8 times, something so small it could never wake me.

Does anyone have an idea about what is causing my frequent awakenings after looking at these zoomed in screenshots. I'm confused and frustrated.

[Personxyz]

The other awakenings.

[Personxyz]

The final two awakenings.

[zonker]

[Zonker: If I remember I may post my sleep hygiene plan on the forum either in this thread or by starting a new one. It might not be for a few weeks though as I'm reluctant to start it whilst I'm tweaking my machine settings as it leads to too many variables. If I improve I would not know what's helped and what hasn't. I wish you well and hope your situation improves.

oh, no rush, just whenever you get "a round tuit", as friend of mine used to say. i want to be sure to stay tuned to this thread. whatever it is that's causing your wake ups, i want to see if it's what's causing mine and if the treatment would be the same.

i see further down thread that you've taken pugsy's advice regarding turning your machine off/on to mark those wake ups. so i'll be on the lookout for what will be suggested!

[Pugsy]

I don't know what to suggest. Of the reports above only one looks like it might be a post arousal breath that happened before the machine was turned off.
I just don't see anything standing out screaming in the flow rate that might point to much of anything.

I don't think the wake ups are related to restricted air flow. Now what they are related to...beats me. Either the normal REM wake ups maybe with an occasional spontaneous arousal probably.

The one at about 5:30 that has the little reduction and UC flag ..there's a big breath right before that reduction which makes me think post arousal or semi awake/awake breathing and thus not real.

There's a couple of good books that RobySue mentions in her blog that might be worth reading.
http://adventures-in-hosehead-land.blog ... er_19.html

I don't understand the tiny subtle differences in the breaths to hazard a guess as to what it may or may not mean unless the change is so obvious anyone can see it...like the 5:30 UC flag.

[Personxyz]

I'd rather know what the problem was, even if it was a bad problem, then be completely clueless about what's causing the awakening issues. It's so frustrating because you can't remedy what you don't understand.

I may see if anyone on the freecpapadvice forum has an idea.

I'll probably continue with turning off the machine when I awaken for a few more nights to gather more data and ensure it's consistent.

Thanks for the help pugsy, I may post again in a few days if I have any ideas about what's happening.

[palerider]

It's so frustrating because you can't remedy what you don't understand.

You can't remedy something that's completely normal, either.

Waking up after REM is normal. most people just don't remember it. You're making the problem worse by making a big deal about it.

I often wake up multiple times during the night, I find a more comfortable position, and go back to sleep.

Sometimes I remember waking up, sometimes I don't... the important thing is that I don't make a big deal about it.

[Pugsy]

I'd rather know what the problem was, even if it was a bad problem, then be completely clueless about what's causing the awakening issues. It's so frustrating because you can't remedy what you don't understand.

Well if they ever figure out a way to determine what causes spontaneous arousals (if that is what you are having) then you can join a very, very long list of people waiting to do whatever they can do to see what the problem is.

On an in lab sleep study...they can see the arouosal easily and decide if it is related to breathing or not but if it isn't related to breathing they don't have any sort of way to know what caused it. That's why they are called spontaneoous.
They can see sleep stages though and maybe if it is right after REM they could tell you that it was the normal post REM arousal.

[Personxyz]

Just a little update.

I've been keeping a sleep diary for the past week. What I've found is that every time without fail I wake up it's whilst I'm dreaming. I know that makes the awakenings seem like normal post sleep cycle awakenings but the evidence suggests otherwise. Sometimes it's two hours between awakenings, often it's an hour or less. Sometimes I have 8 or more awakenings a night. If sleep cycles last roughly 90 minutes then the timing and frequency of my awakenings don't match at all.

I'm pretty sure it's not REM sleep behavior disorder because I slept in the same room as someone until very recently and they never said I talked or moved violently in my sleep. I've also never knocked my mask or got tangled in the hose since starting PAP treatment so it seems to be something else.

[Pugsy]

Don't assume that just because you dream and wake up during a dream that it is REM sleep stage...we can dream in any stage of sleep.
It's just more common for dreams to happen in REM but they can happen in any stage.

[D.H.]

The first thing I noticed is that at least half of your AHI (sometimes all of it) is due to Clear Airway events.

For some (not all) patients, this can be exacerbated by higher pressures.