Inexplicable fragmented sleep

[koy]

I wrote few posts here on the board, but i decided to make this in a post on its own because all the other posts i wrote were not the main issue.
The main issue is i can't have a good night sleep because i keep waking up 4-5 times a night ( always in rem cycle, i wake up remembering the dream)
This sleep quality makes me feel like a zombie all day.
This has been ongoing since August 2018, i developed LPR (inflammation in the larynx) because of prolonged acid exposure from the stomach GERD.
i did a sleep study and it showed :

Total number of awekening > 2 epochs : 44.0
Sleep latency: 60.5mn
N1: 12.4 %
N2: 72.6%
N3: 10.1%
REM: 4.8%
Stage shifts: 191.0
REM Latency: 146.0 mns

22.8 Arousals/HR
0.0 arousals/hr were PLNs related
12.9 arousals/hr : apnea/hypopnea
6.5 RERA/hr
3.4 arousals/hr spontaneous

Sleep continuity : 2.6 mns.
Delayed REM onset.

Sleep quality: avergae moderately restless
Apnea and hypopnea index(REM and NREM) : 16.8/hr
apnea and hypopnea index (REM) : 42.6/hr
apnea and hypopnea index (supine) : 17.6/hr
RDI (REM and NREM) : 23.3/hr
baseline O2 saturation : 95.4 %
lowest O2 saturation : 88%
number of O2 desaturation : 20.0
duration of O2 saturation less than 90% : 0.4

After that i got an APAP REsmed 10 autoset, i tried all possible variables for one and half month but i was still waking up.
here is the SD card data :
https://drive.google.com/open?id=19sS3N ... 54leBJJqC0
my notes are :
i can't tolerate higher pressure because of aerophagia (> 10)
i wake up with rapid large increase of pressure.
i have lower OA pressure when i sleep on my side which i started after Jan 18 in the files using tennis ball.
I think i need a high pressure to overcome RERAs but can't do it because of aerophagia, so i switched to bipap auto : Aircurve 10 vauto.

Here is my first night :
my notes is : i had almost no aerophagia with ps 4, epr 5, and ipap 9 to 13.
i woke up more times than normal ( every 2 hrs, i marked only 2 awekenings by resetting power, but not the rest )


I almost feel like i tried everything, i saw a similar post here for someone with 14 pages of post, with weird airflow curves, who also tried everything and did not have a solution from the board.

I wonder if there is help , i used to sleep 8 hrs straight before august and for the rest of my life.
I am 39 years, male, 6'1" and 210 lbs, just lost 10 lbs with low acid diet to fight reflux, i am not taking ANY medication do not some or drink alcohol.

thank you

[musculus]

What happened August 2018? Any big weight increase around that time?

It looks like pressure should be higher, but you could not tolerate it. I would say increase it 0.5 at a time to higher pressures.

[jnk...]

A tennis ball disrupts sleep.

Consuming nothing but water for the hours preceding sleep can help some with aerophagia. It can also sometimes help the LES heal when there is nothing in the stomach when you go horizontal.

If you go back to sleep after waking up, don't worry too much about waking up.

It took me months of no obstruction before my brain went off high-alert and stopped waking me up at the drop of a hair.

Progress can take time. AHI seems low enough, so start troubleshooting other aspects of sleep and work for gradual improvement one step at a time.

[koy]

What happened August 2018? Any big weight increase around that time?

It looks like pressure should be higher, but you could not tolerate it. I would say increase it 0.5 at a time to higher pressures.

my thorat developed LPR (Laryngopharyngeal Reflux) , which narrowed the airflow.
How do you know i need more pressure from the graphs can you explain ? i keep hearing i need less pressure

[koy]

A tennis ball disrupts sleep.

Consuming nothing but water for the hours preceding sleep can help some with aerophagia. It can also sometimes help the LES heal when there is nothing in the stomach when you go horizontal.

If you go back to sleep after waking up, don't worry too much about waking up.

It took me months of no obstruction before my brain went off high-alert and stopped waking me up at the drop of a hair.

Progress can take time. AHI seems low enough, so start troubleshooting other aspects of sleep and work for gradual improvement one step at a time.

problem is waking up at REM cycle, disturbs my sleep even i can go back to sleep right away, i don't feel rested when i wake up from all the wake ups.
IS this some kind of Insomnia ? or is RERAs ? i can not if i need more pressure to fight RERAs or i developed insomnia because of the apnea ?

[Jay Aitchsee]

I agree with JNK, your chart looks pretty good. You need to remember that CPAP can not fix poor sleep due to causes other than Sleep Disordered Breathing. If poor sleep results from other than SDB, no amount of CPAP tweaking will make it better. That said, it does take some time to become accustomed to the therapy, some take longer than others to adapt. You might take a little longer.

A few wake ups during the night are normal. Most people have them. The trick is not to obsess over them, or other aspects of sleep.

Once SDB has been corrected by CPAP and poor sleep remains, one must start to look elsewhere. Start with good sleep hygiene, Google it and ensure you are following all the precepts. Pay particular attention to exercise and caffeine consumption. Make sure you are regular in your sleep habits, going to bed and arising at consistent times. Identify and remove stressors. Be on guard for depression and seek help if it is suspected. Talk therapy, CBT, can be helpful. Have a comprehensive physical with the routine blood tests along with tests for vitamin D3, magnesium, ferritin, thyroid, B6 and B12 levels. In other words, start ruling out the other factors that could be contributing to poor sleep.

Don't obsess.

Good luck.

[koy]

I agree with JNK, your chart looks pretty good. You need to remember that CPAP can not fix poor sleep due to causes other than Sleep Disordered Breathing. If poor sleep results from other than SDB, no amount of CPAP tweaking will make it better. That said, it does take some time to become accustomed to the therapy, some take longer than others to adapt. You might take a little longer.

A few wake ups during the night are normal. Most people have them. The trick is not to obsess over them, or other aspects of sleep.

Once SDB has been corrected by CPAP and poor sleep remains, one must start to look elsewhere. Start with good sleep hygiene, Google it and ensure you are following all the precepts. Pay particular attention to exercise and caffeine consumption. Make sure you are regular in your sleep habits, going to bed and arising at consistent times. Identify and remove stressors. Be on guard for depression and seek help if it is suspected. Talk therapy, CBT, can be helpful. Have a comprehensive physical with the routine blood tests along with tests for vitamin D3, magnesium, ferritin, thyroid, B6 and B12 levels. In other words, start ruling out the other factors that could be contributing to poor sleep.

Don't obsess.

Good luck.

i appreciate the advice, but it's hard to not obsess if you are feeling like zombie the whole day!
I wish it was just waking up few times at night, it's fragmented sleep which does not let you go to deep sleep i guess. i don't know what happens, i just know in the morning i'm not able to focus or do any work or study, i also know it happened since i started having my throat feels like lump(LPR) and i know it happens when i keep waking up at night after each dream.
I just don't know what to do to sleep.

[Muse-Inc]

Prop head of bed up (bed boosters) to help with the acid issue. A friend has GERD and swears by eating a piece of ginger (candied and rinsed) before masking up to sleep. Just read an article that suggests best sleeping position for people with GERD is on their left side.

In REM sleep, most of us need additional pressure. APAPs are good as they can raise and lower pressure as needed to abort anticipated apneas.

[palerider]

Don't obsess.

Good luck.

i appreciate the advice, but it's hard to not obsess

The problem is, that obsessing about sleep interruptions just makes them worse.

Whenever I wake up, I turn over, get comfortable again, and go back to sleep.

I don't look at the clock, I don't turn on the light, I, for heavens sake, don't look at my phone...

[esel]

i appreciate the advice, but it's hard to not obsess if you are feeling like zombie the whole day!

I just don't know what to do to sleep.

Turning off the brain, calming jumping thought can be really hard... and yes it is a form of insomnia. I would suggest to work on this aspect. Talk about it with friends, find solutions.

Ginger as proposed is worth trying. I use a slice of fresh ginger in a herbal tee.

1/2 a tee spoon of Backing soda dissolved in a glass of water and slowly seeping can help with the acidity in the upper throat. (keep it next to your bead and when waking up take a little seep)

You need to keep the airophagie low (lower pressure) but need to keep the airway open (higher pressure) and this depends on the sleep position the REM / NREM, if you have a cold, ... not easy.

Be happy you have dreams and it is very normal to wake up after a REM phase. Some people just don't notice waking up and consequently don't remember later the dreams.

good luck one needs it some time.

[bonjour]

While I doubt I had the whole solution I did discover in a 2 min segment a series of CA events LT 10 seconds with 45 seconds of not breathing, now that has to be disrupting, but the recommendation of reducing pressure and reducing PS/EPR was met by insisting that the solution was to increase PS and to Increase Pressure. My apologies, He thought the water was cleaner over here.

[palerider]

While I doubt I had the whole solution I did discover in a 2 min segment a series of CA events LT 10 seconds with 45 seconds of not breathing, now that has to be disrupting, but the recommendation of reducing pressure and reducing PS/EPR was met by insisting that the solution was to increase PS and to Increase Pressure. My apologies, He thought the water was cleaner over here.

Does this make sense to anyone? I *think* I'm awake and my brain's working, for the most part... but ... I got nothin.

[ClayL]

You might ask your doctor about taking Famotidine (Pepcid) or omeprazole (Prilosec) until the inflammation is gone. That was what mine recommended. I still often wake up at about 3 am but that isn't related to GERD.

[musculus]

What happened August 2018? Any big weight increase around that time?

It looks like pressure should be higher, but you could not tolerate it. I would say increase it 0.5 at a time to higher pressures.

my thorat developed LPR (Laryngopharyngeal Reflux) , which narrowed the airflow.
How do you know i need more pressure from the graphs can you explain ? i keep hearing i need less pressure

looking at the 2 flow limitations in the 3rd graph, the airway collapsed and then quickly normalized within 2-3 breaths. The airway won't go back to normal unless there is signal from the nervous system, which won't send signal unless arousals happen.

It means your brain was fairly sensitive to flow limitations, aka more arousals, that's why the sleep quality is poorer than what the AHI says since you have more arousals due to flow limitations, and they are not always showing up as event (e.g., the first one) for AHI calculation.

This is more UARS like symptoms. If you expand the flow graph around 1:45am (~the first REM episode) I suspect we will see similar patterns.

[Jay Aitchsee]

What happened August 2018? Any big weight increase around that time?

It looks like pressure should be higher, but you could not tolerate it. I would say increase it 0.5 at a time to higher pressures.

my thorat developed LPR (Laryngopharyngeal Reflux) , which narrowed the airflow.
How do you know i need more pressure from the graphs can you explain ? i keep hearing i need less pressure

looking at the 2 flow limitations in the 2nd graph, the airway collapsed and then quickly normalized within 2-3 breaths. The airway won't go back to normal unless there is signal from the nervous system, which won't send signal unless arousals happen.[emphasis added]

It means your brain was fairly sensitive to flow limitations, aka more arousals, that's why the sleep quality is poorer than what the AHI says since you have more arousals due to flow limitations, and they are not always showing up as event (e.g., the first one) for AHI calculation.

This is more UARS like symptoms. If you expand the flow graph around 1:45am (~the first REM episode) I suspect we will see similar patterns.

Musculus, could you clarify, please? In the 2nd graph, I see two CA but no Flow Limitations. In the third graph, I see two instances of Flow Limitations, but no indication of arousal.

In fact, Flow Limitations look rather minimal throughout the entire night (graph 1), at least to me.