Bad sleep after waking up

[jcs]

Well I had another bad night similar to the one I posted earlier. AHI of ~3 during the first 4 hour session (not great), and an AHI of >9 during the second 3.5 hour session (pretty bad).

There's a nasty cluster of events during the second session about 70-90 minutes after the start. I think that may indicate a REM sleep problem? I've attached a screenshot of the second session and a zoomed in graph on that nasty section.

Is it possible that a section like that would show up while mouth breathing, or is it for sure actual events? I'm not 100% positive that I'm not mouth breathing.

I'm a little concerned because my AHIs have been trending upward for the past month or two. I can identify three factors that may also be contributing, but they may not:
1. I stopped drinking coffee and all caffeine about 2 months ago.
2. I've lost about 20 pounds since the end of January
3. It's spring, and I suspect I have some seasonal allergies which may make it harder to breathe through my nose

I would expect #1 and #2 to actually _improve_ my sleep but evidently not. RE: #3, I don't have any data from last year because I wasn't using CPAP at the time, but I do have data from 2018. Nights in April back then show a mix of nights. It seems I would generally just ditch the CPAP after any mid-night wakeups, and sleep tended to be worse in the hour or two before morning.

Thank you for again for reading and any advice you might offer.

[Pugsy]

You didn't zoom in enough....
Can you do another zoom in but a 4 to 5 minute segment starting at 03:37 or right after the BND flagged time where you turned the machine back on again?

[jcs]

Sorry about that. Here's a 5 minute window at 3:36, right after a short 1s of BND.

If I'm interpreting the data correctly, I think I slept from 22:05-02:16, turned the machine off for ~3 minutes and then started sleeping again around 2:19. When I wake up, I typically leave the mask on until I turn off the machine, but perhaps I breathe weirdly as I reach down for it.

The BND from 3:29 to 3:33 is a little concerning... mouth breathing maybe?

[Pugsy]

Mouth breathing enough to trigger BND should show up on the leak graph as a big, big leak I would think.
What does the leak rate look like before the BND flagged time? I would tend to think total mask removal.

The flagged events on the new zoomed in image....all awake/arousal related flagged events. Not real asleep events.
The are more of an indication of poor sleep quality than sleep apnea not being adequately treated.
Now why the poor sleep quality....million dollar question.

[jcs]

I don't understand how to interpret the leak rate graph. The lines look roughly the same during the BND period as during some "good" sleep earlier in the night.

Also RE: mask removal, I never consciously remove the mask unless the machine is off. I suppose I could mess with it and not remember though...

I will try to contact my DME supplier today, but I don't expect much help. Maybe I will attempt to reach out to another area sleep center as well for help.

[Pugsy]

Large leak territory on Respironics machine will vary as the pressure varies.
Respironics machines report total leak (that top leak line) which is the mask's expected vent rate plus any excess leak.
So somewhere up around 70 L/min total leak is where large leak territory might be at your pressures....you are no where close.

The flow rate is severely constricted right before the BND and after it. I don't know why unless maybe there is a crimp in the hose somewhere blocking air flow and thus messing with the sensing of the flow rate.

If the mask isn't being removed and put back on and there isn't a crimp somewhere in the air flow...I would be wondering about the machine itself having a problem.

Have you thought about trying auto mode to see what it does? There should be auto mode trial available on your machine?

Any event flagged when you aren't asleep doesn't count. Gotta be asleep for it to matter.

With time and experience you should be able to learn to distinguish awake/arousal flow rate from asleep flow rate.
http://freecpapadvice.com/sleepyhead-free-software
the videos above explain how. While it is mainly talking about central/clear airway apneas....it can be any category of event.

You may or may not remember being awake as well.

Here's and example of asleep and then arousal/awake breathing. All those flagged events are arousal/awake related and not real.



I circled the asleep breathing in this image below. I think you can spot the change and all the flow rate after the circle is related to arousal/awake breathing.

[jcs]

Thanks for the reply. It does appear like many events happen after/during arousals/poor sleep quality. I wish I could pin down what's causing the poor sleep quality.

Screen Shot 2020-04-09 at 6.48.32 PM.png (78.64 KiB) Viewed 784 times

I'm quite concerned about these BND areas (like the one attached). The flow rate is quite small prior and then very large immediately after. It's quite erratic for the next half hour or so.

> crimp in the hose somewhere blocking air flow and thus messing with the sensing of the flow rate.

Maybe... I have vague sleepy memories of occasionally waking up sort of on top of the hose. I would hope that the hose would be rigid enough for that sort of thing and able to maintain an appropriate bend radius, but maybe not... I've changed the routing from the machine a bit, so we'll see how tonight goes.

> Have you thought about trying auto mode to see what it does? There should be auto mode trial available on your machine?

I'll contact the DME about that tomorrow.

A couple of other random questions after checking out the Overview tab:
1. The 95% Minute Vent seems to be trending downward slightly. Interesting or no?
2. Max tidal volume was generally around 3000, but for the past few weeks it's been around 5500. Is that weird?

I did contact a sleep specialist today but was told I could not see anyone until June at the earliest due to the outbreak. Televisits are not available to new patients.

[Pugsy]

1. The 95% Minute Vent seems to be trending downward slightly. Interesting or no?
2. Max tidal volume was generally around 3000, but for the past few weeks it's been around 5500. Is that weird?

These data points for cpap/apap machines aren't really particularly useful because there is such a wide range of norms involved.
They would be more useful when the higher end machines are used for people with lung/respiratory problems.

I never even bother looking at them myself because they really don't mean much one way or the other.
There's nothing you can do about them for one thing and if you had a respiratory issue bad enough to show data points always out of the norm.....chances are you would already know about it and be under a doctor's care for it.

Norms vary....because of sex, age, weight, height, body build or even simply altitude. Mine are always all over the place and mean nothing because I know I have no respiratory issues.

[jcs]

Thank you for all your replies, Pugsy. I really appreciate it.

As per usual (lately), I woke up after ~4 hours of sleep. I was pretty conscious when I woke up and noticed that my CPAP machine itself seemed to be struggling a bit. The machine was much louder than usual on every inhale (I usually barely notice it).

As far as maintenance goes, I replace the ultra-fine filter as directed (30 days) and rinse the pollen filter probably half as often as directed (4wks vs 2wks). In fact, I just did both about 2 weeks ago.

I will replace the ultra-fine filter today, but I don't have any replacement pollen filters.

Is there any way to really know if there's something wrong with the machine?
Does the data support this theory?

Here's tonight:

Screen Shot 2020-04-11 at 3.02.05 AM.png (323.56 KiB) Viewed 768 times

Here's a night from last week that seemed ok for the first 2, maybe 3/3.5 hours but quickly went haywire after about 4 hours:

Screen Shot 2020-04-11 at 3.00.42 AM.png (356.13 KiB) Viewed 768 times

[Pugsy]

No...nothing on the reports points to the machine struggling a bit or making weird noises.

Give the pollen filter a good washing and use a towel to pat/squeeze excess moisture out.
Replace the disposable filter.
See if that helps.
If it doesn't contact the place where you got the machine from. It shouldn't be making weird noises.

[jcs]

Well I reached out to a local sleep center here in Chicago back in late April and did a telemedicine appointment. After a week or so trying to get access to my machine's data, the sleep doctor agreed to increase my pressure from 8.0 to 9.0 on 5/8/20.

My AHI is still all over the map, and according to OSCAR my 51 days with 9.0 has an average AHI of 3.57 vs. 8.0's 2.61 average (681 days).

I am still getting rather large periods of time where breathing is not detected (e.g. 2 instances of over 10 minutes last night). When I do wake up during the night or in the morning, it often feels like I was just in apnea (need to breathe deeply), and it also feels like I'm not getting enough air through the mask. Could these large BND periods be caused by mouth breathing? I occasionally wake up with a dry mouth.

Surprisingly I had my best scored night of sleep in a long time last week (AHI 0.53 over ~6 hours) after I got fairly drunk. Weird? I've also noticed that my sleep may be worse on nights where I go to bed dehydrated.

I guess I'm not sure what to do next. I wish I could figure out how to get back to where I was consistently getting AHI's < 2.0 and almost never getting anything above 4.0. Try a full face mask? Try and get a new machine?

[Julie]

Why not try both?

And remember that alcohol can dehydrate you... it does not qualify as 'hydration' at all.

[Revived1]

I woke up and noticed that my CPAP machine itself seemed to be struggling a bit. The machine was much louder than usual on every inhale (I usually barely notice it).

I have had this exact problem myself, and my machine is brand new - only about a week old. The second time I used it, I woke up and could hear my breathing somehow going through the machine. I hoped that was a one-off event, but it happened again this morning. I might start a thread about it, and see if it's harmless or not....or at least common or not. I've recorded the sound on my phone so I have proof of it if I need to get it looked at/repaired some time in the future.
Good luck with your machine. Hope both of our machines behave themselves from now on.