Suro wrote: ↑Thu Sep 05, 2024 9:21 pm
One issue I've had since I can remember is that I can't stay asleep for longer than maybe 45 minutes. Every night I go to sleep, I am constantly waking up and falling asleep over and over until it's time to get out of bed.
So you have a long history of sleep maintenance insomnia. And starting CPAP didn't fix it all by itself. That most likely means that prior to your sleep apnea diagnosis you had two
separate sleep issues: The sleep apnea and the insomnia problem.
Now, it was not an unreasonable hypothesis that the apnea may have been causing or aggravating the insomnia, but since you are still waking up frequently for long enough periods of time to remember the wakes, it may be time to accept that you will need to focus on each problem both at the same time and through
separate treatment methods. More on this in a bit.
This is especially difficult dealing with when I have this mask on my face and I'm having to check and make sure I didn't pull it off.
Sounds like you are a night-time
worrier. Now, in addition to worrying about waking up all the time, worrying about how little you've slept since the last wake, and worrying about how little time there is before morning to get some good sleep, you are also worrying about whether you've pulled the mask off. All this
worrying is quite likely aggravating the sleep maintenance insomnia.
Out of curiosity: When you wake up in the night, do you often look at a clock (including a cell phone or smart watch) to see what time it is and then start "calculating" how much sleep you got since the last wake up?
The worry/fear of pulling the mask off is a common one for newbies. There is a lot of sensory stuff to get used to when learning how to sleep (and sleep
well) with a CPAP mask on your nose. Sometimes the fix is just to allow yourself the freedom to not worry quite so much. In other words, don't worry about pulling the mask off when you are
asleep: If you happen to wake up and the mask is not on your face, just calmly put the mask back on and turn the machine back on if you also turned it off in your sleep or if it turned itself off. Don't start fretting about
why it happened. Just accept it. And accept that as your body genuinely acclimates to this new way of sleeping, the number of times that you pull the mask off while
asleep will go down.
It's also worth checking to see if AutoStop is turned ON in your settings. If AutoStop is set to ON, the I'd suggest turning it OFF. That way if you do pull the mask off while you are actually
asleep, the noise of the machine blowing air into the mask might wake you up enough for you to realize that you need to put the mask back on.
Now having said all that, it's also important to add this: If you are
awake and are tempted to pull the mask off to make it easier to get back to sleep, you need to resist that urge. Consciously pulling your mask off while you are
awake and know that you are
awake simply reenforces your subconscious mind's resistance to the idea that you need to learn to sleep with the mask on your nose.
I'm disappointed to see that the apneas being reduced didn't stop my issue of constantly waking up, and am curious as to what you guys might see from the data. Today I only have one day as I just discovered how to use oscar and such, so pardon the lack of data. Would love to get some feedback on what you guys are seeing, it just looks like a bunch of nothing to me as of right now.
Here's what I'm seeing in your data, even at this "whole night scale"
1) Lots of evidence of arousal breathing, backing up your own feeling that you wake up frequently during the night. My guess is that if you posted the data at SleepHQ and I were to scroll through it using a horizontal scale where we can see the individual breaths, all or most of those CAs being scored would have a large inhalation or two
just before they are scored. In that case, those CAs are post-arousal "false positives"---in other words, they would not be scored on an in-lab sleep test because
you were awake when they happened. They're probably normal sleep transitional events---it's common, even for people with
normal sleep to have a sleep transitional "CA" or two when they are drifting off to sleep and control of the respiration is being transferred to the autonomic nervous system.
2) You are using a ramp that starts at 4cm, but when it starts up, the pressure ramps up pretty quickly. It's worth asking: Do you really need the ramp? When you first turn the machine on and it's blowing at 4cm, do you feel comfortable breathing? If not, describe what's uncomfortable about the breathing. It's also worth asking whether you are sensitive enough to notice (and/or worry about) the fact that the machine starts to increase the pressure pretty soon after you turn it on.
3) Is your ramp set to AUTO? If so, then your data indicates that you are initially falling asleep within about 10-15 minutes of starting the machine. That indicates you don't have any problems with sleep initiation---i.e. falling asleep at the beginning of the night.
4) You are not using EPR. EPR is a setting that reduces the pressure on exhalation, which makes it easier to exhale. For many people, breathing with EPR on feels more natural. The EPR setting corresponds to the drop in pressure. But the pressure will never drop below 4cm. So with a ramp set to start at 4cm, you won't notice any difference in how the machine feels until the pressure increases.
5) You have your minimum pressure set to 6cm. You might do better turning the ramp OFF and turning EPR to FULL TIME with a setting of 2 or 3. That way you would have an inhalation pressure of 6cm and an exhalation pressure of 4cm when you turn the machine on and you'd have the exhale relief on every exhalation you take during the night. If any of your arousals are being caused by difficulty with exhaling against the pressure, turning on EPR may help.
6) You may have a leak problem. While the time spend in Large Leak territory (5.77%) is so small that Mr. Green Smiley Face is going to show up on the machine's LCD and the "Leak" part of the MyAir report will say things look pretty good, the fact is you've got some level of leaks going on all night long. Now, if you were sleeping well and had plenty of energy during the day, I'd say just ignore these leaks. But you are NOT sleeping well. And so it begs the questions: Are the leaks potentially feeding the sleep maintenance insomnia problem? Do you wake up with a dry mouth? Do you ever wake up feeling like air is blowing into your eyes? And since you are using a P10 mask, it's also worth asking: Do you find yourself breathing through your mouth during the daytime? What to do about the leaks is something for another whole post, but it really depends on the answers to those questions.
7) You have a lot of flow limitations being scored. That
may indicate a bit more pressure might be useful. Or it could be that turning EPR on will help smooth them out. Or they may be related to something like nasal congestion or a deviated septum and there's not much to do about them other than
not worry about them. Or it could just be that your normal wake breathing looks sufficiently ragged enough to the machine that it scores flow limitations during periods when you are not really asleep. In other words, it's far, far too early to try to tackle the question, "Are the flow limitations are
real problem?"
That aside, I've been using cpap semi-consistently now for a little over a month. There have been maybe five or so nights in the past month where I'll fall asleep without it, so maybe that has slowed down my progress.
Yep. Using the cpap semi-consistently is a good way to slow your progress down. Every time you allow yourself to consciously sleep without the machine, you are teaching your body and the unconscious part of your brain that you don't really have to learn how to sleep with this dang mask on your nose.
Overall, I can't say I've noticed many benefits of using the cpap yet. Hoping to feel more clearerminded and less daytime drowsiness soon, as I know everybody is different!
Patience, grasshopper. Patience.
We all start out CPAP therapy hoping that we'll start feeling substantially better almost right away. And, yes, there are a few lucky folks who do.
But for most of us? It takes several weeks to several months of
consistently using the machine
all night long before we feel much better.
And that's only if there are no other sleep problems to deal with.
CPAP fixes one thing---sleep disordered breathing, aka obstructive sleep apnea. And if OSA is the
only health problem a person has, then yes the person will start feeling better after they learn to sleep well with the machine.
But if there are other sleep problems, like sleep maintenance insomnia, as well as OSA? Then CPAP ain't going to fix those other problems.
In other words, you need to work on the insomnia issues at the same time you are teaching your body to sleep with the mask on your nose.
So that brings up a whole lot of other
insomnia related questions:
1) What does your sleep hygiene look like? (If you don't know what sleep hygiene is, google it.)
2) What behavior patterns do you have that are feeding the sleep maintenance insomnia? In particular, are you a "clock watcher" when you find yourself awake in the middle of the night?
3) What are your expectations of a "good night's sleep?"
4) Is there a disconnect between how much time you think you are awake in the middle of the night versus how much time you actually are awake in the middle of the night? (Most people with sleep maintenance insomnia over estimate both the number of times they wake up and the length of time they are awake. Consequently they underestimate how much sleep they actually got.)
5) What kind of a sleep test did you have that led to the OSA diagnosis? And did it say anything about
spontaneous arousals and WASO (Wake after sleep onset)? Did the sleep report include a hypnogram so you can see when the wakes occurred?
6) What kinds of things have you tried in the past to reduce the number of night time wakes?
7) Do you use something like a FitBit or SmartWatch (including an Apple Watch) to try to track your sleep? If so, what does that data say about your sleep and the number of wakes you have each night.
Finally, I'll offer this advice: See if you can find a copy of
Sound Sleep, Sound Mind by Dr. Barry Krakow. It is a well written guide to self-treat insomnia, and it's full of information about what things insomniacs do that aggravate the insomnia as well as practical tips on how to replace those insomnia-inducing behaviors with behaviors that encourage better sleep.
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