ANY ADVICE FOR NIGHT WAKING???? HELP!!

[grumpygirl]

Happy Holiday to ALL- I am really struggling with this night time waking. Lately-over the last month or so I have started waking up during the night at 1:30, or 3:00 and then cannot get back to sleep. This is really beginning to get to me. I wonder if any one has had this problem and might have a few suggestions as to what to do to avoid this or how to get back to sleep. I don't know of any differences in my sleep habits or any meds that are new except the GERD meds Pepcid and Prilosec. I stopped the Prilosec because it gave me a headache that lasted ALL day, so I went back to the Pepcid (20 mg. 2 X per day). Do these meds cause insomnia?? Any suggestions would be appreciated!! I know I posted a similar question before but I am hoping that maybe someone who didn't read it last time may have a suggestion this time. Thanks.

[roster]

GG, I suffered from the same problem and then found out my pressure was too low. With the pressure corrected, I still awaken after three to four hours so I take a quick trip to the restroom. Then I can usually fall asleep again in a reasonable time.

Make sure your cpap is at optimal settings and practice meticulous sleep hygiene. Sorry I can't suggest more than this.

[Arizona-Willie]

I was waking up anywhere from 1:30 to 3:30 for no apparent reason.

I started taking 2 capsules of Melatonin just before going to bed.

The bottle says an hour before but immediately before seems to work well -- for me -- since I don't have any trouble going to sleep, just waking up.
Now I sleep through until 6:30 or 7 most nights.

Might even be helping with the AHI numbers too. I know they have gotten better. But can't directly attribute the improvement to the melatonin.
I would get melatonin from a health food store rather than the super market ... more likely to be fresh.

[MusicMan]

I don't know of any differences in my sleep habits or any meds that are new except the GERD meds Pepcid and Prilosec. I stopped the Prilosec because it gave me a headache that lasted ALL day, so I went back to the Pepcid (20 mg. 2 X per day). Do these meds cause insomnia??

Can you try taking Tums one night instead of the GERD meds to see if they are the cause? I used to use those GERD meds off and on, and they seemed to have a stimulant effect on me.

[rstcso]

Same thing here. I've been on the hose about a month. Woke up at 1:30am today. I have found that I best go back to sleep after I resign myself to the fact I don't have much choice but to go back to sleep, otherwise I will be lying there, breathing in and out, counting the seconds until it's "time to get up". I'm serious, I just tell myself I might as well go back to sleep. Seems to work, regardless of how ridiculous it sounds.

[MurphysLaw]

The same thing happened to me and I talked the doc into letting me try an APAP instead of a CPAP. I rarely wake now, once at most and go right back to sleep.

[grumpygirl]

Lately it seems the problem arises while on CPAP or APAP. Using APAP makes me feel like I am drunk the next day and very tired!! I like it for the lack of irritation to my GERD problem but I just cannot stand the HUGE FOG the next day. It really is awful and almost worse than before I began treatment. I am trying (as of last night) to go back on straight CPAP with a lower pressure of 11.4 instead of the titrated 12. 12 just blows my poor hiatal hernia out the window and the aerophagia is almost unbearable the next day. Today, I do feel a little better even though I woke up at 1:40 a.m. , since I went back to straight CPAP. My numbers are always very good with either method usually in the 1.2 range for AHI and leak rates that are low. So I don't know what the deal is with the APAP but I have tried many times to go back to it and just end up feeling like a depressed ragdoll the next day. I feel like I am constantly on a treadmill with this stuff and can NEVER find the right setting or even the right method (APAP OR CPAP). I have an appt. in Dec. with my GI doc and hope maybe he can help with the GERD meds. THANKS!!!

[Snoredog]

I'd put the machine at 8 to 15 EPR off and use it.

Machine is not going to go over 10 cm unless it is chasing Flow limitation or Snore. Doing that will only
aggravate any aerophagia.

If your pressure is running up to 12 or higher and you are not feeling better, drop it down to 10 cm and use Ramp to
get to sleep. That groggy feeling can be from having a too high a pressure chasing a low AHI. Forget the AHI,
go by how you feel and that will take a couple days at a given setting to know that.

I wouldn't take a pill for GERD, you are vertical all day long it only bothers you when you lay horizontally flat. Elevating
your bed by 3-4" can help. I would try not Pecid pills, but PepcidComplete (with RED cap) tablets, they come in berry flavor and you take one tablet right before bed and chew it, it lasts for up to 12 hours. Try that for a week and you won't go back to them other pills.

[stacia123]

I'm having the same problem. For the first 3 weeks I did pretty well, but I now sleep 5 hours without waking (which is really good for me) but then I wake up and can't get back to sleep. Every 10 days or so I end up crashing and sleeping 11-12 hours to make up for this lost sleep. At least that seems like the pattern, it's only been going on for about 3 weeks. I'll take rooster's suggestion and up my pressure which I needed to do anyway and see what happens.

[CorgiGirl]

If GERD is so bad that you have to take an over the counter everyday and what's available over the counter isn't working, I'd see a doctor about a prescription med, if you can.

Another possibility for women of a certain age is that perimenopausal symptoms include sleep problems. I have a friend who describes her sleep problems the same way you are and she's found relief with a prescription sleep med.

If pressure changes don't work, see your doc! And hang in there!

[grumpygirl]

Snoredog- Are you talking about setting my CPAP to 10 instead of 12? Right now I have it set at 11.4 and woke with very good numbers this morning. I know I must be dense but I STILL do not understand why the APAP does not respond to apneas above 10cm. Why even use the darn thing if it will only respond to flow limitations and snores? I just cannot seem to set that thing to a range that will allow me to feel human the next day. If I understand you correctly you are saying I should set the APAP at a range of 8-15. What good would that do if it won't respond to apneas above 10cm? I think I am still not understanding you -do you mean that if I set the range at say 8-12 it will not respond to apneas above 10cm but if I set it to 8-15 it will respond if I need the 12 cm pressure when having an event?? That seems like a very large range 8-15, will the machine respond quickly enough at that range? If I use it in CPAP mode with the setting I now use (11.4) will I eventually feel like crap because my pressure is not high enough?? Will the 8-15 range screw with my GERD symptoms? Who knows? My sleep doc doesn't even pretend to know how to figure this one out!!! When I use the machine in APAP mode my numbers are usually good and my pressure reports the next day say anything from 10.6 one day to 11.6 another day. Mostly it seems to report a pressure around 10.6. Am I just too "anal" about this whole thing or is there some setting out there that will make me feel human again with out having GERD all day??? Thanks!!!

[2girlsmom]

I am nowhere near as knowledgable as most people here but I just got an Autoset II and it was set 7-11. I changed it to 7-14 and I am feeling better and AHI is lower. From Resscan reports I know my apneas are preceeded by hypopneas/flow limitations so I'm thinking it raises the pressure for those and therefore helps with my apneas too.

All that said, my sleep doctor says that some people just do better on straight CPAP, others respond better to APAP.

[Snoredog]

Snoredog- Are you talking about setting my CPAP to 10 instead of 12? Right now I have it set at 11.4 and woke with very good numbers this morning. I know I must be dense but I STILL do not understand why the APAP does not respond to apneas above 10cm. Why even use the darn thing if it will only respond to flow limitations and snores? I just cannot seem to set that thing to a range that will allow me to feel human the next day. If I understand you correctly you are saying I should set the APAP at a range of 8-15. What good would that do if it won't respond to apneas above 10cm? I think I am still not understanding you -do you mean that if I set the range at say 8-12 it will not respond to apneas above 10cm but if I set it to 8-15 it will respond if I need the 12 cm pressure when having an event?? That seems like a very large range 8-15, will the machine respond quickly enough at that range? If I use it in CPAP mode with the setting I now use (11.4) will I eventually feel like crap because my pressure is not high enough?? Will the 8-15 range screw with my GERD symptoms? Who knows? My sleep doc doesn't even pretend to know how to figure this one out!!! When I use the machine in APAP mode my numbers are usually good and my pressure reports the next day say anything from 10.6 one day to 11.6 another day. Mostly it seems to report a pressure around 10.6. Am I just too "anal" about this whole thing or is there some setting out there that will make me feel human again with out having GERD all day??? Thanks!!!

1. Subject title of your thread is "Any advice for Night Wakings??? Help!!", then you go into GERD and mention you have tried other pressure ranges and still don't have positive results. You mention GERD symptoms then question my lowering of the pressure range from 8 to 15. Well if you are using 11.4 cm pressure and GERD symptoms get worse then there can be several reasons for that.

-you may be confusing the "symptoms" of GERD for Aerophagia which is associated w/GERD but different, it is a result of having GERD. Aerophagia produces abdominal pain from the CPAP pressure entering the stomach. It enters the stomach past the LES which may be dysfunctional from the effects of stomach acid splashing on the LES. When the LES does not seal properly it can allow CPAP pressure to enter the stomach. And you are close when you mention being anal, because the LES is similar to the sphincter in your butt. It does the same thing but seals the other end. GERD is only painful if it has allowed stomach contents to irritate the LES, the esophagus or bitter taste of the stomach acid entering the mouth or refluxing back up.

-IF Aerophagia is the problem (common with CPAP and GERD patients) the only way to help that or relieve the pain is by using lower pressure. If you have your Minimum pressure at 11.4 you have it there chasing a low AHI. While that is good, it can also aggravate your GERD related symptoms of aerophagia. IF the LES is working properly CPAP air pressure wouldn't be going past it.

Advice for Waking at night:
There can be many reasons you are waking at night, they are:

-you have muscle skeletal pains that cause you to have light sleep or contribute to neurological arousals, these can result in the light sleep. So what do you do? you address any pains you experience during the day. If those pains exist during the day, they most likely will exist during the night.

-Apnea, an apnea showing up where the pressure isn't high enough will wake you up. This many times happens during REM which is where you are the most relaxed during sleep, REM is also where you are the closest to the wake state. You may not consciously notice you are awake but as far as the brain is concerned you are momentarily awake. If it is an obstructive apnea, it means you were awaken by the body's natural fight or flight response kicking in when recovering from the unaddressed apnea, possibly due to the pressure NOT being high enough.

-Central Apnea while most Central apnea appear in non-REM sleep, they can show up in transitional changes from one stage of sleep to another. These are normally pretty short and you sleep right through these. While it is possible these may be waking you during the night, I doubt very much this is what is happening in your case.

So the possibilites are:

- you are light sleeper, are aroused from sleep easily or you have muscle-skeletal pains that keep your sleep quality on edge, or
- your CPAP pressure is NOT high enough to address those apnea seen during REM sleep, possibly due to the machines inability to respond to frank apnea at or above 10 cm pressure.
- you have aerophagia pains associated with GERD, setting your machine similar to CPAP only aggravates the aerophagia condition.

- if you are experiencing Apnea during REM which wakes you, you should probably be doing something similar as you were before CPAP, such as waking with night sweats, waking startled and breathing rapidly possibly with a rapid heart rate. You woke because your fight or flight response kicked in to open up the airway. If these awakenings and events show up about every 90 minutes during the night, that also can be an indicator they are REM related as you go through a REM sleep cycle about every 90 minutes. You may have 3-5 of those cycles per nightly session.

So what do you do?

1. If there is no improvement to AI seen by Increasing Minimum pressure at 11.4 cm and it only aggrevates the aerophagia,
you might as well lower the Minimum pressure back down and let the AutoSet algorithm take care of things and use a lower
overall pressure to lessen the GERD related issues.
2. See a GI Specialist for a Endoscopy of your GI and LES. Elevate the head of your bed by 3-4 inches. Try a PepcidComplete right before bed.
3. Address any muscle skeletal pains, if your hip hurts when laying on your side during the day, it will hurt during the night and those pains can make for light sleep as you do have pain chemoreceptors. Try taking a Aleve before bed.
4. Lastly, if your machine is a Resmed Autoset, it is a known FACT that it will NOT respond to frank apnea at or above 10 cm. So even when you are using that 11.4 cm pressure, if you experience a frank apnea during REM sleep it will NOT respond to it, and just as explained above your fight or flight response will WAKE you when recovering from that Apnea. Your Resmed Autoset is incapable of addressing those events in the AutoSet mode. The only way you can be assured it is taking care of them is by jacking up the Minimum pressure until the LCD data shows AI=.8 or .6, then even doing that doesn't guarantee a frank apnea might appear during REM. But if that reduces the awakenings from 3 to 1 then that is an improvement. But then you have the side effects of using that higher pressure with GERD.
5. So see a GI Specialist and get your GERD under control either that or lower your pressure so it is more tolerated.

NOTE: We try to WARN newbies when they come here and want the Resmed machine. It is a intentional part of its design. It is called the A10 algorithm and part of the AutoSet. They do that to avoid false response to central apnea. Not everyone has centrals at or above 10 cm pressure, this machine's design assumes they do.

As stated in my first response, if you are at or above 10 cm pressure, your machine will NOT respond to frank apnea. The only way it can address those apnea showing up during REM is if those apnea are preceded with vibratory snore or flow limitation. But if they are frank stand-alone apnea it will NOT respond.

So if frank apnea is what you are having, then well that is why you are waking during the night, the machine is not responding to them. A Remstar Auto will respond to those apnea during REM, a 420e or a Sandman Auto will respond to those same apnea, with the latter doing the best job at it in my opinion.

So my final suggestions are:

-Use a lower pressure range of 8 to 15 cm and hope you have a preceding event to those apnea showing up during REM, might as well lessen the pressure side effects to your GERD/Aerophagia
-Go see a GI Specialist about your GERD, GERD left untreated is the leading cause of stomach cancer, explain to them you suspect you have a possible hiatal hernia or a dysfunctional LES, both of which they can fix quite easily.
-take a pain medication before bed to control nocturnal pain
-try a supplement like melatonin for deeper sleep and less awakenings.

- you can try a Full Face mask interface, those allow more snoring and flow limitations to show up, if it does in your case during REM the machine might respond to those frank apnea by accident when addressing snore and flow limitation, but that is only a guess.

After that, I'm out of suggestions.

[jambo101]

I usually go to bed around 9pm and usually wake around 3am,i dont try to go back to sleep,i get up and after playing around on half a dozen forums its 6am and time to get the kids up and off to school,around 9am i go back to bed for 3 hours ahh the joys of retirement eh.

[grumpygirl]

Thanks Snoredog once again for the detailed info.!! I DO have an appt. in Dec with my GI doc and hope to find some relief from the GERD, until then I am trying to find relief on my own. I guess I will just leave the ResMed on CPAP at a lower pressure for a few days and see how things go. I appreciate your time and apologize for being a bother- just trying to finally get a good nights sleep!! GG