Fragmented sleep---awakenings...HELP, please

[Taz]

Good Morning to everyone. I know I haven’t posted in a while but I still read here on a daily basis. I appreciate all the info I have gained and really depend on it. I’m just past 3 months on CPAP and I’m having a problem with multiple awakenings each night and just don’t know what else to try. My PCP doc is very pleased with how easily I have adjusted to the CPAP therapy and is pretty much on board with whatever I want to try. In other words, he’s rather clueless about the day to day CPAP therapy and is impressed with how much research I've done and knowledge I've gained over the past 3 months. (thanks, cpaptalk.com)

I've read many of the posts concerning this very subject and have made pressure adjustments with some improvements. My pressure settings were ranging between 10 to 16, I've narrowed this to 11 to 14 with some improvements. But….I’m still only sleeping about 6hrs a night with, at least 2 to 3 awakenings…sometimes I can fall back to sleep and others I’m wide awake with no chance of going back to sleep. I have good days & bad days….some days I feel like a zombie due to fragmented sleep.

I’ve studied my graphs and can clearly see that many of the awakenings are the result of pressure changes. My numbers look good, low AHI 1.5 or less, very low leaks & minor snoring. My median pressure range seems to be about 11.5. Now….my question….should I try the straight “CPAP mode” and if so, at what setting? I just really don’t understand how the CPAP mode works or the advantages of it. I thought the APAP was the superior form of therapy however I’ve read that some seem to do much better using the CPAP mode. I just don’t know….I’m grasping for anything to improve my sleep.

Thanks,
Taz

[kteague]

You have nothing to lose by trying CPAP mode and seeing if it reduces the wakings. Some people are sensitive to the changes, and it's hard to know if that's a factor for you without trying it. I'm sure someone will come along more qualified to suggest, based on your data, what an effective fixed pressure might be. I'm guessing since you've been at this a while you've already done things like check meds and/or supplements for known sleep disturbing side effects, ruled out medical causes like thyroid dysfunction, and are reasonably sure limb movements aren't an issue? Hopefully you can sort through this and start getting better sleep.

[49er]

Hi Taz,

If you could use the link in my signature to post screen shots so the experts could take a look at your data, they would be in a better position to advise you on which cpap pressure to use. For some people, the constant changes can be too disruptive to sleep and perhaps you are one who might do better with a straight cpap setting. Only way to know is try it.

Best of luck.

49er

Good Morning to everyone. I know I haven’t posted in a while but I still read here on a daily basis. I appreciate all the info I have gained and really depend on it. I’m just past 3 months on CPAP and I’m having a problem with multiple awakenings each night and just don’t know what else to try. My PCP doc is very pleased with how easily I have adjusted to the CPAP therapy and is pretty much on board with whatever I want to try. In other words, he’s rather clueless about the day to day CPAP therapy and is impressed with how much research I've done and knowledge I've gained over the past 3 months. (thanks, cpaptalk.com)

I've read many of the posts concerning this very subject and have made pressure adjustments with some improvements. My pressure settings were ranging between 10 to 16, I've narrowed this to 11 to 14 with some improvements. But….I’m still only sleeping about 6hrs a night with, at least 2 to 3 awakenings…sometimes I can fall back to sleep and others I’m wide awake with no chance of going back to sleep. I have good days & bad days….some days I feel like a zombie due to fragmented sleep.

I’ve studied my graphs and can clearly see that many of the awakenings are the result of pressure changes. My numbers look good, low AHI 1.5 or less, very low leaks & minor snoring. My median pressure range seems to be about 11.5. Now….my question….should I try the straight “CPAP mode” and if so, at what setting? I just really don’t understand how the CPAP mode works or the advantages of it. I thought the APAP was the superior form of therapy however I’ve read that some seem to do much better using the CPAP mode. I just don’t know….I’m grasping for anything to improve my sleep.

Thanks,
Taz

[Pugsy]

I would start with a pressure around what your median pressure is if I was going to try cpap mode...like maybe 12. See how it goes.
Your range is already fairly small.
Using fixed pressures will eliminate the slight changes in pressure which can be disturbing for some people. Some people are just more sensitive than others. You might be one of them and it hurts nothing to give it a try.

On the other hand...if it doesn't help....you know that cpap and/or sleep apnea isn't the only reason we wake up during the night.
It's normal to have an awakening/arousal with some sleep stage transitions. Normally we go right back to sleep and don't remember them but sometimes we do. 1 or 2 arousals that we remember isn't normally that much of a problem if we go right back to sleep.

Are you having trouble going back to sleep when you wake up or is it just a very brief arousal?

6 hours of sleep isn't ideal even with no arousals. How come not much more? Just can't get back to sleep?
Do you take any meds of any kind?
How is your general sleep hygiene?

[Greenkat]

Hi!

I am also just over the 3 month c-pap mark and still experience on average two awakenings each night. Sometimes it can take 20 minutes or longer to get back to sleep...

Some c-pap members made several suggestions, and one was not to drink anything at least an hour before bedtime. I tend to slip where this is concerned I have noted if I drink close to bedtime I later wake having to pee. If I don't drink I may sleep the majority of the night or have just a couple short-term awakenings.

I also plan on increasing my pressure to see if this helps...it maxes out at 10 currently.

Another issue I have is I do my best address a healthy sleep hygiene by going to bed and waking at the same time, and one short nap during the day. But if I had a 'bad' night I tend to sleep in and/or take a longer nap the next day. Then I notice some difficulty falling or staying asleep.

It's a constant balancing act!

I think the most frustrating problem I have is w/family members. My husband is very forgetful and has agreed to go to sleep at the same time I do, but then is up and down several times because he forgot to do something. We also have a grandchild who comes knocking due to not feeling good, bad dreams or other various issues.

Overall though I can't complain. I haven't experienced many mask or machine issues, feel better and am determined to pursue 100% optimal use.

Kathy

[Wulfman...]

Good Morning to everyone. I know I haven’t posted in a while but I still read here on a daily basis. I appreciate all the info I have gained and really depend on it. I’m just past 3 months on CPAP and I’m having a problem with multiple awakenings each night and just don’t know what else to try. My PCP doc is very pleased with how easily I have adjusted to the CPAP therapy and is pretty much on board with whatever I want to try. In other words, he’s rather clueless about the day to day CPAP therapy and is impressed with how much research I've done and knowledge I've gained over the past 3 months. (thanks, cpaptalk.com)

I've read many of the posts concerning this very subject and have made pressure adjustments with some improvements. My pressure settings were ranging between 10 to 16, I've narrowed this to 11 to 14 with some improvements. But….I’m still only sleeping about 6hrs a night with, at least 2 to 3 awakenings…sometimes I can fall back to sleep and others I’m wide awake with no chance of going back to sleep. I have good days & bad days….some days I feel like a zombie due to fragmented sleep.

I’ve studied my graphs and can clearly see that many of the awakenings are the result of pressure changes. My numbers look good, low AHI 1.5 or less, very low leaks & minor snoring. My median pressure range seems to be about 11.5. Now….my question….should I try the straight “CPAP mode” and if so, at what setting? I just really don’t understand how the CPAP mode works or the advantages of it. I thought the APAP was the superior form of therapy however I’ve read that some seem to do much better using the CPAP mode. I just don’t know….I’m grasping for anything to improve my sleep.

Thanks,
Taz

It's a misconception that APAP mode is "a superior form of therapy". It's only "A" form of therapy. It was originally used to titrate people (to a specific pressure) who couldn't tolerate a night in a sleep study with wires hooked to them. Kaiser still uses this method to test their potential apnea patients.
The changing pressures disturb the sleep of many people (me included) and do better with straight pressure. What happens is when you enter a deep or REM sleep stage, your breathing can change and the machine may interpret that as a need to increase pressures.......the result may be to bump you out of that needed sleep stage and into a lighter one, or actually wake you up. Then, you have fractured sleep architecture and never feel rested or refreshed.

I would also suggest a straight pressure setting of about 12 cm.
I don't see where you've mentioned what your EPR setting is, but you may wish to experiment with those, too.
Also, same thing with the humidifier settings.

I see you have software noted in your profile, so you should be able to see what's going on.


Den

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[Taz]

Thanks for all of your replies. I appreciate your comments and information.

kteague---all lab work is negative and limb movements have been ruled out. The only meds I take is blood pressure meds. I sometimes try 1mg of Melatonin but it only tends to help for a night or two.

Pugsy---thanks, I'm going to try 12cm in CPAP mode. I have good nights & bad nights, some nights I can fall back to sleep even after 3 awakenings in a 6hr period then other nights, its really bad....I can fall asleep, awaken within 90 minutes and then be awake for another hour or so and repeat that pattern, again. I'm still under compliance with the DME so sometimes I just lay in bed. I have an RT from the DME that contacts me monthly but never really seems to offer any advice or suggestions. Her stand response is "you need to discuss that with your doctor". It's very frustrating, the only help I've ever been able to get is here at cpaptalk.com.
My sleep hygiene seems to be OK. I go to bed the same time each night and usually get up around the same time. Sometimes I fall to sleep very quickly and other nights it may take an hour or so depending on whats going on in my life on that given day. I have a long history of insomnia but it seems to be less of an issue since I've been on CPAP. My doctor agrees that 6hr is not enough sleep and I should aim for 7.5hrs. I'm trying but sometimes, I'm just lying in bed longer and not actually sleeping. I don't even set an alarm clock and I seem to automatically awaken around the same time...usually at just about 6hrs after falling asleep.

Greenkat---I have a long history of insomnia so I never, ever take naps. My past experience has proven that even short naps will cause a disruption in my sleep pattern. My husband can take 2 naps on a Saturday and still go sound to sleep at 10PM....just makes me crazy.

Wulfman---Thanks for the explanation of straight CPAP therapy, that's good to know. My EPR is set at 3. I use the Climate Line humidifier hose with no heat. I live on the Gulf Coast in a very humid area.

OK...tonight I will experiment with straight CPAP.

Taz

[Sir NoddinOff]

Fragmented sleep sucks... Taz, I hope you get it sorted out. I suffer from bouts of this from time to time so I'll be watching this thread with interest.

[RogerSC]

Just to try it out, I've also switched from apap to straight cpap some time ago, and I think that I'm awakening less as a result. I've also switched to the AirFit P10 mask from the Swift FX, which has helped (I think) in terms of less air flow noise and being awakened less often by air blowing on me.

So there are some simple things that you can do to wake less. It helps to just try things that might help, and see if they do. I'm still experiencing more CA's than I used to, haven't figured out why that should be yet, but since they don't seem to affect my sleep quality (as far as I can tell at the moment), it's just a numbers game. For the time being, anyways.

[Taz]

UPDATE: First night on "CPAP mode".....DONE!!

So far...so good! AHI 0.88 I had two awakenings and fell back to sleep, both times. I believe the second awakening was due to some mouth breathing and the graph confirms this. I do feel a little more rested but I'm not declaring success, yet....need to try it for a while. Now....since my AHI 0.88 is so low...does this indicate I am probably at the correct pressure setting? How would I know if I needed to increase or decrease the fixed pressure setting?

Taz

[Pugsy]

ince my AHI 0.88 is so low...does this indicate I am probably at the correct pressure setting?

Yes. I wouldn't be changing anything. Based on what you report about your sleep in general and this nice low AHI...I wouldn't change a thing.

[Wulfman...]

UPDATE: First night on "CPAP mode".....DONE!!

So far...so good! AHI 0.88 I had two awakenings and fell back to sleep, both times. I believe the second awakening was due to some mouth breathing and the graph confirms this. I do feel a little more rested but I'm not declaring success, yet....need to try it for a while. Now....since my AHI 0.88 is so low...does this indicate I am probably at the correct pressure setting? How would I know if I needed to increase or decrease the fixed pressure setting?

Taz

Lookin' GOOOOOOD!
I think you're on the right track with the pressure setting.
Now, give it some time and see how it goes.


Den

.

[Sir NoddinOff]

Taz (love that avatar): Regarding CPAP therapy, sometimes going 'backwards' is the right answer. Good for you in being willing to experiment and take a leap of faith. Please keep us updated.

[Taz]

2nd UPDATE....not good:

I'm very disappointed.....I had a really rough night. I went to bed at my regular time and fell asleep, quickly. As I recall, I had two awakenings around 3AM and 5AM, exact same times as the night before however this time..... I did not fall back to sleep, quickly as the previous night. I stayed in bed until 8:30AM and seemed to be going in and out of light sleep. I'm very frustrated and don't know what else to do. I'm just not a happy camper, this morning....

Taz

[Pugsy]

Not all our sleep problems are related to sleep apnea or the xpap treatment as much as we would like for them to be so that we could fix it easily with a little change in the therapy.

Do you take any meds of any kind? I probably have asked this before but I have forgotten.

Last night could just have been a fluke night....the night before with good results could have been the fluke night.
We can't base much of anything on 2 nights with the change from apap to cpap....need more nights to see which night was the fluke...hopefully it was last night for your situation.