Waking 3:30 am

[lorrpb]

I've been using APAP for about 12 nights. I adjusted to the equipment within a few nights so that is not the issue. I have woke up at 3:30am every day since Saturday and unable to go back to sleep. This was a problem before I started therapy and doc said it was due to flight/fight hormones being stimulated due to lack of O2. He said it would improve with treatment. I have had a few nights of improvement the first week, but now it seems to be worse than before I started.

The first week of use, I actually felt somewhat better overall and a more restorative sleep. This week not so much, everything is going downhill.

It is not meds or other medical conditions. It is not a poor sleep environment, all that stuff was addressed years ago.

Is there ANYTHING I can do to help this, or do I just have to wait it out? Graphs of the past 3 nights are below, up until my waking time. I do keep the machine on when I try to go back to sleep, but everything escalates and blurs the overall picture.

PS- After posting I see that only part of my graph is showing when posted as "original" so I also added "large thumbnail" to show the whole night, but it is rather small. Images are on imgur.

[BlackSpinner]

Your starting pressure is 5 and there are times during the night when it has to climb up to 10. It takes time to get there and it isn't handling your events well.

If it were me I would slowly (by 1 cm every few nights) put up the minimum pressure until those ugly lines disappear.

[Pugsy]

Couple of ideas.
1....wonder if it's the change in pressure when it goes up around 10 cm that is disturbing your sleep.
Most of the night you spend well below 10 cm and the pressure is going up in response to the little clusters you are seeing.
Something is causing a higher pressure need only at certain times of the night. The 2 most common culprits are sleeping on your back or REM stage sleep or maybe a little of both. The 3 AM mark is often when we have more REM sleep. Normally the first stage of REM sleep will happen about 90 minutes after sleep onset and last a brief time. Then REM starts to come on sooner and last longer as the night goes on and we usually have the most REM in those wee hours of the morning.
Your OSA may be worse in REM sleep...it's common...mine is and I would often need more pressure during REM.
More pressure as in more minimum pressure to better prevent the clustering.

2..The wake up at 3 AM or so could also simply be habit.

But since there are 2 things on the reports that could potentially be a factor in the wake ups...those clusters of events that slipped past the defenses and the changing pressures I would think that trying to eliminate those as suspects would be worthwhile to try.
It may not help but wouldn't hurt to try and reduce the clusters and reduce the pressure swings.
You don't seem to be going past 10 cm very far or often but that change from 5 to 10 could be causing a sleep disturbance.

If you think maybe you are simply rolling over onto your back during those times you might try doing something to stay off your back. Easier said than done though. If it is REM that is involved then we can't really do much about REM because we really want all the normal sleep cycles.

To break up the clusters...a little more minimum pressure is needed. Probably no more than 1 or 2 cm more minimum that way the machine has a better head start on preventing those clusters. Also, often when the minimum pressure is more optimal we find that wide pressure changes reduce and often it doesn't go as high or stay up there as long.
Will it help your wake ups?...it might if those wake ups are because of either the cluster of events slipping past the defenses or if wide pressure changes are disturbing your sleep. No guarantees but there's a chance it would help and wouldn't hurt to try it while you are giving it time to maybe resolve on its own if the wake ups are just out of habit.

[Nick Danger]

When you wake up at 3:30, what do you do? If the answer is lie in bed tossing and turning trying to go back to sleep the rest of the night, then you might want to try something different. I think your doctor is probably right regarding how you got into the habit of waking up at 3:30. The thing is, it is still a habit even though the original physiological source of the habit has been removed. Could you turn on some soft relaxing music (maybe using headphones if you have a bed partner)? Could you read a "not very interesting" book? Could you watch a boring television show? The idea is to take your mind off of not being able to get to sleep - the frustration and worry about not falling back to sleep is self-defeating.

[Julie]

I agree that your pressure needs to be set higher.

[lorrpb]

I appreciate your thoughts and welcome any additional ones not yet posted.

>>If you think maybe you are simply rolling over onto your back during those times you might try doing something to stay off your back.
I am not aware of sleeping on my back. When I wake up I am always on my side.

>>When you wake up at 3:30, what do you do?
I have tried everything you mention and then some.

I've been holding off messing with the pressures, and wasn't sure I should since most of the night is ok, but it seems that it may be time to start tweaking.

Thanks again.

[70sSanO]

I've been holding off messing with the pressures, and wasn't sure I should since most of the night is ok, but it seems that it may be time to start tweaking.

I have found that making tweaks, based on sound judgment, does add a sense of ownership over your therapy.

Since you are following the data, you can see the results of any adjustments and those changes and the numbers really do become more meaningful.

John

[lorrpb]

Is there a medical danger in setting the minimum pressure too high or increasing too quickly, or is it primarily a comfort matter?

[palerider]

Is there a medical danger in setting the minimum pressure too high or increasing too quickly, or is it primarily a comfort matter?

primarily comfort, in my experience, as long as you don't develop pressure related central apnea (compSA)

[Pugsy]

Since you are already using a higher pressure by allowing APAP to adjust upwards anyway there really isn't any danger in increasing the minimum. Probably the worse thing that might happen would be a little aerophagia but that is unlikely since you are already using higher when the pressure increases anyway ...and you didn't mention any aerophagia issues.

Several reasons why we suggest to go up slowly...one being simply comfort and ease in to the adjustment with starting out with a little more pressure than what you are used to. It's and easier adjustment going in 0.5 cm or 1.0 cm increments than it is to be taking any big jumps. In your case I don't even think a big jump would be needed but if it were I would still say to take it slow because of the 2nd reason we suggest to go slowly...sometimes we don't need as much more pressure as we might initially think.
I would be really surprised if you needed any more than 2.0 cm to clean up those clusters...and my gut says that 1.0 cm would probably be the most you might need.

My OSA is worse in REM sleep so I have first hand experience seeing clusters similar to yours. Since you doubt that you do much back sleeping and since the clusters appear to be within a time frame where we might expect to be in REM sleep...I am betting that you are like me in that sometimes REM sleep just seems to produce more stubborn OSA events. Doesn't happen in all REM stages but sometimes just some REM stages. I never could figure out why I didn't see the pressure spikes in all REM stages or why some nights I didn't have any spikes.

I think I have a report that I could share with you that shows what I am talking about. Sometimes pictures help.

Your 5 cm pressure is really relatively low...going to 6 or 7 (which I doubt the 7 is technically needed) isn't going to hurt anything and might just help and wouldn't hurt to try.

Here in this thread I talk about my clusters when I was figuring out what pressures to use.
viewtopic.php?f=1&t=88508&st=0&sk=t&sd= ... ster+child
I think it is the second image in my first post.
If you go here you can see a hypnogram that shows the normal sleep cycles and when we can expect REM...look on the right side and scroll down just a bit to see it.
http://en.wikipedia.org/wiki/Sleep

I suspect that you are probably in a more prolonged REM stage sleep when you see those 3 AM clusters and just need a little more baseline (that minimum pressure) to help the machine do a little better job.

The other alternative if it's the pressure changing itself that is disturbing your sleep would be to go with a fixed cpap pressure but you would need to use up around 10 or maybe more all night and you might not like that as much.
I would try easiest and simplest first if it were me and that would be just a little more minimum pressure and see what happens.
Cross the "use fixed pressure" bridge only if we need to but keep that idea on the back burner.

[lorrpb]

I set it to 6 and here is last night's chart. Thinking I should try 7 tonite?

[lorrpb]

Here is the graph for Fri night. Overall AHI better, but still having events at 3-3:30 that wake me up and can't go back to sleep.

[Pugsy]

Next time you post an image of your report the leak line graph might be more important than the "by Pressure" graph.
Though from the statistics on the left the leak doesn't seem to be all that high and still well within acceptable limits for the bulk of the night. So I really doubt leaks are a problem unless a small leak is waking you up.

Your reports are "cleaner" looking with the 7 cm minimum. Around the 3 AM witching hour where you seem to wake up the pressure changes are minimal...and you have more changes a lot earlier in the night so I don't know if pressure changes are an issue or not.
Most likely not but at some point you might want to try a really, really tight range and limit the changes to see if you are maybe one of those people who are sensitive to any pressure changes even if the changes are relatively small.

I would use the 7 cm minimum some more nights to see what happens.
Staying asleep can be problematic for some people. Maybe habit and maybe not but it's hard to figure out the cause and it's hard to fix something if we don't know what needs to be fixed.

[palerider]

Here is the graph for Fri night. Overall AHI better, but still having events at 3-3:30 that wake me up and can't go back to sleep.

select the event flags, flow, pressure and leak charts on the left. most of what you're posting is of little use.

[lorrpb]

Here is the flow graph for Fri night. I don't have a problem with leaks. Thx.
What does the flow graph tell you?