Bad sleep after waking up

[jcs]

Hi there,

I could use some help on getting better sleep, particularly after waking up in the middle of the night.

I've noticed several nights where I've had few events up until a ~3am waking. However, my AHI/# of events explodes during the second half of the night. Even on nights where I don't wake up halfway through, there seems to be dramatically more events towards morning.

Is this a common thing? Maybe the mask is getting dislodged as I move around at night?

Thank you for your help.

[Julie]

Couple of things (have not seen your orig. posts from '19) - any chance of your now using an Apap? Are you on plain cpap because it was ordered for you (at that pressure)?

Your leaks are bad and a full face mask would be a lot better (unless you've tried a few with bad results). Whether or not it gets dislodged is hard to say of course. When trying on FF masks you should be lying down as your facial structure changes from sitting.

[Pugsy]

Leaks are not bad. Respironics machine report leaks differently. The only large leak was at the end of the night and was less than 0.1% of the time. The leak line isn't pretty but it is well within the machine's ability to compensate for it. Unless leaks are waking the OP up....they aren't a problem at all.

OP is using the CPAP Pro...except for a limited apap trial mode it's always going to be a fixed pressure only.
The slight variations in the pressure line seen on exhale (bottom line of the pressure graph) are just the Flex exhale relief varying a little bit. Remember Flex varies with how forcefully breathe. This is normal and not big deal.

As far as the bad sleep....first check to make sure you were really asleep when the bad stuff got flagged.
You may not have been fully asleep...sort of halfway asleep with a lot of arousals which you may or may not remember.
Watch the videos here to help you understand how to figure out if you were really asleep when those flaggings happened.
While it talks mainly about central apneas (clear airway) the false positive flagging can happen with OAs as well as hyponeas.
http://freecpapadvice.com/sleepyhead-free-software
OSCAR is based on SleepyHead so if you are using OSCAR the instructions above still pertain to SleepyHead.

If you are indeed asleep...maybe it's REM related flagged events.....maybe you were on your back.
Both REM and supine sleeping can worsen OSA and cause the need for more pressure. If you see this a lot and you are for sure that you were asleep you need more pressure...maybe 1 cm more to cover those special needs.

Remember that the wee hours of the morning is when we tend to have more REM stage sleep...so it's quite common to see ugly stuff in those wee hours of the morning. More time in REM equals more change of needing more pressure.

[zonker]

Hi there,

I could use some help on getting better sleep, particularly after waking up in the middle of the night.

I've noticed several nights where I've had few events up until a ~3am waking. However, my AHI/# of events explodes during the second half of the night. Even on nights where I don't wake up halfway through, there seems to be dramatically more events towards morning.

Is this a common thing? Maybe the mask is getting dislodged as I move around at night?

Thank you for your help.

one of the hardest things i've had to get used to is the maxim "we don't sleep the same from one night to the next or even ONE HOUR TO THE NEXT". now i know that doesn't do you one hell of a lot of good. i remember these old buzzards telling me stuff like this and me sitting out here thinking "WHAAAAAT?". but, nonetheless, it's true.

part of the reason you are having such a disparity of events from one part of the night compared to the other is that your therapy isn't optimized. that is, you aren't where you need to be to get a better quality sleep.

if you were in apap mode rather than cpap, you would have the machine set so that it could raise your pressure so that it could better handle those events that happen later on in your sleep. so that might be something to consider.

are you in cpap mode because the doctor set it that way? you could, yourself, change the settings in the machine. and start getting better sleep.

good luck!

[Pugsy]

part of the reason you are having such a disparity of events from one part of the night compared to the other is that your therapy isn't optimized. that is, you aren't where you need to be to get a better quality sleep.

if you were in apap mode rather than cpap, you would have the machine set so that it could raise your pressure so that it could better handle those events that happen later on in your sleep. so that might be something to consider.

are you in cpap mode because the doctor set it that way? you could, yourself, change the settings in the machine. and start getting better sleep.

1....we don't know for sure that the therapy is not optimal at this time. It was fine until the wake up. So the first thing we need to figure out if those flagged events were real asleep events or not. The machine doesn't know...if in apap mode it would have tried to deal with them with more pressure but in reality if those are arousal flagging more pressure won't fix them.

2.....his machine only has a very limited apap trial available to use...,.. the reason he is using cpap mode is because except for a limited apap trial mode (30 days)....that's all he has to use.

Yes...evidence of crappy sleep after the known wake up....but at this point we don't know if those flagged events are real or not.

Remember what I always say....to fix a problem we have to first identify the cause of the problem. In this situation there are other potential causes for the apparent crappy sleep and we really have to rule them out first if we are going to go suggesting a fix.

We don't always have a way to figure out things but in this situation there is an easy to do way of figuring out if those flagged events happened when asleep or not. Once someone does a little detective work then we know what the problem is and a better chance of how to fix it. If poor sleep quality itself was the cause of the ugliness....we have to try to fix whatever it was that was causing the poor sleep and probably tossing and turning and such.

And to everyone who think that APAP is the only way to deal with this....assuming this sort of stuff is real asleep flagged events.
Yes, apap is probably ideal but people who have no choice but to use cpap with fixed pressures because their machine won't do apap mode...they can still get optimal therapy. They just have to use a little more pressure all night to cover the special needs.
It can be done...for many years that was the only way it was done. Is it ideal...probably not but we don't always get "ideal" in life.
If they are indeed real asleep events..probably either REM or supine related and I wouldn't be surprise if a little 1 cm increase would break up the ugly.

I wouldn't go increasing the pressure though automatically without figuring out if awake/arousal related or not.
20 cm pressure won't fix arousal/awake flagged events...

[zonker]

2.....his machine only has a very limited apap trial available to use...,.. the reason he is using cpap mode is because except for a limited apap trial mode (30 days)....that's all he has to use.

why on earth would this be a thing? not doubting your word, just asking why??

[chunkyfrog]

2.....his machine only has a very limited apap trial available to use...,.. the reason he is using cpap mode is because except for a limited apap trial mode (30 days)....that's all he has to use.

why on earth would this be a thing? not doubting your word, just asking why??

Some doctors refuse to prescribe an apap--the temporary apap allows for limited home titration.
Kind of getting a foot in the door, when the provider is an ignorant a-hole.
These attitudes are rooted in the erroneous belief that single pressure is all anyone needs.
Stupid rules. Some doctors should be fired.

[Pugsy]

2.....his machine only has a very limited apap trial available to use...,.. the reason he is using cpap mode is because except for a limited apap trial mode (30 days)....that's all he has to use.

why on earth would this be a thing? not doubting your word, just asking why??

The doctor may not have been aware which machine was dispensed. Often all a doctor writes in the order is
cpap at so and so pressure with heated humidity..
That's all my prescription says.
DMEs then dispense a machine that fulfills the stated requirements on the RX.
Normally they dispense the bare bones no data or half assed brick models because they are cheaper and thus they make more money since insurance pays the same no matter which model.
Hey...at least he got the Pro model which is a full data machine and not the bare bones base DreamStation CPAP model.

People can get very effective therapy on a fixed pressure. May take a little extra work figuring out the ideal fixed pressure but it can be done. Heck, some people actually prefer fixed pressures and that's fine too.

[jcs]

Thanks for all the replies! I really appreciate it.

> any chance of your now using an Apap?

No, I am still using the Dreamstation Pro. My initial sleep studies were done in 2017. The first study found an AHI of 17.7 and an Sa02 of 86% with no therapy. The titration study done a week or two later found an AHI of 2.2 on my back with 8cm H20.

This whole business of sleep therapy has been a real ordeal for me. First it was difficult to convince my primary care physician to order a sleep study since I don't fit the typical profile. Once I was finally diagnosed, there has been absolutely zero follow-up with any doctor (sleep or primary care) to check in on how things are working. The DME is impossible to get ahold of, even to pay bills.

I struggled with the Wisp mask for a year or so, stopped using the device for about a year, and now I've been using it consistently since August 2019. I find the Dreamwear nasal mask to work much better than the Wisp... I think the Wisp put pressure on my nose, which made it more difficult to breathe through (it's often not easy to breathe through under ideal conditions.) Anyways...

I will review the videos RE: whether or not I was really sleeping, but I would guess that I was indeed sleeping. I tend to fall asleep pretty quickly and will usually take the mask off and read if it's been too long without falling asleep. That's what I did during the short interval at 3:30am last night.

> maybe you were on your back.

It is possible. I tend to sleep on my right side, but it's possible I went over to my back.

> more pressure...maybe 1 cm more to cover those special needs.

I see the post on "Dial wingin." Perhaps I will give it a try after reviewing the videos. I don't really have any other options, since I am not really in contact with any professionals to advise otherwise. I actually called my DME a month or so ago to ask if my usual AHI of ~2-3 could be improved, and they said it was fine.

When I was using the Wisp, I could "feel" the pressure coming into my nose quite clearly (when my nose was not clogged), but I've found that pressure to feel much less with this Dreamwear mask. Is it weird that there are intentional holes in both the hose attachment to the top of the headgear and in the nasal pillows themself? There is definitely air escaping through these small vents all the time... I've set the machine to the correct Mask Type (didn't know that was a thing before getting the new mask), so hopefully it compensates for that loss.

Just for kicks I've attached another screenshot from the night before where the events were more evenly distributed throughout the night, but I think I intentionally slept on my back that night as an experiment.

[Pugsy]

From a quick glance at this new report which is maybe more typical....The clustering of OAs sure looks suspicious for REM.
Google sleep stages and look at the hypnograms of the various sleep stages and when REM normally occurs. Compare the clusters to when normally occurs through the night.

The reason I know so much about REM and OSA...my own OSA is 5 times worse in OSA and sometimes I need a lot more pressure to deal with the REM events.

[zonker]

2.....his machine only has a very limited apap trial available to use...,.. the reason he is using cpap mode is because except for a limited apap trial mode (30 days)....that's all he has to use.

why on earth would this be a thing? not doubting your word, just asking why??

Some doctors refuse to prescribe an apap--the temporary apap allows for limited home titration.
Kind of getting a foot in the door, when the provider is an ignorant a-hole.
These attitudes are rooted in the erroneous belief that single pressure is all anyone needs.
Stupid rules. Some doctors should be fired.

dammit, that ain't right.

[zonker]

2.....his machine only has a very limited apap trial available to use...,.. the reason he is using cpap mode is because except for a limited apap trial mode (30 days)....that's all he has to use.

why on earth would this be a thing? not doubting your word, just asking why??

The doctor may not have been aware which machine was dispensed. Often all a doctor writes in the order is
cpap at so and so pressure with heated humidity..
That's all my prescription says.
DMEs then dispense a machine that fulfills the stated requirements on the RX.
Normally they dispense the bare bones no data or half assed brick models because they are cheaper and thus they make more money since insurance pays the same no matter which model.
Hey...at least he got the Pro model which is a full data machine and not the bare bones base DreamStation CPAP model.

People can get very effective therapy on a fixed pressure. May take a little extra work figuring out the ideal fixed pressure but it can be done. Heck, some people actually prefer fixed pressures and that's fine too.

thanks for the response.

but it STILL ain't right!

anyway, let's get back to the original topic.

[Pugsy]

but it STILL ain't right!

It is what it is. We can't do anything about it except try to make lemonade out of lemons.
Lots of things aren't right. I have enough trouble dealing with stuff that I might have some control over so I don't expend much energy on things I know I have zero control over. All it does is frustrate me.

People can get good therapy with fixed pressures. Takes a little bit of extra work sometimes but it can be done.
When someone has a fixed pressure machine I just roll up my sleeves and we go to work dealing with the limits we have.
No sense in wasting time bemoaning the fact that the person doesn't have apap available.
I can work with anything...even a brick if I have to but it's a lot more work.
Hell... I have used fixed pressure myself and I was able to figure out suitable pressures with it. Far from ideal since I happen to sometimes need so much more in REM BUT....I could do it if I had to. It can be done and is not impossible. Just takes a little more work and sometimes a compromise. Would it be nice if we didn't have to do more work or make compromises...sure but sometimes in life we have to go make some lemonade because we don't always get ideal.

[chunkyfrog]

After suffering for 9 months with an Elite, I invested my FLEX bucks on my S9 Autoset, from cpap.com.
I had already fired the @#$% DME who sold me the Elite, but did not tell them so.
BCBSNE sent me a letter, wondering why I had not been ordering supplies.
This was when I was getting most of my stuff from CPAP.com, the sponsors of this forum.

[zonker]

When I was using the Wisp, I could "feel" the pressure coming into my nose quite clearly (when my nose was not clogged), but I've found that pressure to feel much less with this Dreamwear mask. Is it weird that there are intentional holes in both the hose attachment to the top of the headgear and in the nasal pillows themself? There is definitely air escaping through these small vents all the time... I've set the machine to the correct Mask Type (didn't know that was a thing before getting the new mask), so hopefully it compensates for that loss.

no, not weird at all. "in goes the good air, out goes the bad".

otherwise you'd be re-breathing what you've breathed out.