Still Waking up at night

[Trivium91]

Hey Guys im 5 nights in wearing it all night. I was diagnosed with mild sleep apnea with 6.6 events per hour sleeping on my stomach, so I imagine other positions would be worse. I snore for 75% of the night with heart rate peaks at 109 and drops to 89% oxygen. My symptoms were severe, anxiety, depression, chronic fatigue, body aches and pains ...I was convinced I had adrenal fatigue and lost a ton of muscle since I had no energy to workout or even go for walks, both of which made me so exhausted after and unable to function. After reading more into UARS, I do have a small jaw and snore almost the whole night so this seems very likely. At any rate im setup on an Airsense 11 and so far I find it decent, though the most challenging aspect is the mask rather than the pressure while sleeping on my stomach. Im starting to feel better and am starting with some light exercise and labor chores, since I was able to do nothing before. My issue is that im still waking up at night multiple times at the same times just like I was without the machine, at least I don't get night sweats anymore though. When I wakeup my pressure is anywhere from 5.5-7 CM/H20, typically I don't reset the machine to go back to sleep as my sinus are congested at this point and I appreciate the higher pressure. I also tried sleeping on my side with a thicker pillow and it made it far worse (waking up every 45 minutes), I think because I kept rolling on stomach while sleeping and it restricts airflow having my head craned up on such a big pillow, I had 1.7 events that night. Most of the other nights my AHI is averaging around 1. I've heard of people get central apnea from using a machine, but the machine would measure it would it not? Moreover, if that's the case im only getting 1 events per hour? Why am I still waking up? My theory is that it takes months for the body to adjust due to being hypervigilent at night of being choked and breathing issues for years. My other theory is the pressure changes and perhaps my body just needs to get used to it. Ive heard of others asking for OSCAR software to post more details, how do I do this? I should also mention my machine is locked down and monitored by my sleep specialist. So far she has only looked at the AHI and said my sleep apnea is now super low.

I should mentioned I've had a sore throat as of late, not so much scratchy but like a sore muscle somewhere in my throat/airway. I also assumed this was from the machine and will get better with time. Also masks leaks look good according to the app, I haven't noticed any mouth breathing either. I typically fall asleep with my tongue on the roof of my mouth so I don't think that is the issue. I guess I should go out and buy some oximeter that measures throughout the night?

[Miss Emerita]

Welcome! It sounds to me as though you're doing very well for someone who is just five days in. It's especially encouraging to hear that you're starting to feel a bit better.

I think your first step should be to download Oscar to your laptop or desktop computer. You'll see the link in my signature block. You'll need an SD card in your machine and a way for your computer to read the card -- either a slot in the computer or a plug-in reader. (They're cheap.)

It might also be helpful for you to know that waking up during the night is normal. The key to a restful night is the ability to go right back to sleep. As you get more used to the mask, this should become easier for you.

Yes, if you're having central apneas, the machine will flag them. Again, it's normal to have a few every night; that wouldn't be a cause for concern.

[Trivium91]

Welcome! It sounds to me as though you're doing very well for someone who is just five days in. It's especially encouraging to hear that you're starting to feel a bit better.

I think your first step should be to download Oscar to your laptop or desktop computer. You'll see the link in my signature block. You'll need an SD card in your machine and a way for your computer to read the card -- either a slot in the computer or a plug-in reader. (They're cheap.)

It might also be helpful for you to know that waking up during the night is normal. The key to a restful night is the ability to go right back to sleep. As you get more used to the mask, this should become easier for you.

Yes, if you're having central apneas, the machine will flag them. Again, it's normal to have a few every night; that wouldn't be a cause for concern.

Thanks so I downloaded Oscar. Last night it said I got 1.44 CA (Central Apnea) Events per hour. Isn't this a little high? Im definitely waking up multiple times a night and it's annoying. I've actually caught myself not breathing during one of these central apnea events. I did not have central apnea during my sleep study. Will the central apnea go away? As far as posting my Oscar results, what screen do you guys want to see?

Edit: I just compared most of these central apneas with my apple watch, turns out I was awake during those time periods so they are not really real, I guess I must have been breathing funny or messing with the mask.

Im wondering when I can start working out again, I stopped as I was getting worse. I was so exhausted I would go for a gentle walk and be so tired I could sleep after.

[Pugsy]

As far as posting my Oscar results, what screen do you guys want to see?

http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

I got 1.44 CA (Central Apnea) Events per hour. Isn't this a little high?

Not at all high especially since you already know that some of those flagged events got flagged when you were awake.
If you aren't asleep they don't count for anything except if you have a lot of awake/arousal flagged events it means you aren't sleeping so great.

BTW it is normal to have a few real asleep centrals here and there during the night.

[Trivium91]

As far as posting my Oscar results, what screen do you guys want to see?

http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

I got 1.44 CA (Central Apnea) Events per hour. Isn't this a little high?

Not at all high especially since you already know that some of those flagged events got flagged when you were awake.
If you aren't asleep they don't count for anything except if you have a lot of awake/arousal flagged events it means you aren't sleeping so great.

BTW it is normal to have a few real asleep centrals here and there during the night.

makes sense, well I guess im just hyper aware of anything that wakes me up at night unfortunately. I guess im just hyper vigilant since I struggled with this for four years, I thought it was adrenal fatigue and stress due to exercise intolerance and what not, pretty sure it was just the OSA as im slowly feeling better. Perhaps it's just brain training and that will take time and conscious effort not to focus on not breathing at night? I also suspect I have UARS due to small jaw/narrow airways, not sure if that matters.

[Trivium91]

As far as posting my Oscar results, what screen do you guys want to see?

http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

I got 1.44 CA (Central Apnea) Events per hour. Isn't this a little high?

Not at all high especially since you already know that some of those flagged events got flagged when you were awake.
If you aren't asleep they don't count for anything except if you have a lot of awake/arousal flagged events it means you aren't sleeping so great.

BTW it is normal to have a few real asleep centrals here and there during the night.

Edit: The machine is off by exactly two hours, the clinician must have put the incorrect time in the machine or not set it up properly. Though yes, it appears that moat of the CA events are when I was awake trying to sleep. Not sure why im waking up than.

[Pugsy]

Prior ResMed machines had an internal clock that you could manually set yourself but not the AirSense 11 machines.
They only have a time zone setting available upon initial setup but to correct the time now after it has been used requires a total erasure of all prior data.

https://media.resmed.com/sites/3/202106 ... ER-ENG.pdf

The above manual explains how to get into the clinical setup menu area to make changes like erasing the prior data.

So you could do that and just alert your provider that you are doing that....or you could correct the time by using OSCAR's time offset feature.
To do that just open OSCAR and go to File in the upper left corner and click on it...then from the menu that pops up click on Preferences and then click on the "CPAP" tab and in the upper left corner is the clock drift reset thing. Ignore the warning about the feature not supposed to be used for time zone stuff....you can't reset your clock but you can use the drift offset feature to make the times correct at least on your reports. I do it for the 2 times a years we have DST changes. Now my machine does have a clock that I could reset but it is simpler to just use the clock drift thing in OSCAR. Less work for me.

[Miss Emerita]

When you have a moment, I'd be curious to see a representative daily chart, with the information described in the link Pugsy provided. You can't upload it to the site, unfortunately, but you can use an image-hosting site like Imgur and post a link.

[Trivium91]

Prior ResMed machines had an internal clock that you could manually set yourself but not the AirSense 11 machines.
They only have a time zone setting available upon initial setup but to correct the time now after it has been used requires a total erasure of all prior data.

https://media.resmed.com/sites/3/202106 ... ER-ENG.pdf

The above manual explains how to get into the clinical setup menu area to make changes like erasing the prior data.

So you could do that and just alert your provider that you are doing that....or you could correct the time by using OSCAR's time offset feature.
To do that just open OSCAR and go to File in the upper left corner and click on it...then from the menu that pops up click on Preferences and then click on the "CPAP" tab and in the upper left corner is the clock drift reset thing. Ignore the warning about the feature not supposed to be used for time zone stuff....you can't reset your clock but you can use the drift offset feature to make the times correct at least on your reports. I do it for the 2 times a years we have DST changes. Now my machine does have a clock that I could reset but it is simpler to just use the clock drift thing in OSCAR. Less work for me.

This is awesome thanks, I just adjusted it in OSCAR. I've attached my OSCAR results. The red boxes are times I believe I was awake before the actual event, therefore I believe that the arousals are unrelated to the events with the red boxes. This is according to my Apple Watch so the events are actually much lower. Not sure why im showing CA events when im awake, though its probably because I adjust my mask and hold my breathe, or hold my breathe when flipping positions. Everything looks really good on my end based on this data, at least what I know about this anyways. I always wakeup after a dream and I dont know. I wonder if it's conditioning from untreated sleep apnea. Perhaps my body is used to gasping for air after a dream? My snoring is far far better according to this, I would snore 75% of the night. Also I dont have night sweats anymore. Also im not sure how bad the flow limit is but its likely due to my sinus congestion that gets worse over the night, its just one nostril though.

[Pugsy]

Not sure why im showing CA events when im awake, though its probably because I adjust my mask and hold my breathe, or hold my breathe when flipping positions

Hold your breath for at least 10 seconds. That's essentially a 10 second central apnea. No air is moving but it is because there is no effort.
When awake our breathing is very irregular and we often pause our breathing and don't realize it. Possibly like you say....related to changing position and holding our breath while turning over in bed. These machines only measure air flow. They have zero way to know if we are asleep or not. They just call them like they see them...awake or asleep...they only measure the air flow or lack of.

I like to call them false positives but there's nothing false about them because the machine is just calling them like it sees them.
It can also happen at other times and the other categories of events can also get a "false" label.
I see them all the time....arousal/awake related centrals/CAs or hyponeas or even OAs because I don't sleep so great but not because of airway issues. Instead my false "positives" are arousal related because pain has woke me up.

BTW...did you know it is entirely normal to wake up after a REM stage sleep has ended? Google "sleep stages" and look at the normal hypnograms and you will see what I mean. Normally we just roll over and go back to sleep and not awake long enough to form a memory of the awakening but sometimes it happens that we just don't go right back to sleep.

Do you take any medications of any kind? If so, what?
Any other physical or mental health issues going on that might impact sleep????

Google "sleep maintenance insomnia" and look at all the potential causes for it. That's when we wake too many times during the night or earlier than we want to and can't go back to sleep. A lot of times medication side effects are a factor.
Of course the list is miles long as to other potential culprits....like for me it is the pain thing or in my case also some life stressors issues.

Remember these machines can only deal with airway related issues. These machines can't do a damn thing about my pain or sleep maintenance insomnia issues from life's stressors....no matter how much we might expect (or want) them to fix things. They simply can't fix a problem unless the problem is airway related.

[Trivium91]

Not sure why im showing CA events when im awake, though its probably because I adjust my mask and hold my breathe, or hold my breathe when flipping positions

Hold your breath for at least 10 seconds. That's essentially a 10 second central apnea. No air is moving but it is because there is no effort.
When awake our breathing is very irregular and we often pause our breathing and don't realize it. Possibly like you say....related to changing position and holding our breath while turning over in bed. These machines only measure air flow. They have zero way to know if we are asleep or not. They just call them like they see them...awake or asleep...they only measure the air flow or lack of.

I like to call them false positives but there's nothing false about them because the machine is just calling them like it sees them.
It can also happen at other times and the other categories of events can also get a "false" label.
I see them all the time....arousal/awake related centrals/CAs or hyponeas or even OAs because I don't sleep so great but not because of airway issues. Instead my false "positives" are arousal related because pain has woke me up.

BTW...did you know it is entirely normal to wake up after a REM stage sleep has ended? Google "sleep stages" and look at the normal hypnograms and you will see what I mean. Normally we just roll over and go back to sleep and not awake long enough to form a memory of the awakening but sometimes it happens that we just don't go right back to sleep.

Do you take any medications of any kind? If so, what?
Any other physical or mental health issues going on that might impact sleep????

Google "sleep maintenance insomnia" and look at all the potential causes for it. That's when we wake too many times during the night or earlier than we want to and can't go back to sleep. A lot of times medication side effects are a factor.
Of course the list is miles long as to other potential culprits....like for me it is the pain thing or in my case also some life stressors issues.

Remember these machines can only deal with airway related issues. These machines can't do a damn thing about my pain or sleep maintenance insomnia issues from life's stressors....no matter how much we might expect (or want) them to fix things. They simply can't fix a problem unless the problem is airway related.

Yeah not on any meds just a bunch of different supplements/vitamins due to all the stress (that I thought was adrenal fatigue) but was really just stress due to untreated OSA and more than likely UARS. I've been taking passionflower and valerian to help sleep with the CPAP, but i also regularly take L-theanine, Magnesium L-Threonate, Zinc and 3MG slow release melatonin before bed. How were the Oscar results BTW, did anything stand out? So waking up after REM is normal? That makes sense, perhaps it's just harder for me to fall back asleep as im getting more comfortable with the mask. Sometimes I can fall asleep in a few minutes, other times it takes me 15-20 minutes to go back to sleep. I guess I might just be hyperaware because of everything I went through with untreated OSA for 3-4 years, sort of like PTSD. It does not help that I get sinus congestion for no reason at night in the nostril closest to the pillow, it impacts how quickly I can fall back to sleep. In the past ive struggled to fall asleep but never wokeup in the night so it didn't matter because I would sleep through the night.

Also, yea I seem to have adjusted pretty well to the pressure of the mask. I routinely focus on my breathe to sleep, so perhaps thats why it wasn't too bad for me. I also use the machine for about an hour in the evening close to bed at like 7-8PSI. Than by the time I got to bed and set the ramp pressure, 4PSI feels like nothing.

I attached my sleep from last night, I guess this is normal? Dont worry about the time in bed, it always was says way more.

[zonker]

cat-dance.gif (742.09 KiB) Viewed 4159 times

sorry for the interrupt, but apparently attachments are working!

[Pugsy]

How were the Oscar results BTW, did anything stand out?

Nothing of great excitement on the report. If we remove the awake/arousal false flagged events the AHI is quite acceptable.

It does not help that I get sinus congestion for no reason at night in the nostril closest to the pillow, it impacts how quickly I can fall back to sleep.

Annoying but also could be the normal nasal cycle thing.
https://en.wikipedia.org/wiki/Nasal_cycle

[Trivium91]

How were the Oscar results BTW, did anything stand out?

Nothing of great excitement on the report. If we remove the awake/arousal false flagged events the AHI is quite acceptable.

It does not help that I get sinus congestion for no reason at night in the nostril closest to the pillow, it impacts how quickly I can fall back to sleep.

Annoying but also could be the normal nasal cycle thing.
https://en.wikipedia.org/wiki/Nasal_cycle

This makes perfect sense! Every single night I get it, I wonder if elevating my bed would make it less noticeable? Regarding the report thats more or less what I thought, so I think I just need to keep going and hopefully my brain will start connecting the sleep cycles better. I bought a Bia sleep mask that uses fNIRS to measure brainwaves, similar to an EEG and it uses nuerofeedback via bone induction speakers to aid with different sleep cycles and help you fall asleep quicker. its in kick starter phase but supposed to release Q3 this year. Hoping it will help, but who knows I bet ill be sleeping better by than.

[Miss Emerita]

Your chart looks good! Very nice AHI (bracketing the awake events), excellent leak control, and no snores. You do have some flow limitations off and on, but I wouldn't worry about them if I were you.

I think you've put your finger on something important. As you get more and more used to the mask and the machine, it'll be easier and easier for you to fall right back asleep when you wake up during the night. That's a process of acclimation, and it takes a different amount of time for different people. If you're patient with it, you'll see positive changes over time.

Your body was taking a beating for quite a while, and your recovery probably won't happen in any dramatic fashion. You seem to be on the lookout for small improvements, which is exactly the right frame of mind. As time goes by, you can test out pushing your body a little bit more, so you can make gains in strength and stamina.

Don't forget to get exposure to sunlight during the day, even if that means just sitting on a park bench. It helps to improve sleep. And of course stay off your devices for roughly an hour before bedtime.