Return of the night sweats

[rmeyer23]

Need some help and advice as this is really starting to get to me. After experiencing the "nirvana" of fully restful nights and no night sweats, they have returned and it seems to be getting worse.

First some history; I started on CPAP in late Aug of this year, and everything went well. I had a PR CPAP and my starting pressure was 8 cm. At first it was great, I was sleeping through most of the nights, no more night sweats, and awoke feeling better than I had in years. Went for a second titration study in early Sept because my AHI was near 15 (I was 51 during my first sleep study) and he wanted to get it down to below 5. Sent me home after the second study with a setting of 12 cm. I reacted very badly with this new setting. He set it back to 8 and ordered a new APAP machine since I was so adverse to the higher setting on the CPAP. I also went with a full face mask which I tried in the second study since I had leakage problems with the nose mask.

New machine and mask arrived in late Sept. At first everything was good. At my third titration using the APAP and full face mask, they started me at 9cm and increased to 13 cm which was a successful rate. They home settings on my new APAP was 10 cm/15 cm. Another thing happened at this time. The doctor also had me on sleep pills (Zolpidem 10mg) since early Sept. I had told him I wanted at some time to get off the sleeping pills. In late Oct I started getting an adverse reaction to the sleeping pills (couldn't fall to sleep at all and higher anxiety levels) so I took myself off of the pills cold turkey in late Oct. One week of hell, but I was off of the pills. Once again things were getting back to normal and I could fall off to sleep in no time at all.

Things took a turn for the worse last week. When I woke up in the morning, I noticed that the night sweats had returned. At first only mildly and getting worse as time progressed. I also started being fully awake at 3 to 4am every night, sweaty. That is when I went online and started reading up on the Apnea forums. I got a copy of the SleepHead software so that I could read the SD card. At first looking at this card, to me it does not look as if anything is wrong. I see an AHI of between 3 and 7 with an avg of 3.5. Is there any other data points that I should be looking for?

So I am looking for some help from this forum. Is there any other information that I can supply? I am putting off seeing the doctor until I feel that I have a better understanding as to what is going on. I desperately want to get my sleep back. Any and all help will be greatly appreciated.

Ron M

[rmeyer23]

Here are some images off of SleepyHead:





Here are the numbers from Nov 11th:



Ron M

[Pugsy]

Quick question..on your sleep studies did you see a mention about REM sleep? 3 to 4 AM is when most people typically will have more REM sleep and some people have many more apnea events during REM sleep. On the detailed report you show here, it doesn't look like anything exciting happened at 3 to 4 AM but it is difficult to see (too small for my eyes). Or any mention as to apnea events being worse when you are sleeping on your back.
It may not be mentioned directly but one just looks at events in REM vs NonRem and/or supine vs NonSupine to see if there is much of a difference.

Another thing...even if AHI is relatively low are you seeing groups or clusters of events followed by times with zero events?

AHI itself doesn't always give us a clear picture as to what is going on. Sometimes we have to look deeper and out side the box a bit.

[rmeyer23]

Pugsy

Thanks for all of your help!

Here is a larger version of the data from 11/11/2011:



Under events in SleepyHead:
Cheyne 1
Clear Airway Apnea 2 purple
Flow Limitation 2 brown
Hypopnea 5 blue
Pressure Pulse 4
Respiratory Effort Related Arousal 6 yellow
Vibratory Snore 1

I do notice that I have more apnea when I sleep on my back. When I have the sudden wakeup around 3am I am on my side usually.

Ron M

[Pugsy]

Well, nothing of great excitement on that report.

Have you used SleepyHead to zoom in on those events (obviously not many) that occurred in the time frame where you woke up? Perhaps look to see if it may have been unusually long? Which could stress the body?
Using the Events tab in SleepyHead...then click on the event catagory...then the event within the time frame...SH will automatically zoom in on that specific event and the number in parenthesis next to the time..is a very close duration of event in seconds. You can see the individual breaths and duration on the graph also.

From this report I don't see anything glaringly obvious as a possible reason for the wake ups.
It may not be related to sleep apnea at all. This report is actually an excellent report.
Your pressure lines are extremely stable so I don't think it is related to any pressure increases.
I see nothing to try to improve on in this area.

Anything external that you can think of? Pain? Just the night sweats? or do you wake with pounding pulse? If the event happened to be extremely long...possible Oxygen level drop.. Any other health issues?

[chunkyfrog]

Does your doctor know about the return of the night sweats?
There is a chance they are due to an unrelated cause--many of which require attention.

[Emilia]

Are you male or female? If female, and of a certain age.... you might be having night sweats due to perimenopause or menopause. There are other causes for night sweats, too.....

[ClayL]

Are you male or female? If female, and of a certain age.... you might be having night sweats due to perimenopause or menopause. There are other causes for night sweats, too.....

Yes there are other causes - my night sweats were caused by gastric reflux.

[rmeyer23]

Well, nothing of great excitement on that report.

Have you used SleepyHead to zoom in on those events (obviously not many) that occurred in the time frame where you woke up? Perhaps look to see if it may have been unusually long? Which could stress the body?
Using the Events tab in SleepyHead...then click on the event catagory...then the event within the time frame...SH will automatically zoom in on that specific event and the number in parenthesis next to the time..is a very close duration of event in seconds. You can see the individual breaths and duration on the graph also.

From this report I don't see anything glaringly obvious as a possible reason for the wake ups.
It may not be related to sleep apnea at all. This report is actually an excellent report.
Your pressure lines are extremely stable so I don't think it is related to any pressure increases.
I see nothing to try to improve on in this area.

Anything external that you can think of? Pain? Just the night sweats? or do you wake with pounding pulse? If the event happened to be extremely long...possible Oxygen level drop.. Any other health issues?

There seems to be two clusters of events that I can see on SleepyHead for Nov 11th:

1st cluster
03:24:02 Respiratory Effort Related Arousal (RERA) - 29 sec
03:38:52 Hypopnea - 31 sec
03:43:05 Flow Limitation - 8 sec

2nd cluster
04:07:21 Hypopnea - 13 sec
04:17:28 RERA - 21 sec
04:17"47 Pressure Pulse - 8 sec

What I have noticed is that I am startled wide awake and I am very sweaty. No other symptoms that I have noticed.

Health has been pretty good lately. No colds or flu. Actually have been losing a little bit of weight lately.

Ron M

[rmeyer23]

I tried something different last night. I lowered the setting on my Humidifier. It was 4; I lowered it to 1. Even though I still had night sweats, I had a noticeable improvement. I still woke up (around 3:30am) but nowhere near as sweaty. Also able to get back to sleep.

I know that others have encouraged me to see my doctor about my situation, but it is my intent to become more knowledgeable before I see him. I have a $40 copay and another titration session, even with insurance, will cost me over $500 out of pocket. I want to try a few things and see if I can get it under control by myself.

Comments?

Ron M

[Pugsy]

Interesting that lowering the setting seemed to help. Need more than one night to confirm though. Hurts nothing at all to try it if your nasal mucosa doesn't scream bloody murder (mine would ) but each to their own thing.

While a doctor visit might offer an explanation if he had one..I don't see how a new sleep study would though. I suppose it could but I just don't see how. I just don't see anything glaring out from the reports that might explain night sweats or the 3 AM waking. If you were female we could probably come up with a hormone thing. Been there myself and it is ugly. Unsure if male hormones do the same thing as they age.

[rmeyer23]

Turned the humidifier off last night and got the same results. While not 100% gone, the night sweats have been greatly reduced.

Since I still have the problem of waking early in the morning, I am starting to tweek my pressures. My APAP was set at 10 cm/ 15 cm. On Sat I took the lower level up to 10.5 cm (baby steps). This was when I had the really bad episode of night sweats. I wondered where all the water (my sweating) was coming from the the one area was the humidifier that I lowered.

So I am going to stay on 10.5 cm for the test of the week and read the data this weekend to see how I did and compare it to the previous week. Only then will I consider raising it again and then only to 11.0 cm. The high end will remain at 15 cm.

So, does this sound like the right approach? I noticed on some boards they want no dicussion whatsoever of "self titraion". What should I be on the lookout for with using my methods? I have another appointment with my sleep doctor but it is still a few weeks away. I want to have the data to have a meaningful discussion with him. If he goes all crazy on me, then maybe it is time to look for a new doctor.

Comments?

Ron M

[Pugsy]

So, does this sound like the right approach?

Yes

I noticed on some boards they want no dicussion whatsoever of "self titraion"

Yes, some boards will actually remove your posts if they are advocating the patient doing anything without a physician being directly involved and won't even allow posting of instructions on how to alter anything.
Way too controlling for me. Though some people are more comfortable that way and I guess whatever floats their boat is fine for them.

What should I be on the lookout for with using my methods?

Anything that might seem a bit out of the norm for you and you will have to look at a lot of reports to figure out what is normal for you. Anything that might explain a wake up..increased pressure...cluster of events..could be anything.
If we knew for sure we could tell you straight away.

[chunkyfrog]

Sounds like a gag rule.
There ought to be a law against gags.
The truth should be available to everyone.
I know; I rant.

[rmeyer23]

So, does this sound like the right approach?

Yes

I noticed on some boards they want no dicussion whatsoever of "self titraion"

Yes, some boards will actually remove your posts if they are advocating the patient doing anything without a physician being directly involved and won't even allow posting of instructions on how to alter anything.
Way too controlling for me. Though some people are more comfortable that way and I guess whatever floats their boat is fine for them.

What should I be on the lookout for with using my methods?

Anything that might seem a bit out of the norm for you and you will have to look at a lot of reports to figure out what is normal for you. Anything that might explain a wake up..increased pressure...cluster of events..could be anything.
If we knew for sure we could tell you straight away.

===================================
OK, further "self testing" as occurred.

Turning down the humidifier did reduce the night sweats but did not eliminate them. Setting the humidifier on Zero caused a dry mouth in the morning. I am currently using a setting of 1.

I have also been trying to raise the lower level on my APAP machine. Original setting was 10/15. I had no intention of raising the higher setting at this time. I upped the lower setting to 10.5 cm for one week. No problems at this setting but the night sweats still persisted and I was waking up multiple times. I then raised the lower level to 11.0 cm. I had a new set of problems. Falling asleep now was a problem because I had the sensation of the forcing of air into my lungs. This was the one reason why the doctor switched me from CPAP to APAP . He had raised my level to 12cm on my CPAP and I was getting these sensations of forced air and had difficulty falling asleep. I decided to reset my APAP to the original leves; 10/15.

Looking at the data, it looks like my AHI is under control with readings under 5.0, typically between 1.0 and 3.0 on most nights. My thoughts are now turning to what is waking me up. Maybe I am too light a sleeper and small events like a clear airway or a pressure change is waking me up. I started taking the sleeping pills again (Zolpidem 10mg) on a limited basis. When I use the sleeping pills I am able to sleep through the night with only one wake up at most. I also do not have night sweats. I am next going to try to halve the dosage on the sleeping pills to see if I get the same results.

I would really appreciate only comments you might have. Looking for some validation that I am looking in the right areas. Also if you need me to post more data, let me know what kind of data you would want to see.

Thanks, Ron M