Waking up every hour and a half.

[David40]

Hello everyone,

I was diagnosed with severe OSA back in mid February, wih AHI at 66 per hour and oxygen levels dropping to 79. I asked for the sleep study because of not only being super fatigued during the day but also experienced debilitating headaches and dizzyness, loss of fucus and concentration, and just basically could not function and had to quit my job. I got my CPAP machine about two weeks ago and got used to it fast and dont mind the dreamwear mask and nasal cushion at all, however what is still bothering me is that i am still waking up every hour and a half and always during dreaming state. I know that i must be in rem sleep as this is happening. My AHI numbers actually has dropped to .2 for 8 hours of sleep last night, with the cpap auto set at 5 to 10. I have the sleepyhead app and can confirm that the cpap is working well and the last 7 days my AHI is consistently under 1 but can not understand why i am always waking up 4 to 5 times a night. My headaches are much much better and I am functioning so much better, but due to this fragmented sleep i am still tired during the day. I would appreciate any help on how to fix this fragmented sleep. I dont have any significant mask leak that wakes me up. I can go back to sleep within 15 to 20 minutes but the cycle repeats again and i wake up an hour and half again during d a dream, now my dreams are all normal and nothing scary, but i do remember must of my dreams because i wake up during one. I am 40 years old and prior to my diagnoses always felt tired and in a depressed mood and never dreamed in the past 10 years. I like the huge improvement with cpap however i would really like to also solve the last issue with my sleep sp any ideas as to what is happening?

[Pugsy]

Did you know it's normal to wake after the REM cycle is completed?
Most of the time (or at least we hope) the awake time is so brief that we don't have any memory of it but for some unlucky people they wake up and it takes too long to fall back to sleep and a bit of sleep maintenance insomnia happens.

Google "sleep stages" and look at the normal hypnograms and see when REM typically happens.

And how do you know it's every 90 minutes? Are you clock watching?

2 weeks isn't really all that long in the grand scheme of things to expect to see a big change in something. I know it's not what you wanted to hear but you may just have to give the body and brain some more time to get used to sleeping more and better.

[Pugsy]

Post a detailed report from a typical night.
Let's look to see if anything is showing up that might be a factor in the wake ups.

How to post images and what to post...see this thread.
viewtopic/t158560/How-to-post-images-for-review.html

[Mogy]

Waking up after a sleep cycle finished happened to me at the beginning of PAP therapy. It took a couple of months before I was used to the mask enough to sleep through some of them.

[David40]

Thanks Pugsy,

here is a Sleepyhead chart for last night. I can not pin point exactly why I wake up every 1 hour and half and some times longer, but last night I woke up around 4 to 5 times. the graph shows some leak rate spikes during the time I woke up, so that might correlate to something I did not look into. Maybe I have to tighten the headgear a little better for the time the pressure goes up during REM sleep. What do you think?

screenshot-20180322-173017.png (109.84 KiB) Viewed 5689 times

[Pugsy]

You've done something weird with the graphs.
Your AHI is low but nothing is flagged but one RERA and that's not part of the AHI.
Look down at the bottom left of the graphs where you see the little arrow next to "Flags" and expand the menu and if you see in red/black boxes...click on them to change them to green/black boxes.

The leaks aren't horrible but they are big enough at times that it is possible that they are a factor in disturbing sleep.
Sometimes people get woke up from teeny tiny leaks but they will usually recognize the annoyance.

See if you can get your detailed report to show the events and other stuff like we normally see.
Mainly just to confirm but I doubt that this report is going to be particularly enlightening.

The Flow Limitation graph seems to show increase FLs during probable REM. Either that or you were on your back maybe but the timing looks like REM.

You may just need to give it time and accept that some wake ups are just a normal part of the sleep process.
If you are clock watching...quit it. All that does is feed the insomnia monster making it even harder to get back to sleep.

[TedVPAP]

Congrats - you are relearning how to sleep. Enjoy the benefits that you are receiving and relax as you adjust. Please check back every week or so.

[SnoringInOregon]

I've now been using my machine for 11 months.

I also used to wake up. A lot. Pretty much every hour and a half. Fortunately I was usually able to fall back asleep very quickly. I've seen gradual improvement. It's not something that's apparent day to day, but definitely noticeable from month to month. Nowadays I'll often sleep for 4.5 or 6 hours before I wake up.

It takes time. Lots of time. Even just in the last few months I've seen improvement. So hang in there. Use the machine every night.

[David40]

Thank you SnoringinOregon,

Last night I was able to sleep about 4 hours straight and when I did wake up after that 4 hours, I felt better then I have had in many years. I felt so refreshed and clear headed and energized, and was so happy. I must have had OSA for such a long time that I had forgotten what normal sleep feels like. For that 4 hours of sleep, i looked at my AHI and it was 0. So, I know the CPAP is working just fine and luckily my average pressure is around 6 to 6.5 and only goes up to around 8 to 9 during rem sleep. I have purchased a very comfortable recliner and sleep on that at a slight inclined position, it somehow totally stops mouth leaks and stops my tongue from falling straight back in my throat. I tried a couple of chin straps but they did not work.

Unfortunately, I could not go back to sleep after that 4 hours because i was so rested and energetic, but with time just like you said I hope I can sleep longer. I quit smoking about a week ago and I know that has something to do with it. I am very motivated and feel like I can finally feel normal again.

I will keep you guys updated as I make progress.

Thanks for your help.

[Pugsy]

I think it took me about 3 months before the awakenings reduced down to a smaller number.
Now I still might wake up a few times for various reasons (none related to cpap or sleep apnea) but I normally go right back to sleep.
Sometimes I do like you did last night...wake up (no known reason) and just can't get back to sleep.
Fortunately not often and I think that with time your awakenings will reduce and you will have fewer times where you wake up and can't go back to sleep.

It's still better than what was happening before starting cpap.

[nicholasjh1]

Thank you SnoringinOregon,

Last night I was able to sleep about 4 hours straight and when I did wake up after that 4 hours, I felt better then I have had in many years. I felt so refreshed and clear headed and energized, and was so happy. I must have had OSA for such a long time that I had forgotten what normal sleep feels like. For that 4 hours of sleep, i looked at my AHI and it was 0. So, I know the CPAP is working just fine and luckily my average pressure is around 6 to 6.5 and only goes up to around 8 to 9 during rem sleep. I have purchased a very comfortable recliner and sleep on that at a slight inclined position, it somehow totally stops mouth leaks and stops my tongue from falling straight back in my throat. I tried a couple of chin straps but they did not work.

Unfortunately, I could not go back to sleep after that 4 hours because i was so rested and energetic, but with time just like you said I hope I can sleep longer. I quit smoking about a week ago and I know that has something to do with it. I am very motivated and feel like I can finally feel normal again.

I will keep you guys updated as I make progress.

Thanks for your help.

Yep, that is a common side effect of having the apnea for so long that many people get. I often wake up around 240 after the first 4ish hours of sleep feeling very rested and energetic. For the most part I've taught myself to get back to sleep. My theory is that the body got so used to using energy at night that even after CPAP treatment.... at least for a while. The body still has that extra energy at night... "prepping" for surviving the night. some experiments even back this up, showing raised energy metabolism at night for apnea sufferers... even after CPAP usage (through abnormally high nighttime Creatine levels. )

[David40]

Just an update on my sleep: The past couple of nights I have been waking up less frequently and I think that is largely due to not looking at what time it is and basically just getting comfortable with the mask and falling back to sleep faster. Last night I woke up about 3 times, but rather then staying awake for a long time, I went back to sleep after a couple of minutes. Here is a sleepyhead report from last night. I started with a pressure of 6 because I breath easier that way compared to pressure 4 which seemed like I was not able to take full breaths. The only time the pressure goes up on the machine is during rem sleep I guess otherwise the pressure pretty much stays low. I am amazed at how I went from severe sleep apnea of 66 events an hour to now just .5. I don't know if I could do anything else to improve anything.

I am feeling great, I have quit smoking for two weeks, eating healthier and walking almost every morning. The only thing that is unusual at least for me is that I am constantly dreaming, the dreams are nothing bad, but they seem long and full of stories. I wake up and takes me about an hour or two to fully wake up due to all the dreams I had. I guess I have had SA for such a long time and did not dream at all, and now that I am getting complete sleep cycle I am dreaming more.

[Julie]

David - Quitting smoking can have all kinds of effects short term on things. Glad they're going easier now!

[David40]

Need some opinion guys:

So last night, I set my cpap machine pressure to 6.2 min. and 6.2 max and slept for about 7 hours. Still woke up about 3 times, but these days I can go right back to sleep within 15 minutes. In all, I slept about a solid 6 hours. I have found out that I feel better when I get between 6 to 7 hours a night, anything more or less and I wont feel that good. The sleepyhead report showed only and AHI of .28 which is very low considering that the pressure I set was very low. I have trained myself to basically sleep on my sides. so my questions are. I am asking these questions basically because I can't believe such low AHI, as I was diagnosed with severe sleep apnea of 66 events/hour. During the sleep study I fell asleep on my back (supine) and most of the events were Hypopneas.

1. With such low Cpap pressure of 6.2, is it even therapeutic? Or is it because I am sleeping on my sides?

2. with such low cpap pressure do I even need treatment, or can I just sleep on my sides and that would take care of it?

3. My cpap machine is brand new and sometimes I am thinking if it is detecting events correctly because of such low AHI, but today I traced my flow rate almost breath by breath and did not find any apneas.

Sorry for asking so many questions, I guess I just need some confirmation that the therapy is working and even at pressure of 6.2. I am dreaming a lot these nights and sometimes think that I am in dream all night, but today I feel great.

Here is a sleepy head report from last night.

[Julie]

If you were to not use Cpap, your AHI, never mind your sleep habits and how lousy you'd feel when 'awake', would go right back to where it was pre-Cpap. It's like glasses... you see with them on, but take them off and you're right back being blind. You don't cure OSA, you do treat it ongoing, like diabetes. And severity of events (how many per hr per night) has no relation to how much pressure YOU need to keep YOUR airway open... there are people whose AHI's were e.g. 15 but who need high pressures to keep THEIR airways open... apples and oranges.