On CPAP and waking 3 hours into sleep

[johnwlawrence]

I have moderate OSA. I use CPAP. When I use CPAP my SpO2 averages about 96 and does not fall below 90. I fall asleep within 10 minutes of going to sleep. However, every night I wake up about 3 hours into sleeping and have to get out of bed for one or two hours before sleeping again. I usually sleep 2 to 3 more hours. I am tired during the day. I have tried many adjustments to my CPAP routine but nothing has helped.

I read several studies by Berry Krakow. He suggest that people can experience airflow limitations which wake them even though they do not experience significant drop in their Sp02. In his clinic, he treats people with comorbid insomnia and OSA with more bilevel CPAP or ASV.

My sleep doctor considers my OSA treated, however, I don't sleep well. The sleep doctor stated treating OSA with more advanced CPAP options is not the standard of care. My sleep studies do not appear to try to measure flow limitations when I am on CPAP.

1. What type of assessment can determine what is waking me up?

2. Can I purchase sleep study equipment to do repeated Type 2 sleep studies at home to see if I can identify a pattern of variables that predict me waking up. For example, perhaps, I wake up in a certain stage of sleep.

3. Can anyone recommend a sleep doctor in New York City or Northern New Jersey who would be willing to do an assessment to test the flow limitation hypothesis?

4. Does anyone have other hypotheses about what could be waking me up?

Thank you.
John Lawrence

[LSAT]

Download the free Oscar software so you can monitor your own therapy.
https://www.sleepfiles.com/OSCAR/

[clownbell]

Your sleep doc considers your apnea "treated" because it meats the common definition of AHI being less than 5. Another term is "compliance" meaning use of cpap for >4 hours a night. Your persona comfort is unfortunately not part of the calculus, although I think it should be.

With all due respect to your sleep doc, I believe that many people would strongly disagree with his/her reported statement that "treating OSA with more advanced CPAP options is not the standard of care." More advanced options ARE the standard of care when clinically indicated. From his/her point of view, there is no indication that advanced options are appropriate in your individual case.

Agree with LSAT that getting OSCAR and posting your chart is the best way to obtain better guidance. Experts here are data driven. Without data, experts are largely shooting in the dark. Better input yields better output and advice.

[lynninnj]

As a newbie I say freely that I find posting oscar data here a daunting task.

I find posting sleephq.com a thing I can do in about a minute in the morning that allows me to pull it up later at the office so I can look more closely at it.

Hope that helps.

PS sleephq is sometimes glitchy but I still love it for ease of posting a link vs screenshot and portability.

[ozij]

1. What type of assessment can determine what is waking me up?

Many things could be waking you up of course.
Focsuing, for the moment, on the possibility that it's breathing isssues: There are CPAP (and APAP) machines that report the shape of your beaths breath by breath, and let you see what's happening. What type of machine do you have? Is it capable of showing that data? if it does, then you have flow limitations show on those reports.
If you machine gathers that data,, there is software that lets you view those detailed reports, and share the info.
The software that keeps all data on you own computer is called OSCAR, the "newer kid on the block" which keeps your data on the cloud, and makes sharing it easier is "SleepHQ".

2. Can I purchase sleep study equipment to do repeated Type 2 sleep studies at home to see if I can identify a pattern of variables that predict me waking up. For example, perhaps, I wake up in a certain stage of sleep.

I don't know the answer to that, but suppose you did, and you found out at which sleep stage you woke up - how would that help you?

4. Does anyone have other hypotheses about what could be waking me up?

Mask leaks?
Too much caffeine too late in the day?
Medications?
Some kind of environmental noise?
Pain?
The activity you choose to engage in during that one or two hour break?
Barry Krakow has many suggestion for dealing with insomnia in his book - have you tried them systematically?

have tried many adjustments to my CPAP routine but nothing has helped.

Many of us make adjustments to our CPAP settings - pressure, pressure ranges, humidity, pressure relief based on the nightly breathing data. If your machine does not gather that data, consider buying one that does.
Please read the following, and do what it recommends, in order to make the discussion more effective:
viewtopic/t172378/Sticky--Newbies-PLEAS ... STING.html

[Miss Emerita]

One other thought to throw into the mix: some sleep specialists believe that many people naturally sleep in two phases. You can read more about that here:

https://www.sleepfoundation.org/how-sle ... asic-sleep

The trick would be to get a total amount of sleep that is 7-8 hours. With several hours awake during the night, you'd need to budget more time for the full night.

But as others have said, get Oscar and use Imgur to post links to a chart or two.

[ChicagoGranny]

every night I wake up about 3 hours into sleeping

This is not at all unusual. The problem is being unable to go back to sleep for some hours.

Download the free Oscar software so you can monitor your own therapy.
https://www.sleepfiles.com/OSCAR/

Yes, this would be the first step. I wouldn't consider anything else until a good understanding of OSCAR data is achieved.

Concurrently, you should be studying good sleep hygiene and working on improvements. Don't tell me your sleep hygiene is good. Good sleep hygiene is very rare in the times we live in.

Welcome to the forum! Please stick to this one thread as you make progress.