Last Night Was First Night

[lynninnj]

I actually really do feel rested today. Sometimes I think I sleep better than I realize.

this is good!

4am anything sucks. im annoyed daily when i get up to use the bathroom around 5:15 and sun is coming in and it wakes me the rest of the day.

dial winging is making a lot of changes in settings that dont allow you to isolate what works. gotta give it a few days unless it’s disastrous.

I don’t care for autoramp. Just gimme five minutes ramp to settle in.

[Iancdub88]

I actually really do feel rested today. Sometimes I think I sleep better than I realize.

this is good!

4am anything sucks. im annoyed daily when i get up to use the bathroom around 5:15 and sun is coming in and it wakes me the rest of the day.

dial winging is making a lot of changes in settings that dont allow you to isolate what works. gotta give it a few days unless it’s disastrous.

I don’t care for autoramp. Just gimme five minutes ramp to settle in.

You're right. I do need to chill on these settings for a bit.

[Iancdub88]

I've been using 8.2 - 12.2 for a few days which feels fairly comfortable but I'm still waking up a lot. Is there any way to see what is causing these arousals? I realize it could be unrelated to the numbers and something else but any insight would be great. I am still so tired during the day and getting frustrated. Thanks!

https://sleephq.com/public/ee356aaa-eb8 ... 6d3d499c34

[Pugsy]

Is there any way to see what is causing these arousals?

Unfortunately.....no. Not unless the arousals are all following obvious for sure asleep apneas and even then it's an educated guess.
Remember the machine can't even tell if you are awake or asleep.
Unless someone remembers or knows what caused a wake up....we don't have any way to know "why".
Even during an in lab sleep study with tech in attendance....it's not always easy to spot the "why we woke up"...they just call them spontaneous arousals which is fancy name for "we don't know what caused the arousal".

[Iancdub88]

Unfortunately.....no. Not unless the arousals are all following obvious for sure asleep apneas and even then it's an educated guess.
Remember the machine can't even tell if you are awake or asleep.
Unless someone remembers or knows what caused a wake up....we don't have any way to know "why".
Even during an in lab sleep study with tech in attendance....it's not always easy to spot the "why we woke up"...they just call them spontaneous arousals which is fancy name for "we don't know what caused the arousal".

Thank you. I'm guessing it's something psychological. Doctors just are not helping so I assume I should wait it out and hope things improve.

[robysue1]

Is there any way to see what is causing these arousals? I realize it could be unrelated to the numbers and something else but any insight would be great. I am still so tired during the day and getting frustrated. Thanks!

https://sleephq.com/public/ee356aaa-eb8 ... 6d3d499c34

Unfortunately Pugsy is right when she says:

Is there any way to see what is causing these arousals?

Unless someone remembers or knows what caused a wake up....we don't have any way to know "why".
Even during an in lab sleep study with tech in attendance....it's not always easy to spot the "why we woke up"...they just call them spontaneous arousals which is fancy name for "we don't know what caused the arousal".

Sometimes the best thing to do about these kinds of spontaneous arousals is literally to try real hard to just not worry about them. Fretting and worrying about them and trying to figure them out can be counterproductive.

It could be that even though you have now been using a CPAP for about a month, your brain has simply not yet figured out that it does not need to arouse itself all night long to monitor the breathing. So the brain is still arousing just enough to say to itself: Yep, we're still breathing; no need to worry this time.

And if that is the case, then the number of spontaneous arousals should (eventually) reduce with time as the brain learns to relax and trust the machine to keep the breathing going at night---provided you don't consciously worry about and fret about all these spontaneous arousals to the point of triggering more of them. Or worse, more long wakes because every time you arouse the brain starts worrying, "Why am I awake NOW? I have to figure that out!!!"

But there's also this: Some people just sleep much more lightly than others---as in they are more likely to have spontaneous arousals for no apparent reason. (Spontaneous arousals may increase with age in some people.) Again, worrying about the spontaneous arousals can make the situation worse since it can lead to the brain starting to worry "Why am I awake NOW?" every time you have a normal arousal during the night.

If you were feeling ok, then it would be easier to ignore the fact that your machine's data indicates that you might be having a significant number of spontaneous arousals. The fact that you are still so tired during the day is most likely why you are frustrated about this potential evidence of spontaneous arousals---i.e. you are looking for a reason to explain the continuing tiredness you are experiencing.

But it may be as simple as that your body needs more time to heal from the damage done by the apnea, damage which includes teaching your brain to sleep excessively lightly in order to arouse every few minutes to monitor the breathing.

Having said all that, I'll end with this observation about the last data you posted: You still have quite a bit of activity in the flow limitation graph, and it seems that those flow limitations do disappear when the pressure is increased. It is possible that 9cm of pressure is not enough to prevent the flow limitations, but 10cm would be. For many people, flow limitations don't make much difference in how they feel---i.e. the visible distortions in the flow rate curve are not disrupting the sleep and sometimes they're not even caused by increasing respiratory effort. In this case the machine's programmed response to increase in pressure may or may not eliminate the flow limitations and the increase in pressure may or may not cause additional problems, such as aerophagia.

But for some people, reducing the activity in the flow limitations does improve how they feel during the day. In this case, the flow limitation can be loosely thought of as "RERA-wannabes"---i.e. there's a disturbance in the respiration caused by the respiratory effort, but it's not enough to necessarily cause a clear arousal---i.e. a RERA.

And so that begs the question: Would you feel better, about the same, or worse, if you bumped the min pressure up from 8.2 cm to something closer to 10 cm? (I would not recommend jumping from Min Pressure = 8.2 to Min Pressure 10 in one step: But that's my history of aerophagia screaming at me.)

[Iancdub88]

And so that begs the question: Would you feel better, about the same, or worse, if you bumped the min pressure up from 8.2 cm to something closer to 10 cm? (I would not recommend jumping from Min Pressure = 8.2 to Min Pressure 10 in one step: But that's my history of aerophagia screaming at me.)

I would feel okay doing this but I agree that it should probably be semi-gradual. What would you recommend as far as how much to increase and how often if I want to do it gradually?

[robysue1]

And so that begs the question: Would you feel better, about the same, or worse, if you bumped the min pressure up from 8.2 cm to something closer to 10 cm? (I would not recommend jumping from Min Pressure = 8.2 to Min Pressure 10 in one step: But that's my history of aerophagia screaming at me.)

I would feel okay doing this but I agree that it should probably be semi-gradual. What would you recommend and far as how much to increase and how often if I want to do it gradually?

Resmed machines allow you to increase pressure settings with 0.2cm increments. If you are patient and if you are particularly worried about aerophagia, use that ability to increase the min pressure by 0.2 cm every night or every other night until you reach a min pressure where there is less activity in the flow limitation graph. If the flow limitation graphs with min pressure = 10 cm look just as bad as these, you can probably conclude that flow limitations are not (the only) problem.

If you don't want to go that slow, increase the min pressure by 0.4cm every night or every other night.

But if you have a clearly difficult night after increasing the pressure, go back to the previous pressure, not all the way back down to a Min Pressure of 8.2.

Quite frankly, however, I suspect the problem is more that your brain is still in hyper-vigilant mode and it just hasn't learned that it doesn't need to arouse every few minutes to check on the breathing. And the more you worry about trying to eliminate the arousals, the more your unconscious brain is going to cling to them and keep on having them simply because your conscious brain believes they're "important".

You might try focusing on the positive: The difference between feeling ok and feeling tired during the day is a continuum. If you are slowly starting to feel better, it can be hard to notice unless you specifically go looking for it. If you try to keep a journal, focus the journal on the positive (Did you feel "OK" at any point in the day? If so, when? And for how long?) rather than the negative (How sleepy/tired were you during the day?)

Also keep in mind that many things can cause spontaneous arousals. Pain is a big one. Nasal allergies that trigger congestion is another. Sleeping with a pet (or a significant other) can cause arousals anytime the pet (or significant other) moves around in bed. Being too hot (or too cold) can cause a restless night with lots of spontaneous arousals. Too much caffeine or too much alcohol can cause spontaneous arousals. Some medications can cause an increase in arousals. Recreational drugs can cause an increase in arousals. Eating too close to bedtime can cause too many arousals. Not eating enough during the day so that your body is hungry at night can cause too many arousals. Clock watching and worrying about how little sleep you are getting during the night is almost certainly going to cause an increase in the number of arousals.

[Iancdub88]

And so that begs the question: Would you feel better, about the same, or worse, if you bumped the min pressure up from 8.2 cm to something closer to 10 cm? (I would not recommend jumping from Min Pressure = 8.2 to Min Pressure 10 in one step: But that's my history of aerophagia screaming at me.)

I would feel okay doing this but I agree that it should probably be semi-gradual. What would you recommend and far as how much to increase and how often if I want to do it gradually?

Resmed machines allow you to increase pressure settings with 0.2cm increments. If you are patient and if you are particularly worried about aerophagia, use that ability to increase the min pressure by 0.2 cm every night or every other night until you reach a min pressure where there is less activity in the flow limitation graph. If the flow limitation graphs with min pressure = 10 cm look just as bad as these, you can probably conclude that flow limitations are not (the only) problem.

If you don't want to go that slow, increase the min pressure by 0.4cm every night or every other night.

But if you have a clearly difficult night after increasing the pressure, go back to the previous pressure, not all the way back down to a Min Pressure of 8.2.

Quite frankly, however, I suspect the problem is more that your brain is still in hyper-vigilant mode and it just hasn't learned that it doesn't need to arouse every few minutes to check on the breathing. And the more you worry about trying to eliminate the arousals, the more your unconscious brain is going to cling to them and keep on having them simply because your conscious brain believes they're "important".

You might try focusing on the positive: The difference between feeling ok and feeling tired during the day is a continuum. If you are slowly starting to feel better, it can be hard to notice unless you specifically go looking for it. If you try to keep a journal, focus the journal on the positive (Did you feel "OK" at any point in the day? If so, when? And for how long?) rather than the negative (How sleepy/tired were you during the day?)

Also keep in mind that many things can cause spontaneous arousals. Pain is a big one. Nasal allergies that trigger congestion is another. Sleeping with a pet (or a significant other) can cause arousals anytime the pet (or significant other) moves around in bed. Being too hot (or too cold) can cause a restless night with lots of spontaneous arousals. Too much caffeine or too much alcohol can cause spontaneous arousals. Some medications can cause an increase in arousals. Recreational drugs can cause an increase in arousals. Eating too close to bedtime can cause too many arousals. Not eating enough during the day so that your body is hungry at night can cause too many arousals. Clock watching and worrying about how little sleep you are getting during the night is almost certainly going to cause an increase in the number of arousals.

Thank you for this. I suspect that it is mostly my brain and specifically the fact I do get so worried about it. I will start upping the pressure by 0.4 for the next few nights or every other night and see if that helps. I still have yet to take the stronger sleeping pill my doctor prescribed but perhaps that will be soon too.

[robysue1]

Thank you for this. I suspect that it is mostly my brain and specifically the fact I do get so worried about it.

Worrying about the quality of your sleep is a good way to destroy it.

You might want to try to find a copy of Sound Sleep, Sound Mind by Dr. Barry Krakow. The first half of the book is about common old insomnia and what people do to make their sleep worse. The second half is about sleep apnea and how it can create insomnia if left untreated. But be aware: Dr. Krakow's opinions on ASV, flow limitations, and pressure needed to smooth out the flow rate curve are controversial and some of his ideas may be biased specifically because he practices in a city at relatively high altitude compared to where most of us live.

Still, in the first half of the book, there are a whole lot of good tips for dealing with improving one's sleep when the "bad sleep" is known to not be caused by untreated sleep apnea problems.

[Iancdub88]

Thank you for this. I suspect that it is mostly my brain and specifically the fact I do get so worried about it.

Worrying about the quality of your sleep is a good way to destroy it.

You might want to try to find a copy of Sound Sleep, Sound Mind by Dr. Barry Krakow. The first half of the book is about common old insomnia and what people do to make their sleep worse. The second half is about sleep apnea and how it can create insomnia if left untreated. But be aware: Dr. Krakow's opinions on ASV, flow limitations, and pressure needed to smooth out the flow rate curve are controversial and some of his ideas may be biased specifically because he practices in a city at relatively high altitude compared to where most of us live.

Still, in the first half of the book, there are a whole lot of good tips for dealing with improving one's sleep when the "bad sleep" is known to not be caused by untreated sleep apnea problems.

Well, I live in Colorado Springs, Colorado so that might actually be valuable for me. Thanks for the recommendation!

[Iancdub88]

Flow limits seemed to calm a tiny bit upping by 0.4. I'm going to continue to up the min for a few days to get to 10. I did sleep fairly well but I took a clonazepam. My doctor was very clear that I shouldn't take them every night because they're a controlled substance. But, it does feel good to feel semi-rested. As always, any insight is helpful. You guys are awesome.

https://sleephq.com/public/b05a7c93-8ed ... 95317c0e07

[robysue1]

Flow limits seemed to calm a tiny bit upping by 0.4. I'm going to continue to up the min for a few days to get to 10. I did sleep fairly well but I took a clonazepam. My doctor was very clear that I shouldn't take them every night because they're a controlled substance. But, it does feel good to feel semi-rested. As always, any insight is helpful. You guys are awesome.

I'll offer this bit of advice on how to take the clonazepam: After you've had a sem-decent (for you) night where you took the clonazepam, try sleeping the next night without the clonazepam. If you have another semi-decent (for you) night, continue skipping the clonazepam until you have a bad night where you didn't take the clonazepam. Take the clonazepam the next night.

This should prevent you from dealing with strings of really bad nights in a row, but at the same time means taking the clonazepam at most every other night. The point is to help your body learn how to actually sleep well with the CPAP mask on while not becoming (too) dependent on the sleeping medication to get to sleep and remain asleep.

As for the data: I think it does look better*. Whether that is the result of the clonazepam or the 0.4cm increase in min pressure is difficult to parse. If you opt to not take the clonazepam tonight, I'd keep the min pressure at 8.6cm for a night or two.

By better I mean this: The number of arousals between 12:30 and 5:30 appears to be somewhat lower. It still looks like you had a rough start at the night fighting a leak problem, but the leaks were small pesky ones rather than ones large enough to affect your therapy. And it looks like you didn't really get much real sleep after 5:30. Rather, it looks like you were lying in bed dozing. If you were relaxed and enjoying being in bed after 5:30, that's not a problem. If you were tossing and turning and trying desperately to get back to "real" sleep and worrying about the fact that you were not sleeping very while dreading the fact that you would soon have to get up for the day, then it's a problem.

[Iancdub88]

I'll offer this bit of advice on how to take the clonazepam: After you've had a sem-decent (for you) night where you took the clonazepam, try sleeping the next night without the clonazepam. If you have another semi-decent (for you) night, continue skipping the clonazepam until you have a bad night where you didn't take the clonazepam. Take the clonazepam the next night.

I was planning on taking it tonight just because my doctor wants me to take an oxygen test and falling asleep with something on my hand and face seems hard. However, I could probably wait to do that tomorrow.

Rather, it looks like you were lying in bed dozing. If you were relaxed and enjoying being in bed after 5:30, that's not a problem. If you were tossing and turning and trying desperately to get back to "real" sleep and worrying about the fact that you were not sleeping very while dreading the fact that you would soon have to get up for the day, then it's a problem.

I was just laying there and relaxing so it wasn't a problem.

[Iancdub88]

Last night I slept pretty well without any pills. I do have a few OAs which hasn't been normal lately. Not sure I should be concerned. I also can't seem to sleep past 5am for whatever reason.

https://sleephq.com/public/22fe19da-9c2 ... 988c5a0bf5