OT?: Fragmented Sleep

[teknomom]

I've been on my machine - 100% compliant - for over 6 weeks. I have no problems with the mask or machine. My problem is that my sleep is still fragmented because I waken every time I shift positions in bed (probably 10-20 times per night). I've always done this and just considered myself a light sleeper. Has anyone been able to overcome this? My sleep hygiene is good and I don't have trouble getting to sleep or waking for any length of time. I simply wake, roll over and go back to sleep, but it means I go through a short period of transitional central apnea, which the machine treats, each time. It's not the mattress or pain or anything else that I can pin down. Can "light sleepers" learn to stay asleep? Anyone with ideas?

[jamiswolf]

Hi Technomom,
What's causing you to turn over so much? I have a similar problem only perhaps 3 or 4 times during the night. For me it's usually discomfort. Right shoulder pain from an old injury/surgery and osteoarthritis in my left hip. I suspect a high buck mattress would help a lot...but I'm waiting till I move (back to sea level) this summer. Occasionally I'll have a night where I sleep through the night, but I haven't been able to determine anything different about those nights. I should start a sleep diary but I've never been one to keep a journal.

I know the fragmented sleep isn't ideal but I had a worse problem before cpap. I'm hoping, with time, my sleep will become more steady. I hope the same happens with you...
Jamis

PS: One last thought. Are you sure it isn't related to the pressure bursts from your ASV when it's correcting for centrals? Meaning perhaps it's not the centrals being caused by the arousal but the other way around.

[teknomom]

Thanks, Jamiswolf. I have no chronic pain or health issues and I don't think it's the pressure pulses because I have lots of those during the hour when I'm reading at bedtime and I never notice them. Besides I have been this way all my life even before the machine. I've watched those time lapse videos of people turning in bed at night (as frequently as I do) and they seem to stay asleep when they do it. I just wonder if I could somehow learn to stay asleep, too.

[jamiswolf]

Technomom,
Well, you know how people talk about changing their tongue position during sleep? Point being...anything's possible. I had a hassle turning over until I started suspending my hose from the wall so I can turn with essentially no concern about the hose. It just follows wherever I go. I arouse enough to roll over and re-position my pillow...but fall asleep shortly thereafter.

Do you have a good hose suspension system? Helps a lot. One other question or consideration. I'm single now but when I was married, my wife and I usually turned over in synchrony. Is there any of that going on with you and your husband? Might be you've adapted to his habits or vice versa...just a thought.
Jamis

[Starlette]

Good evening Teknomom.

I don't any answers, just a suggestion as Jamiswolf stated. Starting a sleep journal. Then you'll have in writing what's working/not working. It's MUCH easier to see what's working/not working when you have something in black and white to review. I can testify to that.
If you'd like, I'd be more than happy to email you a clean copy of mine as a starter. Then you can tweak away. When we have our February meeting, bring a copy with you for us go over it as a group.

My humble 2 cents.

Starlette

[Carmen]

I have the same problem and am really angry because my doctors keep blowing it off like it's not important. Meanwhile, I wake up all night and I'm exhausted. Tweaking my machine settings does nothing. I'm more than half convinced that it's a hormonal issue because I have hot flashes all night long--not every time I wake up, but a lot. I plan to throw a fit and insist on HRT therapy at my next appointment in a couple of weeks.

[portiemom]

I have the same problem, on the machine almost 7 years. I've never been a good sleeper, I'm past the hot flash stage, I think I was born with OSA, of course back then they never checked for it. The one thing I do know is that in the hospital after a few operations, Oxygen makes me sleep like a baby, but unless your stats state you need it I hear it's impossible to get! Who new 02 was so hard to get!

[teknomom]

Do you have a good hose suspension system?

I'm satisfied with the way I manage my hose. It runs from the bottom of the bed, under a top flannel sheet and over my blanket which keeps it stable and I don't have to worry about it. Oh, and we sleep in twin beds and I'm never aware of my husbands multiple times of getting up at night. I'll keep thinking about these issues, though. Even when I'm not aware of it, something could be awakening me.

Starting a sleep journal. Then you'll have in writing what's working/not working.

Thanks! I have a blank form. I'm just not sure what to try. I sleep in a dark, cool, quiet room with no distractions. I don't drink caffeine after morning, nap during the day or eat heavily before bedtime.
I don't worry or think about daytime events at night. I'll try to get some suggestions here and work on a sleep journal. See you later this month!

Oxygen makes me sleep like a baby,

I slept like a baby - never remembered waking up - the first night I was on oxygen. (That was between my diagnosis and getting my machine.) After that first night it was back to normal. I'm not on it now. Maybe I need to check my O2 levels at night and see if I'm still desaturating. I should try wearing the ZEO again also and see if it shows anything. I've been avoiding adding these elements at night because they're distractions.

I have hot flashes all night long

Thank heaven my doctor has let me stay on HRT because that used to be a major factor in my sleep fragmentation - not now though.

[robysue]

teknomom,

How long does it take you to fall back asleep after each bed position shift wake up happens?

If you consistently get back to sleep immediately after each of these wakes, it may be that what you need to learn to do is to ignore the wakes and not let them bother you---i.e. if you are waking up for a minute or so to turn over at the end of each REM cycle or each Stage 3 sleep cycle, those wakes may be less of a problem than you think they are. And training your mind and body to just ignore them may be the thing to do.

But if it takes you 5 minutes or more to get back to sleep each time you turn over in bed, then yes, that's enough to cause some real problems with fragmented sleep that leads to the day time sleepies that we all dread so much.

Like others, I think you might benefit from keeping a sleep log. There are some things I think you should keep in mind about the log so that keeping the log doesn't add to the problem of all these wakes for turning over in bed.

1) You do NOT need to track the time of each wake up. You don't even need to track the number of wakes all that accurately. So don't make notes in the middle of the night. Just estimate the number of wake ups when you get up in the morning. Or if it's easy to do and not distracting to you, you can turn your machine off and back on when you wake up significantly enough to feel like you really want that wake up to "count". That way, when you look at the machine's data, it's clear when the wake occurred, but you're not clock watching or turning the light on for note taking.

2) Do NOT look at the clock when you wake up in the middle of the night as your first response to being awake.

3) Remember to estimate the time it takes you to get back to sleep rather than trying to clock watch. It's important to get an estimate for the total sleep time for the night; it's not important that this estimate be 100% accurate.

4) If you do go back to using the Zeo, keep in mind that it's only about 75-80% accurate and that it can have a tough time distinguishing WAKE from LIGHT sleep and distinguishing WAKE from REM sleep. Also keep in mind that the bar graph that's shown on the web site tends to make it look like you were awake a lot more than the Zeo data actually indicates because if there is any WAKE at all in a five minute window, the whole five minutes is labeled as WAKE. Since the EEG readings are taken in 30-second epochs, this means that one 30 second period of WAKE triggers a whole 5 minute bar to be labeled as WAKE. And so a badly timed 1 minute WAKE can show up as 10 minutes of WAKE in that bar graph. If you import the Zeo data into SleepyHead, you'll get a much more detailed sleep state graph than the one shown on the web site.

5) If you do go back to using the Zeo, try to make an estimate of the number of wakes and your total sleep time that is independent of the Zeo data and then compare to the Zeo data. If your estimate and the Zeo's estimate of your total sleep time are pretty close to each other, then you can pretty much guess that the estimate is probably pretty accurate. But if you and the Zeo disagree by a lot on how long you were asleep, then you need to do some reflective thinking about whether you or the Zeo is off.

Finally, another idea to give you some things to think about: I remember reading a peer-reviewed article about an insomnia study that showed many insomniacs think they are awake when the EEG shows that they are actually asleep---as in Stage 2 sleep. It could be that while you think you are awake every time you turn over in bed, you are actually in Stage 2 sleep and you just think that you're awake for some of those position shifts. So if the Zeo shows a lot more total sleep than you think you're getting, it could be that the Zeo's estimate is better than yours.

[teknomom]

Thanks Robysue for the detailed reply.

If you consistently get back to sleep immediately after each of these wakes, it may be that what you need to learn to do is to ignore the wakes and not let them bother you

I don't let them bother me in the sense that I look at the clock or worry (I don't have a clock at my bedside). They bother me in the sense that fragmented sleep is a health issue that can cause serious problems. If I treat the apnea but still have other sleep issues, I don't think I'm receiving the full benefit to my long-term health. After 6 weeks on the machine, I feel that it is doing it's job in treating my apnea. Now I want to look into other sleep issues not related to xPAP. I could also have some degree of PLMD which showed up on my 2nd sleep study but not the 1st. My doctor is ignoring it right now. (My husband hasn't noted any PLMD movements.)

1) You do NOT need to track the time of each wake up.

I think I will keep track of the time for just a night or two because I want to see if they are related to drops in my patient triggered breathing. If they are related, then that is a separate issue. I fall to sleep in a short time and as I said before do not look at the clock. After that it doesn't matter when they happen - in fact they're pretty evenly spaced through the night as far as I can tell.

many insomniacs think they are awake when the EEG shows that they are actually asleep

My sleep study EEG showed that, after every arousal, I did cycle between waking and stage 1 sleep. My pattern is to wake, then cycle like this with central apneas.

I don't plan to use the ZEO at this time. It is more of a distraction and not accurate enough to pinpoint these awakenings.

I am starting to use a sleep journal - making my own since the factors I want to keep track of are not the usual ones (caffeine, alcohol, naps, etc.).

Actually, this might be the wrong place to ask these questions since it's not really related to CPAP or Sleep Apnea. I should probably mark it OT.

[robysue]

1) You do NOT need to track the time of each wake up.

I think I will keep track of the time for just a night or two because I want to see if they are related to drops in my patient triggered breathing. If they are related, then that is a separate issue. I fall to sleep in a short time and as I said before do not look at the clock. After that it doesn't matter when they happen - in fact they're pretty evenly spaced through the night as far as I can tell.

How hard is it for you to just turn the machine OFF and then back ON when you wake up in the middle of the night? That puts the "WAKE UP" data right smack in the middle of the patient triggered breathing data you're looking at anyway since the break in the pressure curve should show up in Encore Viewer. If you use SH for tracing your data, then I know the WAKE UPs show up in the data very, very clearly. (That's how I track my own wake ups.) But I'm not 100% sure if SH works with your PR System One REMstar BiPAP Auto SV Advanced.

I am starting to use a sleep journal - making my own since the factors I want to keep track of are not the usual ones (caffeine, alcohol, naps, etc.).

The best sleep journals are indeed the ones that track the factors that the person keeping them wants to track. Sometimes those things are the obvious ones and sometimes they're not. One of the sillier sounding things that I have to track in my own sleep journal is chapped lips of all things. So track whatever you think could be a factor.

Actually, this might be the wrong place to ask these questions since it's not really related to CPAP or Sleep Apnea. I should probably mark it OT.

No one's ever complained about any of my insomnia posts. I think this thread IS on topic because there are lots of us who struggle with the bigger picture: The PAP machine does its job and we're still not feeling 100%. And it never hurts to be reminded that there's more to fixing some of our sleep problems than getting the sleep apnea under control. I also think it is very important for newbies reading the forum to understand that genuinely feeling better may require more work than simply getting the OSA under control---particularly when they have a more complex medical history that may include multiple sleep issues.

[teknomom]

How hard is it for you to just turn the machine OFF and then back ON when you wake up in the middle of the night? That puts the "WAKE UP" data right smack in the middle of the patient triggered breathing data you're looking at anyway since the break in the pressure curve should show up in Encore Viewer. If you use SH for tracing your data, then I know the WAKE UPs show up in the data very, very clearly. (That's how I track my own wake ups.) But I'm not 100% sure if SH works with your PR System One REMstar BiPAP Auto SV Advanced.

My machine is at the foot of the bed - not in reach. I have a couple of apps on my phone that I could use to mark the times without much effort. If I have problems with them I could move the machine to the side of the bed for a couple of nights. Thanks for the tip. I do use Sleepyhead so that would be handy.

The best sleep journals are indeed the ones that track the factors that the person keeping them wants to track.

I've come up with several factors that might influence my sleep and am asking my husband and others to help with ideas. Do you suppose I could get him to stay awake all night to watch for PLMD? I'll keep the "chapped lips" idea in mind and expand it to other seemingly silly areas.

No one's ever complained about any of my insomnia posts.

I used a lot of information from those posts when I was waking at 3 am every night - before I got my machine. At least I sleep a solid 8 hours or so with the machine.

[Kairosgrammy]

Could you possibly have restless leg syndrome?

I've been on my machine - 100% compliant - for over 6 weeks. I have no problems with the mask or machine. My problem is that my sleep is still fragmented because I waken every time I shift positions in bed (probably 10-20 times per night). I've always done this and just considered myself a light sleeper. Has anyone been able to overcome this? My sleep hygiene is good and I don't have trouble getting to sleep or waking for any length of time. I simply wake, roll over and go back to sleep, but it means I go through a short period of transitional central apnea, which the machine treats, each time. It's not the mattress or pain or anything else that I can pin down. Can "light sleepers" learn to stay asleep? Anyone with ideas?

[teknomom]

Could you possibly have restless leg syndrome?

I had a mild episode of RLS many years ago so I know what it feels like - and I sympathize with those who have it - but I don't have the symptoms now. I was told I had 27.4 PLMs per hour on my 2nd sleep study. I had none on my first one, so who knows what that means! I should do some reading on other sleep disorders, I guess. Thanks for reminding me to check other things!