two strange events last night

[Sharhamm]

I was awakened last night at two separate times. Both were when I was inhaling. The air flow did not cut off when I was finished inhaling. I didn't know what to look for on sleepyhead but did find a flat line (??) on my IE Inspiration chart at the time these events took place. What happened?

Could someone tell me how to post two separate pictures on one post using Imgur?

[ChicagoGranny]

Are you worrying too much? Waking a couple of times during the night as you cycle in and out of sleep stages is common. If you fall back to sleep quickly, you should not be worrying about it.

[Sharhamm2]

It wasn't that I am worrying too much but rather I was unable to exhale as the inhale would not turn off.

[ChicagoGranny]

Here are some instructions on posting the detailed chart - http://www.apneaboard.com/forums/Thread ... 4#pid73584

[Sharhamm]

Here's last nights graphs. Episode #1 happened around 02:06 & 02.07. Episode #2 03.27.30 and 03.28.30.

[ChicagoGranny]

Episode #1 happened around 02:06 & 02.07. Episode #2 03.27.30 and 03.28.30.

Zoom in close on those two times and look at the flow.

I am inclined to think everything works fine when you are sleeping and your autonomous system is easily taking care of breathing. When you awaken you think about breathing and it becomes unnatural and "tricks" the IPAP/EPAP algorithm.

In your estimate, how long did it take you to fall asleep after the two awakenings?

[Sharhamm]

T
This is the flow rate of the last incident At that point I decided to stay up.

[ChicagoGranny]

How is your energy level today? How is it most days?

[Sharhamm]

Energy level is better than before theraphy. Lately, though, I have been feeling more tired but still better than before.

[ChicagoGranny]

I have been feeling more tired

Sharhamm, What about this ->

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Practice total abstinence of caffeine including sources like chocolate
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Optimize emotional stress in your life

?

[robysue]

I was awakened last night at two separate times. Both were when I was inhaling. The air flow did not cut off when I was finished inhaling. I didn't know what to look for on sleepyhead but did find a flat line (??) on my IE Inspiration chart at the time these events took place. What happened?

A flat stretch on the IE chart simply means that all your inspirations during this time frame were the same length. In this case all the inspirations from 3:24:00 to 3:24:30 were about 1.5 seconds long.

T
This is the flow rate of the last incident At that point I decided to stay up.

The flat place in the flow rate between 3:28:20 and 3:28:30 is a pause in breathing that lasts less than 10 seconds. It might be an "apnea/hypopnea wannabe" that just didn't last long enough to be scored. Or it might be a natural pause in breathing as your body was transitioning from sleep breathing to wake breathing. In either case, I don't think there's really much significance in this particular very short pause in breathing.

It wasn't that I am worrying too much but rather I was unable to exhale as the inhale would not turn off.

I'm not sure what you mean by this. You are using a Resmed VPAP in S mode, which means there's a fixed IPAP and fixed EPAP pressure. Do you mean the machine would not cycle from IPAP to EPAP? Or do you mean something else?

[Sharhamm]

Did you see anything in the graphs? I was not awake and thinking about breathing, I was "awakened" with intense blowing and was unable to exhale. It seemed as if the machine thought I was still inhaling. My pressures are 12/16 and these events wakened me.
I do try and practice good sleep hygiene. No caffeine before bed. I could or should exercise more. Meds are only one Aleve in the AM and a blood pressure med. taken in the AM. I'm really trying hard. It's been since Dec. 16 and I have only had one 6hr period where I have sleep continuously and maybe one or two, four hours sessions. These were disturbing events last night. It did happen once before but at that time I was groggy and not very alert. This time I realized exactly what was going on.

[robysue]

Did you see anything in the graphs? I was not awake and thinking about breathing, I was "awakened" with intense blowing and was unable to exhale. It seemed as if the machine thought I was still inhaling. My pressures are 12/16 and these events wakened me.

I don't see anything unusual in these graphs.

It's possible that a glitch in your breathing woke you up. Or it's possible you woke up, then had the glitch in the breathing, and then really woke up. What I mean by that is that waking up is a process and one part of that process is changing the control of the breathing from the autonomous nervous system (night time breathing) to the voluntary nervous system (daytime breathing). And that transition is not always completely smooth. Another part of the process of waking up is coming to a fully conscious, wakeful state. Studies have shown that most people will NOT remember waking up at night if the length of the wake is less than about 5 minutes. In other words, it takes a while for us to get to full consciousness where we're capable of remembering things. If you were in the process of starting to arouse anyway and the breathing glitch happened while you were in the process of waking up, your conscious memory of the events could easily be "the breathing glitch woke me up" simply because you were not aware that your brain was already transitioning to a wake state when the breathing glitch happened.

As for the sensation that you could not exhale fully and that the problem was caused by the machine failing to cycle from IPAP to EPAP: These machines are very, very good at detecting our inhalation/exhalation patterns, but they are not perfect. It is possible that the machine missed the beginning of the exhalation for some reason just as you were starting to wake up anyway. It's possible that you are sensitive enough to the change in IPAP/EPAP pressures that when the machine failed to detect an exhalation, that your body picked up on that fact as "something unusual" and woke up more than it ordinarily would have. Or it's possible that your sensation of the pressure not going down was just a sensation. In order to sort out what might have happened, we'd need to see the following two graphs lined up together:

The flow rate graph at the time of the incident zoomed in to show roughly 3-5 minutes of breathing.
The high resolution Mask Pressure curve that the Resmed machines record zoomed in to show the same 3-5 minutes of breathing.

The Mask Pressure curve (which ONLY the Resmed machines record) shows exactly what is happening to the pressure at the mask end of the hose during each and every breath. You can physically see how the EPR algorithm works on the Resmed CPAP/APAPs and you can physically see how and when the switch between IPAP and EPAP occurs on the Resmed VPAPs.

It's been since Dec. 16 and I have only had one 6hr period where I have sleep continuously and maybe one or two, four hours sessions.

Continuous sleep for 6 hours straight is actually pretty rare---regardless of whether one is on PAP or not. Many people slightly awaken after every REM cycle and they occur about every 90 minutes. But most people don't remember these post-REM wakes because they are short (less than 5 minutes) and cause no disruption of the overall quality of the sleep.

Some people are much more prone to waking up completely after many REM cycles and staying awake long enough to remember the wakes. If the length of the wakes are long enough, the sleep will feel disturbed. The trick here is to try to teach your body to not freak out when you find yourself awake for no real reason, but to quickly get back to sleep. It's easier said than done for many of us. I've been PAPing for 4 1/2 years, and most of the time I wake up every 1-2 hours enough to turn the machine off and back on to reset my pressures back to the min EPAP/IPAP settings. I think the longest I've ever gone without waking up while on PAP is probably about 3 1/2 hours. But when my sleep is actually good (and I'm waking up feeling rested and refreshed), I see many more "turn machine off/turn the machine back on" incidents in my nightly data than I remember wakes. In other words, I may feel that I've pretty much sleep for most of the night, but the data still shows I woke up enough to cycle the machine off and back on after almost every presumed REM cycle. The difference between a good night and a bad night is that I don't remember any of the wakes on a good night and I remember 1/3 to 2/3 of the wakes on a bad night even before looking at the data.

These were disturbing events last night. It did happen once before but at that time I was groggy and not very alert. This time I realized exactly what was going on.

It sounds like you are starting to (inadvertently) train your body to come to full alertness when something like this happens. If you can avoid unnecessary worrying about this kind of event, you may be able to return to sleep fast enough where you no longer remember the wakes and then your sleep will feel much better.

[palerider]

the mask pressure trace would be handy to see in those zoomed in shots.

[Sharhamm]

is this what you need?