I'm not getting enough sleep now.

[Noctuary]

Third day. Yesterday I slept only 4 hours. Today, five. I have no idea why this is suddenly happening.

The last time you used your ResMed AutoSet...
was last night (on Wednesday, May 06, 2015)
You had an AHI of 3.17, which is considered technically "treated"
You machine was on for 6 hours, 56 minutes and 2 seconds.
You had a small but acceptable amount of major mask leakage.
Your pressure was under 13.84cmH2O for 95% of the time.

I didn't sleep 6 hours, 56 minutes; I kept the mask on when I awoke hoping to fall back asleep.

[papa-bear]

It's doing that because you're still using Windows XP. Upgrading should net you 1 hour per version number. Sry, couldn't resist.

For what it's worth, this newbie can't get past at most 6.5 hours nowadays and more recently sleep a total of two 2.5 hour blocks nightly separated by intermission between 1 and 3 am... It's like exercising, your body needs to rest from all the sleep...

[Noctuary]

It's doing that because you're still using Windows XP. Upgrading should net you 1 hour per version number. Sry, couldn't resist.

For what it's worth, this newbie can't get past at most 6.5 hours nowadays and more recently sleep a total of two 2.5 hour blocks nightly separated by intermission between 1 and 3 am... It's like exercising, your body needs to rest from all the sleep...

I bought a $100 craptop just for sleepyhead; I don't use it for anything else.

[JDS74]

CPAP machines for home use cannot tell if you are awake or asleep when you are masked up and the machine is running.
I don't know if the specialized ones used in sleep labs can tell or if that is a post study decision based on the ECG data they also collect.

[Krelvin]

Third day. Yesterday I slept only 4 hours. Today, five.
...
I didn't sleep 6 hours, 56 minutes; I kept the mask on when I awoke hoping to fall back asleep.

If I wake up and can't get back to sleep quickly, I get up, go to the bathroom, and the restart my sleep pattern, put the mask back on etc.

I don't lie there for long periods of time with my mask on when I am not sleeping. You machine will start recording events which are not real since are not sleeping. It doesn't know you are not sleeping.

[robysue]

Third day. Yesterday I slept only 4 hours. Today, five. I have no idea why this is suddenly happening.

The last time you used your ResMed AutoSet...
was last night (on Wednesday, May 06, 2015)
You had an AHI of 3.17, which is considered technically "treated"
You machine was on for 6 hours, 56 minutes and 2 seconds.
You had a small but acceptable amount of major mask leakage.
Your pressure was under 13.84cmH2O for 95% of the time.

I didn't sleep 6 hours, 56 minutes; I kept the mask on when I awoke hoping to fall back asleep.

The data you posted only shows (roughly) the first six hours of time when the machine was running. Let's look at a marked up version of your data:



The first blue box that I've put in at the extreme left strongly implies that you fell asleep pretty quickly after turning the machine on. It looks to me like you probably were asleep by 23:30; I'm basing that on the sudden decrease in the size of the inhalations. My guess is that if you zoomed in on the part of the Flow Rate graph at that point, you would see a marked difference in both the size and the shape of the inhalations.

The first red box that I've drawn in might very well be a short wakeful period, but you were definitely able to get back to sleep after that suspected wake. In other words, I doubt that the centrals scored at this point are real CAs. My guess is that they are post arousal CAs (as you are trying to get back to sleep) or just sleep-wake-junk (SWJ) breathing.

There is another potential arousal around 3:30 that I haven't put in a box. But during the time I have surrounded with the green box, something is going on: The pressure graph is increasing but no events are being scored. That indicates there's probably activity in the snore graph or the flow limitation graph, both of which are missing in this shot. But the breathing itself is less regular than it was---there is now a lot more "spiky-ness" in the Flow Rate curve. I wonder if this represents you starting to wake up/arouse because the pressure increase is beginning to bug you. In other words, I wonder if you are already sleeping very lightly and/or going back and forth between WAKE and SLEEP at this point. Now, if the increase in spiky-ness is due to flow limitations being scored AND you are also actually in half-awake/half-asleep "drowsiness", then the question really becomes: Did the pressure increase cause you to become more awake? Because if it did, then finding a way to limit pressure increases in response to SWJ-caused flow limitations might help you stay asleep in the long run.

The events in the Red Box that I've drawn starting at around 4:30 look to me to be SWJ events. I'm basing this partly on the fact that there's a lot of spiky-ness in the flow rate curve AND also on the fact that you report keeping the mask on after you woke up in an effort to get back to sleep. There's an official Large Leak scored right around 4:30, along with an "unknown apnea". I wonder if the Large Leak is what pushed you from light dozing (and a mixture of Stage 1/2 sleep and Wake) to being fully aware that you were awake and after the large leak was fixed (either by you or the machine), you were now trapped in being in Wake mixed with a little bit of Stage 1/2 sleep mixed in.

Now the relevant questions for you to be asking yourself:

1) Why were you SUCCESSFUL at getting back to sleep after the first arousal/awakeing/bit of SWJ that occurred around 0:30 (about an hour into the night)?

2) What drove the pressure increase that takes place between 4:00Am and 4:30AM? Snoring or flow limitations?

3) Once you realized that you were awake around 4:00 or 4:30, what could/should you have done that would have maximized the chances of your getting back to sleep in a timely fashion?

Finally one more possibly relevant issue to explore: The summary data on the left side bar indicates that your median respiratory rate is 23 breaths per minute. This means that for 50% of the night, your RR was AT or ABOVE 23 breaths per minute, which is on the high side. Normal respiratory rates for adults at rest are typically 12-16 breaths per minute (See http://www.hopkinsmedicine.org/healthli ... 85,P00866/), but many Americans actually have a resting (or sleeping) respiratory that's a bit faster; most American respiratory rates are in the 15-20 breaths per minute range. (See http://my.clevelandclinic.org/health/he ... ital_Signs). According to the Cleveland Clinic site, a resting RR of more than 25 can be a concern. Now if we were talking about your 95% RR, I'd write that off to normal variation both during sleep and because restlessness can increase the RR for short periods of time.

But your RR is over 23 for 50% of the night. And that means that you are doing some over breathing, which may mean that you are blowing off just a bit too much CO2 to comfortably transition from WAKE breathing to SLEEP breathing. (See Morbius's A Sleep Hack? thread.) In other words, it would be useful to see if you are breathing a bit too fast when you wake up and have a hard time getting back to sleep.

[robysue]

There is another potential arousal around 3:30 that I haven't put in a box. But during the time I have surrounded with the green box, something is going on: The pressure graph is increasing but no events are being scored. That indicates there's probably activity in the snore graph or the flow limitation graph, both of which are missing in this shot. But the breathing itself is less regular than it was---there is now a lot more "spiky-ness" in the Flow Rate curve. I wonder if this represents you starting to wake up/arouse because the pressure increase is beginning to bug you. In other words, I wonder if you are already sleeping very lightly and/or going back and forth between WAKE and SLEEP at this point. Now, if the increase in spiky-ness is due to flow limitations being scored AND you are also actually in half-awake/half-asleep "drowsiness", then the question really becomes: Did the pressure increase cause you to become more awake? Because if it did, then finding a way to limit pressure increases in response to SWJ-caused flow limitations might help you stay asleep in the long run.

Or it's also possible that the time in that Green box represents an extended REM cycle. The timing is right for REM, the length of REM cycles grows during the night, and respiration is more unstable in REM. But with your report of waking up and not being able to get back to sleep, I still think the stuff in the Red box is likely you waking up. So then the question is: Was the wake up just a normal post-REM wake and then you could not get back to sleep? If so, why were you unable to get back to sleep after a perfectly normal post-REM wake? And that goes back to the question I wrote in the other thread: Do your negative feelings about finding yourself awake in the middle of the night prolong the wake and add to your misery?

In other words, why were you able to get back to sleep after whatever happened at 0:30, but you were not able to get back to sleep after whatever woke you up sometime around 4:30?

[Noctuary]

Third day. Yesterday I slept only 4 hours. Today, five.
...
I didn't sleep 6 hours, 56 minutes; I kept the mask on when I awoke hoping to fall back asleep.

If I wake up and can't get back to sleep quickly, I get up, go to the bathroom, and the restart my sleep pattern, put the mask back on etc.

I don't lie there for long periods of time with my mask on when I am not sleeping. You machine will start recording events which are not real since are not sleeping. It doesn't know you are not sleeping.

I'll remember that.

[Noctuary]

What would happen if I narrowed the range to 8-15? Or less? Everytime I've gone above 8 I seem to wake up; or at least that's what I remember.

[robysue]

What would happen if I narrowed the range to 8-15? Or less? Everytime I've gone above 8 I seem to wake up; or at least that's what I remember.

Noctuary,

During the last data you posted, the pressure was above 10 for almost the entire night---both when you were clearly sleeping and when you were clearly awake. But I know that you tried increasing the min pressure to 10 with what you described as "disastrous results" in terms of not being able to sleep very well. If you wake up feeling really uncomfortable when the pressure is above 10, it may be worth exploring whether capping the max pressure provides you with some relief, particularly since your biggest pressure increases seem to be driven by flow limitations and/or snoring.

But since you are only topping out at 15cm every now and then, reducing the top pressure down to 15 ain't going to change much: Running in 8-15 is going to make the machine continue to respond in much the same way it's now responding while set at 8-20.

You send most of the night in the 10-13cm range. Since you tried increasing the min pressure to 10cm without any luck, it's worth seeing if decreasing the max pressure to 13 cm helps at all. In other words, it's worth a trial night or two running at 8-13cm for the pressure range. It's possible that limiting the max pressure will allow you to sleep a bit more comfortably without allowing too many real events through. On the other hand if you really do need more pressure than 13cm to keep the obstructive apneas and hypopneas under control while you are sleeping, the increase in real events should be noticeable in your data. In that case, you can make a decision about what to do next after it becomes clear that limiting the upper pressure setting is not working because too many events are getting through.

And also: Since you are using a Resmed machine, there's no way to just restart the ramp in the middle of the night. When you wake up in discomfort because there is too MUCH air/pressure, just turn the machine OFF and back ON. That will lower the pressure back down to your ramp up pressure. Your ramp period is quite short and if it allows you to fall back asleep after an uncomfortable wake, that's a good thing.

[Noctuary]

You send most of the night in the 10-13cm range. Since you tried increasing the min pressure to 10cm without any luck, it's worth seeing if decreasing the max pressure to 13 cm helps at all. In other words, it's worth a trial night or two running at 8-13cm for the pressure range. It's possible that limiting the max pressure will allow you to sleep a bit more comfortably without allowing too many real events through. On the other hand if you really do need more pressure than 13cm to keep the obstructive apneas and hypopneas under control while you are sleeping, the increase in real events should be noticeable in your data. In that case, you can make a decision about what to do next after it becomes clear that limiting the upper pressure setting is not working because too many events are getting through.

I will try it for two nights. One more thing; I've been dieting and losing weight fast. Would that cause me to wake up earlier? And, how does weight loss effect CPAP therapy? I'm losing weight to hopefully help with my symptoms; I've read it can do that. I only had 835 calories yesterday.

[avi123]

I take 5 mg of Zolpidem (generic Ambien, not the extended release), and fall asleep within 15 min. If I don't fall asleep within 30 minutes I take another 5 mg. Rarely, it happens that I need to take 5 mg more but I don't take this dose if I have less than 6 hours left to sleep. I usually sleep for about 6 1/2 hours.

In your case if you can't fall back a sleep why not stop the APAP, remove the mask, and use a chinstrap to help you sleep the rest of the night? Try it out. The chinstrap should stop your tongue falling into your throat and wake you up. Who says that you must use the APAP every night?

[robysue]

One more thing; I've been dieting and losing weight fast. Would that cause me to wake up earlier?
...
I only had 835 calories yesterday.

If you are on a super low calorie diet (and 835 calories for the whole day qualifies as super low calorie in my opinion), then you are likely pretty hungry (even if you don't feel hungry) when you go to bed. And, yes, hunger can wake you up. And if you don't eat something because you are hungry, hunger can keep you up.

And, how does weight loss effect CPAP therapy? I'm losing weight to hopefully help with my symptoms; I've read it can do that.

Like so many things with OSA and CPAP, people's experiences with weight loss vary.

If excess weight is the ONLY cause of the OSA, then losing the weight and keeping the weight off forever can help tremendously. If the weight-caused apnea is very mild (i.e. a diagnostic AHI between 5 and 10), losing the weight and keeping the weight off forever can even be a cure.

But the correlation between weight and OSA is not simple and one-directional. There is a lot of evidence that for many people, the OSA comes first and the OSA leads to metabolic changes which lead to weight gain which worsens the OSA which leads to more weight gain which worsens the OSA which .... In other words, skinny people can get OSA and sometimes skinny people with OSA turn into fat people with OSA. And for this group of patients, losing the weight is very UNLIKELY to bring the untreated AHI down to the normal range.

And it's important to keep in mind that for most people with diagnostic AHIs that are above 15 are seldom lucky enough to have their OSA caused only by weight gain. And yours was 19 back in 2002 and is 28 now and you've only put on 5-10 pounds since 2002 (or so you say in this post). So my guess is that while the extra weight might be aggravating the OSA some, the extra weight is probably NOT the real cause of your OSA. Still losing the weight will likely make you feel better in the daytime and feeling better in the daytime will make it easier to get higher quality sleep at night.

As far as how weight loss affects CPAP therapy: For many people, losing some weight may allow the person to use a bit lower pressure to treat the AHI. For some people there's no discernible change in the pressure needed to keep the airway open. And for a few people, the pressure needs actually go up with weight loss.

When a PAPer loses a lot of weight, many sleep docs do recommend a retitration study to see whether the pressure needs have changed. Of course, if you have an APAP, it's easy enough to just do a week or two home titration study by opening up the pressure range by both lowering the minimum pressure and raising the maximum pressure and seeing where the machine wants to go and what kinds of events are causing the machine to increase the pressure.

But the only way to really sort out what will happen to you is to lose the weight, keep it off for at least 6 months, and then consider doing additional sleep tests. If the hope is that your OSA is somehow directly caused by your weight and has NO other causes, the only way to verify that is to have a sleep study done after you've keep the weight off for 6 months. If the new study is done without a mask and it shows the AHI is back to normal, then as long as you keep the weight off, you're probably good to sleep without a CPAP. The doc ordering the study may also ask you to sleep without a mask for a couple of days before the study is done since there is some evidence that it takes a few nights of PAP-less sleep for the OSA to return to its full, untreated state. But totally curing OSA via weight loss is a very unusual thing and you can't just "assume" that once you've lost x pounds the apnea has disappeared; you really need to get the follow up sleep study done to verify that the apnea has disappeared.

[robysue]

In your case if you can't fall back a sleep why not stop the APAP, remove the mask, and use a chinstrap to help you sleep the rest of the night? Try it out. The chinstrap should stop your tongue falling into your throat and wake you up.

Avi,

There is no way that an external strap of cloth designed to keep your mouth closed is going to do anything to prevent your tongue from falling back into the upper airway. Chin straps are designed to prevent mouth leaks; they are not "stand alone" devices for treating OSA.

[Noctuary]

If excess weight is the ONLY cause of the OSA, then losing the weight and keeping the weight off forever can help tremendously. If the weight-caused apnea is very mild (i.e. a diagnostic AHI between 5 and 10), losing the weight and keeping the weight off forever can even be a cure.

My AHI was diagnosed at 10. Although I rarely weighed myself, through 2013 I drank a lot of beer for several months, as well as eating a lot of fast food. My usual WOE was very low carb. In 2008 I was 145 at my lowest. I should be somewhere in the 160s, I think. Right now I'm at 175 at 5'6. When I was at my docs several weeks ago I was 188.

And it's important to keep in mind that for most people with diagnostic AHIs that are above 15 are seldom lucky enough to have their OSA caused only by weight gain. And yours was 19 back in 2002 and is 28 now and you've only put on 5-10 pounds since 2002 (or so you say in this post). So my guess is that while the extra weight might be aggravating the OSA some, the extra weight is probably NOT the real cause of your OSA. Still losing the weight will likely make you feel better in the daytime and feeling better in the daytime will make it easier to get higher quality sleep at night

Not me. I was diagnosed in 2014.

I also take Temazepam. Could that be a problem?