Need help with CPAP Stats

One observation and then a question.

Now that I'm using the collar and I've adjusted my humidity level to 4 I am no longer experiencing the dry mouth syndrome from before. Hey that's super great news. This makes it far easier for me to fall back to sleep when I wake up in the early morning. Thanks for all the help folks. It is most appreciated.

My question I hope to answer is why do I continue to wake up in the early morning, every morning? It seems it is still always around 3 or 4 am that I wake up (depending on when I start my sleep). I am still tired, not well rested when I wake up at that time. Does it have to do with my normal sleep clock, REM Sleep or something else? The data doesn't always point out large leaks at this time, some times but not the majority of the time.

I ask because I am still not feeling as good as I know I can. Today I have a hint of a headache and some fog like I do nearly every day.

Maybe it is moot if I'm able to get back to sleep using the machine. Please let me know if it is important to try to determine a cause.

tazmania wrote: My question I hope to answer is why do I continue to wake up in the early morning, every morning? It seems it is still always around 3 or 4 am that I wake up (depending on when I start my sleep). I am still tired, not well rested when I wake up at that time. Does it have to do with my normal sleep clock, REM Sleep or something else? The data doesn't always point out large leaks at this time, some times but not the majority of the time.

Could be any of those things.

You also post:

tazmania wrote:Last night's sleep pattern.

In bed and hooked up by 10:10pm
Slept straight through to 3:30am
Turned over onto my side without removing my mask, slept until 4:40am
Alarm goes off around 4:55am so I took off the mask fell back to sleep ....

That 3:30 wake where you turned over could be post REM---it's about 5.5 hours after you first go to bed, and while REM cycles typically occur about every 90 minutes, there's some variance. Sometime you hit REM a bit earlier (80 minutes) after the beginning of the current sleep cycle. Sometimes it's more like 100 minutes. And the REM cycles lengthen as the night progresses. So it could be that you're at the end of a REM cycle by around 3:30AM most nights and the wake is a normal post REM wake.

Or it could be that you are waking up because you need to turn over (to prevent stiffness) and you are still learning how to turn over without fully waking up. After all, turning over with six foot hose attached to your nose is a skill that you have to learn. And it takes some people some time to really master this.

Or it could be part of your normal sleep pattern if a 3:30ish wake predates starting CPAP. Waking up briefly a few times in the middle of the night is actually pretty normal---it's as though we have a need to wake up enough to know that everything is "ok". But in a person without sleep problems, these middle of the night wakes are usually so brief (less than 5 minutes) that we don't remember them when we wake up in the morning. And a very small number of wakes that you don't remember can and should be ignored.

As for the 4:40 wake: Many people start waking up 10-15 minutes before the alarm goes off. We do get onto a sleep schedule and if the body knows the alarm is going off at 4:55, it may indeed want to wake up 10-15 minutes before hand simply to be sure that the alarm does not wind up startling you awake from deep sleep stage or from REM sleep.

You also write:

I ask because I am still not feeling as good as I know I can. Today I have a hint of a headache and some fog like I do nearly every day.

But you have also written:

Alarm goes off around 4:55am so I took off the mask fell back to sleep ....
AND PROMPTLY HIT SNOOZE A FEW TIMES BEFORE WAKING UP FOR THE DAY! Jumped out of bed at 5:18am.

If you actually fell back to sleep for the twenty minutes between 4:55 and 5:18, that might explain the headache and brain fog. The thing is that some of us are super-sensitive in terms of daytime symptoms: Any sleep at all without the mask can allow a whole series of events to occur and that can leave you feeling pretty lousy even though most of the night's sleep was good.

Question: Was the hint of a headache there when you first woke up at 4:55? Or did it only start after you woke up for good at 5:18?

Maybe it is moot if I'm able to get back to sleep using the machine. Please let me know if it is important to try to determine a cause.

I think it's a moot point. Rather than trying to identify a cause for the wake, you need to focus more on your reaction to finding yourself awake in the middle of the night.

If you are doing things that make it take longer to get back to sleep after waking in the middle of the night, what you need to work on is teaching yourself to not over react to the wake.

When you wake up in the middle of the dark, what's the first thing you do? Look at the clock?

After looking at the clock, do you start thinking about how much sleep you've gotten during the night and how close it is to the time the alarm goes off? Do you start worrying about the fact that you are awake? On bad nights, do you then have a lot of trouble getting back to sleep because you are so worried that you're going to be exhausted the next morning when you do have to get up? All of these things tend to prolong the wake, usually to the point where we can remember it in the morning and then worry about how it's messed up an otherwise decent night's sleep.

So if any of that is applicable to your situation, then what you really need to do is teach yourself to not worry about the wake. Don't look at the clock when you first wake up and don't try to figure out how much sleep you've gotten or how close it is to wake up time. Instead work on comfort issues:

• Is there a leak? If so, fix it, snuggle back down and allow yourself to go back to sleep.
• Do you just need to turn over? If so, turn over and get comfortable and snuggle back down and allow yourself to go back to sleep.
• Too hot or too cold? Adjust the covers and snuggle back down and allow yourself to go back to sleep.
• Dry mouth? Try to work it out and snuggle back down and allow yourself to go back to sleep. (Note: you say the cervical collar seems to have fixed most of this issue. You still might want a water bottle on the bedside table in case you need a drink to help the mouth since you say you don't like getting up because that makes it harder to get back to sleep.)
• No identifiable comfort issue to trigger the wake? Assume it's a normal post-REM wake and snuggle back down and allow yourself to go back to sleep.

As you can see, there's a theme here: Deal with any physical thing that might have triggered the wake and then don't obsess about it---just snuggle back down and allow yourself to get back to sleep.

Thanks for all the great feedback robysue.

When you wake up in the middle of the dark, what's the first thing you do? Look at the clock?

After looking at the clock, do you start thinking about how much sleep you've gotten during the night and how close it is to the time the alarm goes off? Do you start worrying about the fact that you are awake? On bad nights, do you then have a lot of trouble getting back to sleep because you are so worried that you're going to be exhausted the next morning when you do have to get up? All of these things tend to prolong the wake, usually to the point where we can remember it in the morning and then worry about how it's messed up an otherwise decent night's sleep.

So if any of that is applicable to your situation, then what you really need to do is teach yourself to not worry about the wake. Don't look at the clock when you first wake up and don't try to figure out how much sleep you've gotten or how close it is to wake up time. Instead work on comfort issues:

I do look at the clock. I guess because I want to know if I got a good night's sleep already.
I don't start worrying. I've been able to function OK despite the lack of a full night's sleep so I don't get too concerned. Maybe a bit disappointed but no real anxiety.
When I awake I believe I mostly start thinking about something relative to life in general. Either what I have to do around the home that day or (and mostly) what I have on my plate at work. Work can be stressful but nothing to the extreme.

I have actually found that I can fall back to the sleep the easiest ... and this may sound really weird but ... I fall asleep the easiest after rewaking if I work at thinking about nothing at all. Literally try to let my mind go blank and have zero thoughts going through it. Uhm. That sounds dumb to say but it is something I've been doing for the last year or so.

tazmania wrote: I fall asleep the easiest after rewaking if I work at thinking about nothing at all. Literally try to let my mind go blank and have zero thoughts going through it. Uhm. That sounds dumb to say but it is something I've been doing for the last year or so.

Why do you think that is "dumb"? An active mind is not conducive to falling asleep quickly.

tazmania wrote:Thanks for all the great feedback robysue.
...
I do look at the clock. I guess because I want to know if I got a good night's sleep already.

And how do you define "I got a good night's sleep already"?

I don't start worrying. I've been able to function OK despite the lack of a full night's sleep so I don't get too concerned. Maybe a bit disappointed but no real anxiety.

Disappointment is a negative emotion and it can lead to worry or anxiety. And how do you define "a full night's sleep"?

When I awake I believe I mostly start thinking about something relative to life in general. Either what I have to do around the home that day or (and mostly) what I have on my plate at work. Work can be stressful but nothing to the extreme.

An active mind makes it much harder to get back to sleep.

I have actually found that I can fall back to the sleep the easiest ... and this may sound really weird but ... I fall asleep the easiest after rewaking if I work at thinking about nothing at all. Literally try to let my mind go blank and have zero thoughts going through it. Uhm. That sounds dumb to say but it is something I've been doing for the last year or so.

As CG says, there's nothing dumb about this at all.

A blank mind is ready to yield to sleep when it comes. An active, thinking mind is going to want to stay up and finish thinking about whatever is on its agenda. And if you're thinking of things that need to be dealt with in the morning, your brain is going to go into problem solving mode, which is almost always incompatible with getting back to sleep.

Learning to get my brain to shut up and let me get back to sleep was one of the hardest things I ever had to do in my own CPAP journey.

ChicagoGranny wrote:

tazmania wrote: I fall asleep the easiest after rewaking if I work at thinking about nothing at all. Literally try to let my mind go blank and have zero thoughts going through it. Uhm. That sounds dumb to say but it is something I've been doing for the last year or so.

Why do you think that is "dumb"? An active mind is not conducive to falling asleep quickly.

Hmm. Good question. I guess I've always been under the impression one should think of relaxing things, things that make you comfortable/happy. Thinking about nothing isn't that.

robysue wrote:And how do you define "I got a good night's sleep already"?

My mindset right now is:

Do I remember waking up a lot?
And did I get at least 6 to 8 hours of restful sleep?

It's just a number but monitoring the number tells me if things are improving.

robysue wrote:Disappointment is a negative emotion and it can lead to worry or anxiety. And how do you define "a full night's sleep"?

Fortunately right now I'm making progress in improving my sleep so I'm not so worried. But I get where you're going with your statement.

I'd love to get around 7 hours or more of quality sleep. It's just a number that I'm working towards. I'm hopeful much of the foggy feeling, short term memory issues, etc will be reduced/dissipate with a better number than the 4.5 hours I was getting before. I definitely am feeling better this week. Granted I know some of this isn't just sleep related, what I eat, how much stress I have, etc all are factors in how good I'm feeling.

robysue wrote:An active mind makes it much harder to get back to sleep.

As CG says, there's nothing dumb about this at all.

Learning to get my brain to shut up and let me get back to sleep was one of the hardest things I ever had to do in my own CPAP journey.

Thanks. I'll continue with that as it has been working for me.

tazmania wrote:

ChicagoGranny wrote:

tazmania wrote: I fall asleep the easiest after rewaking if I work at thinking about nothing at all. Literally try to let my mind go blank and have zero thoughts going through it. Uhm. That sounds dumb to say but it is something I've been doing for the last year or so.

Why do you think that is "dumb"? An active mind is not conducive to falling asleep quickly.

Hmm. Good question. I guess I've always been under the impression one should think of relaxing things, things that make you comfortable/happy. Thinking about nothing isn't that.

Thinking is wake promoting. Even if you are thinking about pleasant things, it's still wake promoting. Since you've mastered the trick of "thinking about nothing", you've masted turning your conscious brain off so that you can get to sleep. It's something I really wish I was better at.

I'll wish you luck, robysue, in turning that brain off.

I recall as an adolescent having issues with sleep patterns. I don't know that it was insomnia but I know there was a long stretch there where night after night I would go wake my parents because I'd lie in bed unable to fall asleep and/or fall back to sleep. I remember being very upset that I couldn't sleep. Knowing I had school early the next day and just the loneliness and even fear of being the only one awake.

My parents put me and my two younger brothers in the basement. Not well heated and noisy with an old cast iron "clanky" furnace (8 feet from my thin bedroom wall) I had a lot of troubles sleeping there. Eventually I asked if I could take back the spare bedroom upstairs to see if that helped. I had far fewer issues with it after that.

The nights as an adult where that would happen I think I developed a sense of calm when I had trouble sleeping. I developed the ability to sort of shrug it off, accept it for what it was. That thought process, I believe, helped me establish the calm I needed to eventually get some sleep.

tazmania wrote:I'll wish you luck, robysue, in turning that brain off.

That's a big part of why I'm now on Belsomra---at the recommendation of not one, but three different of my docs who are keenly aware of my problems and how they interact with each other. There's been a lot of talk and concern that Belsomra is not particularly effective at the dosages the FDA approved, but so far it's doing its job of taking the edge off of things when I first go to bed and it does help my mind shut up its constant internal chatter so that I can get to sleep. It's not particularly effective at keeping me asleep. But the CBT-I stuff usually lets me get back to sleep quick enough where I don't remember the post-REM wakes. I only know they exist because I have a habit of turning my machine off and back on to reduce the pressure so that I don't start focusing on whether I'm going to wind up with aerophagia before I get back to sleep.

I recall as an adolescent having issues with sleep patterns. I don't know that it was insomnia but I know there was a long stretch there where night after night I would go wake my parents because I'd lie in bed unable to fall asleep and/or fall back to sleep. I remember being very upset that I couldn't sleep. Knowing I had school early the next day and just the loneliness and even fear of being the only one awake.

As a kid I had a lot of trouble getting to sleep because the brain just would not shut up. I wound up creating the most elaborate fantasy life for myself and every night was just another chapter in the on-going story. So I never was upset at being the only one awake---I always thought it was kind of cool actually.

But it is funny what we will focus on when trying to get to sleep. In the last few years before my OSA diagnosis I would occasionally wake up and lie in bed thinking about a crack in the ceiling right above the bed. This is a completely stable surface crack in the plaster. But in a half-wake, half-sleep state, the brain would come up with all kinds of scenarios where that crack was going to open up and the whole house was going to fall down on hubby and me while we were in the bed. That stuff continued after starting CPAP as well and added to my misery of aerophagia+insomnia. When the second kid went off to college, we switched bedrooms and no matter how much trouble I have getting to sleep or getting back to sleep on a bad night, at least I'm no longer worrying about that damn crack.

robysue,

I'm not familiar with aerophagia. Is that something that occurs all day long for you or only when you sleep?

Occasionally I have a short episode where I have this respiratory hiccup or belch or whatever ... it's hard to explain. It's not a belch, it's not a hiccup but it is an involunatary action that makes me sort of gasp or gulp for air. I recall my father doing the same thing when I was a child. This happens when I'm wide awake. It's not sleep related.

tazmania wrote:robysue,

I'm not familiar with aerophagia. Is that something that occurs all day long for you or only when you sleep?

When the aerophagia is at it's worst, I'll wake up in pain with a badly swollen and rock hard stomach from the swallowed air. It gets better as the day goes on. Fortunately I don't get it as bad as I used to when I was a newbie.

A lot of my problem is that I have a very difficult time burping the air back out once it's swallowed.

tazmania wrote:Occasionally I have a short episode where I have this respiratory hiccup or belch or whatever ... it's hard to explain. It's not a belch, it's not a hiccup but it is an involunatary action that makes me sort of gasp or gulp for air. I recall my father doing the same thing when I was a child. This happens when I'm wide awake. It's not sleep related.

I know what your talking about. I do this too. I have more at night than I do in the day time. You said yours are not sleep related, but do you also have them at night?? You can tell if you're doing this at night by looking on your Flow Rate graph; and you will see a "single breath spike" with normal breathing before the spike happens and normal breathing, or sometimes breaths with long "breath pause," right after it. There are no events around these "breath spikes." I do not know why they happen or if there are any real significance to these involuntary breaths. I would like to know....

robysue wrote:

tazmania wrote:robysue,

I'm not familiar with aerophagia. Is that something that occurs all day long for you or only when you sleep?

When the aerophagia is at it's worst, I'll wake up in pain with a badly swollen and rock hard stomach from the swallowed air. It gets better as the day goes on. Fortunately I don't get it as bad as I used to when I was a newbie.

A lot of my problem is that I have a very difficult time burping the air back out once it's swallowed.

So sorry to hear that you're going through that. That sounds quite uncomfortable. I'm sure that doesn't help you get to sleep at night. Ugh. I fear even saying that back to you. Just brings to light the things that make it hard for you to sleep.

It sounds like you've gotten this under control some.

lilly747 wrote:

tazmania wrote:Occasionally I have a short episode where I have this respiratory hiccup or belch or whatever ... it's hard to explain. It's not a belch, it's not a hiccup but it is an involunatary action that makes me sort of gasp or gulp for air. I recall my father doing the same thing when I was a child. This happens when I'm wide awake. It's not sleep related.

I know what your talking about. I do this too. I have more at night than I do in the day time. You said yours are not sleep related, but do you also have them at night?? You can tell if you're doing this at night by looking on your Flow Rate graph; and you will see a "single breath spike" with normal breathing before the spike happens and normal breathing, or sometimes breaths with long "breath pause," right after it. There are no events around these "breath spikes." I do not know why they happen or if there are any real significance to these involuntary breaths. I would like to know....

I've only recently started tracking my stats Lily so at this juncture I haven't looked for that "tell" so I'm not sure I can answer. I'm at work and can't view the URL I posted earlier that shows a day or two of my stats.

I plan to pull up my stats tonight. The last 4 or 5 nights I believe I've gotten far better sleep than I have in a long time. I can feel it physically throughout the day. More energy, less foggy.