multiple awakenings in the night

hello, one and all.

i'm here to ask for help again. i've been at this cpap therapy since sometime around april or may of 2015. that seems like a long time to me, but to you old hands, this is not long at all.
i've managed to find a mask i like, though calling nasal pillows a mask seems weird. i've gotten pretty comfortable with the whole thing. there is, however, a problem.
i keep waking up through out the night. about every hour to hour and a half. it's easy to get back to sleep. usually roll over and i'm asleep pretty quickly.
this used to happen to me before my diagnosis. only back then, getting back to sleep was very hard indeed. i would just lay there getting more and more frustrated every time i looked at the clock.
so it's a very pleasant change to be able to at least get back to sleep.
but this isn't what i pictured when i first started. i imagined turning out the light then sleeping soundly until waking up 8 hours or so later. but it's just not happening.
i'm posting some sleepyhead pictures. can you help me figure out what is going on and how i can start getting some solid, uninterrupted sleep?

your minimum pressure is too low, you're having hypopneas all night long.

also: https://sleep.tnet.com/resources/sleepyhead/shorganize

palerider wrote:your minimum pressure is too low, you're having hypopneas all night long.

also: https://sleep.tnet.com/resources/sleepyhead/shorganize

thank you! will turn it up a notch tonight.

also, fresh copy of sleepyhead installed on different machine. i didn't stop to think how my charts were organized!

zonker wrote:will turn it up a notch tonight.

I would also open the max pressure to 20.0 since you are running at the max of 12.0 for some time each night. If you set the max to 20.0 and you are breathing well at 12.0, the APAP algorithm will not raise the pressure about 12.0. But looking at your charts, I think you need pressures about 12.0 at times.

zonker,

You are still having some hypopneas. What's the AHI running these days? You may indeed feel a bit better bumping up the minimum pressure by 1 or 2 cm. (I would do it one cm at a time.) I don't see much need to set the max pressure at 20, but then I tend to be very prone to aerophagia when the pressure gets too high.

You also write:

zonker wrote:here is, however, a problem.
i keep waking up through out the night. about every hour to hour and a half. it's easy to get back to sleep. usually roll over and i'm asleep pretty quickly.
this used to happen to me before my diagnosis. only back then, getting back to sleep was very hard indeed. i would just lay there getting more and more frustrated every time i looked at the clock.
so it's a very pleasant change to be able to at least get back to sleep.

My guess is that those wakes every 90 minutes or so are normal post-REM wakes. As in the kind of wake that people who do not have OSA or insomnia problems typically have. It's just that in someone with normal sleep patterns, those post-REM wakes are so short that the person often does not remember them when they wake up in the morning. (We typically only remember a wake if it lasts at least 5 minutes or so.)

So rather than worrying about the fact that you are still waking up after REM cycles, you need to focus on simply getting back to sleep quickly with a minimum amount of effort and fuss. My advice: Don't look at the clock when you wake up. Just quickly assess if there's anything you need to do to make yourself more comfortable and then turn over and go back to sleep without trying to figure out why you woke up in the first place.

ChicagoGranny wrote:

zonker wrote:will turn it up a notch tonight.

I would also open the max pressure to 20.0 since you are running at the max of 12.0 for some time each night. If you set the max to 20.0 and you are breathing well at 12.0, the APAP algorithm will not raise the pressure about 12.0. But looking at your charts, I think you need pressures about 12.0 at times.

It looks like your minimum pressure is too low, so you are having to "chase" your apneas--the pressure has to really climb to get on top of it. But those flat lines at 12 cm/H2O mean sometimes your pressure is not adequate--maybe because of this "chasing". If raising the minimum pressure doesn't help, I agree with Chicago Granny that opening up the maximum pressure will probably help.

I usually have one wake up per night, around 4 or 4:30 ish. Before CPAP it would mean hours of trying to fall back to sleep, now I fall back to sleep very easily. Thank goodness for CPAP!

ChicagoGranny wrote:

zonker wrote:will turn it up a notch tonight.

I would also open the max pressure to 20.0 since you are running at the max of 12.0 for some time each night. If you set the max to 20.0 and you are breathing well at 12.0, the APAP algorithm will not raise the pressure about 12.0. But looking at your charts, I think you need pressures about 12.0 at times.

hi,chi! i'm going to set the min tonight at 12 and max at 20. while i said i'd "turn it up a notch", i got impatient and went to 11 before i went to bed. you should see my pressure chart! i kept bouncing from 11 to 12 all night.

so yeah, looks like the min of 12 will be the way to go.

thanks!

robysue wrote:zonker,

You are still having some hypopneas. What's the AHI running these days? You may indeed feel a bit better bumping up the minimum pressure by 1 or 2 cm. (I would do it one cm at a time.) I don't see much need to set the max pressure at 20, but then I tend to be very prone to aerophagia when the pressure gets too high.

You also write:

zonker wrote:here is, however, a problem.
i keep waking up through out the night. about every hour to hour and a half. it's easy to get back to sleep. usually roll over and i'm asleep pretty quickly.
this used to happen to me before my diagnosis. only back then, getting back to sleep was very hard indeed. i would just lay there getting more and more frustrated every time i looked at the clock.
so it's a very pleasant change to be able to at least get back to sleep.

My guess is that those wakes every 90 minutes or so are normal post-REM wakes. As in the kind of wake that people who do not have OSA or insomnia problems typically have. It's just that in someone with normal sleep patterns, those post-REM wakes are so short that the person often does not remember them when they wake up in the morning. (We typically only remember a wake if it lasts at least 5 minutes or so.)

So rather than worrying about the fact that you are still waking up after REM cycles, you need to focus on simply getting back to sleep quickly with a minimum amount of effort and fuss. My advice: Don't look at the clock when you wake up. Just quickly assess if there's anything you need to do to make yourself more comfortable and then turn over and go back to sleep without trying to figure out why you woke up in the first place.

since going with the nasal pillows in january, my AHI has been generally around 4.60 to around a hair over 5. the funny thing is, when i first used the nasal pillows, i was hovering around an AHI of 1 for a few nights. weird.

yes, i've read on here before where several people suggest slowly raising your pressure. but as i told chicago granny, i got impatient. now, when i first started therapy, i couldn't abide any pressure over 9. so i started really slowly on this back in january and was increasing by 1/2 every week or so. but palerider just gave me the kick i needed.

with my pressure at 11, i DID get a bit of aerophagia, but no where near what i used to get. and at about 4 a.m. the pressure wasn't bothering me at all.

i understand what you mean about not worrying about the time and just to relax. my problem is that i have sort of a clock in my head. i'm usually off by 10 minutes or so, but generally speaking, i know what time it is. so i'm not sure if i can do as you suggest.

i'm merely keeping my fingers crossed that i can chase the hypopnea away with the higher pressure.

thanks!

Janknitz wrote:

ChicagoGranny wrote:

zonker wrote:will turn it up a notch tonight.

I would also open the max pressure to 20.0 since you are running at the max of 12.0 for some time each night. If you set the max to 20.0 and you are breathing well at 12.0, the APAP algorithm will not raise the pressure about 12.0. But looking at your charts, I think you need pressures about 12.0 at times.

It looks like your minimum pressure is too low, so you are having to "chase" your apneas--the pressure has to really climb to get on top of it. But those flat lines at 12 cm/H2O mean sometimes your pressure is not adequate--maybe because of this "chasing". If raising the minimum pressure doesn't help, I agree with Chicago Granny that opening up the maximum pressure will probably help.

I usually have one wake up per night, around 4 or 4:30 ish. Before CPAP it would mean hours of trying to fall back to sleep, now I fall back to sleep very easily. Thank goodness for CPAP!

yeah, like i told robysue, you should see my graph. mountain peaks going between 11 and 12.

wow! ONE wakeup? i'd really love to have that. and i agree with you one hundred percent. thank goodness for cpap......

zonker wrote: i understand what you mean about not worrying about the time and just to relax. my problem is that i have sort of a clock in my head. i'm usually off by 10 minutes or so, but generally speaking, i know what time it is. so i'm not sure if i can do as you suggest.

I understand about a clock in your head---I've got a pretty good one myself.

However, when I wake up at night, I don't start thinking about the time even when I'm aware of it. In other words, if I wake up knowing that it's around 3:20, I don't start letting myself start thinking "That means it's about 4 hours before the alarm goes off." Nor do I start thinking "That means I just got about 1 1/2 hours of sleep since the last wake." Rather, I simply try my best to say nothing more than "It's 3:20. So what. Let's get back to sleep." Then I deal with any comfort issues, which usually involves turning my machine off and back on because higher pressures still can trigger aerophagia if I'm awake for very long while using the machine at higher pressures. And then I snuggle back down in the covers and go back to sleep.

By not focusing much attention on my wakes, I get back to sleep fast enough where I don't remember most of them. And on a good night, that means that I wake up feeling pretty well rested and ready for the day. When I look at my data I'm usually see there are 2 or 3 wakes that I don't remember: I only know they're there because I can tell when I turned the machine off and back on.

Please let us know how your pressure increases work out for you. Always good to know the outcome.

About not looking at that clock, it's good advice for people who have trouble falling back to sleep. But,

zonker wrote: it's easy to get back to sleep. usually roll over and i'm asleep pretty quickly.

... you don't have that problem, so look at the clock.

zonker wrote:while i said i'd "turn it up a notch", i got impatient and went to 11 before i went to bed.

Making small changes is a good idea for people who don't use software tools like Sleepyhead. But, if you look at the nightly detail and see that your APAP is spending most of the night well above your minimum pressure, then why spend more nights at a minimum pressure that is too low? Go ahead and jack it up closer to where it is going anyway.

robysue wrote:

zonker wrote: i understand what you mean about not worrying about the time and just to relax. my problem is that i have sort of a clock in my head. i'm usually off by 10 minutes or so, but generally speaking, i know what time it is. so i'm not sure if i can do as you suggest.

I understand about a clock in your head---I've got a pretty good one myself.

However, when I wake up at night, I don't start thinking about the time even when I'm aware of it. In other words, if I wake up knowing that it's around 3:20, I don't start letting myself start thinking "That means it's about 4 hours before the alarm goes off." Nor do I start thinking "That means I just got about 1 1/2 hours of sleep since the last wake." Rather, I simply try my best to say nothing more than "It's 3:20. So what. Let's get back to sleep." Then I deal with any comfort issues, which usually involves turning my machine off and back on because higher pressures still can trigger aerophagia if I'm awake for very long while using the machine at higher pressures. And then I snuggle back down in the covers and go back to sleep.

By not focusing much attention on my wakes, I get back to sleep fast enough where I don't remember most of them. And on a good night, that means that I wake up feeling pretty well rested and ready for the day. When I look at my data I'm usually see there are 2 or 3 wakes that I don't remember: I only know they're there because I can tell when I turned the machine off and back on.

i well remember the days before i was lucky enough to retire. that was THE script running the movies of my mind. "how the hell am i going to do any work today on 4 hours sleep!" and on and on. would obsess for hours at a time. while i don't do THAT any more, i can understand what you are saying. just let it go.

and maybe that will be how i end up sleeping. but i just SO want to be able to pass out for long periods of time!

kteague wrote:Please let us know how your pressure increases work out for you. Always good to know the outcome.

thank you for asking, ma'm. <tips hat>.

well i didn't fall into that deep sleep and wake up refreshed this morning. but i wasn't really expecting to. today was caucus day here in washington state. so i was pretty jazzed to go there this morning at 10 am! (first time to a caucus.) i imagine being excited about that didn't help me relax so much.

that said, my AHI was down to 4.1. i know, i know, not an indicator in and of it self. and again, i tolerated the pressure MORE in the "second half" of the night. the hypopneas were still pretty high with exception of about an hour and a half before i got up.

as i tolerated the pressure better than i expected, i'm going to raise it even more. once i have a few more nights worth of data, i'll post the screenshots.

well, after i get them arranged so you all can see them more easily.

ChicagoGranny wrote:About not looking at that clock, it's good advice for people who have trouble falling back to sleep. But,

zonker wrote: it's easy to get back to sleep. usually roll over and i'm asleep pretty quickly.

... you don't have that problem, so look at the clock.

zonker wrote:while i said i'd "turn it up a notch", i got impatient and went to 11 before i went to bed.

Making small changes is a good idea for people who don't use software tools like Sleepyhead. But, if you look at the nightly detail and see that your APAP is spending most of the night well above your minimum pressure, then why spend more nights at a minimum pressure that is too low? Go ahead and jack it up closer to where it is going anyway.

yeah, i figured if the pressure was intolerable to me, i could always change it back. i believe it may have been you who replied to someone last year, something to the effect, "if the pressure gets too high in the night, you can always shut the machine off and start it again.". something like that. and i've done that on numerous occasions.

like i said, i'll go higher tonight as, while i had a bit of bloat, it was perfectly tolerable. we'll see how this goes.