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avi123 wrote:

threeforward_twoback wrote:

You are making a mistake by taking instructions from members of this board none of whom is a qualified medical respiration therapist. Using Auto CPAP is contra indicated for those who suffer from certain ailments. You need to undergo a sleep study in order to verify if you suffer from these ailments such as Central Apnea, Oxygen desaturation disorder, lack of REMs, COPD, Heart failure, etc.

Just to clarify, are you saying I may need a third sleep study? These things wouldn't have been caught by the first two?

Reply:

Were you given an OK to use an APAP at your sleep study, or is it only suggested by members of this website?

shut up, avi.

Last night, I woke up at 3:26 a.m. and I don't think I was able to really fall asleep. If we could somehow figure out what's causing this nightly wake-up around 3 am, that would be great--I really think that's what's preventing me from feeling well-rested. I remember, when my sleep issues started last year, before I was diagnosed with OSA, I would wake up around 3 in the morning, too. Since being placed on CPAP, it's an almost nightly occurrence. Usually I'm able to fall back asleep, but it takes awhile and it's usually a light sleep.

I also awoke to find a hole in my hose, about an inch wide. It's right where the hose attaches to the silicon connector. I should just cover with duct tape, right?

I think it may have ripped because I stretched the hose too much when I was wearing the mask and walked to certain parts of my room. Any suggestions on how to lengthen the hose so that this problem doesn't crop up again?

Anyway, last night's report:

threeforward_twoback wrote:Last night, I woke up at 3:26 a.m. and I don't think I was able to really fall asleep. If we could somehow figure out what's causing this nightly wake-up around 3 am, that would be great--I really think that's what's preventing me from feeling well-rested. I remember, when my sleep issues started last year, before I was diagnosed with OSA, I would wake up around 3 in the morning, too. Since being placed on CPAP, it's an almost nightly occurrence. Usually I'm able to fall back asleep, but it takes awhile and it's usually a light sleep.

I also awoke to find a hole in my hose, about an inch wide. It's right where the hose attaches to the silicon connector. I should just cover with duct tape, right?

I think it may have ripped because I stretched the hose too much when I was wearing the mask and walked to certain parts of my room. Any suggestions on how to lengthen the hose so that this problem doesn't crop up again?

Anyway, last night's report:

Wouldn't be a bad idea to unhook the mask when you are walking around the room. It's made for sleeping!

In my defense, I've only walked around with it around bedtime when I was lying down and needed to get up to get something. I just hate the hassle of having to remove it just for a few seconds, hang it somewhere (I really don't like the idea of my nasal pillows touching any surface, so I always find a place to hang the mask) only have to put it on again. Seemed easier just to keep it on.

Duct tape the tear....yes, that will work. Is the hose a heated hose? If so...it may not work correctly now if the wires got torn.
For extra length you could add in a separate hose of a different length. How much do you think you might need? There are cheap generic 2 or 4 foot hoses...they are going to be heavier and you need to buy a coupling to connect. If it were me and I wanted extra length I would probably go with this hose which is not quite 2 feet but it is lighter and won't need a separate coupling. It would go at the end of long hose that attaches to your mask.
https://www.cpap.com/productpage/circad ... -tube.html

They also make 10 foot hoses...so if you don't need a heated hose you can just use a longer hose to start with and not add something at the end.
https://www.cpap.com/cpap-hose/cpap-hose-tubing.php

There's nothing on the report that I see at around 3 AM that offers much of anything about why you wake up around that time. No leaks...no events really...nothing stands out.
What I suspect is happening is that you are experiencing a normal wake up after a REM stage...it's normal to wake up a little after a REM stage and while most of us don't remember it...some people wake up more alert and it creates a problem getting back to sleep. Those wee hours of the morning are when we are likely to have more REM stages...they come on faster and last longer.
Google "sleep stages" and take a look at the hypnograms and you can see what I mean.
Anyway...that would/could be an explanation for the 3 AM wake ups if you can't isolate any other potential culprit like pain..noise..bed comfort, etc.

I see you explained why you don't like taking the mask off to move around in the room....you know you can just detach the mask from the long hose so that you can still wear the mask but not be attached to the hose. Lots of people do that (like for bathroom breaks and such and they don't want to mess with having to refit the mask).

threeforward_twoback wrote:Last night, I woke up at 3:26 a.m. and I don't think I was able to really fall asleep. If we could somehow figure out what's causing this nightly wake-up around 3 am, that would be great--I really think that's what's preventing me from feeling well-rested. I remember, when my sleep issues started last year, before I was diagnosed with OSA, I would wake up around 3 in the morning, too. Since being placed on CPAP, it's an almost nightly occurrence. Usually I'm able to fall back asleep, but it takes awhile and it's usually a light sleep.

Anyway, last night's report:

3forward-2back,

I am a nasal pillow user as well and I too would always wake up around 3 or 4am. For me the culprit was mouth breathing which showed up as large leaks on my charts. I suspect it was around the time I'd hit REM sleep and really relax and as such my jaw would drop, allowing my mouth to open and thus causing CPAP treatment to fail. By the time I'd notice and wake up my mouth would be terribly dry. I, too, would struggle to get quality sleep after that, although that was because I'd stop CPAP.

I've fixed my problem by using a soft cervical collar. Now I sleep through these times most nights and many days my alarm wakes me at 5:10am.

Sorry I'm at work and can't read your chart so I can't see your large leak readings. I suspect if you were having leak issues someone would have pointed that out already but just wanted to point this out to see if that might be part of your issue.

There's nothing in terms of leak at the 3 AM mark...nothing...nice flat leak line until around 5:30 where a small short lived large leak was flagged. It could have been big enough to wake a person up.
But around 3 AM....nothing...that leak line never really moves at all until just shortly before 5:30.
I wish I had a leak line that good.

Since the 3 AM wake ups happened prior to using cpap...I have my doubts as to whether it is cpap therapy related.

I do have an idea though...while the AHI isn't horrible...maybe it would be worth it to try to reduce it a little more. We can't do anything about the CAs so ignore the CAs.
The machine doesn't really want to go higher so my idea is to try 8.5 minimum and see what happens. Use a little more baseline pressure in this situation since the machine isn't wanting to do it.
Going out on a long skinny limb here...but maybe the OAs, hyponeas, FLs...all mean that the airway is still not held open totally optimally and minor flow reductions going along with all these are maybe causing some low level arousals that may or may not be remembered and then at the 3 AM mark which I suspect is probably REM related...the arousal is more apt to cause a full awakening.
That's a lot of ifs and maybes...but heck, what is there to lose by at least trying something. Maybe with less OAs, hyponeas, FLs, etc you could sleep a little deeper and maybe not experience that full awakening at 3 AM...of if you do have an arousal maybe you won't remember it.

The machine doesn't really want to go higher

Asking out of curiosity: What would be a sign that it does want to go higher? I was wondering if I should increase my max to 12 cm, based on the red line in the Pressure graph. Around 1 am to 1:30 am, it looks like my pressure was topping out at 10 cm. On yesterday's report, it didn't do this.

And while we're on the topic, why are there two lines on the pressure graph? What do the red and green lines represent?

2 lines on the pressure graph...I think inhale and exhale...you are probably using the Flex exhale relief setting and upon exhale the pressure drops a little so you are getting one pressure on inhale and another on exhale.

Raising the maximum won't hurt anything but if the machine doesn't want to go there it won't...and it doesn't seem to want to go up there very much.
The little spikey things are the pressure probe and not the machine responding to something it doesn't like.

It does seem to top out at 10 for a brief time...probably either you were on your back or in REM sleep where it's common, with either, to need a little more pressure. If you were doing this often and we saw you being maxed out for prolonged periods of time then for sure would need to open up the maximum more...but if it doesn't happen often it's not so urgent.

As to what causes the machine to want to go up...snores, Flow Limitations, OAs & Hyponeas (if you have more than one or so within a certain time frame which I forget is how long). It won't think "OMG an OA slipped past the defenses so I need to raise the pressure" instead it mainly looks for flow reductions that might be a precursor to the airway collapsing further. Now it might think "OMG 3 hyponeas/OAs too soon together so I need to raise the pressure"...it's a complicated algorithm that I don't remember exactly how it works. Some of it is explained in the clinical manual but not in huge detail.

For some reason the machine isn't sensing ahead of time enough snores/flow limitations/OAs, etc to cause it to want to go higher at least for the bulk of the night. The minimum pressure is the most critical setting though. That's what acts as a baseline pressure for holding the airway open for the bulk of the night. Increasing the minimum a little might help that baseline do a little better job...not that you really need it in terms of what the report shows but I thought maybe it might help prevent some low level arousals (if you are having some). It was just something to maybe help you stay sleeping a little more soundly. Something to try since it won't hurt anything and might help.

Now the other side of the coin is that some people find that the changing pressures in auto mode tend to disturb sleep...they don't feel like they slept so great and those people may do better at a fixed pressure or even a tighter apap range than you are doing. So a possible experiment would be to not use a range of pressures (which I think you already tried if I remember right but maybe it needs to be a little higher than what you tried) to eliminate the pressure changes as a potential culprit for the arousals.

You can open up the max if you wish...the machine won't go up without thinking it has a good reason.
Now sometimes the reason it thinks is really important might not be so important if the increase in pressure causes a problem (like aerophagia or leaks that wake you up). Sometimes we have to weigh the benefits vs the maybe unwanted side effects. I don't think you are going to see massive pressure changes happen...if it goes up to 12 I would be surprised. It doesn't really matter what the maximum is if you never go beyond a certain point. It's like if the machine could go to 100 and you set the maximum to 100 and it never wanted to go to more than 10...it won't go past 10 and having it set at 100 is a moot point and doesn't affect anything.
Some people feel better (in their minds) if they limit the maximum but in truth if the machine never goes beyond a certain point it really doesn't matter how far beyond that point you set it to. It doesn't affect response time or anything like that if it is set higher than where the machine wants to go.

As to the question "what would be the sign it wants to go higher"....you may not see any signs on the reports that just stand out. You might spot a flow reduction on the flow rate if you zoom way in and put each breath under the microscope but seeing that small of a change could be difficult. But other than maybe some FLs or snores being flagged it's not all that easy to spot the reason for an increase.

I see. I will try 8.5 tonight and see what happens.

I have a rant I'd like to get off my chest...I've tried to make it coherent, but it may jump around a little. I apologize.

I must say, what with not really sleeping after my wake-up early this morning and the news that my 3 am wakeups aren't actually due to any problem with the machine or settings, I am feeling really discouraged right now. I suspected I had insomnia when my sleep issues started about a year ago. I tried many different sleep hygiene practices and medications--cutting down on my exposure to blue light, trying calcium-magnesium supplements, taking Zzzquil, trazadone, melatonin, doing sleep restriction/CBT-I. Nothing really worked as a long-term solution.

Then when I found out I have sleep apnea, I was relieved. "So I can start sleeping normally again!" was what I originally thought. I was also excited to use CPAP because I've had anxiety and moderate depression for awhile (I'm not on medication. I'm trying to treat them through therapy), and I'd read that getting treated was helpful for individuals who were experiencing anxiety and depression. But I haven't experienced that. And I thought using CPAP would help get rid of my early morning wake-ups, but so far, no luck. The CPAP is just exacerbating the depression. So I guess I really do have insomnia.

What's really frustrating, besides the constant sadness/discouraged feeling from not getting restful sleep, is that I feel like I have to plan my life around my sleep problems now. For example, I'll be traveling to the West Coast in a few weeks. While I'm looking forward to the trip, my return flight lands at 1 am on a Monday. And I know I'm going to be exhausted the following nights after--anyone might be, but I'll feel especially so, due to the poor quality sleep I'm already getting and having to sleep in a strange bed. So I hope to sleep as well as I possibly can before the trip to try and off-set how tired I'll be. A normal sleeper wouldn't have to build up some "sleep credit" just to deal with having a greater "sleep debt" later. Either that, or they would feel tired from the trip for awhile but recover with a good night's rest or two. I wish the same were true for me

Another example: I'm about to attend grad school in the fall. I was planning on applying for a part-time job that's advertised as being 15-20 hours a week. But for the first quarter, I'll have to take five classes, and I don't think I can handle the course load, work that many hours,try to get my assignments and reading done under this brain fog AND deal with the tiredness all at the same time. If I did, I know my sleep would be impacted by anxiety. So I probably won't apply for that job. I would hate to say yes to it, knowing I may not be able to handle it and have to quit later.

I also feel like I have to go to bed much earlier now, since it takes me a little while to fall asleep with my machine going, and also since it's hard for me to sleep later than 6 am. I generally get about 5 hours of sleep, but that's only if I go to bed by 10 pm. I can't go to bed at 12 am and wake up at 5 am, for example. If I go to bed later than 11 pm, my sleep is horrible. And my titration study--which was similar to most nights I've had with the CPAP machine in that I fell asleep within 30 minutes of being hooked up, had an early morning wake-up, and then dozed off lightly afterwards--showed that I experienced a low percentage of REM. So even with the five hours I get, it's still not a restful sleep. I don't know what to do. I am really at my wits' end.

I've often thought that maybe, as hard as it will be, I really just need to be in bed by 9 pm whenever I can to try and sleep as much as possible, and maybe over time that will help. This, as opposed to going to bed at 9 pm one night, feeling great the next day, going to bed a little later, and not having the same well-rested feeling.

Finally, I realize I can function under all this fog. I've driven long trips, gone to work, had good times and good conversations with my friends. It's taken me awhile to admit that contrary to what I've always thought, I can do okay even when I haven't gotten good sleep. But I just hate having it in my life. It feels like I'm underwater all day, because I'm just not experiencing anything as "directly" (or "awakely") as I used to. I don't know if it makes it better or worse that sometimes I'll have a really good day without it. Probably worse, because I know it's fleeting and won't last. I just don't feel like I'm in control of my life anymore.

Sleep maintenance insomnia...that's when we wake up during the night either often and/or have trouble going back to sleep. It's a bitch for sure. Sometimes we can figure out what the cause is and fix it...sometimes we can't and that is sure frustrating.

When we find out we have OSA the gut reaction is to blame insomnia issues on the OSA and expect the cpap machine to fix it...but sometimes we have insomnia for other reasons than OSA and the machine can't fix bad sleep if the bad sleep is caused by something other than OSA.

Just because we don't see anything on these reports doesn't mean that something related to the therapy or OSA isn't going on...it just means we don't see anything that just stands out screaming "fix me".
It also doesn't mean we are just going to give up on trying different things in an effort to fix the bad sleep...hey, we might get lucky and stumble onto something that helps.

We know you have to use the machine...you have OSA...while using it let's try different things to see if it helps or not while giving it time.

I don't remember if I asked this question or not...but do you take any medications of any kind and if you do what?

Did you try fixed pressures...if so, at what setting and for how long?

Hi Pugsy,

I don't take any medications, except for Tylenol and Ibuprofen. I had a doctor's appointment about six months ago, and they told me my bloodwork looked normal, although I might call to inquire for more detail, because I know sometimes being low in Vitamin D can be a culprit of bad sleep.

I tried the original prescribed fixed pressure of 8 cm for six weeks. AHI varied wildly. From my first post to this thread:

I've had 16 days where my AHI was above 5.0 (the highest probably being around 7.57) and 26 where it was below 5.0 (the lowest being 1.46, but it seems like the days when my AHI is low are the days I don't sleep very much/at all).

I read somewhere on this forum that taking tryptophan greatly helped another user with insomnia. I'm a little wary of the supplements, though, so I might try eating some foods high in tryptophan before bedtime.

it seems like the days when my AHI is low are the days I don't sleep very much/at all

Not unexpected...if you don't sleep much then there's less chance of the airway collapsing and getting flagged events. One of the reasons a nice low AHI doesn't really mean squat.

You take some OTC pain meds...so I assume some sort of pain/discomfort is going on.
What sort of pain/discomfort? Do you need to take the meds daily or just rarely?
The reason I ask is that if you have some pain/discomfort issues going on it wouldn't be impossible for the pain to be a factor in the poor sleep quality. I have first hand experience with this myself.
I have some pretty bad arthritis issues and if I didn't take something at night I would wake up 30 to 50 times a night with the pain and it isn't always severe pain...sometimes just little aches and pains make me sleep "lighter" so that the least little thing bothers me.
Even with meds I almost always wake up 3 to 7 times (that I remember) and sleeping all night without any awakenings is really rare for me. So I know about sleep maintenance insomnia but unlike you I usually go back to sleep fairly easily...so I pretty much accept it as "normal for me".

Let's see if increasing the minimum pressure to 8.5 helps or not...might want to consider trying fixed at 8.5 or 9.0 since your AHI was a bit higher at 8.0 and you didn't try higher.

Don't give up hope...there's still some things that can be tried in an effort to reduce the insomnia issues.

You take some OTC pain meds...so I assume some sort of pain/discomfort is going on.
What sort of pain/discomfort? Do you need to take the meds daily or just rarely?

Only every now and then. A few times a month, max. I mostly take them for menstrual cramps, though sometimes I take them for headaches which I'm pretty sure I get because of the lack of good sleep. I'm 26 and in good health physically (though I will also admit I don't exercise. Tried doing it at the height of my insomnia for a few weeks and when it didn't have an effect, I stopped exercising).

Let's see if increasing the minimum pressure to 8.5 helps or not...might want to consider trying fixed at 8.5 or 9.0 since your AHI was a bit higher at 8.0 and you didn't try higher.

Should I try the 8.5 cm/10 cm range before going back to fixed? I guess I've just got it in my head that all of this takes time, so I'm just trying to understand how much time I should give a condition whenever I change it. In other words, I'm trying to understand what is the next best step going forward--trying fixed again vs. sticking with the range, I mean.