New user, need sleepyhead help....PLEASE!!!

Frustrated with waking up at 3-4AM since my pressure was increased and then tossing/turning the rest of the night, I took zzz-quil last night. Slept till 5-6AM which was good. Unfortunately, I dont feel any better. Interesting too that my machine was basically flatlined...I have no idea what else to do at this point...

SleepyMcgee wrote:Frustrated with waking up at 3-4AM since my pressure was increased and then tossing/turning the rest of the night, I took zzz-quil last night. Slept till 5-6AM which was good. Unfortunately, I dont feel any better. Interesting too that my machine was basically flatlined...I have no idea what else to do at this point...

your machine agrees, you weren't sleeping well.

palerider wrote:

SleepyMcgee wrote:Frustrated with waking up at 3-4AM since my pressure was increased and then tossing/turning the rest of the night, I took zzz-quil last night. Slept till 5-6AM which was good. Unfortunately, I dont feel any better. Interesting too that my machine was basically flatlined...I have no idea what else to do at this point...

your machine agrees, you weren't sleeping well.

?


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I know you were wanting to fix the bad sleep with cpap tweaks but unfortunately if the bad sleep isn't caused by sleep apnea itself (and it's often hard to figure out what the cause is) then the most perfect cpap therapy in the world isn't going to help.

PR's comment...it seems like when a person is sleeping well...soundly, etc...you will see more pressure probes where the machine is testing things.
When we don't see many pressure probes then apparently the machine maybe thinks you are already not sleeping so great and it has no need to use the pressure probes.
The logic behind how and when the machine decides to use the probes is never really clearly explained.

If you are having difficulties adjusting to the new higher pressures and getting to sleep and all that.
That alone is a reason for poor sleep quality....there are of course any number of other reasons.
You've made some pretty significant changes in pressure and fairly rapidly after using much lower pressures for a considerable amount of time so it doesn't suppress me that you didn't immediately take this latest change like a duck to water.

Pugsy wrote:I know you were wanting to fix the bad sleep with cpap tweaks but unfortunately if the bad sleep isn't caused by sleep apnea itself (and it's often hard to figure out what the cause is) then the most perfect cpap therapy in the world isn't going to help.

PR's comment...it seems like when a person is sleeping well...soundly, etc...you will see more pressure probes where the machine is testing things.
When we don't see many pressure probes then apparently the machine maybe thinks you are already not sleeping so great and it has no need to use the pressure probes.
The logic behind how and when the machine decides to use the probes is never really clearly explained.

If you are having difficulties adjusting to the new higher pressures and getting to sleep and all that.
That alone is a reason for poor sleep quality....there are of course any number of other reasons.
You've made some pretty significant changes in pressure and fairly rapidly after using much lower pressures for a considerable amount of time so it doesn't suppress me that you didn't immediately take this latest change like a duck to water.

Oh OK. That helps clarify a bit for me. I think at this point I continue at the pressure I'm at see if I can get used to it and sleep a full night. The strange thing is though, I find the pressure totally fine. It doesn't bother me...at least when I'm awake. But maybe that changes once I'm asleep and it will just take time for my brain to get used to it while I'm sleeping.


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SleepyMcgee wrote:The strange thing is though, I find the pressure totally fine. It doesn't bother me...at least when I'm awake. But maybe that changes once I'm asleep and it will just take time for my brain to get used to it while I'm sleeping.

if you're good with the pressure, maybe a little more would help things even out... it might be worth a try.

SleepyMcgee wrote:Frustrated with waking up at 3-4AM since my pressure was increased and then tossing/turning the rest of the night, I took zzz-quil last night. Slept till 5-6AM which was good. Unfortunately, I dont feel any better. Interesting too that my machine was basically flatlined...I have no idea what else to do at this point...

The only thing of possible interest that's going on between 3-4AM is that there are 4 RERAs and a VS2 snore scored around 3:30. And since you admit that you were already tossing and turning between 3:00 and 4:00, there's actually a (pretty good) chance that some or all of those RERAs are not real events. The RERAs are too far apart to trigger a pressure increase and the VS2 snore is the kind of snore that does NOT cause pressure increases on a PR machine. The ones that cause the pressure to increase are the VS snores. And nobody around here has any idea what the criteria a PR machine uses to distinguish a VS snore from a VS2 snore.

The "surprise" such as it is in your data is that there are no pressure probes---i.e. there's no evidence of "test pressure increases" to see if the breathing improves with a slight increase in pressure. Now it's possible that's because you are running in a 1cm pressure range and the pressure probes usually involve using a gradual 2cm increase in pressure as part of the PR Search algorithm. Or perhaps its because your breathing is "unstable" enough that the machine is worried that you are restless and are in a light enough sleep that a test pressure increase that is NOT needed in response to events might wake you up. Since there's no wave flow posted we can't test that theory by looking at the wave flow.

In my humble opinion the reason that your sleep remains bad is most likely something UNRELATED to either your OSA or your CPAP therapy. Unless you can pinpoint some kind of discomfort issues with the CPAP therapy, in which case you need to describe the discomfort issues you have with CPAP therapy in language that is more specific than, "I wake up at 3:00 or 4:00 and can't get back to sleep."

In my opinion the reason you are continuing to feel bad is that you are spending several hours each night after that 3:00AM wake fighting to get back to sleep. It's the fighting for sleep that's causing the long periods of tossing and turning and it is the long periods of tossing and turning that are making you feel exhausted all the time.

I still think you might be better off worrying less about how to optimize your CPAP settings, which already look pretty optimal on paper, and more about other potential causes and fixes for the 3:00AM wake and the subsequent long period of tossing and turning for the rest of the night.

When you wake up at 3:00 or 4:00AM, what is the first thing that goes through your mind? What is the very first thing that you DO after you wake up at 3:00 or 4:00? And how long does it take for you to start worrying about the fact that you are tossing and turning instead of getting back to sleep relatively quickly?

Answers to those questions are MORE likely to help you find a fix for your current problems than dial wingin' the CPAP's settings.

robysue wrote:

SleepyMcgee wrote:Frustrated with waking up at 3-4AM since my pressure was increased and then tossing/turning the rest of the night, I took zzz-quil last night. Slept till 5-6AM which was good. Unfortunately, I dont feel any better. Interesting too that my machine was basically flatlined...I have no idea what else to do at this point...

The only thing of possible interest that's going on between 3-4AM is that there are 4 RERAs and a VS2 snore scored around 3:30. And since you admit that you were already tossing and turning between 3:00 and 4:00, there's actually a (pretty good) chance that some or all of those RERAs are not real events. The RERAs are too far apart to trigger a pressure increase and the VS2 snore is the kind of snore that does NOT cause pressure increases on a PR machine. The ones that cause the pressure to increase are the VS snores. And nobody around here has any idea what the criteria a PR machine uses to distinguish a VS snore from a VS2 snore.

The "surprise" such as it is in your data is that there are no pressure probes---i.e. there's no evidence of "test pressure increases" to see if the breathing improves with a slight increase in pressure. Now it's possible that's because you are running in a 1cm pressure range and the pressure probes usually involve using a gradual 2cm increase in pressure as part of the PR Search algorithm. Or perhaps its because your breathing is "unstable" enough that the machine is worried that you are restless and are in a light enough sleep that a test pressure increase that is NOT needed in response to events might wake you up. Since there's no wave flow posted we can't test that theory by looking at the wave flow.

In my humble opinion the reason that your sleep remains bad is most likely something UNRELATED to either your OSA or your CPAP therapy. Unless you can pinpoint some kind of discomfort issues with the CPAP therapy, in which case you need to describe the discomfort issues you have with CPAP therapy in language that is more specific than, "I wake up at 3:00 or 4:00 and can't get back to sleep."

In my opinion the reason you are continuing to feel bad is that you are spending several hours each night after that 3:00AM wake fighting to get back to sleep. It's the fighting for sleep that's causing the long periods of tossing and turning and it is the long periods of tossing and turning that are making you feel exhausted all the time.

I still think you might be better off worrying less about how to optimize your CPAP settings, which already look pretty optimal on paper, and more about other potential causes and fixes for the 3:00AM wake and the subsequent long period of tossing and turning for the rest of the night.

When you wake up at 3:00 or 4:00AM, what is the first thing that goes through your mind? What is the very first thing that you DO after you wake up at 3:00 or 4:00? And how long does it take for you to start worrying about the fact that you are tossing and turning instead of getting back to sleep relatively quickly?

Answers to those questions are MORE likely to help you find a fix for your current problems than dial wingin' the CPAP's settings.

Thanks.

The waking only started this week at the higher pressures. When I wake up I think "I'm tired, sleepy time" and i fall into a restless in and out sleep for the next couple of hours. I never really worry about going back to sleep. I'm exhausted and half coherent not 'wide awake staring at the ceiling'.


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SleepyMcgee wrote: The waking only started this week at the higher pressures. When I wake up I think "I'm tired, sleepy time" and i fall into a restless in and out sleep for the next couple of hours. I never really worry about going back to sleep. I'm exhausted and half coherent not 'wide awake staring at the ceiling'.

Did you make any changes to your CPAP settings shortly before the wakes started?

Did you recently switch from CPAP to APAP?

Did you recently increase your max pressure setting on APAP?

Did you recently increase your min pressure setting on APAP?

If nothing has changed on the CPAP settings, then my guess is that the problem is NOT the CPAP.

Any chance you are under a lot of stress right now? If so, did the stress get worse around the time the wakes started?

I still think you might be better off getting out of bed for a few minutes when you first wake up. Go to the bathroom. Get yourself a drink of water. Stretch your arms and legs if they're restless or antsy. Blow your nose if there's any congestion. And go back to bed in about 5 minutes. That might be just enough to let your mind clear itself of whatever worrying or fretting you might have that also seems to be causing the long periods of tossing and turning after the wake.

robysue wrote:Now it's possible that's because you are running in a 1cm pressure range and the pressure probes usually involve using a gradual 2cm increase in pressure as part of the PR Search algorithm.

pressure probes are a 1.5cm increase, there was what looks to be one at about 12:10

robysue wrote:

SleepyMcgee wrote: The waking only started this week at the higher pressures. When I wake up I think "I'm tired, sleepy time" and i fall into a restless in and out sleep for the next couple of hours. I never really worry about going back to sleep. I'm exhausted and half coherent not 'wide awake staring at the ceiling'.

Did you make any changes to your CPAP settings shortly before the wakes started?

Did you recently switch from CPAP to APAP?

Did you recently increase your max pressure setting on APAP?

Did you recently increase your min pressure setting on APAP?

Yes. I changed min from 7 to 10 and moved the max down from 13-ish to 11. Been at that pressure for almost a week I think. AHI has gone down substantially but now I'm waking up after 4-5 hours of sleep. No fretting or worrying. I don't lie in bed awake. I fall back to sleep (10-30 mins) and then sleep, poorly for a few hours.


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SleepyMcgee wrote:now I'm waking up after 4-5 hours of sleep. No fretting or worrying. I don't lie in bed awake. I fall back to sleep (10-30 mins) and then sleep, poorly for a few hours.

there's a fair amount of talk that a divided sleep schedule used to be the norm, people would sleep a few hours, wake up, get up do some stuff, and then go back to bed for a few more hours.

palerider wrote:

robysue wrote:Now it's possible that's because you are running in a 1cm pressure range and the pressure probes usually involve using a gradual 2cm increase in pressure as part of the PR Search algorithm.

pressure probes are a 1.5cm increase, there was what looks to be one at about 12:10

That pressure blip is way to short AND way too small to be a Search algorithm pressure probe. My best guess is that the machine thought about increasing the pressure in response to the FL scored at around 12:10 and JUST before the pressure blip. And I would guess the machine decided the breathing got less stable rather than more, and hence decided to lower the pressure right back down.

On my PR S1 BiPAP, the probes are 2cm probes---if there's nothing found. Yeah, some of the time it "finds" something before it finishes the probe and then it adjusts the IPAP pressure by an amount that is less than 2cm.

On my new DreamStation BiPAP, the Search algorithm pressure probes still seem to be 2cm probes---if nothing's found before the 2cm is reached.

If you'd like to see the data, I can post some.

palerider wrote:

SleepyMcgee wrote:now I'm waking up after 4-5 hours of sleep. No fretting or worrying. I don't lie in bed awake. I fall back to sleep (10-30 mins) and then sleep, poorly for a few hours.

there's a fair amount of talk that a divided sleep schedule used to be the norm, people would sleep a few hours, wake up, get up do some stuff, and then go back to bed for a few more hours.

I know...But it's not MY norm and I'm going to sleep at 10-11 not 6-7. Additionally it's only been happening for a week...

Also...we just installed electricity so...


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robysue wrote:On my PR S1 BiPAP, the probes are 2cm probes---if there's nothing found. Yeah, some of the time it "finds" something before it finishes the probe and then it adjusts the IPAP pressure by an amount that is less than 2cm.

On my new DreamStation BiPAP, the Search algorithm pressure probes still seem to be 2cm probes---if nothing's found before the 2cm is reached.

If you'd like to see the data, I can post some.

interesting, every other pic I've seen, and raw data I've examined, the probes are 1.5cm, like in this image from Pugsy: