Consistently Waking Up Multiple Times Per Night

chexxum · Post by **chexxum** » Tue Jan 07, 2020 1:49 pm

Hello,

I was diagnosed with mild sleep apnea in September 2018, I started CPAP treatment a few weeks later and noticed an amazing improvement right away. For the first time in my life, I would go to sleep and not have any memory of waking up throughout the night. I had all the positive benefits associated with better sleep: better mood, increased athletic performance, better recovery, etc. Everything was going well until around August 2019, I started to consistently wake up throughout the night. I'll go to bed around 11pm and I'll wake up multiple times a night, usually I'll remember switching the side I am sleeping on. This will continue until around 4-5am when I begin to find it difficult to fall back asleep. Around this time I will usually just get up and start my day. The problem is that I'm not getting a full 8hrs+ of sleep and I'm feeling really fatigued. I've tried several different masks, mask liners, CPAP pillows, humidifier settings, etc. I sleep with an eye mask and earplugs, Breathrite nose strips, I tried mouth tape for a little while. I never drink coffee past 11am but I went caffeine free for 3 weeks. I went to my sleep doctor and explained what was happening and they increased my pressure from 6-10cm to 7-14cm around October 2019. Nothing has worked and I'm starting to lose hope that I will be able to return to the restful sleep that I was having. I'm posting my data here in hopes of fixing this issue.

I live in Germany, if that matters.

Thank you.

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Pugsy · Post by **Pugsy** » Tue Jan 07, 2020 2:13 pm

Welcome to the forum.

Google "sleep maintenance insomnia" and start reading. The list of potential causes for that form of insomnia is huge but I usually start with medication side effects as a potential cause first because it is so common.

There's nothing of great excitement that I can see as a huge potential cause on these reports.
Now there is a rather wide variation in the pressure being used during the night. Probably related to sleeping position (higher when on your back probably) and I don't know if the changes are related to the poor sleep quality or not but maybe try a little more minimum pressure and see if getting the pressure line to stabilize a little more helps with the sleep quality or not. For some people it helps and for others it makes no difference.

Your flow limitation graph is a bit active but not horribly ugly....are you having much nasal congestion going on at night?
If not...more minimum pressure might might help clean up the FL graph which might improve sleep quality.
If you are having a lot of nasal congestion more pressure is unlikely to help though.

chexxum · Post by **chexxum** » Sun Jan 12, 2020 3:16 pm

I don't think I have a lot of nasal congestion in the sense that I'm sick, but I suspect I do have a deviated septum that makes breathing through my nose a little more restricted than normal. I'm not on any medication, I do take some supplements such as creatine that may affect my sleep but I think I was able to rule it out because I was taking it for a good year before I started having my sleep troubles. The other thing I thought might have caused this is that I currently have braces and maybe the shape of my jaw is changing and that might be affecting my apnea in some way? I don't know for sure, just spitballing. I'm going to try raising my minimum pressure to see if that does anything, thank you!

Miss Emerita · Post by **Miss Emerita** » Sun Jan 12, 2020 6:49 pm

It is possible the pressure changes are bothering you. They appear to be in response to your flow limitations.

You should most definitely follow Pugsy’s advice any time she gives you some! And it is usually best to make one change at a time, so for now, just do what she says.

But down the road if you want to try additional adjustments, you could turn on EPR, and you could lower your maximum pressure. About that: capping pressure would make sense only in limited circumstances, but with your generally low AHI and your FLs pushing the pressure up, it might be worth a try at some point.

chexxum · Post by **chexxum** » Sun Feb 02, 2020 5:22 am

Hello,

Here are some stats after I adjusted the pressure and turned on EPR. I think the setup is working better, I'm getting less leaks most nights and it feels easier to breathe out through the mask. Unfortunately, I still haven't slept through the night without waking up multiple times and I'm still feeling exhausted upon getting up. I looked into sleep maintenance insomnia, one change I made is that I've been going to sleep and waking up at a consistent time for the past two weeks. Has anyone else had success in dealing with sleep maintenance insomnia? I'm going to try out a weighted blanket to see if that helps.

chexxum · Post by **chexxum** » Sun Feb 02, 2020 5:25 am

More stats

tan · Post by **tan** » Sun Feb 02, 2020 11:43 am

chexxum wrote: ↑
Tue Jan 07, 2020 1:49 pm
Hello,

I was diagnosed with mild sleep apnea in September 2018, I started CPAP treatment a few weeks later and noticed an amazing improvement right away. For the first time in my life, I would go to sleep and not have any memory of waking up throughout the night. I had all the positive benefits associated with better sleep: better mood, increased athletic performance, better recovery, etc. Everything was going well until around August 2019, I started to consistently wake up throughout the night...

Your charts show noticeable FL limitations, which, given your description, in turn may indicate an untreated UARS, which typically hides itself during the "honeymoon" period.

If I were you, I would try a few things:
1) practice strict sleep hygiene with a goal of waking up every morning at the same time, be it weekend or weekday. Maybe you will have to reduce your total time in bed initially to make yourself sleep through the night and then gradually increase your time in bed, while having uninterrupted sleep;

Let's say you have to wake up at 7:00 in the morning, you have to go to bed at midnight to keep your total time in bed to 7hours. Try a few nights, if your sleep remains fragmented, reduce your time in bed even further, by going to bed later, but waking up at the same time, no matter what. The goal is re-train your body to have a sound sleep. After your sleep is sound and uninterrupted but time-limited, gradually increase the time spent in bed.

Of course, no TV, coffee, alcohol and other things that may disrupt your sleep

2) increase your APAP pressure to at least the 95% figure, which in your case is around [s]11[/s] 12-13, do that gradually

chexxum · Post by **chexxum** » Sun Feb 02, 2020 1:14 pm

Thank you for the suggestions. I will try reducing my time spent in bed. What do you mean by "increase the APAP pressure"? Is this the minimum or maximum pressure? Or is it a different setting all together?

Thank you for the reply!

palerider · Post by **palerider** » Sun Feb 02, 2020 1:22 pm

chexxum wrote: ↑
Sun Feb 02, 2020 1:14 pm
Thank you for the suggestions. I will try reducing my time spent in bed. What do you mean by "increase the APAP pressure"? Is this the minimum or maximum pressure? Or is it a different setting all together?

He means "set your minimum to 10 and max to 20"

tan · Post by **tan** » Sun Feb 02, 2020 9:24 pm

what helped me sleep through the night short term is a half of whole (not ground) nutmeg seed, a spice. But long term you have to stick with a consistent sleep schedule. NO sleep-ins and NO staying in bed past regular awakening is the simple but not easy path.

OP, do you by chance have access to your sleep study results? All too often, in the past or present, sleep doctors only bother to look at AHI, while completely ignoring RDI, which if considerably elevated, causes more sleep problems than the "mild apnea":
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881892/

In other words, patients with AHI < 5 but RDI > 10 felt worse patients with 5 < AHI < 15

Consistently Waking Up Multiple Times Per Night

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