Waking up too early

Hello all. I'm a long time lurker and first time poster hoping someone can help me with this annoying and tiring issue. I'll try to make my history as short as can be:
- sleep issues began with severe sleep-onset insomnia about five years ago. Assumed stress related, medications helped somewhat, failed CBT-I x 2 attempts. Didn't get sleep study because I am slender and otherwise healthy, didn't have hypersomnia or other sleep apnea symptoms.
-three years later developed early awakenings as well, finally got talked into sleep study which showed AHI 7. Prescribed CPAP 6 cm O2, but was not able to fall asleep with it on at home and had poor follow-up so gave up.
- Went to see Dr. Krakow in New Mexico before he retired. Sleep study there showed AHI 7 RDI 33, diagnosed with UARS. Couldn't tolerate BiPAP during titration, eventually able to tolerate ASV after two titrations, albeit with sleep medication and CBT-I to help adjust. At best, this gave me 30% relief of my symptoms.
- Had septoplasty/turbinate reduction/nasal valve surgery summer 2019 with hope of being able to tolerate ASV better, but did not help at all.
- Had expansion sphincter pharynoplasty/lingual tonsillectomy in summer 2020 which improved my overall symptoms by 50-75% depending on the night. Amazingly, three months after the surgery I did CBT-I again and was able to get off medication for the first time in 4 years. I still have occasional sleep-onset trouble but only 1-2 x a month now. I was able to return to work full time after this.
- Six months after that surgery I went back to New Mexico for another sleep study, now AHI 0.5 RDI 15. I stayed the next night to do another ASV titration to see if I could get closer to 100% improvement.

I am currently using ResMed S9 VPAP Adapt SV Auto settings: Max PS 9.6, Min PS 4.6, Max EPAP 10, Min EPAP 7.6. It doesn't appear that this machine is compatible with OSCAR.

My issue is that almost every morning I wake up 1-3 hours too early. It's an abrupt awakening, and I either can't get back to sleep at all after this or I can on and off but remain in a very light, non-restful sleep. When it's mercifully only one hour early, I'm okay during the day. But the closer it gets to the 2-3 hour mark I feel like crap during the day and will usually have a headache all day. I've adjusted the settings on my ASV a bit and it doesn't help. The awakenings also happen whether I use the machine or not. Lately I've been going without it since I still struggle to fall asleep with it on (but not without) so the net gain of sleeping without it has been better than that of using it. I've tried medications and they can help me fall back asleep more easily (with a morning hangover later) but the awakenings still happen.

Any help/thoughts about what is going on would be greatly appreciated!

-Tom

Hello, Tom. What an interesting saga! Did anything change in your life back around the time you began waking up early?

You are probably well aware of the guidelines for good sleep, but it's worth reviewing alcohol use, which can cause disruption partway through the night, and regularity of bedtime and wake-up times.

You might also want to think about your daytime exposure to sunlight, and especially whether it changed around the time of your early awakening. More here:

https://www.sleepfoundation.org/bedroom ... -and-sleep

About Oscar compatibility: it'd be worth trying to see whether the software will accept the data from your SD card (assuming you have one). Here's the relevant information, which is ambiguous given your description of your machine:

Resmed S9 Series

Elite CPAP
Autoset
Autoset for Her
VPAP S
VPAP Auto
VPAP ST
VPAP Adapt (AutoSet CS)

Not Supported by Oscar

AirStart (all models)
Airsense 10 CPAP
AirMini
S9 CPAP SE
S9 Escape CPAP
S9 Escape Auto
Resmed S8 and earlier series

Miss Emerita,

Thanks so much for your response! Regarding OSCAR I tried with my SD card last night and it didn't seem to upload properly, but I am a bit of technophobe so I'm going to see if one of my more computer-savvy friends can help me out.

Regarding sleep habits and such, I keep a strict 8 hour sleep window and adhere to CBT-I style recommendations at all times. I don't drink, smoke, use any illicit substances. I've 5'9 and weigh 150 lbs. I eat a plant-based diet (80% plant, 20% animal source) Before this sleeping problem I was amazingly healthy and had more energy than most people I knew. I have continued to exercise every day even once the sleep issues started. I've also gotten big into meditation which helps with the frustration part of all this but has never resulted in better sleep for me. I don't share my sleep issues with anyone except for my wife and closest friends, and most people would never guess from my outward appearance that I've had so much difficulty. In fact, when I had to fess up to work colleagues that I would be gone for weeks because of sleep apnea surgery, they were stunned because I appeared so healthy.

Regarding sun exposure; I live in the desert and get a lot of sun exposure in the morning and day. I've tried numerous sleeping time schedules, sun lamps, blue-blocking glasses at night, none of which have changed anything.

As far as what happened when the early awakenings started: That was a period where I was trying numerous different medications to help with insomnia. Hypnotics, tricyclics, antihistamines. This was before I realized that SDB issues were at least a part of my insomnia. I don't think any of these medications "caused" the early awakenings, I just think it was the natural progression of my UARS for whatever reason.

Thank you again for your response!
Tom

TomRogers wrote: ↑

Fri Feb 19, 2021 7:53 am

Miss Emerita,

Thanks so much for your response! Regarding OSCAR I tried with my SD card last night and it didn't seem to upload properly, but I am a bit of technophobe so I'm going to see if one of my more computer-savvy friends can help me out.

Regarding sleep habits and such, I keep a strict 8 hour sleep window and adhere to CBT-I style recommendations at all times. I don't drink, smoke, use any illicit substances. I've 5'9 and weigh 150 lbs. I eat a plant-based diet (80% plant, 20% animal source) Before this sleeping problem I was amazingly healthy and had more energy than most people I knew. I have continued to exercise every day even once the sleep issues started. I've also gotten big into meditation which helps with the frustration part of all this but has never resulted in better sleep for me. I don't share my sleep issues with anyone except for my wife and closest friends, and most people would never guess from my outward appearance that I've had so much difficulty. In fact, when I had to fess up to work colleagues that I would be gone for weeks because of sleep apnea surgery, they were stunned because I appeared so healthy.

Regarding sun exposure; I live in the desert and get a lot of sun exposure in the morning and day. I've tried numerous sleeping time schedules, sun lamps, blue-blocking glasses at night, none of which have changed anything.

As far as what happened when the early awakenings started: That was a period where I was trying numerous different medications to help with insomnia. Hypnotics, tricyclics, antihistamines. This was before I realized that SDB issues were at least a part of my insomnia. I don't think any of these medications "caused" the early awakenings, I just think it was the natural progression of my UARS for whatever reason.

Thank you again for your response!
Tom

Have you tried sleeping later? I found that forcing myself to conform to the golden rule of 8 hour sleep doesn't work. Sometimes I feel great when I sleep just 7 hours and if I try to force myself to sleep a lot earlier than usual I keep waking up the whole night and have restless sleep.

Did you change your diet after being diagnosed?

Sleep is very individual and the best metric in my opinion is how you feel upon waking up regardless of how many times you woke up, hours you slept, etc.

Tom, you have really covered the bases. I hope you can get wring some data out of your SD card. If we could look at what happens as you have these abrupt awakenings, we might have a better idea of what is going on.