jolting - waking up and insomnia or not using cpap

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robysue1
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Re: jolting - waking up and insomnia or not using cpap

Post by robysue1 » Sun Sep 25, 2022 3:33 pm

dacotto1984 wrote:
Sat Sep 24, 2022 6:50 pm
robysue1 wrote:The early morning gap
The next most striking thing about your last four days of data is an early morning gap that's about 75-90 minutes long when you're not using the machine. Given your previous posts, I'm assuming this is when you wake up, go to the bathroom, and then can't get back to sleep.

Are you just getting out of bed and doing something else until you get sleepy and then putting the mask back on when you go back to bed? Or are you taking the mask off in hopes of getting back to sleep and then for whatever reason, you finally do put the mask back on?

<much deleted>
you need to tell us more about what's going on during that time frame.
yes. even though i do have large leaks during the 4 to 5 hours of continuous sleep, i am not waking up (Thank goodness! at least i have that!). But its that dreaded 5am - 5:30am wake up, going to urinate and not being able to go back to sleep when i get back into the bed. This has been going on for like 2 - 3 months (before the 2-3 months it was worse. i couldn't sleep at all, no matter what i did.. not even sleeping pills helped (trazodone, melantonin, benadryl), the sleeping pills just made everything way worse.

I think i am now in my third week, where i can actually lay down in bed at around 11pm - 12am, put the mask on and go to sleep in 30 - 60 minutes (which is a god send) . But its that dreaded 5am wake up that has me going crazy. After i come back from bathroom, ill throw the mask on, close my eyes but then feel my heart kind of elevated... maybe like a bit more of a pump/rush than usual (if that makes any sense).. it feels a little bit like "fear", but not so much to be considered fear (if that makes sense) maybe just a bit of a heart race or something.
So if I'm reading this correct there are three things that are relevant to the middle-of-the-night insomnia issue you're dealing with:

1) This dreaded 5am wake started before you started CPAPing. As did the problem of not being able to get back to sleep after you wake up at 5am, sometimes for the whole rest of the night. Sometimes you finally drift back to sleep sometime around 7 am.

2) Before the OSA diagnosis and the start of PAP therapy, a number of sleep medications were tried, but they were not successful. This is not particularly surprising: Sleeping pills are more effective at treating sleep onset insomnia---when you just can't get to sleep at the beginning of the night---than they are at treating sleep maintenance insomnia, which occurs when you can't get back to sleep after successfully falling asleep in the first place.

3) You are noticing weird sensations when you put the mask back on after the dreaded 5am wake and these weird sensations are increasing your worry and anxiety making it even tougher to get back to sleep. The sensations you describe sound like a anxiety attack: Feeling like you've got an elevated heart beat, feeling like your heart is racing, feeling like an unspecified "fear".

It's also worth pointing out that your data indicates that dreaded wake can happen as early as 3:40 (on September 21) or as late as 5:10 am (on September 23). But it also always occurs after a nice, long 5-6 hour CPAP session that at this scale looks like was uninterrupted sleep. That kind of timing indicates this may very well be a (normal) post-REM wake that just gets out of hand. (More on that in a bit.)

So in my opinion, that dreaded early AM wake most likely has little or nothing to do with your PAP therapy since the patter started before you started PAP. And because your PAP therapy shows the OSA is pretty well controlled, I'm not convinced that untreated OSA was the only cause of that wake before you started PAPing because the pattern has continued after the OSA has been brought under control.

In other words, I suspect that the reason the dreaded early AM wake is so troublesome is the fact that you dread it so much: In other words, what I think is happening is that your anxiety takes over as soon as you realize that you have woken up yet again at (roughly) 5am needing to go pee. And the whole time you're out of bed going to the bathroom, your anxiety is working overtime and your brain just can't stop the worry that you will never get back to sleep (again!) from taking over.

And once you do go back to bed, it's a self-fulfilling prophecy: You don't expect to be able to go back to sleep, so the anxiety keeps you from going back to sleep. And the longer in bed you lie there trying to get back to sleep, the more anxious you become and the more you start to notice the racing heart beat. And the more you notice the racing heartbeat, the harder it becomes to tell yourself to just settle down and go back to sleep.

One thing i do notice though.. right before that time when i wake up at 5am, ill kind of have a fearful event happen in my dreams. For example, if im riding a bike, then maybe ill fall off the bike or get scared that ill hit a car and then wake up. Im already getting use to that . But i do notice that does kind of happen... not always, but enough to notice.
This adds to the evidence that your dreaded early AM wake may be a normal post-REM wake that is just careening way out of proportion due to your anxiety about being awake in the middle of the night.

So reviewing some information about our so-called sleep cycles is in order: In normal sleep that is not full of interruptions caused by OSA, a typical person cycles through a "full sleep cycle" approximately every 90 minutes. The sleep cycle typically consists of periods of light sleep (Stage 1/2), deep sleep (Stage 3/4), and REM sleep. Stage 1 sleep is roughly the transition to real sleep and is typically pretty short in a normal sleep cycle. And there's a debate about whether there's really a difference between Stage 3 and Stage 4 sleep.

The typical progression of the stages in a full sleep cycle often looks something like this:

Stage 1 (very short) -> Light Sleep -> Deep Sleep -> Light Sleep -> REM

And at the end of the REM cycle? A person typically either wakes up (very briefly), goes to Stage 1 sleep (very briefly) or goes back to Light sleep and the next sleep cycle starts.

Now it's important to note that in a person without insomnia, that post-REM wake (when it occurs) is typically so short that the person doesn't remember it the next morning: We typically only remember wakes that are at least 5 minutes long when we wake up in the morning. Now why would a normal person wake up briefly and then go immediately back to sleep? Well you can think of it this way: The person briefly awakes just to make sure there's nothing that presents some kind of need to get up, realizes that everything is just fine, and then goes back to sleep.

But insomniacs have a tendency to first of all worry excessively when they find themselves awake in the middle night---i.e. an insomniac's brain is screaming, "There must be SOMETHING wrong since I'm AWAKE." Add to that the fact that many insomniacs can confuse Stage 1 and light sleep with wake: Most insomniacs vastly overestimate the time they are actually awake and tossing and turning and trying to get to sleep and consequently also underestimate the amount of sleep they've actually gotten. They also sometimes overestimate how much sleep they actually need in order to "sleep well."

Now add in the fact that in sleep cycles near the beginning of the night, the amount of time in deep sleep is usually longer than the amount of time in REM. As the night progresses, in each subsequent sleep cycle, the amount of deep sleep decreases and the amount of REM sleep increases. So vivid, prolonged dreams (of all types) are more likely to occur in the later sleep cycles.

Now as I mentioned earlier, your dreaded early AM wake seems to occur at the end of 5-6 hours of real sleep. In other words, you're waking up at the end of the 4th full sleep cycle. You've probably just come out of a prolonged REM period with a relatively vivid (but normal) dream. And your bladder is also saying it's full enough to be relieved by going to the bathroom. So you get up to go pee (which extends the length of the wake) and by the time you're back in bed, your anxious, insomniac's brain has taken over and that's what's preventing you from drifting back off to sleep relatively quickly.

I also noticed that in my dreams, after i sleep around 7am, ill wake up a few times with dreams like im going to choke in something.. like the roof of a house comes falling on me slowly.. or that i travel down a tight corridor or a tunnel that all of a sudden gets tighter and tighter as if im going to get buried alive and choke, ill wake up out of fear
Choking dreams are not uncommon for folks with untreated OSA: Each obstructive apnea and each obstructive hypopnea is a mini-suffocation. And for many people, the OSA is much worse during REM sleep, so those mini-suffocations are occurring more frequently to feed the choking dreams.


You also write:
ill wake up out of fear and after seeing last nights AH events i noticed i have a few events there.. so those dreams might be related to those apneas and my brain trying to scare me awake.
I think you are letting your anxiety run wild here. When I look at your data, this is what I see:

On September 20, the closest events to the 4:20 wake are a pair of RERAs scored around 3:15. Yes, there's a bit of large leaking going on, but those large leaks are still under 40 L/min so they're not likely to be interfering with the machine's ability to track your breathing or detecting OAs and Hs. So the dreaded early AM wake on this night is not tied to any OSA event.

On September 21, the closest event to the 3:40 wake is a hypopnea scored around 2:45. Yes, there is a large leak, but the leak level is only around 35 L/min so it is not likely to be interfering with the machine's ability to track your breathing or detecting OAs and Hs. So the dreaded early AM wake on this night is not tied to any OSA event.

On September 22, the dreaded early morning wake appears to be around 4:10. You turn the machine off and then back on, but don't get back to sleep. You turn the machine off again about 4:20 for what looks like the bathroom break, and then there's the large gap where you're not using the mask after you come back to bed. The nearest event to the 4:10 awake is a RERA at about 3:55. The nearest actual hypopnea is at 3:35. While it's possible that RERA triggered the wake, it's also possible you were already awake and the RERA got scored as part of SWJ. But there's no real evidence that the H at 3:35 had anything to do with the wake.

On September 23, there is an hypopnea scored around 5:00 and you turn the machine off at around 5:10. But the whole CPAP session between 4:15 and 5:10 has characteristics of SWJ breathing. In other words, it would not surprise me if this was a night where you tried to keep the mask on after the 4:15 wake and just never got to sleep. So you turned the machine off at 5:10. And then did what? Lie in bed and fall back into a light sleep without the mask? Or continue to toss and turn? There's no way to tell from the data. It's also worth noting that while there is a RERA scored around 4:10 and you turn the machine 4:15, the SWJ stuff appears to start around the time of the end of the last large leak. Yes, there are a couple of hypopneas scored at the end of that large leak. So it is possible that either the hypopneas or the large leak or both is what triggered an obviously less than restful period of "sleep" with the mask on your nose from roughly 3:40 to 5:15.

after i wake up, i check to see if im somehow not suffocating in my own mask somehow, my brain might still be trying to throw fear to me to wake me up, perhaps my brain doesnt quite know that there is a mask on my face trying to save my life vs a pillow smothering my face to death, blocking my oxygen.. or perhaps the mask is twisted off and is smothering me or not providing the pressure to open my air ways...
This is a actually quite common experience for newbies, particularly newbies with anxiety problems. There is a tendency to wake up and notice, "Hey there's this thing on my face and over my nose and mouth. Is it trying to kill me???"

That's part of why us more experienced people tell new CPAPers that it can take a while to learn how to sleep with the mask on your face: Your brain has, in fact, been in a hyper-vigilant mode prepared to wake up up (for 20 seconds or so) to restart the breathing every time you have an obstructive apnea. It's not a big surprise that it can take a while for the brain to relax and realize this new monster clinging so tightly to the face is a friendly monster that is helping you breathe instead of your own airway collapsing and nearly choking you every few minutes.
But anyway, yes ill wake up around 5am, urinate, put the mask on for like 10 to 30 minutes, try to sleep, fail, then take off the mask and just concentrate on breathing and relaxing without the mask.. ill just lay there, think, think of future, organize my thoughts, turn to the phone and watch memes, read comments or whatever, then put phone down after 40 minutes, ill quietly and softly put on my mask, relax and luckily, fall asleep (which is a god send).
There are a whole bunch of somewhat conflicting comments I have to make about this. So bear with me.

First, treating insomnia requires teaching your body that being in bed = being asleep. But what you are doing here, particularly when you turn your phone on and start using it for 40 minutes to distract yourself is actually teaching your body that being in bed = not needing to be asleep.

So if you really want to increase the likely hood that your body will go back to sleep quickly after that dreaded early AM wake, you may be better off getting out of bed if you haven't been able to get back to sleep in about 20 minutes. Yes, that sounds awful. But all I'm suggesting is this: When you reach for the phone, go ahead and get up. Move to another room and curl up in a comfy chair and allow yourself to enjoy looking at the memes (maybe even laugh out loud if there's a funny one). Don't start reading comments on anything that might be upsetting. (In other words, avoid reading about politics. Avoid reading about OSA. Avoid reading about hurricanes, earthquakes, etc.). Once you start to feel sleepy go back to bed and see if you can get back to sleep in a timely fashion. If you still can't get back to sleep, get out of bed and repeat the go to another room and distract yourself.

Now I do want to mention: Being on a phone at 5:00 am might not be the best choice of what to do to distract yourself. Screens emit blue light which can be exceptionally disruptive to our melatonin cycles, and hence to sleep. One (partial) fix is to make sure "night" mode is on. It also helps if you change the phone's "light temperature" much further to the orange/red end of the spectrum. There are apps that will do this and some phones will have settings that will do this automatically.

Also, if you are lying in bed for extended periods of time thinking of future and organizing your thoughts, that too can help teach the body that being in bed does not mean being asleep. If you are someone who enjoys journaling, it can be more relaxing (and better for your sleep) to go ahead and get out of bed and write those plans and thoughts down in your journal and then go back to bed when you are feeling sleepy.

Now the down side to this plan for tackling the insomnia associated with that wake is that it is possible that your body (and brain) may decide that it likes being awake in the very quiet early AM hours when everybody else in the house is asleep specifically because you can use that time as me-time: Time for you to do the quiet thinking (or meme-watching on the phone) that you don't have time for during the day. And if that happens, the best thing to do is to simply accept that your body may actually want what is called a divided sleep schedule.

Divided sleep schedules were quite common before the invention of reliable interior lighting in the 1800s: People went to bed when it got dark, woke up a few hours later in the wee hours of the morning and often did various things. (Sex being one of the most common. But quiet prayer and reflection among religious folks was another. And various night time chores was another.) And after being up for an hour or two in the middle of the night people returned to bed when they got sleepy and then woke up when daylight returned a few hours later.

My husband's current sleep patterns follow this pattern: He usually falls asleep hard (with his CPAP) around 9:30 or 10:00 and sleeps well until his "little old man" bladder wakes him up sometime between 3:30 and 4:30. He gets up, goes to pee, then goes downstairs and makes himself some coffee and starts reading business related stuff on his computer. He finds that his mind is fresh and awake and he enjoys the uninterrupted time to do some serious thinking. When he starts to get sleepy around 5:30 or 6:00, he comes back to bed and typically sleeps one more full sleep cycle before getting up for the day. This works for him. His total sleep time is enough to keep him functioning long term---he gets 7.5-8.5 hours of quality sleep per night and he's learned to not worry at all about being up in the middle of the night for an hour or two.

Even though i hate the fact that i wake up at this time and i am not able to sleep from 11pm to 7am, i am at least happy that I CAN fall to sleep at some point. Its extremely bittersweet to me.
Before my issues, if i would wake up and 5am. id look at the clock and say, omg, its 5am.. back to sleep.. and go back sleep no issues. Couldn't for the life of me stay up during that time. Now its like, normal and i really dont like that.
it feels like im at the brink of insomnia everytime.
Clock watching feeds the insomnia monster. If at all possible, try to not look at the clock every time you wake up. And try to not look at the clock every few minutes when you are lying in bed trying to get to sleep or trying to get back to sleep after you've gone to the bathroom.
i just wish i can continous sleep from 11pm to like 7 or 8am like i use to.
It's worth remembering that you did not have continuous sleep from 11pm to 7 or 8 am before you started CPAP: Your brain was waking up every few minutes for maybe 20 seconds at a time in response to the apneas. But you didn't remember those wakes because they were so short.

It's worth remembering that not everybody needs 8-9 hours of uninterrupted sleep to function long term. Some of us really only need 6.5-7 hours. Other people find out that a divided sleep schedule works fine for them. In other words, you may eventually find that you will settle into a pattern of going to bed between 10 and 11pm, getting up for about 60-90 minutes and doing something you enjoy after that early am wake, and then going back to bed and sleeping another 90 minutes or so after you go back to bed. And that's fine as long as you're functioning during the daytime.

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Re: jolting - waking up and insomnia or not using cpap

Post by dacotto1984 » Tue Oct 04, 2022 4:52 pm

hey sorry for not posting. Have been very busy these past few days.

i just want to say thank you so much for all your words and help!

After reading all your information i have been applying it.. i have been working with the settings... changing the ramp and other settings... My leaks are getting way better. I started seeing the green face more often now. I noticed i real more rested when the seal is good and have minimal leaks!

And after all this information you have given me and seeing that my sleep apnea results are in the "good" range i began to associate my issue with anxiety. I have been able to pass that 530am wake up.. i even went to the bathroom and have been going back to sleep. I have been using all the techniques mentioned on here.. changing sleeping position and so much more. All this information has been great and useful. I am finally not waking up scared but wake up feeling rested. I just want to thank you so so much for all your help. Not a drop of it has gone to waste. It has been extremely helpful. I pray and hope that insomnia monster never ever creeps up on me again and I thank you so much for helping me and others with this great service you are giving. I still have to reply back to some of the replies on here but i am tangled with time... but definitely want to say thank you so much again. I have been seeing some normalcy come back to my life! i hope it stays this way always now! thank you so much!

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Re: jolting - waking up and insomnia or not using cpap

Post by robysue1 » Tue Oct 04, 2022 5:22 pm

dacotto1984 wrote:
Tue Oct 04, 2022 4:52 pm
And after all this information you have given me and seeing that my sleep apnea results are in the "good" range i began to associate my issue with anxiety. I have been able to pass that 530am wake up.. i even went to the bathroom and have been going back to sleep. I have been using all the techniques mentioned on here.. changing sleeping position and so much more. All this information has been great and useful. I am finally not waking up scared but wake up feeling rested.
It sounds like you've really turned a corner. Here's hoping that you have many more mornings where you wake up feeling rested.
I just want to thank you so so much for all your help. Not a drop of it has gone to waste. It has been extremely helpful. I pray and hope that insomnia monster never ever creeps up on me again and I thank you so much for helping me and others with this great service you are giving.
You are welcome!
I still have to reply back to some of the replies on here but i am tangled with time... but definitely want to say thank you so much again. I have been seeing some normalcy come back to my life! i hope it stays this way always now! thank you so much!
Again, it sounds like you've turned a corner. And it's nice that you've let us know that some of the advice we all gave you has helped you work out your issues with PAPing.

Here's wishing you many more peaceful nights with waking up feeling rested the next morning.

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Re: jolting - waking up and insomnia or not using cpap

Post by dacotto1984 » Thu Oct 06, 2022 11:27 am

Hey again,

so i noticed something last night. Not sure if i celebrated too early here.

Last night around 200am - 215am, i woke up. I jolted out of fear once again.
Had dream i was going into a tunnel and was suffocating.
At the same time i had to go to bathroom came back to bed and took me a long time to sleep again. Felt like it was 2 hours being awake but i am not sure. (I wish these devices told you when you actually fell asleep.)

I eventually slept.

But i noticed kept waking up.. i think i woke up like 10 times but fell asleep. Felt like it was back to back... as if woke up, slept for 10 - 30 mins. Woke up, slept for 10-30 minutes and so on. Not sure if its true. (once again, i wish there was a way to tell)

im looking at my data to see if i notice anything. I do see that
1. RERA events were 9 (i noticed that i do have some nights with RERA 9 events. I am not sure if i understand RERA and if it is something to be very concerned about)
2. I noticed at around 115 to 200 my pressure went down to zero.
also noticed flow rate stopped, and flow limit stopped as well and a bunch of other data went missing.. i did take off my mask to go to bathroom for like 10 minutes just to catch some fresh air but i think that was around 230am or so. Not sure if thats the event. Anyway, just wondering if my data looks fine if that choking was related to an apnea scaring me awake or once again... dreaded anxiety... i was able to sleep at least so i am not too concerned. Thank you so much for any help out there.

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Re: jolting - waking up and insomnia or not using cpap

Post by robysue1 » Thu Oct 06, 2022 1:40 pm

dacotto1984 wrote:
Thu Oct 06, 2022 11:27 am
Hey again,

so i noticed something last night. Not sure if i celebrated too early here.
It's a process. You celebrate the victories as they come and you deal with the setbacks as they come.
Last night around 200am - 215am, i woke up.

I jolted out of fear once again.
Had dream i was going into a tunnel and was suffocating.
The data you posted has an obvious 10-15 minute wake occurring at roughly 1:20---you turn the machine off and then back on about 10 or 15 minutes later. Is that what you are talking about?

If so, then yes you could have had a bad dream inspired by OSA events---there are two hypopneas scored shortly before that wake. These things happen. As long as you don't have them happening every single night, it's important to not get too worried about them.
At the same time i had to go to bathroom came back to bed and took me a long time to sleep again. Felt like it was 2 hours being awake but i am not sure. (I wish these devices told you when you actually fell asleep.)
It's quite believable that you didn't get soundly back asleep for a couple of hours after that 1:20 wake: The whole period between 1:40 and 3:40 looks (on this scale) to quit likely be filled with SWJ stuff. It also looks like you may have been pretty restless between 4:40 and 5:20. And it looks like you may have been dozing between 6:20 and 6:55 before getting out of bed at around 6:55.

As for wishing these devices told you when you actually fall asleep: Technically that would require an EEG attached to your head. However you could think about getting a smart watch or Fitbit type device that tracks sleep. These devices use breathing rates and pulse rates to guesstimate when you are asleep as well as guesstimating what sleep stage you are in. They're not 100% accurate and they certainly are not going to pick up every single micro-arousal. But they are decent enough for the basic questions of the sort:
  • When did I likely fall asleep?
  • How restless was I during the night? How many times did I wake up for at least a couple of minutes?
Wearing one of them to bed might help you train your overanxious brain to accept that you are, in fact, getting some sleep. And that you are likely getting more sleep than you think you are when you have the mask on.
I eventually slept.
Yep. The breathing between 3:40 and 4:40 and well as the breathing between 5:20 and 6:20 both look (at this scale) to be pretty normal sleep breathing.

But i noticed kept waking up.. i think i woke up like 10 times but fell asleep. Felt like it was back to back... as if woke up, slept for 10 - 30 mins. Woke up, slept for 10-30 minutes and so on. Not sure if its true. (once again, i wish there was a way to tell)
It would not surprise me at all if this is what was happening between 1:40 and 3:40, given the raggediness of the flow rate data.

And again, one way to gather some reasonably decent data on how many times you woke up and fell asleep would be to get a smart watch or Fitbit type device that measures sleep. Since they're the size of a wristwatch (and double as such in the daytime), sleeping with one on your wrist doesn't add any kind of sensory stuff to feed the anxiety and insomnia monsters.
im looking at my data to see if i notice anything. I do see that
1. RERA events were 9 (i noticed that i do have some nights with RERA 9 events. I am not sure if i understand RERA and if it is something to be very concerned about)
On an inlab sleep test, RERAs are formally called respiratory effort related arousals. They are scored when it's clear that you have an arousal that is related to some form of flow limitation, but the flow limitation does not meet the definition of a hypopnea. Informally, you can think of them as places where you wake yourself up before your airway is compromised enough to cause an actual hypopnea.

Machine-scored RERAs are sophisticated guesswork: The machine is looking for a breathing pattern that indicates there is some flow limitation going on followed by a breathing pattern that indicates an arousal followed by a patter of better breathing than before the RERAs
2. I noticed at around 115 to 200 my pressure went down to zero.
You turned the machine OFF and then back ON.
also noticed flow rate stopped, and flow limit stopped as well and a bunch of other data went missing.. i did take off my mask to go to bathroom for like 10 minutes just to catch some fresh air but i think that was around 230am or so.
I think you took that bathroom break at 1:15, not 2:30. There is no evidence that you took the mask off around 2:30.
Not sure if thats the event. Anyway, just wondering if my data looks fine if that choking was related to an apnea scaring me awake or once again... dreaded anxiety... i was able to sleep at least so i am not too concerned. Thank you so much for any help out there.
Again, there were a pair of hypopneas scored right before you turned your machine off around 1:15. So, yes, those events could have triggered a bad dream.

What you need to do when this happens is get up, go to the bathroom, and then repeatedly tell yourself that your machine is preventing the vast majority of the OSA events from happening. And that if one or two still manage to get through the PAP defenses, your brain is still capable of waking you up enough to restart the breathing. And then try super hard not to dwell on the bad dream or the possible events that lead up to it while you are trying to get back to sleep.

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Humidifier: DreamStation Heated Humidifier
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Re: jolting - waking up and insomnia or not using cpap

Post by robysue1 » Thu Oct 06, 2022 2:10 pm

dacotto1984 wrote:
Thu Oct 06, 2022 11:27 am
2. I noticed at around 115 to 200 my pressure went down to zero.
You turned the machine OFF and back ON. And you appear to be using Resmed's AutoRamp feature with the beginning ramp pressure set to the default value of 4cm. And the bottom line of your pressure graph is at 4cm. So during the period when your machine is keeping the pressure right at 4cm, the pressure graph is lying right on top of that bottom horizontal line for the graph.

I also want to point this out:

The AutoRamp setting is designed to keep the pressure at the beginning ramp pressure until the machine "thinks" you are asleep. It uses the following criteria to determine when you have likely fallen asleep, and then it starts to increase your pressure up to your Min Pressure setting:
  • 30 breaths of stable breathing (roughly 3 minutes). Sleep breathing is much more stable and regular than wake breathing is.
  • 5 consecutive snore breaths. The assumption is people don't snore when they're awake.
  • 3 obstructive apneas or hypopneas within 2 minutes. The assumption is that if you've had two OAs or H's in a short period of time, you are probably asleep and/or your airway becomes unstable during your transition to sleep.
  • enough time has passed since you turned the machine on that it needs to start increasing the pressure to insure the pressure is at your Min Pressure setting 30 minutes after you turned it on.
On the night you posted data for, you first turned the machine on at 21:58. The pressure remained at 4cm until about 22:22 and it ramped up from 4cm to your Min Pressure = 8 setting between 22:22 and 22:27ish. So it seems likely that your Resmed machine did not detect 3 minutes of "sleep breathing", 5 snores, or a pair of events between 21:58 and 22:22, but since it takes about 5 minutes to ramp up to your minimum pressure, it started the ramping process just in time to make sure that it was at 8cm of pressure by 22:28, which is 30 minutes after you turned the machine on.

The fact that you are using the ramp and that your beginning ramp pressure is set to 4cm does raise a question: Are you comfortable breathing at that pressure when you first turn the machine on and you are trying to get to sleep? Some people subjectively feel like there's not enough air coming through the mask for them to fully inhale easily when the pressure is only 4cm. And the fix for that problem is quite simple: Either turn the ramp off and start at your minimum pressure or bump the beginning ramp pressure up to where it is comfortable for you.

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Re: jolting - waking up and insomnia or not using cpap

Post by dacotto1984 » Fri Oct 07, 2022 9:36 pm

Thank you so much for mentioning the ramp feature.
I am definitely going to start putting the ramp on off or within a few minutes.. In my data, i see that when i come back from bathroom, i get alot of events. I am not sure why exactly but i believe if i turn off the ramp than it might help put me to sleep faster. perhaps the drop in pressure is what causing me to not get back to sleep.

Thank you so much for analyzing my data.
last night was also bad.. my AHI was 3.42 and i felt it!
While the other night it was less than 1 AHI and i felt that.

Not sure what is causing it. I do remember feeling like it couldn't breathe well at all last night in bed. Felt like i was struggling for air. Not sure, if it was cause i had a bit congestion and sinus. Plus, my lung or right side of chest hurt a bit. I think it was from breathing in too hard. In the beginning of my CPAP therapy, i had the same issue where my chest would hurt from breathing in so hard... feeling like i was not getting enough fresh air.

Thank you again for analyzing the data. Is there a tutorial that you would recommend that can teach me more about the data.. i want to become a master at reading all my data myself and understanding more of whats going on.

i might look into getting one of those watches if it helps. thank you so much for suggesting them and thank you so much for everything.

tonight i turn that ramp to a few minutes instead of auto to see if it helps!

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Re: jolting - waking up and insomnia or not using cpap

Post by dacotto1984 » Wed Oct 26, 2022 7:12 pm

Hello everyone, i hope every/any one reading this is having a blessed moment in there lives. May blessing fall upon you and your loved one the moment you read this.

I was hoping someone could answer this question.
How does a sleep doctor know if you no longer need a CPAP machine.

I was hoping to look at my OSCAR data over time to see if my sleep apnea is getting better with my weight loss.

My guess is, if your AHI goes down then its an indicator.
But also, will the AP (Automatic Pressure) also be another indicator?

Heres a screenshot of my Pressure
https://imgur.com/a/FZPVEgb

My AHI was 1.32 for that night.

My guess is that i still have severe apnea because the pressure is averaging at 12cm (i am not sure if that is high).

But either way, if my apnea were indeed getting better.. then my belief is that the AHI will either stay the same or drop but also the pressure would be going down. I wonder if that's correct

Either way, was wondering if my doctor would be able to detect at some point if i would still need it.. if so how would he know?
and is it possible that i can tell too by looking at my OSCAR data. thanks again in advance for any and all help!

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Re: jolting - waking up and insomnia or not using cpap

Post by Pugsy » Wed Oct 26, 2022 7:26 pm

dacotto1984 wrote:
Wed Oct 26, 2022 7:12 pm
How does a sleep doctor know if you no longer need a CPAP machine.
Sleep study without cpap being used has to be done if someone wants to know if their OSA has gone away.
No other way.
dacotto1984 wrote:
Wed Oct 26, 2022 7:12 pm
My guess is that i still have severe apnea because the pressure is averaging at 12cm (i am not sure if that is high).
Now I don't want to speculate as to the level of severity of your OSA.....severe or mild....but the pressure going up and pretty much staying up all night is a prime indicator that something for sure is going on that the machine wants to kill. Maybe with the weight loss the OSA is reduced a bit in numbers but there is still a whole lot of something going on that the machine wants to kill with more pressure.
Something related to the airway is alarming enough for the machine to increase the pressure to prevent the collapse.

dacotto1984 wrote:
Wed Oct 26, 2022 7:12 pm
is it possible that i can tell too by looking at my OSCAR data.
Sorry , not really possible because all the machine can show you is treated results and even 4 cm pressure is considered therapy.

I tell you what you can do that MIGHT....note I stress might...give you some answers is use your machine at a fixed pressure of 4 cm and see what happens...see what events might happen and get flagged when the machine can't go to 12.
If you have a truckload of apnea events get flagged....you got your answer.
If you use 4.0 fixed and the AHI stays at around 1.0....then you talk to your doctor about another sleep study.

THE ONLY WAY TO KNOW FOR SURE IF OSA IS GONE OR NOT.....ANOTHER SLEEP STUDY.....either in a lab or a Type 2 home sleep study.
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Re: jolting - waking up and insomnia or not using cpap

Post by dacotto1984 » Thu Oct 27, 2022 6:49 pm

Now I don't want to speculate as to the level of severity of your OSA.....severe or mild....but the pressure going up and pretty much staying up all night is a prime indicator that something for sure is going on that the machine wants to kill. Maybe with the weight loss the OSA is reduced a bit in numbers but there is still a whole lot of something going on that the machine wants to kill with more pressure.
Something related to the airway is alarming enough for the machine to increase the pressure to prevent the collapse.
very interesting. I wonder how its able to detect when my air way collapses. Guess thats a whole other subject... but its interesting. So yeah, i see that my pressure has even been going up to almost 16. Wonder if its due to leaks.
But thank you so much for clarifying that for me. I guess i should do a sleep study when i reach a significant weight loss then. Truly appreciate your feedback.

Another question is an average of 12cm high?

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Re: jolting - waking up and insomnia or not using cpap

Post by lynninnj » Thu Oct 27, 2022 6:56 pm

dacotto1984 wrote:
Thu Oct 27, 2022 6:49 pm
Now I don't want to speculate as to the level of severity of your OSA.....severe or mild....but the pressure going up and pretty much staying up all night is a prime indicator that something for sure is going on that the machine wants to kill. Maybe with the weight loss the OSA is reduced a bit in numbers but there is still a whole lot of something going on that the machine wants to kill with more pressure.
Something related to the airway is alarming enough for the machine to increase the pressure to prevent the collapse.
very interesting. I wonder how its able to detect when my air way collapses. Guess thats a whole other subject... but its interesting. So yeah, i see that my pressure has even been going up to almost 16. Wonder if its due to leaks.
But thank you so much for clarifying that for me. I guess i should do a sleep study when i reach a significant weight loss then. Truly appreciate your feedback.

Another question is an average of 12cm high?
Dunno what your experience is but last week I helped a friend whi had to use the air compressor to push the water out of the outdoor water lines that run underground, so they don’t freeze and burst.

When she was closing the spigots (must’ve been drained) I felt the air blasting back out at me that felt like an airplane. Next spigot opens and air moves out. Then blast as its closed.

I would imagine the machine registers the pressure much like that.

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Re: jolting - waking up and insomnia or not using cpap

Post by robysue1 » Thu Oct 27, 2022 7:14 pm

dacotto1984 wrote:
Thu Oct 27, 2022 6:49 pm
very interesting. I wonder how its able to detect when my air way collapses. Guess thats a whole other subject... but its interesting.
The machine is measuring how much air is moving in and out of your lungs with each breath. Detecting an apnea or a hypopnea is actually pretty easy: The machine is looking for little or no air moving in/out of your lungs for at least 10 seconds in order to score an apnea, and it looks for a significant drop (I think its 50%) in airflow into/out of your lungs that lasts for at least 10 seconds in order to score a hypopnea.

Determining whether an apnea is an OA (obstructive) or a CA (central/clear airway) requires a special algorithm, and different manufacturers have different algorithms for doing this. Resmed uses an FOC algorithm involving a series of oscillations in the pressure. A blocked airway responds differently than a clear airway does in terms of what happens to the pressure and airflow.

So yeah, i see that my pressure has even been going up to almost 16. Wonder if its due to leaks.
No, the pressure increase is not because of leaks. In the presence of a leak the machine has to increase the airflow into the "system" that consists of the blower, the hose, the mask, your nasal & oral cavities, and your upper airway in order to maintain the current pressure. If the leaks get large enough, the machine will actually reduce the pressure setting in an effort to see if the mask will reseal itself.

Another question is an average of 12cm high?
I think the "average" pressure is around 10cm. But the pressure needed to prop a particular person's airway open does not always depend on the severity of the untreated apnea. Rather, it depends on the structure of the airway itself. My husband's untreated apnea is mild, but he needs more pressure than I do, even though my untreated apnea is well into the moderate range.

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Re: jolting - waking up and insomnia or not using cpap

Post by dacotto1984 » Sun Nov 06, 2022 6:30 pm

robysue1
Thank you so much for your response and clear clarifications on my questions. Wishing you blessings, love and good fortunate towards you!

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Re: jolting - waking up and insomnia or not using cpap

Post by dacotto1984 » Sun Nov 06, 2022 7:09 pm

This question might not be considered 100% related to sleep apnea but i did want ask just in case someone has come across this scenario.

Im approaching middle ages and my health seems to be okay but i am experiencing dizzy spells and not too long ago, issues with anxiety and well my mind also hasnt been as strong it once was.
I have been working my job fine but mentally i am struggling and feel mentally exhausted with work. My body is telling me i need at least 7 months of complete release from everything but thats not a possiblity.

My big fear is that i will burn out and not be able to perform my job and i will eventually lose my job. The issue too is that, i am so burnt out that my mind doesnt even feel like continuing in the field that i am currently in but its the only field i know that can pay off the bills! If i were to lose my job and lets say work minimum wage. I will not be able to survive. I might be able to get by but any small like car getting an issue could ruin me. (i still want to work my current field however, i just feel like my mind will give out. its like a muscle thats been at the gym and its at the peak of its rep and your now just burning out a sore muscle)

I have been having visions/daydreams of me being homeless and ending up in the streets.
The big issue I would be facing is my severe sleep apnea.
I believe my apnea is so bad that my brain will not allow me to sleep because i will essentially choke and keep jolting awake. I already had an issue like this in the past and it induced almost a month long insomnia where i was not able to function at all.
My sleep therapy right now is working and i am able to finally sleep well (thank the lord)

but i do have fears on this matter. What does one do if they end up in the streets and they have something severe like this? Are they just doomed to go mentally insane in the streets. I know one solution would be to get a battery back-up and try to charge it during the daytime. or get a car adapter to plug in and try to live off your car...

I have had some friends become homeless in the past... i have not been homeless myself... but i also never had this apnea situation and issues with anxiety in the past either... so i do feel like my fear is a bit rational...

If someone out there has been in a similar situation like mine. Please share your story and how you overcame it or if anyone has any advice on how to survive in a situation like this then that would be awesome. Thanks for hearing me out!

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Re: jolting - waking up and insomnia or not using cpap

Post by robysue1 » Mon Nov 07, 2022 10:59 am

dacotto1984 wrote:
Sun Nov 06, 2022 7:09 pm
Im approaching middle ages and my health seems to be okay but i am experiencing dizzy spells and not too long ago,
You ought to have the dizzy spells checked out by your PCP. There are lots of things that can cause dizziness. Some of them are not very serious, but some are. And dizziness can be treated in different ways, depending on what you mean by "dizziness" and what is causing it.

Do note: When talking about dizziness to a doctor, nurse practitioner, or PA, you need to distinguish between vertigo and lightheadedness. Both are commonly referred to as "dizziness" by people experiencing the symptoms.

Vertigo is a sense of movement: Either a sense that the world is moving around you rapidly or that you are turning rapidly when you are standing still.

Lightheadedness is a sense that you may faint or fall down for no reason. Usually with lightheadedness there's no sense of movement. Usually lightheadedness will either (temporarily) go away or be eased by slowly sitting down and resting your head.
issues with anxiety and well my mind also hasnt been as strong it once was.
Lots of people have mid-life crises. And they come with anxiety and worry about the mind (and body) not being as strong as it once was. It may help to realize that others your age are likely having some of the same feelings you are having.

I have been working my job fine but mentally i am struggling and feel mentally exhausted with work. My body is telling me i need at least 7 months of complete release from everything but thats not a possiblity.
I've re-read this whole thread. You clearly have a lot of anxiety and there's a lot of stress in your life that is not related to your now-treated OSA.

You've also admitted that you may be dealing with depression. The anxiety, the depression, and the stress are most likely what are causing you to struggle and meal mentally exhausted at work and at home. You really need to talk to someone about developing positive ways to cope with the stress, anxiety, and depression. Because right now the only tool you have is worry. And worrying about everything is making the anxiety, the stress, and the depression worse.

While a 7 month period of complete rest is out of the question for just about everybody who is still working and/or raising kids, taking some time off each week to recharge your batteries is not. You need to find some very small ways to allow yourself to relax a bit every day. In other words, you need to learn to live in the present and do what you can for today. Worry about tomorrow when it comes--at least for now.

You also need to reconnect with your kids and your wife---while you mention your fears and worries about losing them, you also don't speak of anything you do as a family that you enjoy. It doesn't have to be something big. Even something as simple as reading the kids a bedtime story every night may help you recharge your batteries. Sharing the burden of preparing the nightly meal and then eating it as a family can become a comforting ritual that allows some people a chance to recharge their batteries after a long day at work.

Recharging the mental batteries as well as the body sometimes involves actually being more (not less) physically active, even when you don't want to be physically active. If the kids want to play outside, go outside and play with them. If the leaves need to be raked and you are to exhausted to think about it, take the kids outside and encourage them to make a big pile of leaves and let them jump in it. When they've had their fun, have them help you get the leaf pile to where it needs to be.

My big fear is that i will burn out and not be able to perform my job and i will eventually lose my job. The issue too is that, i am so burnt out that my mind doesnt even feel like continuing in the field that i am currently in but its the only field i know that can pay off the bills! If i were to lose my job and lets say work minimum wage. I will not be able to survive. I might be able to get by but any small like car getting an issue could ruin me. (i still want to work my current field however, i just feel like my mind will give out. its like a muscle thats been at the gym and its at the peak of its rep and your now just burning out a sore muscle)

I have been having visions/daydreams of me being homeless and ending up in the streets.
You can cut your anxiety with a knife.

Seriously, this kind of worry is not normal. And you need to get counseling for your anxiety problems. You currently have a job that is supporting your family. But you are allowing your fear of losing that job to control your life, and your fear and anxiety may in fact be a serious impediment to your actually doing your job. You don't want the fears to become a self-fulfilling prophecy. And the way you prevent that from happening is you talk to someone who is qualified to help you work through the anxiety and depression so that they don't control your life.

Start by talking to your PCP and tell the doc that your level of anxiety and your fears are taking over your life and making it hard to function. Yes, earlier in this thread you wrote,
dacotto1984 wrote:
Sat Sep 24, 2022 11:10 am
Yes, i think counseling could help greatly. Alot of my issues to are tied to my religious beliefs. so there might be a conflict because I might want to seek counseling tied to my religious beliefs. Maybe I can do both. I dont have a church right now and spiritually i feel lost.
But the fact is your anxiety and depression and the stress you are currently under are eating you alive. And that's having a negative affect on those you love. You may need medical help (in the form of an anti-anxiety drug or an anti-depressant) to start being able to cope. But at the same time, you may also benefit from finding a religious counselor who you can trust to help you with how you are feeling spiritually. It's not an either ... or, it's a both ... and situation. You can get both medical help and talk to a religious counselor at the same time.

dacotto1984 wrote:
Sun Nov 06, 2022 7:09 pm
The big issue I would be facing is my severe sleep apnea.
I believe my apnea is so bad that my brain will not allow me to sleep because i will essentially choke and keep jolting awake. I already had an issue like this in the past and it induced almost a month long insomnia where i was not able to function at all.
My sleep therapy right now is working and i am able to finally sleep well (thank the lord)
You apnea is now well treated through CPAP.

Hence, your brain is now learning that it can allow you to sleep without the worry that you will choke in your sleep. Because your apnea is well treated, your brain no longer needs to "keep jolting you awake" in order to restart your breathing every minute or so. It can take a while for the brain to really understand that the new normal (sleeping with the mask on your nose) means that it no longer needs to be hyper vigilant all night long. But the brain will get there if you quite the conscious worrying about choking to death in your sleep because of untreated OSA.

Accept the fact that your sleep therapy has started to work. Allow yourself the privilege of really reveling in the fact that you are now able to sleep well instead of fretting about what was happening in the pre-CPAP days. Those days are gone and your body is no longer fighting hard to stay alive every night---your body is now getting the sleep it wants, it needs, and it craves. Accept that fully as a good thing, rather than worrying excessively about the OSA.

In other words, quit worrying about the OSA---you've fixed that problem by learning how to sleep with the CPAP.

but i do have fears on this matter. What does one do if they end up in the streets and they have something severe like this? Are they just doomed to go mentally insane in the streets. I know one solution would be to get a battery back-up and try to charge it during the daytime. or get a car adapter to plug in and try to live off your car...
You are allowing your generalized anxiety to grab onto a (potential) worry and run with it and obsess over it. In other words, your worrying about what might happen if you become homeless is interfering with your ability to enjoy the life you actually have: A good job, a loving family, and a roof over your head right now in the present.

In other words, right now concentrate on your present. Do what you can to enjoy the quality sleep you are now able to get. Do what you can to enjoy the presence of your wife and kids in your life rather than worrying about all the potential bad things that could happen. Do what you can to be present in the life of your mother who is seriously ill with what may be her terminal illness. Do what you can to get through your job each day and don't fret about every thing you didn't get done at the end of the day.

But in order to do that, again, you will need to tackle getting the anxiety and depression under control. You may always wind up being an anxious person. You may always wind up feeling a bit low and depressed. But you can learn (with the help of the appropriate doctors and counselors) to keep the anxiety and depression at levels that still allow you to function normally and live your life with some real joy instead of just constant dread about what might happen in the worst case scenario.

I have had some friends become homeless in the past... i have not been homeless myself... but i also never had this apnea situation and issues with anxiety in the past either... so i do feel like my fear is a bit rational...
Personally I think your fear is a bit irrational. I understand where it's coming from, but that doesn't change the fact that this fear is a bit irrational. The reason I say that this fear is irrational is because your fear is preventing you from doing the things that will minimize the chances that this worst case scenario happens to you.

To prevent homelessness from happening, you need to keep your job. To keep your job, you need to be able to function without the constant fears that something is going to go wrong in the immediate future. To keep your job and your family, you need to maintain your emotional health as well as your physical health. To maintain your emotional and physical health requires that you find a way of letting go of the counter-productive anxiety that is sucking up so much of your mental energy right now. To let go of the counter-productive anxiety requires you to work with your doctor and one or more counselors. You may need medication. You may need some cognitive behavior therapy. You may need to talk with a spiritual advisor you can trust. But most likely, you'll need to do all three of those things to get the anxiety under control.

Fixing your sleep apnea with CPAP is a start: Your body is now finally capable of getting the restorative sleep it needs to recharge its batteries every night. But fixing the sleep apnea with CPAP has not fixed the need for you to also address the fact that your anxiety is a genuine health problem that also needs to be addressed in order for you to be able to live your life.

I wish you well in your efforts to work on controlling the anxiety regardless of what approach you choose.

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