The Sheikh,
As someone who had a long, drawn out War on Insomnia, I have spent a great deal of time in figuring out how to improve the overall quality of my sleep, and part of that has been dealing with multiple
significant wakes after sleep onset. And while reducing the number of wakes/arousal has played a role in conquering my insomnia, a far more important part of my CBT-I focused on
teaching myself how to NOT over think about my wakes and how to PREVENT myself from overreacting to normal, insignificant awakenings/arousals.
Even folks with high quality sleep will have a few arousals and awakenings during the night. (Waking a few times during the night to assess one's safety is an evolutionary advantage.) But the total number of these arousals/awakenings is relatively few in number AND they are relatively short. Studies have shown that non-isomniacs do wake up periodically during the night (often at the end of a REM cycle), but after quickly verifying there's no need to be awake, they snuggle back down into the covers and fall back asleep almost immediately. And in the morning, these non-insomniacs typically remember none of these short wakes/arousals because a wake typically has to last at least five minutes before a non-insomniac stands a chance of remembering it.
I point this out because it can be counterproductive to focus large amounts of time and energy attempting to eliminate every wake and arousal. The immediate goal should be to get to where a short wake or two (or three) during the night does not cause you to stress out about waking up. Rather than worrying about the wake, the focus should be teaching your body how to get back to sleep so quickly that these last few (normal) non-respiratory wakes/arousals are not remembered in the morning.
In particular, you write:
I have looked at the SleepyHead data for clues of arousals, but feel the short wake-ups to roll over are buried in the data. I thought about using a camera, but wondered if anyone has worked out a more systematic method to work on this problem? There are some very clever people on this BB and I don't want to reinvent the wheel....
"Short wakes to roll over" are NOT a problem with your overall sleep architecture. And hence there's no need to try to find or eliminate them. Most people benefit from changing position a few times during the night: It minimizes stiff necks and sore backs caused by sleeping in an awkward position for too long. Moreover, trying to identify and eliminate these short "normal" wakes may inadvertently get you so focused on trying to "remember" all the wakes that you wind up
increasing their lengths to at least 5 minutes, and that in turn can create a problem with sleep maintenance insomnia.
Now you also describe your situation as:
WAKE-UPS:
Over the last five nights I have seen my wake-ups go from about 5-6 times, mostly for bathroom breaks, down to only one per night. Last night I slept 9 hours and got up after 7 hours for the bathroom.
Sounds like nocturnia was a symptom of your sleep apnea. Could be that last bathroom break will also disappear all by itself --- if you don't get worried about the fact that you are not sleeping.
However, I can "remember" waking up to toss and turn a few times. These are the events I'd like to work on and don't show up in the data.
Ok---"remembering" tossing and turning is no fun. And it can take a lot out of you the next day. But rather than focusing on the vague sense of tossing and turning as evidence of "wakes/arousals that must be eliminated", you should focus your time and energy on trying to figure out
what was creating the discomfort that lead to the restlessness and work on minimizing that.
Let's look at some potential causes of the restlessness. That will give you some ideas on where to start working to reduce the restlessness, which in turn will give you more continuous sleep.
Leaks
You write:
My mask stayed on the whole night and is not a factor, unless the occasional leaks are bothering me.
You mention, but seem to dismiss, leaks as a very real possibility for what triggered your restlessness. So what's your leak line look like? Was last night's leak line similar to the one you posted to that other thread? That one looks like this:
So what's the take on this leak line? You're using a ResMed S9 ASV. So that leak line includes only the
unintentional leaks. Now, it's true that your leaks on this night are mostly below the RedLine at 24 L/min that ResMed uses to define a large leak. But your leaks on this night were still both long enough and large enough to make leaks into a very plausible source for the restlessness. So look at last night's leak line. Are there some bumps on it? The bumps do NOT need to be big enough to affect your therapy---even a small leak in the wrong place can cause you to get restless. Can you show us your leak line for last night?
Necessary pressure swings from the ASV
You write:
My ASV PEAK pressure can hit nearly 20 cm/H20 at times.
The ASV PEAK pressure shooting up to 20 cn H2O might also be triggering some restlessness. It's going to just take some time (as in several weeks to a few months) for your brain and body to get fully accustomed to all the sensory stuff coming from having a mask on your face, being tethered by a six foot hose, and having your machine blast your airway with 20cm H2O because the machine doesn't like the way you are breathing (or perhaps more accurately, not breathing.) So if this is the source of the restlessness, the problem may resolve itself in a few weeks---if you don't start obsessing about the fact that you are not yet sleeping as well as you would like to.
Other possible causes of the restlessness
All sorts of (external) things can cause us to be restless during the night. Some of them we can work on; others mat be beyond our control. Common causes of restlessness include pain, side effects from drugs, bad sleep hygiene, disruptive sensory stimuli (dogs barking, traffic noise, bed partner tossing and turning, feeling too hot, feeling too cold, too much light), allergies, cold and flu symptoms, weather (some folks are sensitive to changes in the barometric pressure), an uncomfortable bed, and
worry.
So read through that list and add anything that you know has caused you to be restless in the past to the list. For the ones you can do something about, work on solving the potential trigger problem. For the ones that are out of your control, work on controlling your nighttime response to finding yourself awake or restless during the night. Learn to chill out about the wake and allow yourself the pleasure of going back to sleep. And if sleep doesn't come, get out of bed, go to the bathroom (even if you don't "need to go") and allow yourself to relax and get sleepy before going back to bed.
