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[CPAP] Waking up multiple times a nught for no reason
#1
Waking up multiple times a nught for no reason
Hi!

I have been using CPAP for 6 months to you guys and for the last month I have been sleeping with it +7 hours every day!!

I wake up way more rested but still feel tired, specially the days I get 7 hours instead of 8 or more.

The issue that is happening is that CPAP is waking me up multiple times a night, I do not wake up feeling I need more air or stressed, I just wake up with the mask still on, turn sides, and in a matter of minutes fall sleep again.

For context, I use the Resmed Airsense 10 with the Resmed P10 nasal pillows, I also mouth tape every night to avoid leaks!

So far I have tried playing with EPR, reducing and increasing the pressure, but with no luck. Some days I wake up 2 times and others 8 times, it depends.

For instance, today I woke up at: 3:30, 5:25, 7:40 and 8:20 (I know the exact times because I use a wearable to track my sleep)

And these are the OSCAR graphs:

   

Any advice would be appreciated! Thanks for your time!
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#2
RE: Waking up multiple times a nught for no reason
your pressure rises against flow limitations, the cause of which remains to be seen, which can wake you and also be the source of your central events. not much more you can do with the ca with your machine at fixed pressure of 10 other than try reducing/turning off epr.

post a couple 10 minute view scale screenshots, one around 1:30 and another from around 5:45. post a 3rd screenshot at a 3 minute view scale from anywhere that corresponds to some flow limitations. view scale can be adjusted by moving the slider at the bottom of the 'events' tab. maybe we can learn something about the flow limitations.

edit: your profile shows cpap 10cmw pressure but your screenshot shows 7-8cmw. I doubt that a range that small has much negative impact but you could try min=max at the lowest pressure that resolves any obstructive apnea/hypopnea you have to see if it reduces the centrals.

let's see the zoomed screenshots first, then do one change at a time for a night or 2 each: turn epr off, set min=max.
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#3
RE: Waking up multiple times a nught for no reason
(04-04-2021, 05:06 PM)sheepless Wrote: your pressure rises against flow limitations, the cause of which remains to be seen, which can wake you and also be the source of your central events. not much more you can do with the ca with your machine at fixed pressure of 10 other than try reducing/turning off epr.

post a couple 10 minute view scale screenshots, one around 1:30 and another from around 5:45. post a 3rd screenshot at a 3 minute view scale from anywhere that corresponds to some flow limitations. view scale can be adjusted by moving the slider at the bottom of the 'events' tab. maybe we can learn something about the flow limitations.

edit: your profile shows cpap 10cmw pressure but your screenshot shows 7-8cmw. I doubt that a range that small has much negative impact but you could try min=max at the lowest pressure that resolves any obstructive apnea/hypopnea you have to see if it reduces the centrals.

let's see the zoomed screenshots first, then do one change at a time for a night or 2 each: turn epr off, set min=max.

Thanks a lot for your answer, the pressure is different since I have been playing around to see if I can fix it

Attaching the requested screenshots:
[Image: attachment.php?aid=31402]


[Image: attachment.php?aid=31403]

I dont know if this may help, but here is an example from another day where I did not reach flow limit, and I woke up at: 0:50, 4:05, 5:20, 6:18,7:35
[Image: attachment.php?aid=31404]


Attached Files Thumbnail(s)
           
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#4
RE: Waking up multiple times a nught for no reason
I was looking for signs of periodic limb movement to see if that might be causing flow limitations, explain your awakenings and possibly the ca. there are suggestions of it in your flow rate pattern but it's not clear enough on that basis alone. you'd have to confirm or rule it out by seeing if it showed up in your sleep test if you had one, asking someone to monitor you in sleep or audio/video recordings.

everyone wakes up and changes position during the night. you aren't masking off so I suspect the awakenings and whatever is causing them are relatively benign. are you aware of these awakenings or 'know' by reference to your wearable? do you truly feel disturbed at the time of the awakenings and/or feel unusually tired during the day, or is more like 'my tracker says I woke up all these times and that can't be good'?

the times you report waking up correspond very roughly to some snores, flow limitations and leaks, none of which are of a magnitude that would cause immediate suspicion. in fact, your charts don't look bad at all, really, suggesting what's bothering you may be something other than disordered breathing.

about all I can suggest at the moment is to drop epr to 1 or turn it off to see if it reduces your ca without increasing oa and flow limitations too much. with apap you have to find the sweet spot that balances oa & flow limitations versus ca because they tend to respond inversely to pressure. but again, to my eye, there isn't a whole lot of room for improvement in your charts.

besides trying lower/no epr and investigating periodic limb movement, pay attention to what's going on around you, what your thoughts are and how you feel at those moments of awakening to see if you can identify what's waking you. lots of environmental factors (noise, light, temperature, movement of bed partners, etc.) and physical factors (food, drink, health conditions, pain, stress, meds, etc.) can affect sleep. track what you consume, whether you're feeling stressed, sleep hygiene stuff. when you awake, are you breathing hard, heart pounding, hot, cold, sweating, thirsty, feeling discomfort, etc. maybe something will jump out at you.

other members may have additional thoughts and suggestions.
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#5
RE: Waking up multiple times a nught for no reason
If you're having some issue with flow limits, you can try EPR 3 or being mindful of the small amount of Central Apnea you'd need to increase pressures, likely with a wider range than 7-8. I'd try 8 - 10, 12 somewhere about there.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Waking up multiple times a nught for no reason
the difference between Dave's and my suggestions illustrate the problem with apap in the presence of ca. raising epr (or pressure) might reduce flow limitations but increase ca. lowering epr (or pressure) might reduce ca but increase obstructive issues. hence the need to search for that 'sweet spot' that generally you have to subjectively determine produces the most refreshing sleep.
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#7
RE: Waking up multiple times a nught for no reason
Yep sounds about right, a teeter-totter with CA vs OA/FL etc. Acting on one side affects the opposite.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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