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Frequent arousals/Light Sleep despite low AHI's (95% of which are CA;s)
#1
Frequent arousals/Light Sleep despite low AHI's (95% of which are CA;s)
My problem in a nutshell is I am suffering from recurring arousals a night. I wake myself up right after falling asleep, and I feel like my sleep is light for at least half the night. On unusually bad nights (stress related) I sleep for 5-15 mins at a time only to wake up mid breath (or for seemingly no reason at all). More than 95% of flagged events are always clear airway events. I posted about ~2 years ago on a similar issue, though it turned out to be related to a clogged exhaust port on my P10 mask (http://www.apneaboard.com/forums/Thread-...ew-machine) which I recapped in the BACKGROUND section below. The BACKGROUND section also explains why I have been using my AUTOSET For Her in CPAP mode, as well as give other info. Feel free to skip to the PRESENT section.
 
**************************BACKGROUND***************************
I am a 44 y/o, 193 lbs male (5’ 8”) diagnosed with moderate sleep apnea (AHI 16). I am a mouth breather but couldn’t tolerate a full-face mask, so I bought an Airfit P-10 nasal pillow, chin strap, and Somnifix Mouth Strips. For about one year I experienced particularly good sleep (AHI 0.2-0.9).

Then, I started suffering through periods of poor sleep quality characterized by frequent awakenings throughout the night (10 or more awakenings). At its worst, I was waking up 20-30 times with at least for 4-8 (usually stressful) dreams per night. The AHI’s didn’t always correlate with sleep quality. Sometimes they were > 5, sometimes < 1, but I was getting no rest regardless. It turned out that my P10 nasal Pillow was the problem. When I replaced it with a new one, I noticed how much more exhaust was coming from the micromesh compared to my old one. Most likely I had been rebreathing CO2 all along, which would explain why I always woke up out of breath and gasping for air. I will note that I still wake up ~1-4 times a night (my baseline) but fall asleep again very quickly and still felt rested the next day. During this ordeal I had bought an Airsense 10 AUTOSET FOR HER out of pocket and started using OSCAR. With a fresh mask, the best pressure that worked for me was still FIXED 11 cm H2O with EPR 3 cm (AHI < 1.0), so I continued using the AUTOSET in CPAP mode.

FYI:
- I am a very anxious person.
- I work overnights (and I truly love being up at night), 10-hour shifts, and I work seven consecutive days on and 7 consecutive days off, and the job is stressful (healthcare worker).
- Even on my 7 days off, I stay in overnight mode, but I tend to keep an irregular schedule. Every day I wake up later and stay up later. The day before returning to work I take a Benadryl so I can go to sleep and reset my schedule. This in my opinion is better than switching back and forth days and nights like most overnight workers do (which kills you).
- I drink lots of caffeine (as a trial I gave up caffeine for about at least a month and it had ZERO impact on my sleep quality).
- I have chronic gastric reflux. I take omeprazole 20 mg daily. It is usually under control (asymptomatic) unless I am stressed. No other pre-existing conditions.
- I am now 193 lbs and exercise 5-6 times a week. I consider myself to be in good shape now.

 
*****************************PRESENT*************************************

About 2.5 weeks ago I started waking up 20-30 times a night about 2.5 weeks ago, usually in the middle of taking a breath. Sometimes I would wake up feeling like I was not breathing at all. It’s important to note that work has been particularly stressful over the last month. In fact, after many days of little sleep and feeling constant chest pressure (felt like deep anxiety), I went to the ED to get checked out, and all the cardiac workup (including NT pro-BNP to detect heart failure) was negative, and the most reasonable explanation seems to be stress related anxiety. They prescribed me hydroxyzine as needed to sleep, which I take as the last resort (It keeps me down all night) but try to avoid given its prolonged hung-over effect. Given my history w/ P10 issues, I decided to change masks (it’s always a confounding variable in my sleep issues, i.e. every time the humidity is high the exhaust port gets clogged).  Tried the Fisher & Paykel Brevida Nasal Mask but settled on the Philips Respironics Dreamwearer Nasal Pillow, which I find more comfortable.

Now my sleep seems to be returning to normal but I still struggle with day to day variability. Looking at my Oscar data for the last 1.5 year it seems 95% of my events are clear airway events whether the sleep is good or not. All anxiety does is worsen the issue.  I think some of it is junk (right before I sleep). It seems I hardly have events flagged as either OA or Hypopnea:

   

A night of good decent sleep looks like the following:

   

But upon closer observation there are  time lapses of seemiingly periodic breathing:

   

I see that flow limitations seem to be associated with those instances of periodic breathing. Are they just unflagged hypopneas? Would that explain why I seemingly feel like I am either not asleep or constantly aroused from sleep throughout the night? Should I set the machine back to AUTOPAP retitrate?

I am going to post a couple of more images in a follow up post. Thanks for reading so far.
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#2
RE: Frequent arousals/Light Sleep despite low AHI's (95% of which are CA;s)
For example, following the night of good sleep I posted above, I went ahead and scaled back down EPR to 2. Though the numbers seem fine, I felt like I was awake half the night, and never reaching true deep sleep. I woke several times.

   

I also had tried re-titrating my settings 6 days ago (I wanted to see if my pressures maybe were too high?), so I used the following parameters: 6-11 cm H2O, EPR off (was on for only 2 hours at a setting of 2 cm H2O but I found the lower pressures ~ 6 cm to be unbearable):

   

I noticed my median pressure was only 9.06 cm H2O, 95% pressure 10.76 cm H2O. I do acknowledge that there were a couple of confounding variables: 1. EPR was off, and I as mentioned, I have a hard time with that; 2. I was still feeling quite anxious, so stress was heavily in the picture. Still, would a median pressure 2 cm H2O below my set CPAP pressure be indicative of an issue with my current settings?

I was thinking of setting the following parameters:
- Pressure: 8-13 cm H2O (to include my median pressure plus allow the machine to overcome the flow limitations I have noticed coincide with periods of periodic breathing)
- EPR 3 cm H2O (my most comfortable setting)
- Algorithm: For Her (so far this is the only mode I have used)
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#3
RE: Frequent arousals/Light Sleep despite low AHI's (95% of which are CA;s)
Or I could try the following:

- Pressure: 11-14 cm H2O, EPR 3. This assumes that my issue is not enough pressure and that I will gain nothing from allowing the machine to start at a lower pressure?
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#4
Question 
RE: Frequent arousals/Light Sleep despite low AHI's (95% of which are CA;s)
So I have been experimenting with pressure range 11-13, EPR 3 cm H2O. My sleep quality has returned to normal, sort of (I still wake up frequently at night, but fall right back to sleep). I just got  a LOKEE O2 Ring, so hopefully I can get a better picture of what is going on (maybe my O2 levels are dropping right beforte I wake up). But looking through my flow curves, I noticed a weird pattern of small peaks preceeding the larger inspiratory peak:

   

   

   

ANyone know what these might be?
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