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Is wanting a full night of sleep, without waking up, having too high of expectations?
#1
Is wanting a full night of sleep, without waking up, having too high of expectations?
Hello all,

Finally trying to get my sleep right. I can't recall the last time I've been able to sleep through the night, and the catalyst that brought me to getting a sleep study was my partner saying that I sounded like I was struggling to breath while sleeping. 

I've had my Resmed Airsense 10 Autoset for about a week. Still getting accustomed to using it, and tweaking the settings. I think I'm making progress.

Last night was my most successful night I'd say, with 7 hours clocked in, and an AHI of 0.52. Even with this number of events, I still woke up 3 times, and didn't feel well when waking up. It's hard to ascertain what causes me to wake up. While I don't yet know how to fully interpret my data, waking up seems to be following clear airway events, according to my OSCAR results, but not all of the time.

I have my pressure set to 6-20, and EPR is full time and set to 2.


My question is: is it too out of the question to expect to get a full night of sleep, and has anyone on here been able to not wake up at all in the night after starting treatment?


Sleep study results and most recent night of OSCAR data found attached

Thanks!


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#2
RE: Is wanting a full night of sleep, without waking up, having too high of expectations?
Your chart sure looks good even with the low end pressure of 6 with EPR of 2. You really did not mention what is making you wake up, is it breathing issues or going to the bathroom?
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#3
RE: Is wanting a full night of sleep, without waking up, having too high of expectations?
I would set at 8 and 15. Reason - when the machine senses an event it has to move from where it is set to the pressure it needs to control the event. You also pressure support at 2 which brings down the low you have to 4. You top number was never up to 11. So to get to the event controlled it does not have to rev up as much

2nd is leaks they are not terrible but you had a couple times when it went way up. During those times you were NOT getting therapy. Go to wiki and search mask fitting and see if you can get some tips. I will give you 2. First don’t over tighten it causes leaks. Second adjust your mask in your normal sleep position. If you do it just sitting on the bed when you lie down it will leak.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
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#4
RE: Is wanting a full night of sleep, without waking up, having too high of expectations?
Turn off ramp. You have a 30 minute ramp starting from 4.0 and with a starting pressure of 6.0, you don't need it. I don't see a need for higher pressure at this point. Your AHI is negligible and pressure is staying within a narrow range. The therapy has apparently resolved the hypopnea and flow limitation observed in the sleep study. What we want to do is focus in on what causes sleep disruptions, and it may just be a matter of time for you to fully adapt to the therapy. It appears to be extremely good. Do you have a history of arousals or insomnia from before you started CPAP therapy?

In the chart you provided, we see therapy is broken into 3-sessions. How long were you awake before pausing therapy? One way to mark an arousal is just to cause a brief intentional leak. We can then go back into a zoomed view and see if anything is there that might be a clue to the arousal.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Is wanting a full night of sleep, without waking up, having too high of expectations?
(08-26-2020, 06:03 PM)Canuck 2 Wrote: Your chart sure looks good even with the low end pressure of 6 with EPR of 2. You really did not mention what is making you wake up, is it breathing issues or going to the bathroom?

Nocturia was for sure one of the reasons.   [Image: coffee.gif]  Which was a bummer because I was pretty mindful to not drink anything long before going to bed, and I even went to the bathroom a few times before passing out.

Hard to say for the other two. Taking a look at my sleep study, I had a decent number of RDIs, perhaps the arousals last night stemmed from something similar?

Looking a few of my other nights, attached, I had a few clear airway events, perhaps some other breathing issue could have caused me to wake up?


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#6
RE: Is wanting a full night of sleep, without waking up, having too high of expectations?
(08-26-2020, 06:28 PM)Sleeprider Wrote: Turn off ramp. You have a 30 minute ramp starting from 4.0 and with a starting pressure of 6.0, you don't need it.  I don't see a need for higher pressure at this point. Your AHI is negligible and pressure is staying within a narrow range.  The therapy has apparently resolved the hypopnea and flow limitation observed in the sleep study.   What we want to do is focus in on what causes sleep disruptions, and it may just be a matter of time for you to fully adapt to the therapy. It appears to be extremely good.  Do you have a history of arousals or insomnia from before you started CPAP therapy?

In the chart you provided, we see therapy is broken into 3-sessions. How long were you awake before pausing therapy?  One way to mark an arousal is just to cause a brief intentional leak. We can then go back into a zoomed view and see if anything is there that might be a clue to the arousal.


History of arousals, yes. Me getting up several times per night was a primary incentive to me getting a sleep study done. Some sporadic cases of insomnia, but I'm able to go to sleep fairly easy for the most part. 

I paused therapy pretty much immediately after getting up, just to give me an indication of when I woke up.

I've attached a zoomed in portion of my awakenings, please let me know if that's what you're referring to. Seems like leaks were had but I was able to stay asleep a bit longer before waking up. Perhaps I need to adjust my mask.

I posted a few other nights of OSCAR results in my other post in this thread. I had a pressure of 4 those nights, seems like upping to 6 did the trick for last night?


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#7
RE: Is wanting a full night of sleep, without waking up, having too high of expectations?
(08-26-2020, 06:13 PM)staceyburke Wrote: I would set at 8 and 15. Reason - when the machine senses an event it has to move from where it is set to the pressure it needs to control the event. You also pressure support at 2 which brings down the low you have to 4. You top number was never up to 11. So to get to the event controlled it does not have to rev up as much

2nd is leaks they are not terrible but you had a couple times when it went way up. During those times you were NOT getting therapy. Go to wiki and search mask fitting and see if you can get some tips. I will give you 2. First don’t over tighten it causes leaks. Second adjust your mask in your normal sleep position. If you do it just sitting on the bed when you lie down it will leak.

I don't know what is deemed an acceptable amount of leaks per night, ideally zero yeah? Looking at my OSCAR data, I have various fluctuations of leaking throughout the night, so I'll definitely give my mask an adjustment before knocking out!


Just a thought, the medium sized nose piece seems to fit pretty well. While I don't have a huge nose, I am very tall, so I may proportionately need the large size. I'll do the leak test on all of the sizes while in my sleeping position and see what happens.
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#8
RE: Is wanting a full night of sleep, without waking up, having too high of expectations?
I don't see any obvious respiratory disturbances ahead of the therapy breaks. I will repeat you need to turn off ramp. Your minimum pressure of 6.0 allows your EPR 2 to work consistently from the beginning of therapy. When you are using ramp, the EPR gradually increases from zero until you reach the therapy pressure. Starting without ramp will help you achieve better mask fit and might help your sleep.

Keep in mind that your sleep still incorporates behaviors or habits you continue from the years before starting therapy. In time, your need to awaken for a bathroom break will go away and the number of arousals will diminish because there is no longer a respiratory disturbance. Your first night of effective therapy was where you raised pressure to 6.0, so please just give it time and have faith it will get better as you adapt and let go of the habitual arousals.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Is wanting a full night of sleep, without waking up, having too high of expectations?
I also have a problem with waking up in the middle of the night. If you think that you are making progress after one week, that is extremely encouraging. If you are waking up to go to the bathroom, you should limit what you drink in the evening, especially alcohol. Try not having any alcohol after 2:00 and no fluids at all after dinner.

You should Google cognitive behavior therapy for insomnia. It helped me a lot. I was able to go to a therapist at a university, but it can be DIY. I was taken aback when the therapist said that I need to go to bed later and wake up earlier, but I eventually got big improvements. Now I go to bed at 10:30 and wake up about 6:30. I wake up at night, but I can get back to seep in 15 minutes instead of more than an hour.
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