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Losing the will to fight
RE: Losing the will to fight
Last night I turned the machine off for a brief period everytime I awoke so that I had a record of exactly when it happened. My mind was racing a little yesterday and I think that's why I ended up awakening 9 times. I only stopped the machine 8 times because on the first awakening (which happened around midnight) I forgot to turn the machine off.

I've been learning about sleepyhead in the past 24 hours, particularly to do with the flow rate graph in an attempt to find out why I keep awakening. I've attached screenshots for each of the 8 awakenings below where I have zoomed in to try to find out what happened. I'm only a beginner at analyzing data but I can't see why I'm waking up.

There are no pressure increases just before I wake up and there is barely any flow limitation at the awakening times (on some there is zero). The flow rate graph for most of the awakenings stays consistent right up to awakenings. It looks like I was perfectly asleep and then woke up out of nowhere. I checked the leak rate at the time of each awakening and it was at roughly 2 in 7 out of the 8 times, something so small it could never wake me.

Does anyone have an idea about what is causing my frequent awakenings after looking at these zoomed in screenshots. I'm confused and frustrated.

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RE: Losing the will to fight
Here are the last 3 awakenings.

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RE: Losing the will to fight
Awakenings don’t look relaxed to therapy.
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RE: Losing the will to fight
Hi sleeprider, are you saying that you think I'm still getting used to the therapy and that it's possible with time the awakenings will become less frequent as I become more comfortable.
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RE: Losing the will to fight
Just a little update.

I've been keeping a sleep diary for the past week. What I've found is that every time without fail I wake up it's whilst I'm dreaming. I know that makes the awakenings seem like normal post sleep cycle awakenings but the evidence suggests otherwise. Sometimes it's two hours between awakenings, often it's an hour or less. Sometimes I have 8 or more awakenings a night. If sleep cycles last roughly 90 minutes then the timing and frequency of my awakenings don't match at all.

I'm pretty sure it's not REM sleep behavior disorder because I slept in the same room as someone until very recently and they never said I talked or moved violently in my sleep. I've also never knocked my mask or got tangled in the hose since starting PAP treatment so it seems to be something else.
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RE: Losing the will to fight
hmm... interesting; I've gotta finish reading that book – I haven't gotten to that part yet.
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RE: Losing the will to fight
In my post above, I meant, awakenings do not appear related to therapy. I was probably on the phone. I hope you find out what disturbs your sleep, but the CPAP is working great.
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RE: Losing the will to fight
"Awakenings don't look related to therapy." - Sleeprider

personxyz: I'm about to ask sleeprider to help me (and others) learn more about interpreting waveforms; yours, in this case.  underlying my question is an assumption that may or may not be valid so I'm not discounting what others have said and encourage us all to listen to their advice.

mons and mods:  I ask this here because it's in reference to personxyz's charts and because the question might interest the OP.  I leave it to you to determine whether to split it off into it's own thread.

sleeprider:  I've made it clear elsewhere that I suspect disordered breathing as one of the possible causes of frequent awakenings.  sure, lots of other factors independent of breathing and cpap may be in play but it's that occam's razor thing: if we know we have breathing problems identified by the machine, the simplest explanation may be that we have breathing problems that aren't identified / flagged by the machine.  Dr. Barry Krakow tells us as much in the UARS wiki article sometimes cited in these threads and elsewhere found easily with an internet search.  it makes sense that the severity of apnea occurs along a continuum and that the ones identified by the machine are only those meeting a certain narrowly scoped clinical definition.  it makes sense that we have partial events and other precursor breathing anomolies.  upper airway respiratory syndrome; flow limitations, hypopnea, and apnea not meeting the clinical definition; and I would argue, just plain stressed breathing, as indicated by ragged flow rates, are sure to cause us distress.  why not awakenings?  if recognized, these things ought to respond to cpap therapy.  it may not be safe to assume that therapy that resolves flagged events will also necessarily resolve these precursor breathing anomolies.   

when I look at personxyz's charts I see a lot of flat-ish topped inspirations suggesting flow limitations that aren't severe enough or long enough to be flagged by the machine.  I see some ragged breathing and I see a different kind of flat-ish line at the midpoint between inhale and exhale, suggesting apnea that aren't severe enough or long enough to be flagged by the machine.  

even if therapy resolves nearly all flagged events; especially if therapy has yet to resolve all flagged events, shouldn't at least part of the therapeutic approach be an effort to address these unflagged apparently-UARS issues?  I'm not saying don't look elsewhere as well, I'm just saying we shouldn't dismiss the possiblilty; in fact, shouldn't we attempt to fix these or demonstrably rule them out?  and by 'we', I don't mean you necessarily.  according to Dr. Krakow, much of the sleep medicine communty largely overlook UARS.  

the intent of this question is academic.  nothing personal with respect to the OP or any apnea board advisors.  certainly not intending to second guess you, sleeprider or put you on the spot.   I'm obviously not qualified to advise anyone so I'm asking for a conversation to help those of us interested in this stuff.  

besides commenting on the theory (if you care to), what is it in personxyz's charts that lead you to assume something other than insufficient or inadequate therapy?  and apparently rule out breathing anomolies as a cause of fragmentation?  

thanks for everything you do here!
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RE: Losing the will to fight
This is moderate flow limitation and it is not flagged, and Sheepless has it right. This is a pretty common feature of your respiration.

[Image: attachment.php?aid=6455]

This is totally messed up, It arises from flow limitation and it caused an arousal

[Image: attachment.php?aid=6461]

Sheepless raises a good point, your arousals and perhaps the CA events start with flow limitation. I think adding one cm to minimum pressure and EPR at 3 might not be a bad idea.
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RE: Losing the will to fight
Is it the flat part of the wave that indicates flow limitation? The first image I've uploaded is basically how my flow rate looks for most of the night if I scroll through the entire night on sleepyhead.

The second image is what my flow rate looks like for some of the night (not too often).

The third image is what my flow rate was like a few minutes before a known awakening (I turned the machine off to record what time the awakening happened). This type of flow rate actually happens for some pretty long chunks of the night.

Every now and then I'll have flow rates like in image 4. I thought it was just from me shifting in bed or something but clearly I'm no expert.

I also have quite a few periods through the night with a flow rate similar to the second picture you showed sleeprider, where the flow rate looks spiky/pointy.

Sleeprider, when you say add one cm to minimum pressure and put the EPR at 3 I'm a little confused. In the last images I uploaded my min pressure was 7 and max was 8 so are you making recommendations based off of that. Would that mean I'm at a fixed pressure of 8? I'm now back on the settings you told me to use a while back, min pressure of 6 and max of 10 with EPR on 2. The images I've included in this post are from a night on the 6 to 10 settings, the same flow rate issues seem to be happening as when I was on 7-8 pressure. Should I turn the min pressure to 7 and then and increase my EPR to 3?

Sheepless, it's helpful for me to learn more about my flow rate as well so I'm grateful for you inspiring this discussion.
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