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Post 3-4 months of PAP therapy, still waking up inbetween
Post 3-4 months of PAP therapy, still waking up inbetween
Hi All,

Been using the ResMed Vauto and averaging under 1 AHI every day but I can't go 6-7 hours without waking up once in between. 

I note some obstructives and hypopnea before I do wake up. I work in a small pressure range - if I try increasing the max or min pressure (currently 4.4-8cm), I wake up midway with a giant burp.

I do have nasal congestion which I feel may have an effect on my awakenings. (my left nostril is more congested than my right)

I have attached last night's chart. Please see where I can make the right adjustments?

Attached Files Thumbnail(s)
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RE: Post 3-4 months of PAP therapy, still waking up inbetween
I'm sure there will be people ready to try helping you. But first could you re-format your chart so we can see more of the information that matters?

First, turn off the calendar (use the triangle to the left of today's date.

Then make sure all and only the following graphs are in your screenshot:

Flow rate
Flow limitations.

You can squeeze the graphs by grabbing the gray bars that separate them and pushing up. You can move the graphs up and down by left-clicking on the graph titles and dragging.
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RE: Post 3-4 months of PAP therapy, still waking up inbetween
Hi Dorme,

Thanks for your patience and for pointing out the necessary details with the screenshot.

I have attached a new chart in the way that you have said. This is from yesterday's sleep - woke up twice in between.

PS  - the big leak rate rectangles are when I was awake/when I had just put my mask on

Attached Files Thumbnail(s)
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RE: Post 3-4 months of PAP therapy, still waking up inbetween
Thanks for fiddling with the formatting; this is perfect! And your graphs look great. I would recommend sticking with your current settings, which seem to be serving you very well.

I don't see any clues to why you woke up. Did you get out of bed during the break in therapy? Perhaps to urinate? Sometimes people figure they might as well go to the bathroom since they're awake anyhow. Possibly a better approach, unless you really need to go, is to roll over and go right back to sleep.

It might be useful to you to know that it's normal to wake up multiple times during the night. Often those wake-ups are so short we simply don't remember them. It's the longer wake-ups that we remember. Waking up is bad mainly if it means losing a significant amount of sleep time or if small wake-ups are so frequent that they disrupt the normal progression of sleep stages (light, deep, REM).

Your nasal congestion could be interfering with your sleep, although your very low level of flow limitations doesn't really suggest a problem. At any rate, you might benefit from using something like Flonase an hour before bed time. Saline rinses or sprays can also be of some help, because they help to remove allergens from your nose that might be causing congestion. If the congestion persists and is bothersome, you might consider a visit to an ENT.
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RE: Post 3-4 months of PAP therapy, still waking up inbetween
Glad this is more readable!

Yeah, I have a consistent < 1 AHI but I'm not sure I feel as good as the numbers say.

I'm 24 years old. I don't really wake up to urinate but I notice I have a bad dream of sorts before waking up and finding my heart beating tangibly quick.

I'm sure this is not one of those micro awakenings - I know when I wake up and I don't feel good when I do.

Yeah, the nasal congestion is an issue for me because yesterday I was for sure congested in both my noses when I woke up. This is post my septoplasty/turbinoplasty from 2020 - I've been having these awakening problems post the surgery. I'm not too confident about revision septoplasty either but something to check with my ENT. I read online that its probably better to do MSE/EASE than meddling with cartilage/soft tissue in the nose...your thoughts on that?

I have tried flonase - after repeated usage, I start having slight fever and it went after I stopped using flonase. saline rinses are fine too, but then again - I wake up the same, albeit a little lesser.
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RE: Post 3-4 months of PAP therapy, still waking up inbetween
Your profile mentions unsure under humidifier. Do you have a humidifier with your machine? Is it set? I have congestion issues, but with the humidifier setting, it helps a lot. Especially if I use flonase before bed. I remember reading on this forum that flonase also causes some tightening/constriciton of vessels that helps a little with snoring. 

I too have the same issue as you with not feeling rested even with perfect ahi results. I usually average 1 or two nights a week with 0 ahi and average 0.3 or less. 
I wake during the night, sometimes with the rush of adrenalin and my heart racing. And sometimes I wake up, start thinking about stressors and then have a hard time falling back to sleep. And when I review my charts, I don't see any events or leaks that occur prior to arousal. 
Do you think you have more wakefulness occurring because of stressors that you may be dreaming/thinking about, or are you waking more without any prior memories of thought, just the adrenalin rush from like when you're not getting oxygen?

It definitely makes a difference on those few occasions when I wake up from the alarm in the morning, not remembering waking up during the night at all. But I mostly always wake up before the alarm in the morning, and usually several hours before...

Good Luck, hope you get some answers.
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