[Treatment] Fragmented Sleep - Waking up multiple times throughout the night - Help

[Gling1993]

Hi, 

By a way of brief introduction, I am new to the sleep apnea community. I was diagnosed with sleep apnea (OSA mild, AHI of ~13) in late October and purchased my CPAP (AirSense 11, with AirFit P10 mask) in December 2022. 

Prior to starting CPAP therapy, my sleep was very fragmented. I would wake up every 1-2 hours to urinate, drink a sip of water, and then repeat each time I woke up. I generally fell back asleep very quickly. However, I felt fatigued in the morning due to not getting "deep sleep" because of my OSA. 

When I started CPAP therapy in December 2022, within the first week, there were some very good sleeps. I noticed a big enough difference that I did not need a coffee to get through the next day. On those days, my sleep was less fragmented. For example, there would be periods where I would sleep for 3-4 hours before waking up. I find the AirFit P10 nasal pillow to be very comfortable since I am a side sleeper. 

As 2 months have passed now on CPAP therapy, I noticed that normally my sleep is still very fragmented, waking up every 1-2 hours. Each time I wake up, my bladder feels uncomfortable and I need to urinate (even if it's very little pee), drink a tiny sip of water, and then this makes me comfortable enough to fall back asleep. I generally go to bed at 11pm and stop drinking fluids and eating by 9pm. I also try to drink lots of water throughout the day. 

I've read online that people have had similar issues to me (i.e., the urge to urinate) prior to starting CPAP therapy, however, CPAP therapy resolved this issue. I'm wondering if there is something with my CPAP (e.g., leak, pressure, OSA/CSA events, etc.) that's causing me to wake up throughout the night or whether there is another medical issue (e.g., nocturia). 

I would really appreciate if anyone that had a similar problem as me to share their experience and how they resolved (i.e., tips and tricks). I've also posted up my OSCAR results for what a typical sleep night looks like for me, if you could also help me interpret the results. 

Thank you so much!!

[chewielotuses]

Hi OP! I have a similiar issue with the fragmented sleep, so am hoping the gurus here could shed some light on the best way to tackle the problem

[quiescence at last]

When you awaken do you have a memory of a dream or that you dreamt. Is that most times you awaken, or few times?

I will in most cases awaken with an awareness that I had a dream just prior.

QAL

[chewielotuses]

Yes! There would almost certainly be memory of a dream sequence prior; this is something i notice consistently 4 out of 5 awakenings per night

[quiescence at last]

check out the link posted, scan through the article, and then read specific info under the banner Dreaming.

Sleep - Dreaming

I generally also look for nih studies about REM sleep and dreaming.

I feel that the wakenings at intervals throughout the night is very natural and is not a burden for me.  I have also formed an opinion that those that do, especially if they naturally concluded sleep cycles with this type of awakening tend to feel more rested and complete.

check out, also: What Is Segmented Sleep and Is It Healthy? (webmd.com)

Relax, and get some sleep.

QAL

[quiescence at last]

Dreaming since treated is way different than while untreated suffering sleep apnea.

Before seeking treatment, most of my dreams were bizarre, nightmarish, and frustrating.

After (while) getting treatment, mostly sane non-frustrating.

Personally, most of the remembered dream sequences at the time seem plausible, though often it is utter nonsense when reality sets in. examples: (1) flying by stroking the air like you would swim underwater, where each stroke gets you a little higher or faster. (2) realizing that, of course, the worm hole is behind the double doors adjacent to the pantry.

nightmarish and frustrating dreams have occurred maybe 4 or 5 times in the last 9 years.

You'll read that mostly dreaming is done in REM sleep, but some can happen in other sleep stages. I think that my problem before treatment was a lack of REM sleep, and further that when I dreamt it was stuffed into another sleep stage.

QAL

[Lucid]

Hi, Gling1993

I have three suggestions:

1. Here is a recent article with background on and tactics to counter waking up frequently during the night.  This should be a "gift" link that you can access without a subscription:

https://wapo.st/3WYOKEE

Let me know if you hit a paywall, and I will post a new gift link.

2.  You mention trying to drink plenty of water during the day.  Try drinking only when you feel thirsty.

3.  Download OSCAR and post your charts here on this Forum.  There may be something about your settings that you could fine tune with analysis and suggestions from experienced folk here.

It's great that you're asking about this.  It's a widespread problem, and the comments you're getting are so interesting.  Good luck!

[Dormeo]

As others have noted, we can dream during all our sleep stages, and it's quite natural to wake up after a period of REM sleep.

I'd suggest four things.

1. Because you're feeling an urge to urinate but then passing relatively little urine, please talk with your doctor about this. You may have a mild urinary tract infection or an enlarged prostate or some other treatable physical condition.

2. You may have habituated yourself to the pattern of getting up unnecessarily to urinate if you feel even the least little urge. Try staying in bed and relaxing into a continuation of your sleep.

3. Stop fluids and food at least three hours before bed-time, and make sure none of your usual evening fluids are diuretic (e.g., tea, coffee, alcohol).

4. To make sure you're not causing needless awakening from pressure changes and flow limitations, try setting your minimum to 7 while keeping your EPR at 3. Because your OAs are so well treated, you could also try lowering you maximum to, say, 9. With your current settings, you aren't getting the full EPR of 3 all night, since your machine can't go lower than 4. EPR can help with FLs. Also, the changes in your pressures are mostly in response to FLs, though higher pressure is not especially effective in treating FLs. -- These changes may make no difference, but they're worth an experimental try. Unless they make things worse, give them a week or so before you decide whether to stick with them.

[Gling1993]

QAL - I tend to have more vivid and memorable dreams when I'm in deeper stages of my sleep, which happens later in the evening / morning. I find that my fragmented sleep in the morning is really deep and I always have dreams. In the early night, I tend not to dream but still find myself waking up every 1.5-2 hours.

---

Lucid - Thank you! I'll take your recommendations into consideration. I have posted my OSCAR results in the original post above.

[Gling1993]

Dormeo - Thank you for your recommendations! I will definitely try the settings and see what happens.