[Health] UARS diagnosed twice, using a CPAP, and still waking in the middle of the night.

[gainerfull]

You sleep data looks good - how is your sleep quality?

Flow limits are low but your leak rate could use some work. Based upon the behavior of the leak data you're opening your mouth at night and that can impact your cpap therapy. Try buying some $3 medical fabric tape from your local store and taping your mouth at night.

Also, you had an obstructive event and a pressure spike right before you woke up the second time plus you have EPR set to 3. For me, when EPR is set that high I feel like I'm suffocating and it only starts working at 7cmH20 so that might explain why you woke up. Your airway collapsed, the CPAP tried to compensate and sent the pressure above 7 where EPR kicked in and you woke up.

Considering your AHI is so low I'm hesitant to make any recommendations but there are some things you could tweak if you're interested.

[logart89]

You sleep data looks good - how is your sleep quality?

Well, my sleep quality is now better, but keep in mind i'm using ZOLPIDEM and CLONAZEPAM, If i don't use CLONAZEPAM when i wake up in the middle of the night, i can't get back to sleep, my doctor prescribed me Slow release Zolpidem, to lower the dose of clonazepam and start getting rid of that horrible addictive drug, so i feel good when i sleep if every time i wake up i use clonazepam to get back to sleep.

Flow limits are low but your leak rate could use some work. Based upon the behavior of the leak data you're opening your mouth at night and that can impact your cpap therapy. Try buying some $3 medical fabric tape from your local store and taping your mouth at night.

I'm already using 3M micropore medical tape to tape my mouth, i guess i could use two layers next time, since micropore allow air or gas exchange to go through, i will now use two layers instead. 

Also, you had an obstructive event and a pressure spike right before you woke up the second time plus you have EPR set to 3. For me, when EPR is set that high I feel like I'm suffocating and it only starts working at 7cmH20 so that might explain why you woke up. Your airway collapsed, the CPAP tried to compensate and sent the pressure above 7 where EPR kicked in and you woke up.

Considering your AHI is so low I'm hesitant to make any recommendations but there are some things you could tweak if you're interested.

Yes, I'm interested, these are the settings that my doctor told me to use, but I'm one of those that like to try different things, so go ahead and display your setting tweaks please.

I don't even know what EPR does and how that affected the time i woke up at 3:45 AM. Can you explain your theory further?

[gainerfull]

Well, my sleep quality is now better, but keep in mind i'm using ZOLPIDEM and CLONAZEPAM, If i don't use CLONAZEPAM when i wake up in the middle of the night, i can't get back to sleep, my doctor prescribed me Slow release Zolpidem, to lower the dose of clonazepam and start getting rid of that horrible addictive drug, so i feel good when i sleep if every time i wake up i use clonazepam to get back to sleep.

Zolpidem is for insomnia and clonazepam is anti-seizure, do you have epilepsy or was it prescribed off-label for sleep difficulty or anti-anxiety? Have you considered experimenting with Gaba? Myoinositol? L-Theanine?

What is your exercise routine like during the week?
https://www.unisa.edu.au/media-centre/Re...al-health/

I'm already using 3M micropore medical tape to tape my mouth, i guess i could use two layers next time, since micropore allow air or gas exchange to go through, i will now use two layers instead. 

From your last screenshot it looks like your humidity level is set to 3 so it's likely either you're mouth leaking through the micropores or the added humidity is making the tape wet and it's losing it's stickiness overnight. You may consider lowering your humidity level to 1 and test. Even w/ tape you could still experience mouth drop so beware. Do you have a chin strap or a soft cervical collar to eliminate mouth drop as a variable? You might also try a double sided boil & bite mouth guard but they can be tough on your gums.

Yes, I'm interested, these are the settings that my doctor told me to use, but I'm one of those that like to try different things, so go ahead and display your setting tweaks please.

I don't even know what EPR does and how that affected the time i woke up at 3:45 AM. Can you explain your theory further?

EPR is expiratory pressure relief which is a comfort setting that dynamically lowers the exhaust pressure when you exhale so it makes it easier to breathe. EPR at setting 3 can only work with a minimum pressure of 7 so if you look at around 3:40 when you had the light blue obstructive event "OA" your cpap machine ramped up the pressure to over 7 to inflate your airway and clear the obstruction then EPR kicked in. You can tell EPR kicked in because of the green peaks at the bottom of the pressure chart so it would make sense that you woke up when EPR kicked in for the first time that night because you probably aren't used to it and your body felt oxygen starved so it woke you up to take a breath.

Since you're not using EPR for 99% of the night the simplest approach would be turning EPR off since you're getting great results at lower pressure and when it does kick in it may be waking you up. Your success criteria here is getting the same results but not waking up after events. If you're not dealing with fragmented sleep, that alone can increase your quality of life.

[logart89]

Zolpidem is for insomnia and clonazepam is anti-seizure, do you have epilepsy or was it prescribed off-label for sleep difficulty or anti-anxiety?

I been suffering from Generalized Anxiety Disorder (GAD) since more than a decade, at first i had lots of anxiety in daytime, anxiety attacks, this feeling that you will have a heart failure, difficulty falling sleep, i stopped getting those anxiety attacks eventually, but the difficulty of falling sleep remained, so even tho i stopped getting anxiety attacks, i'd still needed anxiolitics like clonazepam for sleeping, i have periods in my life where i drop off completely clonazepam from one day to another and slept 8 hours without interruption, but then night anxiety came back to harass me once again and i have to use it. This time is different, now i don't have trouble falling asleep, now i wake up at 2-3 AM every night, my neurologist that found that i have UARS me told me he suspects I have my circadian rhythm displaced, like if i was living in a different continent, in example, I should be getting to sleep at 8 PM to sleep at 3AM (7 hours of sleeping) so my body automatically wakes up at that hour, and it kinda make sense, and that i'm kinda making it worse with clonazepam, he says is hard to change circadian rhythm disorder that is so displaced, it could take months. He prescribed me Stilnox CR (zolpidem) CR stands for extended release, so the first dose of zolpidem put me to sleep, while the second dose will kick in at 2:AM and that would help me to not wake up at 3:AM but even with all the CPAP, zolpidem CR, etc, i still wake up at 3:30 AM, so he is convinced has to be a circadian rhythm displacement disorder because is not normal, he also prescribed me zolpidem so if i wake up at 3:30 AM i would use less clonazepam to fall sleep again, kind of to begging dropping off clonazepam.   

 Have you considered experimenting with Gaba? Myoinositol? L-Theanine?

Yes, i just bought all you mentioned except myoinositol, I'm waiting them to arrive at my door, i'm really concerned about testosterone levels going down, even tho, there are studies that say T levels went up in older men taking myoinositol, there are also studies that in women it helped to lower T levels, so there's really no definitive answer, I must say i'm attracted to the anxiolitics benefits of myoinositol, I still really afraid it could lower my libido, which is already very low.

What is your exercise routine like during the week?
https://www.unisa.edu.au/media-centre/Re...al-health/

I make exercise 7 days a week, as soon as i wake up (around 7-8 AM) i make ABS routine and then HIIT, then i wait about 6 hours and make my resistance training (around 2PM), I don't like to make exercise close to evening cause i feel it could alter my sleep. I might skip one day of workout if i have a terrible night where i only slept 3 hour, but i generally do exercise everyday, I'm a fit and ripped person. 

From your last screenshot it looks like your humidity level is set to 3 so it's likely either you're mouth leaking through the micropores or the added humidity is making the tape wet and it's losing it's stickiness overnight. You may consider lowering your humidity level to 1 and test. Even w/ tape you could still experience mouth drop so beware. Do you have a chin strap or a soft cervical collar to eliminate mouth drop as a variable? You might also try a double sided boil & bite mouth guard but they can be tough on your gums.

I have a Chin strap resmed brand, but is very lame, don't buy it, at least it doesn't hold my chin as much as i want even if i tight it at max. I will try 1 humidity setting, this lame chin strap and double micropore mouth tape to improve the leaks, i have a soft cervical collar that i bought for the same reason as the chin strap but i just feel is too much uncomfortable to sleep with, specially with this Airfit N20 mask which i hate and makes red marks all over my nose, i just bought the nasal pillow mask awaiting to arrive to try them. I also bought a hybrid to try, the F30i. But i heard people say is just better to go nasal pillow masks and learn to close the damn mouth hehe. 

EPR is expiratory pressure relief which is a comfort setting that dynamically lowers the exhaust pressure when you exhale so it makes it easier to breathe. EPR at setting 3 can only work with a minimum pressure of 7 so if you look at around 3:40 when you had the light blue obstructive event "OA" your cpap machine ramped up the pressure to over 7 to inflate your airway and clear the obstruction then EPR kicked in. You can tell EPR kicked in because of the green peaks at the bottom of the pressure chart so it would make sense that you woke up when EPR kicked in for the first time that night because you probably aren't used to it and your body felt oxygen starved so it woke you up to take a breath.

Since you're not using EPR for 99% of the night the simplest approach would be turning EPR off since you're getting great results at lower pressure and when it does kick in it may be waking you up. Your success criteria here is getting the same results but not waking up after events. If you're not dealing with fragmented sleep, that alone can increase your quality of life.

It kind of make sense, i will try with the EPR OFF setting, because yeah is too much coincidence that the first OA i experienced at 2:20AM i didn't wake up, and the EPR did not activated, but at 3:45 i woke up and the EPR setting kicked in, maybe these sudden variations in pressures are waking me up, but it could also be this circadian rhythm disorder theory of my doctor he thinks i have, which also matches up with the 3 AM every night wakening.

[Sleeprider]

Your pressure fluctuates a lot. At 4-11 pressure, I can guarantee I can make you more comfortable with EPR. Set minimum pressure to 7.0, maximum pressure to 11.0 and EPR full-time at 3.0. Life is going to get better.

[logart89]

Will try, thank you.

[logart89]

Your pressure fluctuates a lot. At 4-11 pressure, I can guarantee I can make you more comfortable with EPR.  Set minimum pressure to 7.0, maximum pressure to 11.0 and EPR full-time at 3.0.  Life is going to get better.

Question: a UARS patient doesn't have to have wide pressure ranges?

[Sleeprider]

You will still have 7-11 pressure, but will also have a difference between inhale and exhale pressure. With 3-cm of pressure support (EPR is nothing but bilevel pressure) you will get increasing pressure just as you need it. This is what treats UARS. Trust me, 7-11 pressure with EPR 3 is going to be amazing.

[logart89]

Here is the one from may 11 zoom out picture and the zoom ins of each event, i sleep bad, but that because i lowered the dose of clonazepam, i sleep 3-4 hours at max. Also the airfit n20 mask is very uncomfortable. 

[logart89]

What i find is that flow limitations are much lower than the previous day, thanks to the 7 min pressure. Is just the arousals at the middle of the night that wakes me up due to my anxiety, can you guys see in the waveforms the arousals?