Sleepy, too many arousals?

[Jdougc74]

Looking for some insight and advice, thanks in advance. I have been on a cpap machine since fall of 2018. I was using the Phillips dreamstation and I replaced the air chamber with one without foam after the recall notice. I got a ResMed AirSense 11 this past July 2024. Previously the dreamstation would not give me data on the sd card, but I have data now for Oscar and SleepHQ.
I switched from an Amara view to the very soft Resmed AirFit F40. Sadly I had to replace that with a N30 nasal cradle mask. I am having neck surgery in Jan 2025 and the neck straps seemed to aggravate my neck issues. I am a side sleeper and have experienced the leak battle, possible when I am aroused and switch to the other side. I presently use mouth tape and a chin strap and have tried the soft cervical collar, I am awaiting deliver of a new collar today.
My numbers appear ok, but the ResMed machine seems to “miss” events that may be causing arousals. I am on opioids for my pain, which doesn’t help my breathing issues. I am prediabetic and battle high blood pressure. I have to fight the urge to chase numbers, I need a better rest night, period. I have attached some Oscar screen shots with my fitness tracker sleep data. Not sure how accurate, but it seems consistent.
I use the CPAP mode and use the ramp feature only to emphasize my awakenings with the mask off. I have experimented with turning on EPR, but have increased the pressure to compensate, sorry for the long post.

[Miss Emerita]

Welcome! Increasing your EPR did an amazing job of clearing up flow limitations and snores. You might consider raising EPR to 3 and also increasing your minimum to keep your obstructive events well-controlled.

To see any "missed" events, we'd need to be able to look at your Sleep HQ charts. Could you send a link, and could you identify (by time) one place where you think there's a missed event?

Do you know why you're having leaks all night long? If they're from your mouth, see whether the new collar helps, and then consider trying a FFM whose straps don't exacerbate your neck problems.

Have you googled all your meds to check for side effects involving sleep or daytime sleepiness?

[Jdougc74]

Miss Emerita , thanks for the fast reply.
Here is a link to my data from SleepHQ.
https://sleephq.com/public/teams/share_ ... /dashboard
I am not an expert at looking at arousals and missed event, maybe one last night Friday Oct 25th 2024 around 10:29:30 with the deeper breath. Seems like was having issues after that.
I am afraid to go down that rabbit hole of looking at side effects on my medication, haha… Nothing newer for me. The opioids can cause breathing issues. The other meds have less common side effects like that.
I am a side sleeper and I probably let my mouth fall open when I hit deep sleep and rem sleep

missed event oct 25th 2024.jpg (153.43 KiB) Viewed 6576 times

[robysue1]

I am not an expert at looking at arousals and missed event, maybe one last night Friday Oct 25th 2024 around 10:29:30 with the deeper breath. Seems like was having issues after that.

The thing that you highlighted with the red arrow appears to be a spontaneous arousal. In other words, there's no evidence in this snippet that indicates respiratory problems were the cause of this arousal.

The little bit of erratic breathing immediately following that arousal is not a missed event: The decrease in the size of the inspirations is not severe enough to count as a hypopnea. It looks to my eyes like it took you about a minute to fall back into a real sleep, and I think the little bit of ragged breathing is just your transition back to sleep---in other words, this doesn't look like sleep disordered breathing per se.

Now why you might have had a very short arousal---one that you most likely have no memory of because it is so short---is another question. Fact is even people with no sleep problems have spontaneous arousals now and then every night. For example, it's common to arouse just a bit when you turn over in bed. It's common to have a short arousal or wake after finishing a REM cycle. It's common to have a short arousal if there's an outside noise or if a pet jumps on the bed or all kinds of other reasons.

Now one thing that can cause spontaneous arousals for CPAPers is a leak that has gotten to be large enough or loud enough to wake you. And you were leaking when the arousal occurred. So it's not unreasonable to ask whether the leak is what caused the arousal. But the leak rate actually increases after the arousal happens, and so it seems like you either weren't bothered enough by the leak to "solve" the problem or you were sleepy enough to just go back to sleep even though you hadn't fixed the leak.

[Jdougc74]

robysue1, thanks for the reply. I may have zoomed in a bit too much. Thanks for clarifying as I wasn't sure how much change in the size of the inspirations would be needed to be an event or just an normal arousal after my daughter's cat jumping on our bed or me rolling over.

[Jdougc74]

My new cervical collar should arrive today, tried the old collar that I am returning, as it is too small, supposed to be a large. The night got better once I fell asleep, but after waking up the 2nd time, could not get the cervical collar to fit comfortably, so that part of the night went not so well.
I zoomed in on a good part of the night to show a possible missed event, probably not long enough?

missed events maybe screenshot-20241027-071759-2.jpg (228.79 KiB) Viewed 6177 times

the whole night.

cpap and sleep oct 26th 2024.jpg (470.26 KiB) Viewed 6177 times

[Pugsy]

I zoomed in on a good part of the night to show a possible missed event, probably not long enough?

All hyponeas, OAs and CAs/central apneas have some certain requirements that need to be met to earn a flag and duration of said event is one of those requirements. They all must have a lasting duration of at least 10 seconds to earn a flag.
Even if there was a total blockage that lasted 9.9 seconds....no flag.

[Miss Emerita]

You did some impressive snoring for a while there! Do you think maybe you rolled onto your back?

[Jdougc74]

I saw that snoring, but I am strictly a side sleeper, never on my back.. The neighbors used to complain about my snoring before my cpap machines.

[Jdougc74]

I have a decent night according to my numbers, but we had family leaving around 5am and I struggled again early with my small soft collar, waiting for the new one still.

cpap and sleep oct 27th 2024.jpg (442.14 KiB) Viewed 5512 times

[Jdougc74]

Still waiting on soft cervical collar. Just used mouth tape and my ResMed N30 nasal cradle mask, no chin strap last night. Strictly side sleeping, and I think i was trying to talk in my sleep though the mouth tape, when I woke a little past 12:30 AM. Very. very groggy this morning, but the typical good Oscar score. That is my fitness watch sleep data pasted in.
Thanks again for advice.

cpap and sleep oct 28th 2024.jpg (471.72 KiB) Viewed 5326 times

[robysue1]

That is my fitness watch sleep data pasted in.

Can you clue us in on how to read your fitness watch sleep data?

I assume it's the colored bars that are showing up in the Flow Limitation graph. But I have no idea how to interpret "light purple" vs. "dark purple" vs. "orange" vs. "green" and that interpretation is important if we're to make anything at all out of that data.

[Jdougc74]

robysue1, yes my sleep data is the colored bars that are showing up in the Flow Limitation graph, I hid the key in the bottom left and should have noted that, my bad.

sleep guide.jpg (25.53 KiB) Viewed 5130 times

I was unable to wear the cervical collar with my neck issue. I only had one big time of leakage. I just used mouth tape.

cpap and sleep oct 29th 2024.jpg (433.41 KiB) Viewed 5130 times

[Miss Emerita]

I'm puzzled that your device shows you in light sleep from the minute your head hits the pillow, and also that it shows no REM sleep at all during the first part of the night. I'd treat these read-outs with some skepticism if I were you.

[Jdougc74]

Miss Emerita, I also treat the sleep data from my knock-off fitness tracker with skepticism, but it is some what consistent. Rarely does it show REM sleep at all during the first part of the night, so only a reference. I was very tired last night and fell asleep quickly.
Thanks again for taking the time to give advice.
You may not realize how important your advice is to many of us. I was on my own with no sleep data from the fall of 2018 to this fall. My Phillips Dreamstation would not write to sd cards. I had no sleep report, I had too many primary care physicians in the last 15 years, they would leave the practice. I finally sorted this out a bit and tracked down my original sleep report from 2018 and the new one I did this last winter. Found the pulmonologist who signed the report and met him last month. He would not share my data with me, he said it would make me to anxious. He also said engineers are some of the worst patients. I have an appointment with his assistant next month and will try again.
I said all of that to make the point how helpful you all are! Thanks.