I'm waking up every 30-35 minutes all night

I can't tell why. I have an extra home security camera with night vision trained on my bed and hooked to the security DVR. I mean spot-on all throughout the night, typically averaging about 33 to 35 minutes apart, I wake up to turn over and go back to sleep. 2018 in-lab study showed 4.7 AHI and 18 RDI (indicative of UARS). Had deviated septum fixed and turbinate reduction surgery. Lots of RERAs - 50 breathing events noted in 2.75 hours. Severe sleep fragmentation noted. In-lab results showed no central sleep apnea and no significant desaturation of oxygen levels. Heart rate went down to 57bpm and spiked up to 112bpm max.

A home sleep study after that surgery showed a 5.2 AHI overall, but some of the positions had higher AHI like 9 listed in the technical details. Also, an apnea listed as 85 seconds long and yet no oxygen level drops below 92/93. I'm puzzled. It even showed a heart rate down to 42bpm and spikes up to 100+ during the night. Been to heart doc for a full Stress Echocardiogram, had all kinds of blood work, thyroid checked, had an MRI and CT scan of the abdomen to check for stuff like adrenal tumors and such.

Should I be chasing the UARS? I feel like garbage every morning. This has led to panic attacks due to "fight or flight" mode malfunctioning of the sympathetic nervous system. Between December and January, I went to the ER 3 times after randomly developing panic attacks, high blood pressure spikes, adrenaline dumps in the body that make me shake to pieces, fast heartbeat, etc. They thought I was having a heart attack. Lots of EKG's were done. My home blood pressure monitor shows considerable differences in beats speeding up/slowing down and/or palpitations on some days when I also feel quite lightheaded and dizzy, but heart rate is usually normal around 80-100 beats per minute during that time. Now I have had Gastritis for like 1.5 months. This can apparently be caused by UARS upsetting the digestive and GI system. I feel short of breath in spurts throughout the day and I've been extremely dizzy-headed the past 1.5 weeks. When I take a nap, sometimes my legs hurt afterwards with calve cramps. No energy daily no matter how much I sleep. I'm scared to exercise because it makes my heart rate too high and I feel exhausted and dizzy.

Is the UARS causing all of this stuff? Off to sleep doc next? Or should I be checking with the primary care doc? I have been around to various forums and some people are telling me that CPAP can treat the RERAs of UARS, while others are saying that I need a BiPap to treat it because even with the full 3 EPR set on the Air Sense 10, the exhale pressure makes the body panic because it is too high. Others have mentioned that they developed some kind of anxiety until they went on BiPap, but then it went away after starting that.

I also wake up a lot at night being fully awake with my brain and knowing where I am, but my physical body is still asleep until I move my head too far, reach for my phone or reposition my body. Then my physical body wakes up. It is weird as heck. Otherwise, I could say there for at least 2 minutes feeling my body 'vibrate/twitch' all over in sleep mode until it physically wakes up. Is this a sleep disorder of its own? I don't have hallucinations like part-dream/part-reality that people experience with sleep paralysis. Something is clearly off in my brain, but I don't know quite what to do about it if it is chemically off and not just something that a sleep study could detect.

The big problem is also getting the study. I don't remember sleeping any during the in-lab study, but they could tell when I was asleep or awake, of course. There is a more thorough sleep study (compared to the home one that I did before) that I'm planning to do through mail-order via a place called AXG Sleep Diagnostics. It is $500 for a Type 2 study with electrodes on the head and everything, so it can detect RERAs and hopefully figure out what is going on a little better so that I can sleep in my own bed. I may need another in-lab study at some point. Old sleep doc was a quack and joked about my high RDI, saying that I didn't have sleep apnea, but that "if I didn't have an active job and had a desk job, I'd be falling asleep in my chair." He apparently doesn't acknowledge or treat RERAs or UARS. My ENT was flustered at the sleep doc when I showed her the results. He wouldn't let me get a CPAP prescription. ENT doc wrote one for an APAP just so that I could get it and try it. Got an Air Sense 10 Autoset For Her with a P30i nasal pillow mask because I sleep on my side and stomach a lot. Tried the algorithms in For Her mode, tried regular APAP mode to get an idea of my obstructions (always maxed out at 9 even if I had it set for 12 or higher) and averaged normally about 7-8. I fine-tuned it to CPAP mode and got to 7.8 set all night. I did that because all night every 30 minutes or so, I'd pop awake on camera and reach for my mask and look around confused, then go back to sleep. I figured the Ramp mode was waking me up. I still did it with CPAP mode, too.

What in the world? Have I got something wrong with my brain causing this? Suspected to have been going on since as far back as my early high school days. School was awful, I was exhausted, couldn't concentrate, etc. I can't drive right now. I'm not alert enough mentally. At any given time or place of the day, I could go to sleep upright in a chair, on a bus on the way home from work (just a 25-30 minute ride, but I'll be out in like 10), in the car as a passenger, etc. I'm so tired most days that my eyelids visibly twitch all day and I've got 3 wrinkles under each eye with no other wrinkles on my face. Clearly my sleep issues are taking a toll.

Here is a scan of the chart regarding my RERA's. https://i.postimg.cc/FFjsGvhd/RERAs.jpg

An hourly index of 60 RERAs, which they reduced down to 18 RDI based on the NREM index alone. Their charts are a mess of confusion and I don't think even they know where a lot of that came from. That's a disturbing amount. Arousals and awakenings were 166(!) for just 2.75 hours. Over 130 of them were in NREM sleep.

This sounds miserable; I'm so sorry. I think it is important for you to follow up with your primary care physician, making sure you describe all the experiences you've mentioned here. Even during these times, a phone appointment could be helpful.

You might ask your doctor whether it sounds as though several things are going on: maintenance insomnia? panic attacks? respiratory-related sleep disorder? anxiety? You might also ask about cognitive behavioral therapy for insomnia (CBT-I); more here from a trusted web site: https://stanfordhealthcare.org/medical- ... omnia.html

In the meantime, I recommend that you taper down as fast as you can on coffee and other caffeine-containing food and drink. I also recommend that you observe the following rules faithfully, even if they sound kind of mickey-mouse:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

Please don't be put off when your symptoms are not exactly classic textbook descriptions. There are so many variables and even outliers, so don't dismiss a certain diagnosis prematurely. Just my non professional opinion, but I wouldn't bother with any more home tests. You need the intricacies a lab study offers. A few questions to ask yourself... Did your other lab study or your home camera give you any reason to suspect limb movements? Are you on any meds known to disrupt sleep? Do you drink alcohol in the evenings? Your descriptions of things you experience when waking make me think of two possibilities. One is narcolepsy. The other is that your sleep stages have been so fractured for so long that the lines are blurred between sleep and wake. That happened with me, but once my sleep improved, so did those strange experiences. Hopefully you can work with a doctor who is committed to sticking with you until they can diagnosis your problem.

Hi pianoman37, I just found your post after searching the forums for adrenaline issues.

I think I'm in a very similar boat. Adrenaline spikes when dosing off, feeling terrible in the morning, weird heart rate/tachycardia, anxiety, panic attacks, GI issues.

Did you manage to feel better now? Anything that helped you?

I also wanted to suggested increasing your exercise if possible. I heard lots of these symptoms are made worse by deconditioning.

I can't find in your lengthy post where you've told us what all of your settings are. If you're using a range of pressures, it could be that the pressure changes are disturbing your sleep, or the subsequent leaking if the pressure goes beyond the mask adjustment limits.......or, it could be a number of possibilities of many other things.
Without looking at some software reports, it's almost impossible to guess.

EDIT TO ADD: I see that this was an older post resurrected by someone else.


Den

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pianoman37 wrote: ↑

Sun Apr 05, 2020 6:58 am

Had deviated septum fixed and turbinate reduction surgery.

Sorry to hear about your sleep issues. Obviously the surgery did not fix your sleep problems. However are you nose now no longer congested at night time? Has the surgery been a success in that sense?