Three hours into the night is the point at which the first major cycle of REM sleep occurs. Typically, people have many more apneas during REM. My overall AHI was only 19, but my AHI during REM (when I could sustain REM) was 83, and Imwoild desaturate to life threatening levels.
The reason is that during REM, to avoid you acting out your dreams, which can be dangerous, your muscles disconnect from your brain. Sleep walking, sleep eating etc., are what happens when that disconnection is incomplete or unsuccessful. I suspect your flow limitation are occurring during periods of REM sleep. How badly are yoj desaturating? If you don’t know, check your sleep reports or use overnight recording oximetry.
Biguglygremlin: I concur in your view that the way your mask interfaces with the machine is the problem. Have you tried a variety of other style nasal masks?
The problem is that sleeping with a mask on, and your machine off, due to lack of power is far worse than sleeping with no mask at all, because the mask, notwithstanding the exhalation ports, presents far more resistance to your breathing than using no mask at all.
If, like me, you already desaturate to life threatening levels without PAP, a power outage while using a nonfunctioning mask/machine could be fatal.
I very much share the OP’s concern. I live in an area with an unreliable electrical grid, so I have gone to some effort to deal with this issue. The other source of my concern is that I can regularly desaturate below 60% which can be life threatening.
Here’s what I have done:
1) installed a whole house standby propane generator. It automatically kicks in less than 25 seconds after a power outage. Not inexpensive, but I love it, and given the unreliable grid, a popular addition to homes in my area. I seem to be able to endure
Less than 25 seconds of a machine outage without problems, but be sure your machine is set to go on automatically.
2) purchased the manufacturer’s recommended batteries, usually used by campers, and I have several for each of us. You will also need matching inverters. A pigtail setup can help you seamlessly go from one battery to the next during the night. There are algorithms that can help you ascertain how many hours of service you can get from each battery and hence how many to purchase to provide coverage for a given number of nights.
Other possibilities are:
1) an alarm to alert you when the power goes out. It’s something you plug into an outlet. But it can be annoying if your power flickers off for only a second or two frequently—- and ours does.
2) an uninterruptible power source. You may already be using one of these on your computer set-up. It is essentially a battery that you insert in-line between the outlet and your CPAP machine. If the grid power flickers out, this will keep your machine running for a specified period, perhaps forty minutes or so. So, you won’t have to wake up to deal very brief outages. Given the generator, I haven’t felt it necessary to use one of these. But if the 25 second lag time on the generator kicking in troubles you, that’s a possible alternative.
3) Another solution might be roof top solar panels with whole house battery power storage. Beware, however. In many areas, you won’t get service from your rooftop solar when the grid is down, which, in this context, defeats the purpose.
Does anyone have any other solutions?
Raquel2: I know of a neurologist turned sleep doc, who, two years after becoming a sleep doc realized HE had sleep apnea. But because he was slender, he had a very hard time getting insurance to pay for his sleep study. So, knowing what the screening questionnaires would ask, he simply gamed the questionnaires to get the study.
He turned out to have an AHI of 28. The stereotype that says that only middle-aged, morbidly-obese males have sleep apnea is killing people. But most sleep docs still subscribe to it, sadly.
None of the questionnaires are validated, and many of them will very effectively screen out young, thin women, or just thin people in general. I was misdiagnosed with anxiety and insomnia for decades, when all the time the problem was that I obstructed so severely during REM that couldn’t sustain REM sleep and I would regularly desaturate to 60%, which is life threatening.
There is a lot wrong with this field.
Have you tried pediatric head gear?
Ideally, your machine should be PREVENTING obstructive apneas by keeping your airway open. That’s the point of the positive air pressures. And the algorithms are designed to anticipate a collapsing airway and provide increased pressures before you actually experience an apnea. The machine can detect the narrowing of the airway in a hypopnea and impending obstructive event and increase pressures pretty quickly to avoid it. RESMED says their machines can do so within three breaths. So, my questions would be:
1) what machine and settings are you using?
2) is your machine working properly?
3) And what’s your residual AHI?
There can be a lot of variation from night to night and many different things can contribute to that: the weather, including humidity, allergies or nasal congestion, what you ate or drank, and whether you are coming down with even a mild a respiratory infection, etc. sometimes you can find a physician who will prescribe a machine, but if your condition is milder than what your medical system/insurance is willing pay to treat, you may need to pay out of pocket.
Sleep Apnea is well known to create free floating anxiety. But the anxiety is the result of being effectively strangled or smothered all night- not the cause.