CPAP and headaches

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
pgflrob
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CPAP and headaches

Post by pgflrob » Thu Nov 20, 2014 8:20 am

I was tired upon waking and all day, loosing the ability to concentrate, and my memory was not as sharp as it should be. One time, while working in the heat of the day, I just felt like I would collapse.

Late April this year, I went to my PCP, told him my symptoms and I told him my wife said I really snored a lot. He was on CPAP and sent me to a sleep specialist. I did a home study. My overall AHI was 16.9 with 42 Central and 47 Obstructive and 47 Hypopneas. The specialist ordered a RemStar Auto with A-Flex (560P). APAP 5.0-12.0. I had a really hard time finding a mask that was comfortable. The over the nose type feels suffocating to me. I eventually settled on the Airfit P10. Even that was hard to get used to. I eventually figured out that using a little battery operated nose hair trimmer stopped the tickling and switching form large to medium pillows and back every few days cures the sore nostril problem. It took about two weeks to get the mask right. BTW, I have had the opportunity to try a few other masks since then and the P10 is the most comfortable but it tends to fall off sometimes when I sleep.

So for the first two weeks I struggled a bit with the mask but did not figure out the humidifier. Within 10-14 days I was using the gear regularly sans humidifier and I was really feeling better. Then in July I began to have a very runny nose and was in sneezing fits all day long. I though I might have caught an infection and I was told to really clean the gear. I did. It did not work. I then found that applying a bit of neo-sporine on a q-tip to the most sensitive area about 3/4 of inch up the nasal passages (suggested by an ENT) just after and before bed really helped. I also began experimenting with the humidifier. Between the neo-sporine and finding my humidifier setting (4) the irritation stopped although I still clean/switch the gear regularly, stopped the neo-sporine, and continue w. the humidifier. I use SleepyHead software to monitor my usage and leaks. I do not understand all of the charts, however.

Then about two months ago I began to slip back into the daytime sleepiness and started waking up with terrible headaches that never completely went away. It was as if I had built up resistance to the therapy, but this time with headaches. I went back to my sleep doctor with my machine data and he adjusted the pressure (APAP 6.0-12.0). That had no positive effect.

An MD friend suggested a second opinion and recommended a second study at a different place. This was at a sleep center. I was put on the same gear I use at home with the same settings. The results of this test and this second opinion of my machine data is that when using the machine I do not have much central or obstructive apnea. The new center suggested upping the settings to 7.0-12.0. But that gave no help for the headaches or other symptoms.

To be a bit anal, I borrowed an oximeter for three nights. First night no CPAP. Second night I used CPAP but was restless from the oximeter and knocked both off. The third night I rested better and got good data from the oximeter and the machine. In all three cases my O2 remained well within the range except for on one night there was brief drop to 86%.

If I understand the big picture of sleep apnea, the problem is that either central, or obstructive, sleep apnea causes not enough breathing and that reduces blood oxygen. So if your blood oxygen is OK that pretty much R/Os apnea as the cause of the symptoms. Correct me if I am wrong.

So the only other thing I can think of is that somehow the CPAP is causing some other issue. What could that be? Or are these symptoms not related to apnea at all? I had a CT of the head and it was negative for any sort of brain problem.

So has any one around here had symptoms like this: i.e., the pre-CPAP fatigue and memory function issues return after the CPAP therapy had originally completely cured them but now with waking headaches? Can one actually become resistant to CPAP therapy -- that does not make much sense to me. Is there any other way CPAP can cause headaches, etc.

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Pugsy
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Re: CPAP and headaches

Post by Pugsy » Thu Nov 20, 2014 9:17 am

Your machine is a full data machine. Have you used the software to see what might be going on? If not....use it (links in my signature line)...if you are using the software already..please post a typical night's daily detailed report...
just these graphs..AHI and event category breakdown on the left and these graphs on the right
Events
Flow rate
pressure
Leak

Let's make sure your therapy is optimal first.
How to post images of the above so we can see what you see explained here
Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779

Secondly..question about your neck...has it been bothering you lately?
Headaches if caused by cpap...are more of a byproduct from the straps or maybe the neck and weird sleeping positions. The P10 doesn't have much in the way of straps though...so maybe the CSpine???
What is the pattern to the headaches...wake up with them and have them go away in a couple of hours or do they stay with you all day? Do you get them every day?

How many hours of sleep using the cpap machine are you getting on average?
Are those hours fragmented for any reason (wake up a lot)?

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Julie
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Re: CPAP and headaches

Post by Julie » Thu Nov 20, 2014 9:27 am

One thing is that you may have the humidifier on a high setting when the actual ambient (room/climate) humidity is already high, so try turning it down (or even off - it's a comfort thing, not 'therapy') and see if your 'cold' clears up.

pgflrob
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Re: CPAP and headaches

Post by pgflrob » Thu Nov 20, 2014 9:34 am

Yeah the cold cleared up. I think not using the humidifier for a couple of months including a trip to the high sierra was the cause.

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palerider
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Re: CPAP and headaches

Post by palerider » Thu Nov 20, 2014 9:40 am

pgflrob wrote: If I understand the big picture of sleep apnea, the problem is that either central, or obstructive, sleep apnea causes not enough breathing and that reduces blood oxygen. So if your blood oxygen is OK that pretty much R/Os apnea as the cause of the symptoms. Correct me if I am wrong.
you're half wrong.

sleep apnea frequently causes o2 desats, (as you saw when you got down to 86%) but it also prevents you from getting good, restful, restorative sleep.

if you don't breath long enough, you get all the problems that causes, organ damage, high blood pressure, having to pee all night long, etc.

if you arouse yourself often enough to keep up enough air, then you're constantly being prevented from getting into good refreshing sleep so that your mind is shaper and your body gets to heal during the night, even if your o2 doesn't drop dangerously low.

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Re: CPAP and headaches

Post by pgflrob » Thu Nov 20, 2014 9:48 am

So typical night data
~7 hours therapy
AHI 5.08

Hypopnea 3.43
Obstructive Apnea 0.90
Clear Airway Apnea 0.75
Flow Limitation 0.45
Respiratory Effort Related Arousal 0.30
Vibratory Snore 1.34
Large Leak 0.41
Periodic Breathing 0.49

Channel Min Med 95% Max
PressureTherapy Pressure (cmH2O)
W-Avg: 7.40 7.00 7.00 9.00 9.00
Minute Vent.Amount of air displaced per minute (L/min)
W-Avg: 7.52 0.12 7.00 12.12 103.00
Resp. RateRate of breaths per minute (Bpm)
W-Avg: 17.73 8.43 18.00 19.60 21.64
Leak RateRate of detected mask leakage (L/min)
W-Avg: 2.35 0.00 0.00 11.00 84.00
Total LeaksDetected mask leakage including natural Mask leakages (L/min)
W-Avg: 24.20 17.00 21.00 37.75 107.00
SnoreGraph displaying snore volume (??)
W-Avg: 0.06 0.00 0.00 0.96 2.00
Insp. TimeTime taken to breathe in (seconds)
W-Avg: 1.97 0.60 1.80 2.92 7.86
Exp. TimeTime taken to breathe out (seconds)
W-Avg: 1.44 0.26 1.46 2.06 4.46
Tidal VolumeAmount of air displaced per breath (L/min)
W-Avg: 421.06 13.33 380.00 700.00 6950.00

I have had two sleep docs and my PCP look at the data and they say the therapy is working. Plus the O2 tests says I got plenty. Could be the neck thing but I took a few days off from using the machine and I still got the headaches?

Has anyone else seen this before (i.e. CPAP fixes technical apnea but the symptoms remain).

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pgflrob
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Re: CPAP and headaches

Post by pgflrob » Thu Nov 20, 2014 9:56 am

palerider wrote:
pgflrob wrote: If I understand the big picture of sleep apnea, the problem is that either central, or obstructive, sleep apnea causes not enough breathing and that reduces blood oxygen. So if your blood oxygen is OK that pretty much R/Os apnea as the cause of the symptoms. Correct me if I am wrong.
you're half wrong.

sleep apnea frequently causes o2 desats, (as you saw when you got down to 86%) but it also prevents you from getting good, restful, restorative sleep.

if you don't breath long enough, you get all the problems that causes, organ damage, high blood pressure, having to pee all night long, etc.

if you arouse yourself often enough to keep up enough air, then you're constantly being prevented from getting into good refreshing sleep so that your mind is shaper and your body gets to heal during the night, even if your o2 doesn't drop dangerously low.
So, something else besides apnea (which the docs R/O) could be disturbing my sleep? That makes sense. But if you are not breathing I would assume it would show up on an oximeter. Right?

My BP is good. I do not get up to pee but once a night max and I do consume a lot of water. I do dream a ton. I mean a ton. If I could write it down I could be the feature writer on the next re-lanuch of the Twilight Zone).

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Re: CPAP and headaches

Post by Pugsy » Thu Nov 20, 2014 10:02 am

Are you seeing any clustering of those hyponeas or are they spread out over the entire night?

It doesn't sound like your oxygen levels are dropping low enough to cause the typical OSA headache.
You know it's very possible that the headaches are unrelated to cpap therapy or OSA and thus need to look elsewhere for a remedy.
Pugsy wrote:What is the pattern to the headaches...wake up with them and have them go away in a couple of hours or do they stay with you all day? Do you get them every day?
and for those 7 hours of sleep you are averaging....are you sleeping soundly for the most part or are you waking up more than a couple of times? If so, any problems going back to sleep.

Remembering dreams....I have read that we don't remember them unless we wake up (at least partly) during them so remembering dreams may not be a good thing...so if you are remembering a lot of dreams it makes me wonder if are having a lot of arousals (that you may or may not remember) and thus maybe not optimal sleep quality.
Also...that AHI.. 5 ish...if you are seeing some clustering it very well could be causing multiple arousals.
That and the snores and FLs and RERAs points to maybe not quite optimal therapy.
Would need to see a detailed report showing the pressures to have a better idea (numbers don't make for good pictures of what might be going on) but maybe the minimum pressure is not quite optimal.

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pgflrob
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Re: CPAP and headaches

Post by pgflrob » Thu Nov 20, 2014 10:09 am

Pugsy wrote:Are you seeing any clustering of those hyponeas or are they spread out over the entire night?
Definite clustering. Around 5:30AM.

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Re: CPAP and headaches

Post by palerider » Thu Nov 20, 2014 11:17 am

pgflrob wrote: So, something else besides apnea (which the docs R/O) could be disturbing my sleep? That makes sense. But if you are not breathing I would assume it would show up on an oximeter. Right?
apneas, hypops, flow limitations, snores, they all disturb sleep.

as to your assumption, stick your oximeter on your finger, let it stabilize, and then hold your breath for 10 seconds.

how much change did you see?

that's how much one 10 second apnea will show up, but it'll disturb your sleep when you snort and rouse a bit and start breathing again.

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Re: CPAP and headaches

Post by Tatooed Lady » Thu Nov 20, 2014 2:19 pm

Just for grins...has your caffeine intake changed substantially lately? Especially near the onset of the headaches? I get withdrawal headaches...ugly things.

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Re: CPAP and headaches

Post by pgflrob » Thu Nov 20, 2014 2:39 pm

Thanks for you comment. I am looking for similar grasping at straws since the docs tell me the CPAP has cured my sleep apnea when they look at the data. Has to be something else, possibly related to the machine. Cannot figure out what it is.

I was never a huge coffee drinker. One cup in the morning max. I switched to green tea about two years ago. One cup in the morning.

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Re: CPAP and headaches

Post by kteague » Thu Nov 20, 2014 3:14 pm

Just a thought - 5 events per hour x 8 hours per night = 40. It is reasonable to expect some percentage of those to cause arousals, disrupting sleep stages. If only 1/4th of those events caused arousals, that's still 10 arousals a night. I would think those disruptions could make one suffer from lack of sleep continuity. If you happen to be sensitive to pressure changes, add that to the mix and it looks worse. Wondering if you'd still have the symptoms if you either increased your lower pressure or used a straight pressure.

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Re: CPAP and headaches

Post by pgflrob » Thu Nov 20, 2014 5:10 pm

Just a quick question. Before I first got tested for sleep apnea I never had headaches. I was just tired, had to nap, and had a lack of concentration. Now I have them every morning. Does that seem odd? Related? Common?

For people with sleep apnea is having headaches something experienced before CPAP?

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Re: CPAP and headaches

Post by msla » Thu Nov 20, 2014 9:41 pm

Do you notice any sinus issues? I have one that seems to act up every few weeks and then I get a doozy of a head ache. Nasal rinses and Nasonex seems to help me.

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