510 days later ... CPAP is only part of the solution

[tschultz]

I have recently found that I am now setback to roughly where I was 1 year ago after having my OSA well under control and seeing health improvements. This setback however is not due to the OSA, but low levels of deep sleep from working too much over the past 5 months. The symptoms I am now seeing are very similar to what I had before CPAP; headaches most the time, high blood pressure (162/99 after sitting at rest for 1 hour), and feeling tired or drained of energy.

I've been monitoring my sleep stages with Zeo, and although not perfect, the trends do show a very clear picture. As the amount of time I worked, and corresponding stresses, increased the amount of time in deep sleep decreased. I was seeing 55 to 75 minutes of deep sleep in December, and now am seeing levels as low as 6 to 8 minutes, with nothing above 30 minutes for the past 4 months. All throughout this my OSA was well controlled, my AHI varied from 0.3 to 1.5 with no clear correlation of AHI to the levels of deep sleep. The amount of time spent sleeping each night remained quite consistent, varying between 6:30 to 7:30 minutes over the past 6 months. The amount if time spent in deep sleep also seems to have little relation to the amount of sleep I get, almost all of the deep sleep seems to occur for me approx 90 minutes of first falling asleep.

This has been a lesson learned that even though things improve when OSA is treated, sleep is a much more complex issue than simply breathing. When I started feeling better I started to work more and evidently pushed too far and crossed a delicate line. Now it will take a while to bounce back but hopefully not as long as before. Although I had noted my amount of time in deep sleep dropping I did not realize the impacts, and it was only the past month that I started to feel the impacts which have increased.

I am posting this as information for anyone starting who has been on CPAP is discouraged that things are not entirely as they would like to see. Sleep deprivation comes in many flavors and OSA is only one contributor.

[MaxDarkside]

It sounds like you need a nice vacation. I prescribe a tropical island, a bungalow, secluded, beach-side, with the soft sound of lapping waves, breezes in the palms. I also prescribe in the morning a bowl of cool tropical fruit, melon and very ripe pineapple, and in the evening a meal with large prawns, or perhaps lobster, with drawn butter, a squeeze of lemon and before bed an ounce or two of the finest rum. Repeat until Deep > 1 hr

[Julie]

Hi - so sorry you're having the trouble you talk about and hope you can turn things around.

Can I suggest that you consider the possibility that you might be losing some air through your mouth?

It can happen well into using Cpap for a long time, for whatever reasons it does, and while I can't tell you much about REM, you could try a chinstrap or taping to see if it helps for 1-2 nites and if it does, then maybe getting a full face mask would be an idea.

[tschultz]

It sounds like you need a nice vacation. I prescribe a tropical island, a bungalow, secluded, beach-side, with the soft sound of lapping waves, breezes in the palms. I also prescribe in the morning a bowl of cool tropical fruit, melon and very ripe pineapple, and in the evening a meal with large prawns, or perhaps lobster, with drawn butter, a squeeze of lemon and before bed an ounce or two of the finest rum. Repeat until Deep > 1 hr

I think you are right, I'm actually booking next week off as vacation as that is the best short term thing I can do, but not going to the tropics unfortunately. As for the prawns and lobster, not a good idea for someone with an allergy to shellfish but the rest of it sounds good.

I know you have had your own battles with sleep architecture. The biggest lesson from this for me is that the actual health impacts are delayed from the cause but the data trends certainly do tell when something is changing. I just wish I had paid more attention to what I saw.

[tschultz]

...
Can I suggest that you consider the possibility that you might be losing some air through your mouth?
...

Thanks for the idea but my leaks are very well controlled, and if I was losing through my mouth I would expect to see that in the leak data. SleepyHead shows my 7 day 95% leak as 0.0 and my 7 month 95% leak 6 as 1.2. Nights I do see spikes in leak they rarely go above 15 and do so only for a few minutes. The only leaks I tend to see is if I roll over and my mask gets pushed against the pillow, this does however make noise which causes an awakening. I have looked at the correlation to these awakening and sleep and there are times that it looks like such an event cut my deep sleep short but these are isolated cases and not the norm.

Everything so far indicates that the CPAP/APAP is doing a good job at treating my OSA, the problem is now sleep architecture with the biggest area of concern the deep sleep. My doctor concurs with this and is concerned also with the low levels of deep sleep.

[Drowsy Dancer]

The biggest lesson from this for me is that the actual health impacts are delayed from the cause but the data trends certainly do tell when something is changing. I just wish I had paid more attention to what I saw.

I have also grown quite interested in sleep architecture as I too have learned in the last year-plus that CPAP is necessary but not sufficient for good sleep. I.e. I can't get away with chronic partial sleep deprivation just because the quality of the sleep I do get is better. The lag time when we change any variable can make it hard to see patterns.

[MaxDarkside]

I know you have had your own battles with sleep architecture. The biggest lesson from this for me is that the actual health impacts are delayed from the cause but the data trends certainly do tell when something is changing. I just wish I had paid more attention to what I saw.

I know in my data I can see screwed-up sleep architectures during times of stress and stress can be a "sneaker", that is you don't always realize you are under stress nor the effects on you over time. My wife and I went to Mayo for a week for her testing and though I thought I slept well according to the CPAP machine, my sleep architecture "came apart" and it took about 2 weeks back at home for my sleep architecture to return to normal.

Allergy to shellfish, eh. Poo. Maybe substitute fresh fish instead.

[jen4700]

It sounds like you need a nice vacation. I prescribe a tropical island, a bungalow, secluded, beach-side, with the soft sound of lapping waves, breezes in the palms. I also prescribe in the morning a bowl of cool tropical fruit, melon and very ripe pineapple, and in the evening a meal with large prawns, or perhaps lobster, with drawn butter, a squeeze of lemon and before bed an ounce or two of the finest rum. Repeat until Deep > 1 hr

Uhh - yes please!!

[Jay Aitchsee]

TS, I can certainly sympathize. Like you, I've had my OSA well controlled for some time but do not obtain sufficient deep sleep to overcome daytime fatigue. Lack of my deep sleep is reported by my Zeo and verified by multiple PSG's.
I have done a lot of research about drugs which promote deep sleep and unfortunately I haven't found many. You can Google "drugs which promote deep sleep" and you'll get some leads, but not many. As you stated in one of your posts, most of the sedating drugs do not improve deep sleep and may also depress REM.
Some of the "gaba" drugs and derivatives show promise but did not work for me. My best results were obtained with gabapentin+ibuprophen+acetominofen. Unfortunately, I was not able to tolerate the combination and had to stop.
I would suggest, if you haven't had it done lately, that you have your Vitamin D, B12, Ferritin and Thyroid levels checked. Low Ferritin can cause RLS/PMLD which can cause arousals and low levels of Vitamin D, B12, and improper Thyroid levels can also cause disturbed sleep.
I have found a connection between Vitamin D and deep sleep. Last year when I had mine checked, it was low and I began supplements. Soon after, my deep sleep improved and kept improving for some time. Then it fell back to only a few minutes a night. When I had my D3 checked it had improved from around 30 to about 60, but I wasn't sleeping. I stopped the supplements for a while and restarted and my deep sleep improved again until suddenly falling off. So, there is a connection for me, but I can't seem to find the right dosage. I think it might be periodic, like weekly or so. My B12 and thyroid levels were also low and have been corrected with supplements, but haven't seemed to help. But even if they don't help, having these levels checked and corrected allows you to at least rule out some things.
I wish I could offer more help and I hope you find an answer, maybe just relaxing will do the trick - certainly won't hurt.
Good luck,
Jay

[tschultz]

...
Some of the "gaba" drugs and derivatives show promise but did not work for me. My best results were obtained with gabapentin+ibuprophen+acetominofen. Unfortunately, I was not able to tolerate the combination and had to stop.
...

I'm a bit surprised at the Ibuprophen in that combination, it is know to reduce deep sleep and impact sleep continuity as well. Aspirin also has the same effects, but the acetaminophen I have not seen any such information on. The Gabapentin is known to increase deep sleep, REM sleep ad well as improve sleep continuity. It's short half life tends to not cause much sedating effects the next morning which is a good thing.

I did do some research into herbal options and started to look into both Valerian and Nutmeg. I have been told by some that a combination of Nutmeg, Ashwaganda, and Long Pepper seems to work well and increasing both deep and REM sleep without the sedating effects. I had found one product, Sleep HRX, that had these but it has been discontinued and was told it is being "tweaked" and will be available in the next few months. Oddly enough any of the mainstream natural or herbal shops I spoke with only knew anything about Valerian and Melatonin being used for sleep. I had tried Valerian and it did not seem to improve anything by itself.

Doctor has put me on Gabapentin in the hopes that it will help stimulate the deep sleep and at this point I'm willing to give it a try. I know taking a rest and reducing stress is likely to have the biggest impact but that is going to take some time to realize the benefits from. I booked the next week off as vacation but got the feeling that my employer was "not impressed".

I'm just hoping that I can start to increase the deep sleep soon as it seems that once levels my drop below 30 minutes is when I seem to feel the daytime tiredness that I had previous to CPAP. Going to simply take it easy, not worry about things, and try and enjoy some quality time with my wife and cats for the next week. Then when I do return back to work no overtime for a while.

[MaxDarkside]

I did do some research into herbal options ...

Most every night I have a cup of Tulsi tea.
http://en.wikipedia.org/wiki/Ocimum_tenuiflorum
Read the Pharmacology section. It is considered a stress reducer. Whether it helps me, I'm not entirely sure, but my thinking is it does, mildly. If you can't find it in stores, you can get it from Amazon, get the "Original", the other versions have "other stuff" in them:
http://www.amazon.com/Tulsi-Tea-Origina ... 231&sr=8-1

You might give it a try for a week, 1 cup each evening before bed. Might help... who knows!

[tschultz]

Most every night I have a cup of Tulsi tea.
http://en.wikipedia.org/wiki/Ocimum_tenuiflorum
Read the Pharmacology section. It is considered a stress reducer. Whether it helps me, I'm not entirely sure, but my thinking is it does, mildly. If you can't find it in stores, you can get it from Amazon, get the "Original", the other versions have "other stuff" in them:
http://www.amazon.com/Tulsi-Tea-Origina ... 231&sr=8-1

You might give it a try for a week, 1 cup each evening before bed. Might help... who knows!

Thanks, I may just try that too, doesn't look like it will hurt anything. Amazon won't ship that product to Canada but I was able to quickly find on-line sources in Canada that carries it as well so it shouldn't be too hard to get.

[MaxDarkside]

This is about as clean as I can get my sleep. From last night...



1 cup Tulsi Tea
50 mg benadryl, generic
1 oz brandy
1/4th tab pseudo-ephedrine during the day to eliminate grog
some exercise during the day (climbing a hill out back)
worked (thinking type) until I hit a wall (could not do any more)
soft cotton mask liner I made for my Quattro FX mask
Humidity at 4.0
AHI was 2.47 (pressures lowered to stay just under 5.0 most often)

7 hr, 4 min of sleep
52 minutes of Deep
2:07 hrs of REM

[tschultz]

This is about as clean as I can get my sleep. From last night...



1 cup Tulsi Tea
50 mg benadryl, generic
1 oz brandy
1/4th tab pseudo-ephedrine during the day to eliminate grog
some exercise during the day (climbing a hill out back)
worked (thinking type) until I hit a wall (could not do any more)
soft cotton mask liner I made for my Quattro FX mask
Humidity at 4.0
AHI was 2.47 (pressures lowered to stay just under 5.0 most often)

7 hr, 4 min of sleep
52 minutes of Deep
2:07 hrs of REM

Congrats! That does look like a good nights sleep.

[tschultz]

I did do some research into herbal options ...

Most every night I have a cup of Tulsi tea.
...
You might give it a try for a week, 1 cup each evening before bed. Might help... who knows!

I've tried the Tulsi tea each night but don't see any noticeable difference. I don't think it did any harm though so I think I will keep at it and see.

I have found that if I get the majority of my exercise in the mornings I seem to have more deep sleep that night but not enough data yet to know for sure.
The week's vacation has helped (BP is lower now) even though I did not do much, just some quality time with the wife and cats, although I expect by now the wife will be glad to see me go back to work tomorrow.