Considerable Increase in AHI

[nycdug]

I just had a physical...no other problems. EVERYTHING is normal except the sleep. The only medications I take are for sleep. I don't even take pain meds for the occasional headache or body ache from exercise unless it's really bad. The only reason I got tested was because I saw a new PCP and I asked for the Ambien. He said he wouldn't write for it and sent me to the pulmonologist that was in his group. It was kind of funny. They both did the same thing: looked at my throat and immediately told me I had sleep apnea.

I’ve been fatigued mentally and sleepy but can’t sleep when I try to. I just figured I needed to exercise but was always too tired. I never napped and couldn't just fall asleep anywhere. My score on the Epworth test was only 6 before CPAP therapy. Since I've started using CPAP I have excessive sleepiness. Last week I fidgeted my way through work to keep from sleeping at my desk. I had many near misses in the car and finally on Friday sideswiped a light pole in the parking lot at the market. Every day I just wake up and go on autopilot because I don’t have any other options. I’m in a constant fog and really just do things without thinking. I really don’t remember fixing breakfast and driving to my office this morning. I just know I’m here trying to get through the day so I can go home and go back to bed.

In the past I’ve used stimulants to help me be more alert during the day. I’m about ready to try it again, seemed to work just fine at the time. I’m so desperate to feel better that I’d eat broken glass if I thought it would help. I’ve tried everything – acupuncture, essential oils, blackout curtains, masks, meditation, baths. I’m constantly on the edge of losing it and being pleasant is a constant struggle. This not sleeping is making me depressed and I know I’m not a danger to myself but being dead would be better than surviving like this.

[Pugsy]

So you had insomnia prior to the diagnosis of OSA and the implementation of cpap therapy? Is that correct?
Do you think that the insomnia is now worse maybe than before starting cpap therapy?
How many times do you wake up each night?
What do you do when you wake up?
Does it take you a long time to get sleepy again?
This last report shows an approx 90 minute break...is this common for you to do?

[Wulfman...]

I just had a physical...no other problems. EVERYTHING is normal except the sleep. The only medications I take are for sleep. I don't even take pain meds for the occasional headache or body ache from exercise unless it's really bad. The only reason I got tested was because I saw a new PCP and I asked for the Ambien. He said he wouldn't write for it and sent me to the pulmonologist that was in his group. It was kind of funny. They both did the same thing: looked at my throat and immediately told me I had sleep apnea.

I’ve been fatigued mentally and sleepy but can’t sleep when I try to. I just figured I needed to exercise but was always too tired. I never napped and couldn't just fall asleep anywhere. My score on the Epworth test was only 6 before CPAP therapy. Since I've started using CPAP I have excessive sleepiness. Last week I fidgeted my way through work to keep from sleeping at my desk. I had many near misses in the car and finally on Friday sideswiped a light pole in the parking lot at the market. Every day I just wake up and go on autopilot because I don’t have any other options. I’m in a constant fog and really just do things without thinking. I really don’t remember fixing breakfast and driving to my office this morning. I just know I’m here trying to get through the day so I can go home and go back to bed.

In the past I’ve used stimulants to help me be more alert during the day. I’m about ready to try it again, seemed to work just fine at the time. I’m so desperate to feel better that I’d eat broken glass if I thought it would help. I’ve tried everything – acupuncture, essential oils, blackout curtains, masks, meditation, baths. I’m constantly on the edge of losing it and being pleasant is a constant struggle. This not sleeping is making me depressed and I know I’m not a danger to myself but being dead would be better than surviving like this.

Reading this, it sounds to me like your medications are out of sync with your sleep patterns (or vice versa).
You're trying to sleep when you should be awake and you're awake when you should be sleeping.
Are you NOW taking Ambien?

What are all of your machine settings?


Den

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[nycdug]

Yes, Pugsly. I've had trouble sleeping for as long as I can remember. I'm 44 and have been taking some sort of sleep aid (not every night) for about 15 years. I don't think my insomnia is any worse now than previously but I feel worse after using the CPAP then I did when not using it. I have never been this foggy headed or sleepy before and I have certainly never napped like I do now. My memory is awful and I am mean as Hell.

I cannot fall asleep at night while wearing the mask without a sleep aid, at least not within an hour. (Even at my first sleep study it took me an hour to fall asleep after taking a 10mg Ambien and 300 mg of Trazadone.) I have been able to lie down for a nap (using the CPAP) without a sleep aid but this requires me to lie down for an hour and maybe nap for 10-20 minutes. I don't feel any better afterwards.

I wake up several times a night. Many times I go to bed around 10:30 or 11 and then wake up around 3:30 or 4am, pretty much like clockwork. Sometimes I have to use the restroom, other times I will go back to sleep and other times I will lie there until I'm frustrated and then get up and watch tv or use my computer. Most of the time I will be sleepy again by 5am sometimes 6am. Then I will sleep until 8am and rush out the door to be at work at 9am. If I am able to go back to sleep at 3:30am I will usually still wake up somewhere around 5:30-6:30am. I used to think maybe it was the daylight but I blackened out the windows in my room to keep it darker and it hasn't really helped. Sleep for me is a crapshoot.

I never dream anymore. I used to have some really fantastic vivid dreams. Now it seems like when I start to dream I wake up. Looking at my graphs my wake times are usually when the pressure goes up to the highest point. I would blame the high pressure but I wake up with the lower pressure too.

Of course I'm frustrated because the mask really doesn't bother me that much. And I use it religiously hoping that tonight is the night. The CPAP has been much more tolerable since my septoplasty and with the pressure starting at 7. It used to start at 7 and then ramp to 10-15. I don't use the ramp anymore. The pressure seems to stay at 7 and then go back and forth to 8 or 8.5 but then goes up to 10 right before I wake up (right at REM time). The machine is so tolerable in fact that I almost don't even notice it...sometimes I pull the nasal pillows to make sure there is air flow. I had trouble when my pressure was set from 10-15. It seemed so strong and I used to feel my cheeks fill up with air until my lips burst open. That hasn't been happening, my leaks are in check. Even my OSA is low. It's the hypopneas that are getting worse.

[Wulfman...]

Try a straight pressure setting for awhile.
Sounds like the pressure changes are screwing up your sleep.


Den

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[nycdug]

Den, I take the Ambien/Trazadone at bedtime. My setting just decreased after Septoplasty surgery from 10cm-15cm to 7cm-15cm(the max has only gone up to 10). I'm just so puzzled that when I told my sleep doctor I felt worse even after using the machine for 6-8 hours each night that he told me he was "perplexed" and that no one has ever told him that before. I find that hard to believe because of my medical history (insomnia) and because there is so much information on the internet about other causes and treatement options for people who are having the same issue. His suggesting I stop using the CPAP machine for two weeks just seems so stupid especially since he practically strapped it on me in the first place. I stopped using it for 5 days post surgery. I did actually feel better than I do right now.

So try just setting the CPAP to 10?

[Wulfman...]

Den, I take the Ambien/Trazadone at bedtime. My setting just decreased after Septoplasty surgery from 10cm-15cm to 7cm-15cm(the max has only gone up to 10). I'm just so puzzled that when I told my sleep doctor I felt worse even after using the machine for 6-8 hours each night that he told me he was "perplexed" and that no one has ever told him that before. I find that hard to believe because of my medical history (insomnia) and because there is so much information on the internet about other causes and treatement options for people who are having the same issue. His suggesting I stop using the CPAP machine for two weeks just seems so stupid especially since he practically strapped it on me in the first place. I stopped using it for 5 days post surgery. I did actually feel better than I do right now.

So try just setting the CPAP to 10?

That would be a reasonable place to start. It's the "average" (typical/most used) pressure setting, overall.
When my sleep doctor prescribed a pressure of 18 cm. (in 2005) and I couldn't hack that, I reset my machine to 10 as a starting point. Funny thing was it worked very well. About a year later, I ended up going to 12 (mainly to get rid of some snoring), and that's where I've been ever since. I used the Encore Pro software to monitor my therapy from "day one" so I would know how things were working.
I started out with a data-capable straight CPAP, but about a year later I acquired a lightly used APAP and tried it in a range of 10 - 15 for one week (in July of 2006) and it was the longest week I've ever slept......I couldn't wait till it was over because I was frequently waking up during the night and was very tired. However, it did confirm that the pressure I had been using (12 cm) was optimal. I only hit 15 for about a minute and a half that whole week......which told me the "prescribed" pressure of 18 was pulled out of my sleep doctor's backside orifice.

Some people can handle pressure changes and some people can't. The user with an APAP needs to try both options to see which works best for THEM. I know it probably seems that I "preach" about straight pressure usage alot, but for the most part, I see new users in trouble trying to adapt to a range of pressures with their new "whiz-bang" Autos and have a multitude of troubles doing so. For me, their symptoms are so familiar. I'm just trying to get them to TRY straight pressure to see if it works better. That's all.


Den

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[nycdug]

Certainly sounds logical. I will try it tonight. Thank you!

[nycdug]

Sorry Den, but that just didn't happen. I tried setting the pressure to 10cm and watch TV before making that leap at bedtime. OMG that was awful! I felt like a German Shepard with his head out of the car window. Even with the C-Flex set at 3 I could barely exhale. My cheeks puffed up, my chest hurt, my ears popped and I had a terrible headache. I am quite certain now that the reason I have been waking up is because the pressure jumps so high. I kept stopping and restarting the machine and it took at least three breaths for the C-Flex to make the 10cm tolerable. No wonder I woke up.

I ended up setting the pressure to 7.5-11. When I woke up in the middle of the night I took the Ambien and slept until my alarm went off at 7. Still felt like crap although I did feel better around 4 pm which is unusual. I think I'll keep the pressure setting at 8-15cm and see how it goes. Certainly can't feel any worse. AHI was 2.51.

[Wulfman...]

Sorry Den, but that just didn't happen. I tried setting the pressure to 10cm and watch TV before making that leap at bedtime. OMG that was awful! I felt like a German Shepard with his head out of the car window. Even with the C-Flex set at 3 I could barely exhale. My cheeks puffed up, my chest hurt, my ears popped and I had a terrible headache. I am quite certain now that the reason I have been waking up is because the pressure jumps so high. I kept stopping and restarting the machine and it took at least three breaths for the C-Flex to make the 10cm tolerable. No wonder I woke up.

I ended up setting the pressure to 7.5-11. When I woke up in the middle of the night I took the Ambien and slept until my alarm went off at 7. Still felt like crap although I did feel better around 4 pm which is unusual. I think I'll keep the pressure setting at 8-15cm and see how it goes. Certainly can't feel any worse. AHI was 2.51.

So, try a lower pressure.......like 8. Keep trying till you find a pressure you can handle......and then gradually work up.
Actually, 10 cm. is pretty mild. My wife can handle that with no problems and she's a relatively small woman. Just to test her on one of my machines, I set up a machine for her at 9 and she didn't feel like she was getting enough air and asked me to bump it up.

After you changed it back to a range, your data looks "terrible" (to put it mildly).


Den

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[Wulfman...]

Actually, looking at your chart again, you really don't have many events at a pressure of 8 cm.


Den

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[nycdug]

Well, like I keep reading on here...everyone is different. As far as I'm concerned the whole treatment is terrible. It's just like all other medical treatments...no one really knows for sure. I think I'll keep using the range and start at 8. I can't justify a constant pressure of 8 if I really need 10.5 but I can't tolerate a constant pressure of 10.5 without being knocked out...does anyone else see the vicious cycle here? I wish I had never started this.

[Wulfman...]

Well, like I keep reading on here...everyone is different. As far as I'm concerned the whole treatment is terrible. It's just like all other medical treatments...no one really knows for sure. I think I'll keep using the range and start at 8. I can't justify a constant pressure of 8 if I really need 10.5 but I can't tolerate a constant pressure of 10.5 without being knocked out...does anyone else see the vicious cycle here? I wish I had never started this.

So, you're going to keep doing the same thing, over and over and expecting different results?
What if you REALLY DON'T NEED a pressure of 10.5? I really don't see that you DO need a higher pressure than about 8.
Snores and Flow Limitations are the main things that trigger pressure increases. No machine will increase pressure if they detect an Apnea. I don't see hardly any Snores or Flow Limitations preceding your Apneas. And, it appears that the majority of your events occur when the pressures rise higher, and not necessarily because the pressure is chasing those events. Snores and Flow Limitations by themselves are nothing to worry about. So, in all honesty, I don't see how a range of pressures is being any help to you.......it's actually making your therapy worse (if you can call that "therapy").


Den

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[nycdug]

Thanks again Den. I understand what you are saying, I do and I'm not saying you are wrong. Everything I read on here says "give it some time" so I don't want to keep making changes every night. I'll keep the range for a few days and then I can try straight pressure of 8 if I don't feel any significant change.

Last night I set the pressure to 8-15cm. It was the best sleep I've had in a long time. And by that I mean i wasn't awake for any significant period in the middle of the night. I do feel "better" this morning and for the first time in weeks I actually remember having dreams. Do I feel refreshed? No, but I don't feel as bad as I have been. That's just one night though.

[Wulfman...]

Thanks again Den. I understand what you are saying, I do and I'm not saying you are wrong. Everything I read on here says "give it some time" so I don't want to keep making changes every night. I'll keep the range for a few days and then I can try straight pressure of 8 if I don't feel any significant change.

Last night I set the pressure to 8-15cm. It was the best sleep I've had in a long time. And by that I mean i wasn't awake for any significant period in the middle of the night. I do feel "better" this morning and for the first time in weeks I actually remember having dreams. Do I feel refreshed? No, but I don't feel as bad as I have been. That's just one night though.

That's good. But, your report looks much better, too. I still see way too many needless pressure bumps and increases in your report that could be problematic for getting restorative sleep. In my opinion, it's chasing meaningless events and/or you're having events after your pressure has increased. You only need to look at the lack of events you're having when your pressure is around 8 and the number of events after your pressure goes higher. Those 1 cm. pressure "bumps" (probes) could be enough to jolt you out of deeper sleep stages or REM.......and that's not good.
You say you remember dreaming. Dreams can happen in any sleep stage and more often, if you can remember them, you're probably in a lighter sleep stage and almost awake anyway. REM is also a lighter sleep stage, but it's an important one.

It's YOUR therapy. I'm just trying to help you get it ironed out a bit. But, you should now know where I'm coming from and some of the reasoning and logic I use and things I see in the reports and why I'm saying what I'm saying.

Your call.
This is all "baby steps". The vast majority of folks don't have an overnight "restoration"......it's a slower, progressive journey.


Den

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