Frustrated and Exhausted

I am on my 11th mask and went from a cpap machine to a bi pap machine. Just changed doctors because I was getting no where with the avenue the first doctor was taking. This is the second time I have been out on a leave from work. Back in 2012 I went out and my body respond well to the meds and I was able to put myself in a routine and take off some of the weight. In February everything came to a halt. And things this time are 3 times as worse. Im trying my best to stay positive but nothing seems to be progressing. Any suggestions

Dropping in to say that I can empathize with you. I'm still very new to the CPAP world and though I haven't had as many mask/machine swaps, I have suffered more sleep deprivation with than without. I've taken leave from work to try to catch up on sleep. All that being said, keep in mind knowing you're doing this for the benefit of your health and for those around you. At 2am when I'm awake, that's what I try to focus on. There are some amazing people on this board. I'm sure that if you can post some of your data they can parse through it and perhaps offer you some additional feedback. In the meantime, best of luck!

Welcome to the board! The first thing that we need you to do, so that we can better help you, is have you go to your user control panel and update the equipment that you use in your profile (machine, mask, any other pertinent info). And then, tell us what the most problematic things are for you (mask fit, leaks, hose management, noise, etc) so that we can help you get this more comfortable.

I'm sorry you are having a rough time. There are a lot of knowledgeable people on the forum. No matter what you are going through, odds are someone else has been down that path. Let us know how we can help.

trvlinteddy69 wrote:I am on my 11th mask and went from a cpap machine to a bi pap machine. Just changed doctors because I was getting no where with the avenue the first doctor was taking. This is the second time I have been out on a leave from work. Back in 2012 I went out and my body respond well to the meds and I was able to put myself in a routine and take off some of the weight. In February everything came to a halt. And things this time are 3 times as worse. Im trying my best to stay positive but nothing seems to be progressing. Any suggestions

I can understand your frustrations. And it's good that you are trying to stay positive about the whole mess.

Some questions that may help us help you:

You say "things are 3 times worse" and that you are on your 11th mask. Can you be a bit more specific about what kinds of PAP related problems you are having that we might be able to help you with? In particular:

What kind of mask are you currently using? What's the best thing about that mask? What's the worst thing about that mask? And what's the worst mask you ever tried?

What kind of BiPAP are you using? How long have you been using the BiPAP? Does the BiPAP feel better, worse, or about the same as the CPAP in terms of comfort and your ability to sleep with the machine? In other words, did things get marginally better with the switch to BiPAP? Or did they get worse?

Do you know your pressure settings on your machine? Do you know how to find and read the efficacy data that your machine records? If so, do you know whether your leaks are well controlled, so-so, or out of control? And do you know what your treated AHI is running on your BiPAP?

When you put the mask on and try to go to sleep, how uncomfortable are you? Does it feel as though there is too much air coming through the mask? Or does it feel as though there is too little air coming through the mask? Does the air feel too dry? too wet? too stuffy? too hot? too cold?

Do you lie in bed for what seems like hours fighting to get to sleep every night? Or can you fall asleep ok, but then you wake up in the middle of the night and find it hard to get back to sleep? Or do you seem to sleep all night long, but you still wake up feeling tired and exhausted?

Do you feel trapped by the hose? Are you constantly waking up fighting with the hose? Or fighting with a leaky mask? Do you feel as though you have to sleep in a position that is not natural for you to sleep in?

You also write, "Back in 2012 I went out and my body respond well to the meds and I was able to put myself in a routine and take off some of the weight." This hints that OSA was not your only medical problem back in 2012. Not meaning to be nosy, but it would help us help you if we had some idea of whether those other medical problems are still being treated and whether the treatment is working in your opinion. It would also be useful to know if you are on any daily medications: Many drugs have side effects that can make you feel pretty fatigued or sleepy during the day and at the same time make it harder to sleep once you do get to bed. It would also help us if we knew whether weight is a big problem---as in have you gained back all the weight you lost in 2012? Have you gained back more weight than you lost in 2012? And is the weight clearly tied directly to known medical problems that are not currently well controlled?

The Resmed Airfit P10 Nasal Pillow Mask:
I am suppose to wear this mask with a chin strap and it consistently slips off my head.
Best thing about the mask is that it has limited headgear. The worst thing about the mask is that it leaks frequently.
The worst mask I have had was the Total Face Mask with head gear.
The bipap machine is a Resmed Bipap Advanced Auto ASV
I do not really notice a comfort difference between the 2 machines. I know I am sleeping longer with the bipap I just do not feel rested.
My pressure setting for this machine are 12 over 20.
When I wear the current mask to bed it is alittle uncomfortable. It is not vented for when I exhale. The machine has a heated humidifier on it so the air is fine.
When I goto bed it is normally between 11pm and midnight. I takes anywhere from 15 minutes to an hour to fall asleep. I have nights that go either way. Some nights I fall right back to sleep and other nights I am up for awhile. There are nights where I sleep a few hours and then there are nights when I sleep thru the night. I still wake up feeling exhausted, groggy, and unmotivated.
The hose doesnt bother me at all, what bothers me the most is the leaks in the machine.
I take 250 mg of Nuvgil 1x, 20mg of Fluoxetine 1x, Lisinopril HCTZ 20/12.5, Multivitamin, Omerpazole 20mg 2x, Ipratropium .06% 2 doses 1x, Nasoneb Cup 10ml Saline
I do 2 nebulizer treatments a day, Allergy shots 1 aweek, My allergies range from dust to dairy products.

I am being treated for depression, anxiety disorders, consistently wrestling with headaches they range from mild to unbearable.
When I went out in 2012 I was on wellbutrin and nuvigil I was able to take off 72 lbs get myself into a routine and start to sleep more regularly. Sometime last year my body just stop responding to the wellbutrin, My work schedule changed and I put back 30lbs. Yes I know the weight makes a difference. About 4 months ago the cat naps started getting out of control which is why the doctor put me on a leave of absence. I am noticing that the days that I feel the most exhausted I have either a battle with the anxiety or depression.

Also the consistant moods swings have caused major damage both personally and professionally

You say "what bothers me the most is the leaks in the machine." I don't think the machine leaks - what would leak out of it? If air, it would be the hose or the mask that is leaking. If air is leaking directly from the machine, then you wouldn't be getting air into the hose at all... in other words, no therapy air. Almost every mask has some leakage, and it's a struggle for most of us to find the right mask - size, fit and leaks are the troublemakers. Have you tried mask liners? They were a game changer for me.

Sorry I meant the leaks in the mask

trvlinteddy69 wrote:The Resmed Airfit P10 Nasal Pillow Mask:
I am suppose to wear this mask with a chin strap and it consistently slips off my head.
Best thing about the mask is that it has limited headgear. The worst thing about the mask is that it leaks frequently.

So it looks like you are are mouth breather. Do you put the chinstrap on first or the AirFit P10 on first? Reversing the order you put the two things on may give you a more stable arrangement.

You might also want to try the Swift FX nasal mask. Its headgear is more adjustable than the one-size-fits-most strap for the P10. The downside of the Swift FX is that the exhaust vent does NOT have a built-in diffuser and it is concentrated enough to remind some of us of a jet plane engine.

The bipap machine is a Resmed Bipap Advanced Auto ASV

This is NOT a plain vanilla bi-level. It's a very expensive and very specialized machine that is usually prescribed only when there are real problems with central apneas that persist after several weeks to several months of CPAP therapy. Do you know why this machine was prescribed for you? If not, you need to find that out from the doc who prescribed it.

I do not really notice a comfort difference between the 2 machines. I know I am sleeping longer with the bipap I just do not feel rested.
My pressure setting for this machine are 12 over 20.

I would suggest starting a new thread with the title: New ASV user and I still feel exhausted. There are some very knowledgeable ASV users on the board, but some of them don't read posts without ASV in the subject line.

It's also going to be important to include the following on that thread if you know them: Is your diagnosis Central Sleep Apnea or Complex Sleep Apnea? Do you have breathing issues other than sleep apnea? And can you confirm the mode your machine is operating in and all the therapeutic settings? (ASV machines have more than just an IPAP and EPAP setting and those other settings are important.)

When I wear the current mask to bed it is alittle uncomfortable. It is not vented for when I exhale. The machine has a heated humidifier on it so the air is fine.

I don't know what you mean by saying the P10 is not vented for when you exhale. Unless some modification to the mask has been made, the vents at the sides of the pillow cradle allow air to escape at all times when the mask is on your face and the machine is turned on and blowing air.

How is the mask uncomfortable? Does it feel like the mask is pushing your nose into your face? In other words, does it feel like "piggy nose"? Or is it more that the outsides of the nostrils are sore? Or is it something else?

When I goto bed it is normally between 11pm and midnight. I takes anywhere from 15 minutes to an hour to fall asleep. I have nights that go either way. Some nights I fall right back to sleep and other nights I am up for awhile. There are nights where I sleep a few hours and then there are nights when I sleep thru the night. I still wake up feeling exhausted, groggy, and unmotivated.

Have you talked to the sleep doc about your on-going insomnia-type sleep problems that continue even though you are using the machine?

What do you do when you don't fall asleep within 15-30 minutes of going to bed?

What is the first thing you do when you find yourself awake in the middle of the night? What do you do if you can't get back to sleep in 15-20 minutes after waking up?

And how many nights per week (on average) would you say that you have trouble either getting to sleep or staying asleep or both? Is it 1 or 2 nights per week? Or is it 3 or 4? Or is it 5 or 6?

And do you have a regular wake up time? Do you get up at the same time every day---including weekends, days off, and holidays?

The hose doesnt bother me at all, what bothers me the most is the leaks in the machine.

Have you looked at the leak data recorded by your machine?

Where do you detect the leaks? From your mouth? Or from around the nostrils where the nasal pillows seal? Or from the exhaust vents?

I take 250 mg of Nuvgil 1x, 20mg of Fluoxetine 1x, Lisinopril HCTZ 20/12.5, Multivitamin, Omerpazole 20mg 2x, Ipratropium .06% 2 doses 1x, Nasoneb Cup 10ml Saline
I do 2 nebulizer treatments a day, Allergy shots 1 aweek, My allergies range from dust to dairy products.

That's a pretty lengthy list of daily meds. It's well worth talking to each of the prescribing docs about your multiple issues and ask whether some of these might be an unwanted side effect from one of the medications. And if so, whether there might be an alternative drug that may have fewer side effects.

In particular:
Side effects of

• Nuvgil include headaches and insomnia (http://www.drugs.com/nuvigil.html)
• Fluoxetine include insomnia and strange dreams (http://www.drugs.com/fluoxetine.html
• Lisinopril HCTZ include headaches, tired feeling, and a depressed mood (http://www.drugs.com/mtm/hydrochlorothi ... opril.html)
• Omepazole include headaches (http://www.drugs.com/omeprazole.html)
• Ipratropium include headaches (http://www.drugs.com/mtm/ipratropium-inhalation.html)

It's important to realize that you have been prescribed each of these meds for treating medical conditions, and it's NOT a good idea to just not take them. But it is worth mentioning to the docs who prescribed the Nuvigil, Fluoxetine, and Lisinopril that you are having a lot of headaches, some real problems getting and staying asleep during the night, and that you have a lot of issues with fatigue during the daytime.

I am being treated for depression, anxiety disorders, consistently wrestling with headaches they range from mild to unbearable.

Is any doctor actually treating you for the headaches? As a chronic headache sufferer myself, I know just how debilitating they can be. But all too often, headaches get overlooked in our society. It's also important for you to tell the doc treating you for the depression and anxiety that you are "consistently wrestling with headaches" and ask whether or not there's any chance that the medication being used to treat the depression and anxiety may be making the headaches worse.

robysue wrote:

trvlinteddy69 wrote:The Resmed Airfit P10 Nasal Pillow Mask:
I am suppose to wear this mask with a chin strap and it consistently slips off my head.
Best thing about the mask is that it has limited headgear. The worst thing about the mask is that it leaks frequently.

So it looks like you are are mouth breather. Do you put the chinstrap on first or the AirFit P10 on first? Reversing the order you put the two things on may give you a more stable arrangement.
I have tried it both ways and which ever one is on top is the one that slides off.

You might also want to try the Swift FX nasal mask. Its headgear is more adjustable than the one-size-fits-most strap for the P10. The downside of the Swift FX is that the exhaust vent does NOT have a built-in diffuser and it is concentrated enough to remind some of us of a jet plane engine.
The next mask I was asked to try is the Pilairo Q Nasal Pillow Mask. After last night I also realize I dont like the fact that the headgear on the airfit is not adjustable. I found the vents you were referring to, I think because of how I sleep it just doesn't feel like the exhale is going out.

The bipap machine is a Resmed Bipap Advanced Auto ASV

This is NOT a plain vanilla bi-level. It's a very expensive and very specialized machine that is usually prescribed only when there are real problems with central apneas that persist after several weeks to several months of CPAP therapy. Do you know why this machine was prescribed for you? If not, you need to find that out from the doc who prescribed it.
I went from the cpap machine to a bipap machine when I went from obstructive sleep apnea to central sleep apnea. But the neurologist had me go see a different sleep doctor. He went thru my previous studies plus the data from my machine and told me that something was not right. So I had a sleep study done on July 20th and am waiting for my follow up to see whats going on. He also feels that there may be another issue at play that no one has caught because what he saw in the data does not explain how I feel. He is aware of all of the meds I am taking and said if anything I should feel more energy because 2 of the pills should act like caffine

I do not really notice a comfort difference between the 2 machines. I know I am sleeping longer with the bipap I just do not feel rested.
My pressure setting for this machine are 12 over 20.

I would suggest starting a new thread with the title: New ASV user and I still feel exhausted. There are some very knowledgeable ASV users on the board, but some of them don't read posts without ASV in the subject line.

It's also going to be important to include the following on that thread if you know them: Is your diagnosis Central Sleep Apnea or Complex Sleep Apnea? Do you have breathing issues other than sleep apnea? And can you confirm the mode your machine is operating in and all the therapeutic settings? (ASV machines have more than just an IPAP and EPAP setting and those other settings are important.)

When I wear the current mask to bed it is alittle uncomfortable. It is not vented for when I exhale. The machine has a heated humidifier on it so the air is fine.

I don't know what you mean by saying the P10 is not vented for when you exhale. Unless some modification to the mask has been made, the vents at the sides of the pillow cradle allow air to escape at all times when the mask is on your face and the machine is turned on and blowing air.

How is the mask uncomfortable? Does it feel like the mask is pushing your nose into your face? In other words, does it feel like "piggy nose"? Or is it more that the outsides of the nostrils are sore? Or is it something else?
Actually yes it does feel like piggy nose than when I wake up in the morning my nostrils are sore

When I goto bed it is normally between 11pm and midnight. I takes anywhere from 15 minutes to an hour to fall asleep. I have nights that go either way. Some nights I fall right back to sleep and other nights I am up for awhile. There are nights where I sleep a few hours and then there are nights when I sleep thru the night. I still wake up feeling exhausted, groggy, and unmotivated.

Have you talked to the sleep doc about your on-going insomnia-type sleep problems that continue even though you are using the machine?
Yes I have spoken to all three of them about it.

What do you do when you don't fall asleep within 15-30 minutes of going to bed?
Mostly toss and turn until I do. Listening to music used to but me out but it no longer does

What is the first thing you do when you find yourself awake in the middle of the night?Try to get comfortable and go back to sleep What do you do if you can't get back to sleep in 15-20 minutes after waking up?Watch tv or check emails

And how many nights per week (on average) would you say that you have trouble either getting to sleep or staying asleep or both? Is it 1 or 2 nights per week? Or is it 3 or 4? Or is it 5 or 6? between 4 and 5

And do you have a regular wake up time? Do you get up at the same time every day---including weekends, days off, and holidays?
'Since I am out of work no I do not have a set time it ranges between 8:30 and 10:30

The hose doesnt bother me at all, what bothers me the most is the leaks in the machine.

Have you looked at the leak data recorded by your machine?
I was never shown how to get the data from my machine I was just instructed to take the card in and have it read

Where do you detect the leaks? From your mouth? Or from around the nostrils where the nasal pillows seal? Or from the exhaust vents?
With this mask I do not know how to answer that. I normally am awaken by the leak alarm on the machine. I clear the alarm, reseat the mask and go back to bed. Sometimes Im good to go and others the alarm goes off an hour later

I take 250 mg of Nuvgil 1x, 20mg of Fluoxetine 1x, Lisinopril HCTZ 20/12.5, Multivitamin, Omerpazole 20mg 2x, Ipratropium .06% 2 doses 1x, Nasoneb Cup 10ml Saline
I do 2 nebulizer treatments a day, Allergy shots 1 aweek, My allergies range from dust to dairy products.

That's a pretty lengthy list of daily meds. It's well worth talking to each of the prescribing docs about your multiple issues and ask whether some of these might be an unwanted side effect from one of the medications. And if so, whether there might be an alternative drug that may have fewer side effects.

In particular:
Side effects of

• Nuvgil include headaches and insomnia (http://www.drugs.com/nuvigil.html)
• Fluoxetine include insomnia and strange dreams (http://www.drugs.com/fluoxetine.html I had issues with insomnia prior to this drug
• Lisinopril HCTZ include headaches, tired feeling, and a depressed mood (http://www.drugs.com/mtm/hydrochlorothi ... opril.html)
• Omepazole include headaches (http://www.drugs.com/omeprazole.html)
• Ipratropium include headaches (http://www.drugs.com/mtm/ipratropium-inhalation.html)

It's important to realize that you have been prescribed each of these meds for treating medical conditions, and it's NOT a good idea to just not take them. But it is worth mentioning to the docs who prescribed the Nuvigil, Fluoxetine, and Lisinopril that you are having a lot of headaches, some real problems getting and staying asleep during the night, and that you have a lot of issues with fatigue during the daytime.

I am being treated for depression, anxiety disorders, consistently wrestling with headaches they range from mild to unbearable.

Is any doctor actually treating you for the headaches? As a chronic headache sufferer myself, I know just how debilitating they can be. But all too often, headaches get overlooked in our society. It's also important for you to tell the doc treating you for the depression and anxiety that you are "consistently wrestling with headaches" and ask whether or not there's any chance that the medication being used to treat the depression and anxiety may be making the headaches worse.

Over the next 2 weeks I will see all 3 doctors so I will ask. My concern is that I have been on the Lisinopril and Omeparzole for awhile and the headaches were not an issue for the first few years I took them

The P10 is actually highly adjustable for me - using changes in the angle of the two split straps. The top one on top of the head and the bottom one low on the ears is the loosest, both together mid way up the head is tightest. On my head shape at least. And the straps pretty much stay put in my short buzz cut hair.

trvlinteddy69 wrote:

robysue wrote:

trvlinteddy69 wrote:The Resmed Airfit P10 Nasal Pillow Mask:
I am suppose to wear this mask with a chin strap and it consistently slips off my head.
Best thing about the mask is that it has limited headgear. The worst thing about the mask is that it leaks frequently.

So it looks like you are are mouth breather. Do you put the chinstrap on first or the AirFit P10 on first? Reversing the order you put the two things on may give you a more stable arrangement.
I have tried it both ways and which ever one is on top is the one that slides off.

So the easy fix didn't work. More on this in a bit.

You might also want to try the Swift FX nasal mask. Its headgear is more adjustable than the one-size-fits-most strap for the P10. The downside of the Swift FX is that the exhaust vent does NOT have a built-in diffuser and it is concentrated enough to remind some of us of a jet plane engine.
The next mask I was asked to try is the Pilairo Q Nasal Pillow Mask. After last night I also realize I dont like the fact that the headgear on the airfit is not adjustable. I found the vents you were referring to, I think because of how I sleep it just doesn't feel like the exhale is going out.

I think the fact that you don't like nonadjustable headgear is enough to say, "The P10 and the Pilairo Q are NOT the masks for me."

See if you can try the Swift FX Nasal pillows mask. Or the Nuance. Or the Opus 360. All three have minimal, but adjustable head gear. Hence any one of them may provide you with a better fit than the P10.

The bipap machine is a Resmed Bipap Advanced Auto ASV

This is NOT a plain vanilla bi-level. It's a very expensive and very specialized machine that is usually prescribed only when there are real problems with central apneas that persist after several weeks to several months of CPAP therapy. Do you know why this machine was prescribed for you? If not, you need to find that out from the doc who prescribed it.
I went from the cpap machine to a bipap machine when I went from obstructive sleep apnea to central sleep apnea. But the neurologist had me go see a different sleep doctor. He went thru my previous studies plus the data from my machine and told me that something was not right. So I had a sleep study done on July 20th and am waiting for my follow up to see whats going on. He also feels that there may be another issue at play that no one has caught because what he saw in the data does not explain how I feel. He is aware of all of the meds I am taking and said if anything I should feel more energy because 2 of the pills should act like caffine

Have you contacted the new sleep doc and informed him that you are still having serious problems getting and staying asleep at night? And that you are NOT feeling more energy in spite of the fact that "2 of the pills should act like caffine"? If you haven't contacted the new sleep doc's office and informed them of what's going on, you really should call them on Monday, briefly inform the receptionist that you are having some serious problems adjusting to the ASV machine and that you need to have a call back from either the sleep doc or one of the PAs or nurse practioners in the office.

When I wear the current mask to bed it is alittle uncomfortable. It is not vented for when I exhale. The machine has a heated humidifier on it so the air is fine.

I don't know what you mean by saying the P10 is not vented for when you exhale. Unless some modification to the mask has been made, the vents at the sides of the pillow cradle allow air to escape at all times when the mask is on your face and the machine is turned on and blowing air.

How is the mask uncomfortable? Does it feel like the mask is pushing your nose into your face? In other words, does it feel like "piggy nose"? Or is it more that the outsides of the nostrils are sore? Or is it something else?
Actually yes it does feel like piggy nose than when I wake up in the morning my nostrils are sore

Piggy nose indicates that the P10 is too tight on your face. You can try to adjust the "tightness" of the P10 by separating the two back straps as far as possible. This may or may not make the mask more stable on your head.

But a more adjustable nasal pillows mask may be the better solution. The Swift FX has a tendency to maintain a good seal even when worn quite loosely. And some people have managed to add some "hook side" of velcro strips to the FX's back strap to help anchor that strap a bit more firmly to the back of their head.

When I goto bed it is normally between 11pm and midnight. I takes anywhere from 15 minutes to an hour to fall asleep. I have nights that go either way. Some nights I fall right back to sleep and other nights I am up for awhile. There are nights where I sleep a few hours and then there are nights when I sleep thru the night. I still wake up feeling exhausted, groggy, and unmotivated.

Have you talked to the sleep doc about your on-going insomnia-type sleep problems that continue even though you are using the machine?
Yes I have spoken to all three of them about it.

Any ideas from any of them? If not, you may have to push harder about this issue: "Try harder" without giving you ideas on what to do in order to "try harder" is not a useful answer. Seriously, you need to press your docs on this issue and keep reminding them that your daytime exhaustion, grogginess, and lack of motivation are NOT getting better with the switch to ASV and the script for Nuvigil. Tackling the insomnia itself needs to be considered.

What do you do when you don't fall asleep within 15-30 minutes of going to bed?
Mostly toss and turn until I do. Listening to music used to but me out but it no longer does

Talk to your sleep doc about what you need to do to establish good sleep hygiene and why good sleep hygiene is important. It is generally counter productive to lie in bed for more than 30 minutes if all you are doing is tossing and turning and NOT sleeping. Self-help tips for insomnia usually recommend getting out of bed if you are actively tossing and turning after 30 minutes of trying to get to sleep. And going into another room and doing something to get your mind off the fact that you're not yet asleep. And going back to bed when you feel like you are getting very sleepy. And note: Feeling sleepy is not the same as feeling exhausted.

What is the first thing you do when you find yourself awake in the middle of the night?Try to get comfortable and go back to sleep What do you do if you can't get back to sleep in 15-20 minutes after waking up?Watch tv or check emails

Both of these are probably making the insomnia symptoms worse. The blue light emitted by TV screens and computer/tablet/smart phone screens is damaging to the melatonin cycle. And checking emails can lead to "work planning" or "work worrying", both of which can make it harder to get back to sleep.

Have you considered reading a plain old fashioned, boring book when you're up in the middle of the night? Or listening to quiet music while working a crossword on paper?

And how many nights per week (on average) would you say that you have trouble either getting to sleep or staying asleep or both? Is it 1 or 2 nights per week? Or is it 3 or 4? Or is it 5 or 6? between 4 and 5

You are reporting enough problems with "getting to sleep" and "staying asleep" for the symptoms to be considered insomina. And they've been going on long enough for the insomnia to be considered chronic. Given that the insomnia has NOT gotten better with the medications for the depression and the ASV for the sleep apnea, it's worth making an appointment with the sleep doc that focuses on the insomnia as it's own problem. It could be that cleaning up the sleep hygiene may take the edge off of the insomnia. Or it could be that you need some real medical advice on what you might do to try to rein in the insomnia. Out of curiosity: Have any of your docs ever suggested either cognitive behavior therapy for insomnia (CBT-I) or have any of your docs ever suggested a prescription sleeping medication? If so what's been suggested and what's been tried?

And do you have a regular wake up time? Do you get up at the same time every day---including weekends, days off, and holidays?
'Since I am out of work no I do not have a set time it ranges between 8:30 and 10:30

As hard as it is to hear this: The lack of a consistent wake up time is probably making the night time insomnia worse. You might be better off trying to make your self get up by 9:00 every day regardless of how awful you feel. That will encourage your body to start getting sleepy by around midnight or 1 AM and also make it easier to fall asleep when you do go to bed.

The hose doesnt bother me at all, what bothers me the most is the leaks in the machine.

Have you looked at the leak data recorded by your machine?
I was never shown how to get the data from my machine I was just instructed to take the card in and have it read

Do you know how to get the data off your machine yet? If not, let us know and we'll be happy to help you. I think that if you were able to look at your own data whenever you wanted to so that you could see how well or how poorly the machine is managing your OSA and CSA, that would help. Looking at the leak data is also the only way to figure out whether you could ditch the chin strap completely.

Where do you detect the leaks? From your mouth? Or from around the nostrils where the nasal pillows seal? Or from the exhaust vents?
With this mask I do not know how to answer that. I normally am awaken by the leak alarm on the machine. I clear the alarm, reseat the mask and go back to bed. Sometimes Im good to go and others the alarm goes off an hour later

We need to see the leak data from your machine to help you figure out when, where, and why you are leaking. Once you fix the leaks, that will be one less disruption to your already fragile sleep.

Fluoxetine include insomnia and strange dreams (http://www.drugs.com/fluoxetine.html I had issues with insomnia prior to this drug

Have they gotten any worse while being on Fluoxetine? Also, was the Fluoxetine prescribed in part as a way of trying to help you sleep better?

I am being treated for depression, anxiety disorders, consistently wrestling with headaches they range from mild to unbearable.

Is any doctor actually treating you for the headaches? As a chronic headache sufferer myself, I know just how debilitating they can be. But all too often, headaches get overlooked in our society. It's also important for you to tell the doc treating you for the depression and anxiety that you are "consistently wrestling with headaches" and ask whether or not there's any chance that the medication being used to treat the depression and anxiety may be making the headaches worse.

Over the next 2 weeks I will see all 3 doctors so I will ask. My concern is that I have been on the Lisinopril and Omeparzole for awhile and the headaches were not an issue for the first few years I took them

While side effects usually occur when you first start a medicine, if there's been a real change in something like the number and severity of the headaches while you are taking a particular medicine, it is well worth asking the prescribing doc whether a change in the medicine or the dosage may be worth trying.

And it's also worth having a long chat about the headaches with your neurologist and asking whether or not you need to see a headache specialist.

I have now using the nuance mask which I find very comfortable. Even though I have had on sleep study the doctor has scheduled a second because the results were skewed because of a mistake the technician made. The current mask is control the sleep apnea but I am still not getting rest. I was told that I have all of the signs of narcolepsy but I do not score low enough on paper to qualify for the drug used to treat it. The doctor now has me on 20mg of adderall 2x daily and I take klonipin at bed for the restless leg syndrome. I had to go see a new shrink who has me on 40mg of Prozac. And the Allergist put me on Singular 10mg. All of this changes just happened in the past 5 days so we will see where it takes me. The only positive not so far is that I have goto the gym 3 days this week. My biggest hurdle is controlling the emotion roller coaster till the meds kick in for I have already lost to friends. Because apparently and I quote' On a bad day Jonathan your like hurricane Sandy on red bull