Should I increase my pressure?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
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Re: Should I increase my pressure?

Post by Pugsy » Sat Feb 21, 2015 10:09 am

Do you take any meds of any kind? If so, what?
Any other health conditions?
How is your sleep quality in general? Do you find that you are waking often for some reason or other?
Any pain or discomfort issues?

You know it may be that you just need to give it time but while you are giving it time it wouldn't hurt to dig deep into other potential causes for feeling less than optimal or not as good as we want.

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loveoverbooks
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Re: Should I increase my pressure?

Post by loveoverbooks » Sat Feb 21, 2015 10:30 am

Medication: birth control, flonase, gabapentin
Health conditions: high cholesterol, allergies, restless legs
My sleep quality has increased since starting CPAP. No more nocturia. I've had insomnia off and on for years but even that is improving thanks to the gapabentin since RLS was just making it worse (as long as I keep a consistent bedtime). I wake up a few times a night to fix mask leaks or due to insomnia.
No pain or discomfort otherwise. I had headaches or bodyaches 4-5x/week before CPAP and those disappeared right away.

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Pugsy
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Re: Should I increase my pressure?

Post by Pugsy » Sat Feb 21, 2015 10:43 am

gabapentin....

The most common side effects of gabapentin in adult patients include dizziness, fatigue, drowsiness
http://en.wikipedia.org/wiki/Gabapentin

Now I am not saying not to take it...just saying that it might be a factor in how you feel during the day.

The restless leg thing...you know that it can mess with your sleep.
And of course waking due to leaks or general insomnia isn't doing you any favors either.

You already know that you have seen actually substantial improvement...heck for me just the absence of getting up to pee every hour has been worth it.
Since there are other potential culprits for not sleeping so great and not feeling so great you may be expecting the machine to fix something that it can't fix because the machine can't fix problems unrelated to OSA or the airway issues.

Give it more time (like you have much of a choice ) and continue to work on the things that you can work on that are messing with your sleep...like mask leaks and the insomnia.

I don't know how much those flow limitations are messing with how you feel. I have always had pretty much zero flow limitations and a nice low AHI but I have some pain issues that mess with my sleep quality but while I don't wake up feeling like I am ready to run a marathon....at least I don't wake up feeling like I just ran one.

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Julie
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Re: Should I increase my pressure?

Post by Julie » Sat Feb 21, 2015 11:14 am

Could something as simple as a cervical collar make a difference - keeping the airway more open?

loveoverbooks
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Re: Should I increase my pressure?

Post by loveoverbooks » Sat Feb 21, 2015 1:26 pm

My neuro said that I'm taking the gabapentin early enough (8pm) that it shouldn't affect me in the morning, but I will ask him when I see him again at the end of March if I'm still not improving.

I may have to try the cervical collar next. I have been just so averse to wearing even more stuff at bedtime that I haven't wanted to try it yet.

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Pugsy
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Re: Should I increase my pressure?

Post by Pugsy » Sat Feb 21, 2015 1:40 pm

If your flow limitations are in the nasal passageway up higher than the throat airway area....the cervical collar might not help but wouldn't hurt to try.
So if you have nasal congestion then that could possibly be what you are seeing as flow limitations and the nasal part of the airway may not respond to positioning with the cervical collar.

I don't know the half life of gabapentin....but I bet some of it is still in your system the next day. You might check around to see if you can find the half life for it and remember that it compounds with repeated dosage.
I don't think that we can blame all your problems on the meds though...just pointing out it could have a potential impact.
Most of the time it isn't any one single thing that causes this sort of problem...it's usually a lot of little things. Makes for difficult detective work for sure. Plus even if it was a significant factor...there's a reason that you take it and sometimes we have to weigh the risks vs rewards for any meds we take.

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loveoverbooks
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Re: Should I increase my pressure?

Post by loveoverbooks » Sat Feb 28, 2015 9:25 am

Google says the half-life of gabapentin is 5-7 hours and is unaffected by dose or following multiple dosing. I can believe it, because if I wake up later in the night, it's clearly not helping me anymore. I am taking iron since RLS has been linked to low iron levels, which I have, but since I've had RLS since I was young (less than 10 if I remember correctly) and I have multiple family members on both sides of the family with it, there's more likely to be a genetic link and I'm not sure iron will help.

The nasal flow limitation comment reminded me that I saw an ENT last fall before I found a neuro who would write me a CPAP prescription. He said my nasal turbinates are large and a reduction might help. He had me take Afrin two nights in a row to see if it would make a difference in how I felt the next morning. I reported I felt no different, and he said that insurance required the Afrin to make a difference before they would pay for it. For curiosity's sake, I tried the Afrin again last weekend. No change in how I felt, and no change in how my CPAP data looked (no reduction in flow limitations either).

I have ordered a cervical collar because I couldn't find one locally. It should arrive next week.

The last three days I have been experimenting with using my machine on straight pressure (min=max). I also turned EPR off. Previously, whenever the pressure got up to 12 and hung out up there, it often made my mask leak or woke me up, which made for horrible sleep. I figured if it's mostly just chasing flow limitations (and failing), it wouldn't hurt to try keeping the pressure constant. I can't say I've slept any better (insomnia), but it's nice to not wake up to mask leaks. It's too early to say if it's helping the flow limitations.

Anyway, one interesting thing I found was that I haven't experienced any aerophagia at the higher (to me) straight CPAP pressures. I was up to 9 last night without any problems, but last week when I was experimenting between 8-12 with EPR 1 or 11-12 with EPR 3 I was very uncomfortable.

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archangle
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Re: Should I increase my pressure?

Post by archangle » Sat Feb 28, 2015 11:38 pm

Julie wrote:You've got more centrals than obstructive events and they won't respond to higher pressures. But hopefully Pugsy will give you more useful info about the results here... but I personally would lower my pressure a bit for now and you should get a little relief from aerophagia. You do need to look further into what's going on however... wait for Pugsy.
With a CA index of less than one, they're probably not very meaningful. They may very well be arousals. OP should probably look at the centrals in SleepyHead, and unless they're really long and complete. ignore them, but watch the CAI to be sure it doesn't go up.

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