My Apnea thread.

[Noctuary]

SleepyHead crashes with your S9 Escape Auto because it is not compatible with that model machine. You don't need a new computer...you need either ResScan or a full data S9.

That's good to know. I bought a refurbished laptop just for this purpose. I could try the ResScan; haven't done that yet.

Some questions that need to be answered no matter what machine you are using....please take the time to answer each one as I don't ask them if I don't think they are important.

1....I know you are on some meds...can you please tell us exactly the names and dosages and why they are being taken? If you want to do it privately send me a PM.

I take Temazepam at night, 30 mg. I just got a prescription for Provigil, but its totally ineffective.


2...What is "feel like shit"? I mean what symptoms are you having that are unwanted? Is it fatigue? Is it being excessively sleepy all day? Fatigue and being sleepy aren't the same thing.

It varies daily. One day I will feel a deep body fatigue but refreshed, the next I will feel "wired and tired"; unrefreshed. The latter is the worst, I would much prefer the former.

3...How many hours of sleep are you getting and do you wake up often during those hours?

7-9 hours a night. I usually wake up once.

4...Any other physical or mental health issues going on that can either impact sleep quality or how a person feels in general during the day?

Mental.....I'll admit it, I'm nuts. Severely depressed (according to several tests). Yet I'm okay with being depressed; exercise made me feel grand, at least before the onset of this disease.

I'm using a ResMed S9 Escape APAP, pressure range 8-20, full face mask. I have had a couple of days where I felt good, almost normal, so I know its possible. And yet its rare. Overall I'm better with the therapy; I have dreams, the house is clean, I pay my bills on time, and can exercise a little.

[Pugsy]

Thank you for starting a new thread. It will help keep things clearer and more consolidated and you will get more attention with your own thread.

I had wondered about the depression thing just because I was getting concerned about the overall tone of some of the things you said.. Scared me a bit.
I think you said that you have had this depression a long long time....is that true?

Temazepam side effects....how low have you been taken this drug?

If any of the following side effects occur while taking temazepam, check with your doctor immediately:
Less common

False or unusual sense of well-being
fear or nervousness
mood or mental changes

Rare

Difficult or labored breathing
fast, irregular, pounding, or racing heartbeat or pulse
loss of appetite
loss of memory
nightmares
problems with memory
seeing, hearing, or feeling things that are not there
shakiness and unsteady walk
shortness of breath
tightness in the chest
trouble sleeping
uncontrolled eye movements
unsteadiness, trembling, or other problems with muscle control or coordination
unusual excitement, nervousness, restlessness, or irritability
weight loss
wheezing

Incidence not known

Muscle cramps
seizures
shakiness in the legs, arms, hands, or feet
stomach cramps
sweating
trembling or shaking of the hands or feet
vomiting


sleepiness or unusual drowsiness
unusual tiredness or weakness

Some temazepam side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:
Less common

Diarrhea
dry mouth
feeling of constant movement of self or surroundings
headache
nausea
sensation of spinning
unusual dullness or feeling of sluggishness

Rare

Backache
burning eyes

For Healthcare Professionals

Applies to temazepam: oral capsule
Nervous system

Nervous system side effects are common and include drowsiness (9.1%), headache (8.5%), fatigue (4.8%), nervousness (4.6%), dizziness (4.5%), and lethargy (4.5%) most frequently. Sleep disturbances, morning "hangover" symptoms, hyperexcitability, confusion, amnesia, and ataxia have also been observed.[Ref]

Adverse effects
Common

Side effects typical of hypnotic benzodiazepines are related to CNS depression, and include somnolence, dizziness, fatigue, ataxia, headache, lethargy, impairment of memory and learning, longer reaction time and impairment of motor functions (including coordination problems),[13] slurred speech, decreased physical performance, numbed emotions, reduced alertness, muscle weakness, blurred vision (in higher doses), and inattention. Euphoria was rarely reported with its use. According to the FDA, temazepam had an incidence of euphoria of 1.5%, much more rarely reported than headaches and diarrhea.[12] Anterograde amnesia may also develop, as may respiratory depression in higher doses.
Less common

Hyperhydrosis, hypotension, burning eyes, changes in libido, hallucinations, faintness, nystagmus, vomiting, pruritus, gastrointestinal disturbances, nightmares, palpitation and paradoxical reactions including restlessness, aggression, violence, overstimulation and agitation have been reported, but are rare (less than 0.5%).

Before taking temazepam, one should ensure that at least 8 hours are available to dedicate to sleep. Failing to do so can increase the side effects of the drug.

The use of this drug in combination with alcohol potentiates the side effects, and can lead to toxicity and death.

Though rare, residual "hangover" effects after nighttime administration of temazepam such as sleepiness, impaired psychomotor and cognitive functions may persist into the next day, which may impair the ability of users to drive safely or may increase the risks of falls and hip fractures.[14]

[JDS74]

This is the pharmacology entry from Epocrates on this drug.
Note that the half-life if 8.8 hours and that pertains to healthy adults. If you are older ( 60 or older ) then the half-life is longer. What that means is the that 50% of the drug is still in your system and acting in the morning when you get up 9 hours later.

So, what you might try is taking your med earlier in the evening. If your bed time is 11:00 for example, then try taking the med at 8:00 PM for a few days to see if you feel different in the morning or if you feel better by noon the next day when the drug is almost completely eliminated. The other thing that might help is a large glass of water upon first getting up since most of the drug is excreted via urine. That will help clear your system of after effects sooner in the morning.

Just some thoughts.

Pharmacology:
Metabolism: liver; CYP450: none
Excretion: urine 80-90% (<1% unchanged); Half-life: 8.8h
Subclass: Benzodiazepines 2: Mid-acting; Insomnia
Mechanism of Action
binds to benzodiazepine receptors; enhances GABA effects

[Noctuary]

I've been taking Temazepam for about 8 months. To be honest I don't see any problem with it; none of the things listed above are applicable to me. I do feel a little morning grogginess, but it dissipates. As for depression, I've been this way for decades. My currenct condition with sleep apnea aggrevates it, to say the least.

Today I feel much better than yesterday, body fatigue but refreshed. I am almost certain that tomorrow I will feel wired and tired; this is the basic patter for months. According to the S9, last night's usage was 9 hours with an AHI of 1.3. If everyday could feel like today I would be in much better shape.

[Pugsy]

You know it is very possible that the depression is playing a significant role in your daytime symptoms.

Would it be possible to go to your doctor or DME and ask for a loaner machine that shows more data?
Just so you could rule out leaks maybe being a factor or flow limitations maybe being a factor.
The full data S9 machines will give you both leak data and flow limitation data. Flow limitations may be a factor in your daytime symptoms (they also may not) but it's stone to turn over in the quest to see if there is anything possibly showing on the software reports that might explain some of your symptoms.

If your AHI is good and leaks are not the issue and flow limitations aren't the issue....then maybe the issue is unrelated to sleep apnea itself and the machine can't fix stuff that is unrelated to sleep apnea no matter how much we want it to.

I understand that not everyone can go out and buy a different machine...that's why I asked about the possibility of getting a loaner machine for a week or so just to see those leak graphs and flow limitation graphs.
Without that data we are just guessing but sometimes that's all we can do.
You know your machine is auto adjusting and I think set for apap mode. Perhaps the changing pressures are a factor in sleep quality and perhaps you might do better with a fixed pressure or a really tight apap range.
Unfortunately we don't know exactly where the pressure is going to and seeming to want to stay.
Sleepyhead is simply not compatible with the S9 Escape Auto but ResScan is and it will show where the pressures are going for 95% of the time.
I think you said you tried cpap mode (I forget) but maybe it wasn't at the right pressure to do the best job.

You have some options and while they aren't all that attractive and none guarantee the success you yearn for...
1..buy a full data machine so you can rule out leaks and flow limitations being a potential factor in sub optimal therapy despite the low AHI.
2..see if you can get a loaner machine to assess the data that is lacking and explained in #`1 option
3..explore the role of depression in your unwanted symptoms
4..try some different cpap fixed pressures to see if they help or hurt but that involves long term commitment at each pressure experiment and going only by how you feel which with a history of depression makes it really hard to accurately evaluate results.
5..you can keep doing nothing and having good days and bad days and feeling like shit and venting/complaining that it isn't working but forgetting that the machine can only fix sleep apnea stuff and the cold hard facts of life is that often we have more than one thing going on and often that thing is totally unrelated to sleep apnea...and the machine can't fix it.

[Noctuary]

You know it is very possible that the depression is playing a significant role in your daytime symptoms.

I doubt it. I was depressed for decades before this began and I slept well. This present condition came on suddely early last year. One day I slept as I normally do, then next day it all went to hell. Literally overnight.

If your AHI is good and leaks are not the issue and flow limitations aren't the issue....then maybe the issue is unrelated to sleep apnea itself and the machine can't fix stuff that is unrelated to sleep apnea no matter how much we want it to.

I've wondered if I have low testosterone. I do have some symptoms of it, symptoms I was glad to have. But I read that low-testosterone therapy can worsen sleep apnea.

I have tried fixed pressures and didn't see any difference. Also, my original APAP settings were 5-20. Setting it to 8-20 hasn't made a difference I can detect. Yet I am far better with the therapy than without. Realizing that I find it difficult to believe that its not just sleep apnea, but I won't rule it out. And yet, I can't get past how this all came on suddenly. One thing that may or may be not worth mentioning is that a few days earlier I had went to the hospital with pains in my shoulders and neck. The "web" said it may be a heart attack. Two nurses and a cardiologist told me that health sites on the web overstate things for liability purposes. I wasn't having a heart attack after all. But a few days later I told a co-worker about this, and the pains in my shoulders and neck. She said I may have fibromyalgia. I looked it up and read the symptoms, one of which said unrefreshing sleep. This wasn't a symptom I had, nor were most of the other ones. Yet a day or two later I awoke with unrefreshing sleep. I cannot remember ever feeling like that execpt on the occasions where I just didn't sleep enough hours, which were rare. So again this condition of mine literally came overnight.

Thanks for the posts.

[robysue]

Noctuary,

I have not read everything you posted in the other thread, but I do want to comment on a couple of things you write here:

You know it is very possible that the depression is playing a significant role in your daytime symptoms.

I doubt it. I was depressed for decades before this began and I slept well. This present condition came on suddely early last year. One day I slept as I normally do, then next day it all went to hell. Literally overnight.

Was this before or after your OSA diagnosis? Was this before or after you started CPAP?

A sudden and severe decrease in sleep quality is not the usual way that OSA symptoms manifest themselves. Usually there is a slow, steady deterioration in sleep that takes place over months or even years. It's possible you are an outlier, but I suspect that you may have been sleeping more poorly than you realize for a fairly long time. That actually *is* pretty common with undiagnosed OSA---the deterioration in sleep quality can be so gradual that people just think their sleep is normal until they get the results of the sleep test.

If your AHI is good and leaks are not the issue and flow limitations aren't the issue....then maybe the issue is unrelated to sleep apnea itself and the machine can't fix stuff that is unrelated to sleep apnea no matter how much we want it to.

I've wondered if I have low testosterone. I do have some symptoms of it, symptoms I was glad to have. But I read that low-testosterone therapy can worsen sleep apnea.

I have tried fixed pressures and didn't see any difference. Also, my original APAP settings were 5-20. Setting it to 8-20 hasn't made a difference I can detect. Yet I am far better with the therapy than without. Realizing that I find it difficult to believe that its not just sleep apnea, but I won't rule it out.

Why is it so hard to believe that you may have more than one medical issue going on?

And yet, I can't get past how this all came on suddenly. One thing that may or may be not worth mentioning is that a few days earlier I had went to the hospital with pains in my shoulders and neck. The "web" said it may be a heart attack. Two nurses and a cardiologist told me that health sites on the web overstate things for liability purposes. I wasn't having a heart attack after all. But a few days later I told a co-worker about this, and the pains in my shoulders and neck. She said I may have fibromyalgia. I looked it up and read the symptoms, one of which said unrefreshing sleep. This wasn't a symptom I had, nor were most of the other ones. Yet a day or two later I awoke with unrefreshing sleep. I cannot remember ever feeling like that execpt on the occasions where I just didn't sleep enough hours, which were rare. So again this condition of mine literally came overnight.

Again, are we talking about this happening before or after your OSA diagnosis? Before or after starting CPAP?

I am assuming that this happened before you got your OSA diagnosis and started CPAP. If that's the case, what led to your getting the sleep test? Just this incident? Or were there multiple other reasons that went into the decision to get the sleep test?

What were the results of the sleep test? Just how bad is your untreated OSA?

[Noctuary]

Was this before or after your OSA diagnosis? Was this before or after you started CPAP?

It was months before. This came on literally overnight.

A sudden and severe decrease in sleep quality is not the usual way that OSA symptoms manifest themselves. Usually there is a slow, steady deterioration in sleep that takes place over months or even years. It's possible you are an outlier, but I suspect that you may have been sleeping more poorly than you realize for a fairly long time. That actually *is* pretty common with undiagnosed OSA---the deterioration in sleep quality can be so gradual that people just think their sleep is normal until they get the results of the sleep test.

I felt fine up until this began. However I know I snored for years. I would occasionally, rarely, wake myself up.

Why is it so hard to believe that you may have more than one medical issue going on?

It isn't. My latest blood test showed my thyroid is okay, as is my blood sugar and no anemia. However I wonder about my testosterone, since I do show at least one symptom of that.

Again, are we talking about this happening before or after your OSA diagnosis? Before or after starting CPAP?

Months before my diagnosis and months before starting CPAP.

I am assuming that this happened before you got your OSA diagnosis and started CPAP. If that's the case, what led to your getting the sleep test? Just this incident? Or were there multiple other reasons that went into the decision to get the sleep test?

I did some internet research and thought that I may have apnea, so I brought the issue up with my doctor. He then had a sleep test prescribed.

What were the results of the sleep test? Just how bad is your untreated OSA?

Untreated AHI of 10.

[Noctuary]

I did a home sleep test, btw.