Atypica patient

Hi I am a new user and a very atypical patient. last night was myfirst time I slept with the Apap. I got 10hours and ahi avg was 3.0 but still feel tired and sleepy during the day,no leaks. I have even been taking nuvigil 150 mg with no improvement in daytime sleepiness. other meds before cpap were Adderall, concerta at high doses and they had no effect either. even 300 mg of nuvigil before cpap did nothing and i even took a nap. i read that normal people taking that dose would stay awake for days.
I have recently been diagnosed with mild OSA with AHI 7 and rem AHI 34 . Also when i wore the mask i felt air hunger and felt that no air was coming into my nose but when i pulled the mask i would feel a blast of air(the staring pressure is 6).Instead i feel air going through the small holes in a steady stream outwards instead of into mynose.(i use the quatro face mask)..sorry about the long paragraph---did anyone have similar experiences? do i need a higher pressure? whats wrong with me?

Well the stream of air going out those little holes is CO2, and very necessary, so don't allow it to be blocked by bedding (tho' a sheet probably wouldn't be terrible). What kind of mask are you wearing? Because if you e.g. are losing Cpap air by mouth breathing when asleep, a nasal mask won't be much good and a full face one might need to be considered. Also, 6 is a very low pressure to breathe comfortably at and if you raise it to even 7 or 8, you might be more comfortable. And don't sleep on your back because that provokes more apneas than anything else. I also wonder if e.g. nuvigil isn't having some rebound effect at night, making you sleepier than you'd be otherwise... regardless of others' experiences.

i'm using the quattro full face mask and it has little holes on the nasal bridge. when the machine is turned on there is a stream of air continuously coming out from the holes.i thought maybe the air is going out of the holes into the atmosphere instead of into my nose.I didnt understand what a rebound effect of nuvigil is and how it would make me sleepier. could you please explain...thanks

One night is not going to do a lot for you - you have years of damage to catch up on. Many people will feel sleepy for the first few weeks, many will sleep many extra hours to catch up (usually referred to as "sleep debt").

You wouldn't consider running the day after you get a cast on your broken leg, would you?

Congrats on getting a full night in so quickly!! Just as some people are able to tolerate the mask from the very first night and others takes weeks or months to get a full night's sleep with the mask, some people feel an immediate energy boost and others feel better over time. Keep it up and, if there is no other health issue causing your sleepiness, you will feel better.

As the others have indicated, the venting air is normal and helps remove CO2 so you don't just rebreathe your stale air. It sounds like your mask is working normally.

You had a good first night, with hours of sleep and AHI... much better than I did my first night, so congratulations on that! It takes quite a while, several weeks or more in many cases, to start feeling the positive effects of CPAP. So, do stay with it; your health depends on it. You will start to feel better, but it's gradual. The air vent is to prevent you from rebreathing the CO2. I started CPAP on Quattro Air a little over 6 months ago, and I recall being a little anxious about the vent, but soon learned to ignore it.

Nuvigil is a stimulant in that it tries to force you to stay awake in the daytime... well the fact that it didn't work for you doesn't necessarily mean that the come-down effect of it's wearing off at night (whether or not you felt daytime benefits) could be keeping you asleep for longer than you might otherwise be.

Thank you all for your helpful answers, glad that i'm not the only one experiencing the same issues. would anyone know why stimulants like adderall,concerta at even high doses have no effect on me? I cant even drink coffee anymore because the stimulants make me feel extremely tired with heavy muscle weakness 1hr after consuming them. Can this be because my brain is suffering from OSA and not working properly?

imptogf wrote:i'm using the quattro full face mask and it has little holes on the nasal bridge. when the machine is turned on there is a stream of air continuously coming out from the holes.i thought maybe the air is going out of the holes into the atmosphere instead of into my nose.

what you have to realize is that cpap isn't about blowing air, it's about *pressure* . your system is set to 6cm/h2o, the cpap will attempt to blow however hard it needs to in order to get 6cm of pressure. when you take the mask off, it tries really hard to make that 6cm. but, of course, it can't... but it tries... ergo, it blows really hard.

as soon as you put the mask on, it's able to get that 6cm, so it only blows hard enough to maintain the 6cpm pressure against the vent from the holes.

the only air going into your noise is the same air you'd breath normally, the pressure just keeps your throat open.

from everything you're saying, the machine is working as designed. however, if you feel you're not getting enough air, you may need a higher pressure for your comfort. many people feel that it's difficult to breath with low pressures, even though over 20 liters a minute of air is being vented out of those hose, and the machine can blow much more to keep the pressure up

does that help any?

yes, thank you for the clarification, i was confused as to how the machine works. On a another note, do you know why the stimulants would have an opposite reaction and make me fell more sleepy/tired?

imptogf wrote:Thank you all for your helpful answers, glad that i'm not the only one experiencing the same issues. would anyone know why stimulants like adderall,concerta at even high doses have no effect on me? I cant even drink coffee anymore because the stimulants make me feel extremely tired with heavy muscle weakness 1hr after consuming them. Can this be because my brain is suffering from OSA and not working properly?

I don't know, but I can tell you that people have different reactions to the same thing. I used to drink a high caffeine pop, and I could drink it all day, just before bed, and then fall right to sleep. When I actually quit drinking pop for 6 months, I did not experience any changes. I did not sleep any earlier (I have been an extreme night owl since I was 17). I did not lose weight. I actually got dehydrated as I really didn't like water that much, and not much of anything else to drink either. I was drinking less and less, barely sipping through a small bottle of water a day. I finally gave up and went back to pop, but I switched a caffeine-free pop as I figured that was better even if I didn't notice the effects. I do drink 5 hour energy drinks sometimes, but never more than half of one. I normally get 5 uses from one of those little bottles. I do not feel high energy, but I don't feel sleepy anymore and that is all I want. I am glad they taste nasty.

I also have found that most medications that make people sleepy do NOT make me sleepy. Allergy meds. No problem. Codeine cough syrup. No problem. I have had a variety of OTC and prescription meds that warn about alertness, and none of them have bothered me. Any of them will make my mom sleepy in a heart beat. Years ago, I took one OTC primatene pill for asthma. The dosage said to take 2, but I only took one. I could not sit still or sleep for a day and a half. My heart raced, and I was exhausted. It was horrible. Never took another one. I heard years later that some people had really bad reactions to that.

I have also had less than stellar results from narcotic pain medications. I was prescribed codeine once for back pain. The nurse said it would give me a nice nap with pain relief. I waited 5hours to fall asleep and had to stick with an ice pack until I was past the time frame and could switch to a different medication. I was prescribed darvocet a couple years later for the return of back pain. Didn't help, and I almost passed out while home alone. I got really dizzy and took a nap on the floor in the bathroom to keep from falling and hurting myself. Never took one again. Back to the ice packs. Finally. my doctor prescribed a mild muscle relaxer and I found that using a home shiatsu massage chair thing on a regular basis keeps my back muscles from tightening down on the sciatic nerve. I only have problems now if I go a couple weeks without using it, and the warning signs are mild, but enough to get me back on track.

When I had my wisdom teeth out, I was given vicodin for pain relief. It made me so sick, I could not eat. I quit taking it, and I was able to get by with just some regular Tylenol.

I have no idea why, but I have better luck with tylenol for regular muscle pain, headaches, etc. I do limit their useage so that when I do use it, it works well. I use Aleve for inflammation type pain (doesn't help at all for headaches and muscle pains). We all know that these medications seem to work better for some people and not so much for others.

Some folks get opposite reactions to some medications, a Paradoxical reaction. Or they just may not work at all. You may be able to find a stimulant that works when others don't, or they all might not work for you unfortunately. I have heard of others describing their reaction to caffeine and even stimulants the same as you did. Best wishes.

imptogf wrote: On a another note, do you know why the stimulants would have an opposite reaction and make me fell more sleepy/tired?

I can offer some explanations about how the machines work technically, how various medications will effect you are questions best left to others

I think that issue is something you do need to talk to your doctor about, and possibly even a neurologist. Not everything is about OSA or Cpap and you might need to be tested for other conditions which may be affecting you.

imptogf wrote:Thank you all for your helpful answers, glad that i'm not the only one experiencing the same issues. would anyone know why stimulants like adderall,concerta at even high doses have no effect on me? I cant even drink coffee anymore because the stimulants make me feel extremely tired with heavy muscle weakness 1hr after consuming them. Can this be because my brain is suffering from OSA and not working properly?

Hi imptogf - like others have posted, not everyone who takes a stimulant (or other) type of med will react the expected way, and many people can have adverse reactions that can be serious. From what I know about the stimulants Adderall and Concerta, these are often prescribed for those with diagnosed ADD/ ADHD, however (again) - not all ADHD patients will have the same outcome with these meds.

An opposite expected reaction to stimulants should be discussed with your primary care physician, or the doc who prescribed these meds for you. To my understanding, this forum is not meant to take the role of a physician's care, but rather to help support each other in our efforts to adjust to apnea therapies.

Here's to more restful nights for all!