New to CPAP - opinions welcome

Hi!

I'm new to the forum and to CPAP. After many years of poor sleep and depression caused, in my mind, by a pretty stressful life, I started falling asleep in my car on my way to work.

My doc referred me to a neurologist who ordered a sleep study which showed AHI of 29. No titration was done at the time but I am using the ResMed AirSense 10 on auto.

I started CPAP on 9/18/15 and was hoping to be one of those people who get instant results but that didn't happen. I'm committed to treatment so I'm here asking for opinions and ideas.

Here is my most recent SH screen.



I purchased a DreamWear mask and have been using it since the 23rd. Prior to that I'd been using a Mirage FX for her nasal mask, which was slowly but surely eroding the skin off the bridge of my nose despite a gecko pad and a re-set of the headgear by my doc.

It takes me a while to get the mask settled and sealed but I do like the ability to sleep comfortably on my side.

I'd like opinions on what the graph is showing and anything I might change to improve my sleep. I have my sleep study so I can add the info from it.

For some reason your AHI isn't showing ... ?

Julie wrote:For some reason your AHI isn't showing ... ?

Sorry! I had "unclicked" that...

Looks like you're doing really well, newbie or not!

Your pressure is up and down all night. For some people, that is fine,, but for others, it is really disturbing. You may find that a more narrow range will work just as well without disturbing your sleep. Your starting pressure is 6, but it never goes back down that far before needing to go up again. You might try raising your minimum pressure to 7 and see how you do. I suspect it will probably be better at 8, maybe 9; but it is better to try a small change, wait a few days, and see how it goes.

The report looks good at at least on paper.
What unwanted symptoms are you experiencing that you haven't seen any improvement in?
Daytime sleepiness or wanting to nap?
Daytime fatigue?
Poor sleep quality at night?

You ge the same speech that we start with when the reports look good on paper but you don't feel the good numbers.
How many hours of sleep are you averaging?
Are those hours fragmented with multiple wake ups? If so, how many and any idea why?
What meds do you routinely take?

story1267 wrote:anything I might change to improve my sleep.

A standard checklist ---->

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps.
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Optimize emotional stress in your life
- Use CPAP software to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems.

Which items do you need to work on?

story1267 wrote: After many years of poor sleep and depression caused, in my mind, by a pretty stressful life

Sounds like you understand now that untreated sleep apnea was causing poor sleep and depression?

Pugsy wrote:The report looks good at at least on paper.
What unwanted symptoms are you experiencing that you haven't seen any improvement in?
Daytime sleepiness or wanting to nap?
Daytime fatigue?
Poor sleep quality at night?

I continue to have daytime sleepiness (sleepy rides to work - it's better than it was pre-CPAP but not ideal).
I continue to have daytime fatigue (I have things I really want to get done, but struggle to do them) (I'd love, love to take naps but I don't take them).
My sleep quality is hard to describe. I don't feel like I'm waking up as often as I did pre-CPAP but I'm still not feeling refreshed.

Pugsy wrote:You ge the same speech that we start with when the reports look good on paper but you don't feel the good numbe
How many hours of sleep are you averaging?
Are those hours fragmented with multiple wake ups? If so, how many and any idea why?
What meds do you routinely take?

My sleep doc wants me to get 7 hours so I'm working on that. I've been able to be in bed and plugged in for 7 hours or almost 7 hours over the past week or so. Before this most recent visit I'd been in the 6 hour range. I used to have extremely fragmented sleep. I'd wake up and look at the clock, sometimes get up for bathroom trips, etc. I could get back to sleep but never felt like my sleep was deep enough.

I used to attribute my light sleep and frequent awakenings to hyper-vigilance. My son was born with severe congenital cardiac defects and was very ill the first year of his life. The cardiac situation stabilized and then, one night, he had a hugely terrifying (to me) tonic-clonic seizure that lasted a long time and was the first of many seizures - all occurring only at night. Now my theory is that I'd been waking up all this time due to OSA and the stress didn't help.

I'm working with my psychiatrist now to optimize my med regimen. I'd been taking wellbutrin, effexor, amitriptilyine, and lorazepam as needed. I've come off all of those and am only taking brintellix. All a work in progress. I take a multi, and some supplements (fish oil, zyflammend, curcumin, calcium, iron, and glucosamine).

ChicagoGranny wrote:

story1267 wrote:anything I might change to improve my sleep.

A standard checklist ---->

[img]- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps.
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Optimize emotional stress in your life
- Use CPAP software to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems.[/img]

Which items do you need to work on?

Oh...chocolate.... ...the humanity. I'm willing to do what needs to be done, including trying diet alterations. My overall diet is comparatively good but I wonder about sub-clinical pre-diabetes. I'm looking into this and have ordered a glucose monitor and will educate myself on it's usage.

I'm reviewing everything I take with my psychiatrist. She's a rare gem, she listens, and understands what I'm trying to say even when I can't speak clearly.

I'm working on emotional stress - have a great therapist, and a lovely husband.

Sleepyhead is in use, working on understanding what it's trying to tell me.

Thank you for your thoughts. Sometimes the most obvious seeming thing will get overlooked. It can make all the difference.

story1267 wrote:I wonder about sub-clinical pre-diabetes. I'm looking into this and have ordered a glucose monitor and will educate myself on it's usage.

Gramps became concerned a few years ago and putzed around with a monitor for a few months. Then a local hospital offered a free A1C test. They were strictly looking to test for pre-diabetes. He went for the test (I had one also.), and when he got a good results he quit worrying with the glucose monitor.

story1267 wrote:Oh...chocolate.... ...the humanity.

It is awful.

I buy the giant sized Hershey's dark chocolate bars and many days eat two squares after lunch. That's about all I can handle and fall asleep easily at 11:00 p.m. or so. If I eat two squares after 3:00 p.m., it causes a problem.

story1267 wrote: I continue to have daytime sleepiness (sleepy rides to work - it's better than it was pre-CPAP but not ideal).
I continue to have daytime fatigue (I have things I really want to get done, but struggle to do them) (I'd love, love to take naps but I don't take them).
My sleep quality is hard to describe. I don't feel like I'm waking up as often as I did pre-CPAP but I'm still not feeling refreshed.

So things have improved but not to where you expected or wanted them to be.
You know that is not unusual at all. That happened to me as well. We all want to be the recipient of the "cpap miracle" that we read about people having but in reality that miracle is relatively rare and happens to people who have no other issues to mess with how they feel except sleep apnea. Remember the cpap therapy can only fix sleep apnea issues and it can't fix bad sleep if bad sleep is caused by something other than sleep apnea and there's a big long list of things that can mess with our sleep besides sleep apnea.

I don't know how much of an impact the brintellix may have on your unwanted symptoms or how much the condition that you are taking it for may be a part of your unwanted symptoms. From what little I read about brintellix it didn't seem to have as many of the unwanted side effects (like messing with sleep, or drowsiness, or insomnia) as the meds you used to take as those are so well known I didn't even have to look them up. It's something to be aware of and talk with your doctor about.
Meds for depression often cause the very same symptoms as sleep apnea in terms of daytime drowsiness and even insomnia...of course the depression can also cause those same symptoms.

So this is where the other part of the speech comes in...other health conditions that might impact how we feel or sleep....and that includes mental health.

The machine can only do so much to improve things but it can't always fix everything that we want it to fix.
No matter how much we wish all our issues can be blamed on OSA it doesn't always work out that way.
So what do we do? We continue to use the cpap because it does help...maybe not as much as we want but it does help...and work on anything and everything we can in terms of meds, stress, life in general to hopefully have continued improvement. Sometimes we do have to "give it time" but use that time to investigate other potential culprits (like meds side effects) or other health issues and try to fix what we can fix to maybe make things even better.

You may need more sleep than you are getting which I know is much easier said than done.
I know that if I don't get around 8 hours of good decent sleep I don't feel so great the next day.
The nights where I get less than 7 hours I pretty much will expect to have a my butt drag the next day and want to take a nap.

In terms of your report...it looks really good so nothing on it screams out "fix me" which is both good and bad ...good because on paper it's working but bad because you don't feel as good as it looks and there's nothing that we see than needs fixing to maybe help you feel better.
The only thing I might offer is to consider trying either a much tighter pressure range or even cpap mode to see if the pressure changes happening in auto mode are a disruptive factor to your sleep quality.
Some people sleep quite well through some massive pressure changes (that would be me) but others find that the least little pressure changes can impact sleep quality and it's something to think about because I suspect you are already probably tending to be hyper vigilant because of the baby's issues and you sleep with one eye open anyway. I don't know if removing the wide range of pressures will help or not but it sure wouldn't hurt to try and would be worth looking at.
Don't ask me what pressure though...I haven't thought that far ahead and haven't seen enough reports. It was a bit of a struggle to compose all this here. We can talk about that later if you wish to investigate trying a limited range or cpap mode.

Thanks so much Pugsy. I agree that many things just aren't as clear as we might like.

I'll continue working on my sleep hours. And when I have more data I'll share more. The idea of trying a steadier pressure makes sense.

I feel like I'm missing out on REM sleep. I had 15.8% REM the night of my sleep study.

Hello again! I've had some time to change my pressure setting. Just a small change of minimum pressure from 6 to 7. Please see the below charts. Further opinion and suggestions are welcome.

I have an appointment early next week with an ENT to address a known deviated septum and long-standing sinus trouble "non-allergic rhinitis".

How are you feeling now? Any improvement since your earlier posts? Just saw your thread for the first time today. I think a lot of times we don't give ourselves enough credit for all the other stuff going on in our lives that can disrupt sleep. Having a little one with medical problems makes it tough. Hope that also has gotten better.

Your AHI seems to be really good. I think people also don't give enough credence to paying off the sleep debt they have accumulated after years and years of SA.

Hope you are doing well and feeling better.