Insomnia + new Cpap

Hi - I was diagnosed last week with moderate/severe apnea after a sleep study. My AHI is 29.4, and I had no REM sleep at all during the study.

I have had severe, chronic insomnia for the last 18 months. I have done CBT-I, tried several sleeping pills (all of which I hated), seen a psychiatrist for my anxiety, etc. I have excellent sleep hygiene and in the last four months have managed to mostly control my insomnia with a combination of herbal supplements (primarily GABA, magnesium and L-Theanine). With these I generally fall asleep within 45 minutes and get 5-6 hours of sleep a night. I still have fatigue and headaches, although I never fall asleep on the couch or outside of my bed, no matter how tired I am (that Epworth sleepiness scale doesn't work at all for me--I feel like crap most of the time but don't fall asleep and I have always been like that).

The apnea diagnosis was a surprise because I don't snore, I'm a 41-year-old woman of normal weight, no alcohol and never smoked. I'm an athlete and in excellent health otherwise.

I got a CPAP (the Dream machine) and tried a nasal pillow--didn't work because I'm a mouth breather. Got a face mask that covers my mouth and it feels fine--no leaks or whatever. But my herbal supplements don't work and I can't sleep AT ALL with it on. If I don't fall asleep within that 45-minute window, I am awake all night. So I'm going on three nights with literally no sleep and I don't think I can persevere with this anymore. I am a full-time single mom and have a full-time job--I need to sleep. I understand the long-term implications of apnea but I'm pretty sure sleep deprivation will kill me quicker.

I don't know what I'm asking....just frustrated and not sure how to proceed. My sleep doctor doesn't believe in meds of any type, and he's not been much help in any of this.

I too have severe insomnia on top of what is now Moderate OSA. Still waiting on the new CPAP. As far as sleep meds, I've tried 2: Trazodone (100mg) & Belsomra (5mg). I refused to try Ambien, Lunesta or any of the others because they are addictive & can stop working suddenly. I've occasionally taken Xanax to help me sleep, BUT that is super addictive & probably not the best long term solution. The Trazodone worked well for me - fell asleep & usually stayed asleep & no morning hangover. I switched to Belsomra because I have a new issue with my 2nd go-around with CPAP: Heightened claustrophobia & feeling "smothered" by the machine pressures due to being in an abusive relationship where I was choked & left with the parting gift of mild to moderate PTSD. Trying to breath against the pressures in the lab was almost psychologically unbearable even on 0.75 mg of Xanax when I woke up in the middle of the sleep study. I talked to my dr who agrees Xanax is not a great long term solution & suggested I try Belsomra. As I am waiting on my CPAP machine, we don't know if Belsomra will address my anxiety with the pressures, however I can tell you that it works even better than the Trazodone in regards to helping me sleep through the night. The only hiccup for me is there is a bit of a hangover in the morning if I take it too late the night before. It's expensive though. I know Merck, the company that manufactures it offers coupons & most drug co's have payment assistance programs. It really does help me sleep. Here's to hoping it suppresses my fight or flight response in regards to breathing against the pressures. If it doesn't, I'm pretty much back to square one.

If your doctor doesn't believe in meds for sleep, at least try OTC Melatonin...it works for some people.

almondcake,

Welcome to the forum.

And I also am sad to hear that you are the newest member of my CPAP&Insomina Club. My own battles with OSA, CPAP, and Insomnia are well documented in the many, many posts I made back when I was a newbie. I'm now well into my sixth year of fully compliant PAPing. And when all of my sleep problems are properly under control, I feel much better on BiPAP than I did before starting.

I was diagnosed with moderate OSA when I was 52. At the time I was 5'1" and weighed about 105 lbs. So I can understand where you're coming from in terms of your diagnosis.

I wish I could tell you the magic formula for teaching yourself how to sleep with the hose on your nose. In my case it took 3 hellish months before I was willing to admit that I needed to have help from the sleep doc's PA to design a CBT-I that would actually tackle the problem. After 2 or 3 months of hard CBT-I, I was able to get to sleep with the mask in roughly 10-15 minutes, which was a shorter sleep latency than I had ever had in my adult life. Five years after completing the CBT-I, I still usually fall asleep within 10 minutes of putting my mask on. However, if I don't fall asleep within about 15 minutes, I still have real problems getting and staying asleep all night long.

You write:

I have done CBT-I, tried several sleeping pills (all of which I hated), seen a psychiatrist for my anxiety, etc. I have excellent sleep hygiene and in the last four months have managed to mostly control my insomnia with a combination of herbal supplements (primarily GABA, magnesium and L-Theanine). With these I generally fall asleep within 45 minutes and get 5-6 hours of sleep a night. I still have fatigue and headaches, although I never fall asleep on the couch or outside of my bed, no matter how tired I am (that Epworth sleepiness scale doesn't work at all for me--I feel like crap most of the time but don't fall asleep and I have always been like that).

Some questions that will help me provide better help to you:

1) What did your CBT-I involve? And how well would you say it worked?

2) Which prescription sleeping pills did you try? And were side affects the reason you hated them?

3) Is anxiety under control? Or was it under control before you started CPAP? You get to define "under control" however you want to.

4) How long did it take you to fall asleep before you started using the combination of GABA, magnesium and L-Teanine to help with your sleep?

5) Before CPAP did you wake up with a headache? Did your headaches get better as the day went on? Do you have a history of migraines and/or tension headaches?

6) Describe your sleep hygiene in more detail than "excellent." What is your desired sleep time--both bedtime and wake-up time? Do you get up at the same time every day? Do you have a bedtime routine? What do you do if you are not sleepy at your regular bedtime? And note that feeling sleepy is very different from feeling fatigued.

You also write:

I got a CPAP (the Dream machine) and tried a nasal pillow--didn't work because I'm a mouth breather. Got a face mask that covers my mouth and it feels fine--no leaks or whatever. But my herbal supplements don't work and I can't sleep AT ALL with it on. If I don't fall asleep within that 45-minute window, I am awake all night. So I'm going on three nights with literally no sleep and I don't think I can persevere with this anymore. I am a full-time single mom and have a full-time job--I need to sleep. I understand the long-term implications of apnea but I'm pretty sure sleep deprivation will kill me quicker.

First, I really do understand what you are going through. Night 3 on CPAP was particularly bad for me---so bad I still remember it in pretty vivid detail. But it does get better if you find a way to stick with it.

However, you are right: You've got to find a way to get *some* sleep instead of *no* sleep.

Personally the thing that I think you need to think about is your latency to sleep. 45-minutes is a very long latency to sleep, and lying in bed fighting with your machine for that 45 minutes is probably making a bad situation much, much worse.

One thing I was told to do when I was dealing with a similar problem was to get out of bed 20 minutes after I went to bed if I was not yet asleep. I was told to go out of the bedroom and do something to get my mind off the dang CPAP. What I did when I was out of bed was up to me, but the PA suggested that it not be work related or cleaning related. I did a lot of crosswords and Sudukos and reading at the start of my CBT-I when I couldn't get to sleep (or back to sleep) within 20 minutes or so. Some nights it felt like I was in and out of bed for most of the night, but after about a month of using the rule combined with "get up at the same time regardless of how much sleep", I started to notice that on most nights I was getting to sleep much faster than I ever had in my adult like. Was it easy? No. Was it worth the hard work? Yes.

Another thing I was explicitly told (that I already did most of the time) was to NOT go to bed if I was NOT actually sleepy at my desired bedtime. It's tough to get to sleep when you feel like you're fighting with a machine if you are not actually sleepy to begin with. And learning the difference between feeling sleepy and feeling tired or fatigued was important. Even today, if I try to go to bed when I'm not actually yawning with the sleepies, I run the risk of having a hard time falling asleep before the machine makes me mad. And getting mad at my machine guarantees a rough, rough night.

I'll end with a concrete suggestion: You ought to keep a simple sleep log for a week or so in order to document the full scope of the problem for your doctor(s). You also need to keep track of whether there's even the most minor improvement in terms of the daily headaches. The disappearance of morning headaches is often an early sign that CPAP is doing some good in people who have a rough adjustment period.

Thank you for the welcome!
I'll do my best to answer your questions, and thank you for any advice you may give.

1. I did two different sessions of CBT-I--one was in-person with a therapist that talked about sleep hygiene and the like, but drifted off into core issues and my childhood so wasn't all that helpful. I also did an online program. I don't think either was particularly helpful, but I've done a lot of therapy (included CBT) in the past and am pretty aware of my triggers and whatnot.
2. Oxazepam (loved it, worked great, my doc wouldn't let me stay on it), Mirtazapine (hated it, worked ok for sleep but I gained 15 pounds in 3 weeks), and Zopiclone (works for sleep, but I feel so groggy in the morning and it also tends to set off a co-morbid vertigo disorder I also have. I also keep having to increase the dosage (started at 3.5, now I'm at 7.5 or so)
3. Yes, my anxiety is under control. I saw a psychiatrist recently who considered it "sub-clinical." I have really good coping skills.
4. The time to fall asleep would vary. It's always (since I was a kid) taken me a long time to fall asleep, I've never been one of those people who is asleep as soon as my head hits the pillow. Sometimes 15-20 minutes, sometimes a couple of hours. During the worst of my insomnia last spring, I would often have repeated nights of zero sleep.
5. During this bout of insomnia, I would wake up with a headache 4-5 times a week. They did usually get better through the day. No history of migraines or tension headaches.
6. Sleep hygiene: I go to bed and get up at the same time every day (11pm and 6am); one cup of coffee per day, always before 8 am, no other stimulants or caffeine through the day; no alcohol; no smoking; cool and dark room; white noise at night; computer and devices off an hour before bed; exercise regularly but never late at night; solid bedtime routine; and I'm always sleepy (and fatigued) at bedtime. If I'm not, I stay up reading until I am.

I have tried the get out of bed after 20 minutes thing, but I feel like it wakes me up more and makes me more alert. I understand the science behind it and I have done it, but it never helps me sleep--usually it just means that I'm up for the rest of the night. And, at the risk of sounding like "I've done it all and nothing will work" I have kept sleep logs as well. They don't offer any insight for me other than that I either fall asleep quickly (for me) or I don't fall asleep at all.

I think the most frustrating thing is that I have finally felt like my sleep was under some kind of control, and then this diagnosis has thrown me a total curveball and set me back months in terms of sleep management.

almondcake,

Thanks a lot for answering my questions.

I know is going to seem like I keep pestering you with more questions, but I'm trying to get a good feel for what your insomnia really feels like and what kinds of things to suggest with your current problem of not being able to get any sleep to speak of with the CPAP machine.

almondcake wrote: 1. I did two different sessions of CBT-I--one was in-person with a therapist that talked about sleep hygiene and the like, but drifted off into core issues and my childhood so wasn't all that helpful. I also did an online program. I don't think either was particularly helpful, but I've done a lot of therapy (included CBT) in the past and am pretty aware of my triggers and whatnot.

I understand that you've had two nonproductive rounds of CBT-I. But I have a question for you: What did you want to get out of the CBT-I?

I know the simple answer is "better sleep", but I want a bit more detail than that. Were you hoping to address the latency to sleep problem? Or just the "I feel tired all the time and I know I don't sleep well" issue in a more general sense.

My own CBT-I didn't focus at all on my "triggers" for insomnia. It did focus on teaching my body and physical brain the simple facts that they needed to learn: Being in bed = Time for sleep and Time for sleep = wearing the mask. The PA and I didn't waste a lot of time talking about why the mask/cpap made me angry; we did spend a lot of time troubleshooting my specific comfort problems and talking about my positive progress towards being able to fall asleep fast enough for the CPAP to not make me miserable.

My sleep log wasn't meant to provide any deep insights into why I was having trouble falling asleep and staying asleep with the CPAP. The purpose was much simpler: First it helped me document the immediate comfort issues (aerophagia, chapped lips, etc) that were noticeable enough to me to make a note of them so that they could be addressed and more importantly, it allowed me to document the small positive steps of progress so that I would not lose sight of them. It's easy to lose track of small positive developments when you feel tired and exhausted all the time. The two earliest positive things about my CPAP therapy that emerged from my sleep logs were when comments in the "How do I feel on waking in the morning" column that said, "No headache this morning" and "No hand and foot pain this morning" started appearing a few times each week.

2. Oxazepam (loved it, worked great, my doc wouldn't let me stay on it), Mirtazapine (hated it, worked ok for sleep but I gained 15 pounds in 3 weeks), and Zopiclone (works for sleep, but I feel so groggy in the morning and it also tends to set off a co-morbid vertigo disorder I also have. I also keep having to increase the dosage (started at 3.5, now I'm at 7.5 or so)

Are you still taking the Zopiclone? If so, how regularly?

4. The time to fall asleep would vary. It's always (since I was a kid) taken me a long time to fall asleep, I've never been one of those people who is asleep as soon as my head hits the pillow. Sometimes 15-20 minutes, sometimes a couple of hours. During the worst of my insomnia last spring, I would often have repeated nights of zero sleep.

This sounds like my pre-CPAP history. I would often do a lot of involved daydreaming after going to bed, and that was my way of positively coping with my long latency to sleep every night.

With CPAP, however, I found that wearing the mask while awake was not very comfortable. In the early weeks, putting the mask on at bedtime was like having a double shot of expresso right before going to bed. So in my case getting my sleep latency down to a more typical 10-15 minutes was a huge part of finally adapting to CPAP. I still miss lying in bed while daydreaming at times. But I've learned that for me, falling asleep quickly after going to bed is a critical part of keeping me compliant and making me feel decent during the daytime.

5. During this bout of insomnia, I would wake up with a headache 4-5 times a week. They did usually get better through the day. No history of migraines or tension headaches.

Sure sounds like those headaches were OSA-induced. So if you can ever get to the point where you are falling asleep with the machine and sleeping with it, the headaches should start to disappear.

6. Sleep hygiene: I go to bed and get up at the same time every day (11pm and 6am); one cup of coffee per day, always before 8 am, no other stimulants or caffeine through the day; no alcohol; no smoking; cool and dark room; white noise at night; computer and devices off an hour before bed; exercise regularly but never late at night; solid bedtime routine; and I'm always sleepy (and fatigued) at bedtime. If I'm not, I stay up reading until I am.

Do you read in bed? Or somewhere else?

If you like reading in bed, you might try reading while using the CPAP. When you are ready to turn out the light, the mask will already be on your nose and you may already be comfortable. On the other hand, you might also find that you just can't get comfortable while awake and using the mask. So if you've never tried reading for a while with the mask on, it's an idea that is worth trying for a night or two or three to see if that helps.

And, at the risk of sounding like "I've done it all and nothing will work" I have kept sleep logs as well. They don't offer any insight for me other than that I either fall asleep quickly (for me) or I don't fall asleep at all.

What things did you track in your sleep log?

Again, the point of the sleep log is not necessarily to provide insight what is wrong, but rather to provide a record of progress that can get lost in the shuffle of day to day living, particularly when positive changes are small at the start of the process adjusting to CPAP while dealing with insomnia.

I think the most frustrating thing is that I have finally felt like my sleep was under some kind of control, and then this diagnosis has thrown me a total curveball and set me back months in terms of sleep management.

Again, I understand. But look long and hard at what you have written about your sleep: With the aid of a bunch of supplements, you were able to fall asleep in about 40 minutes after going to bed most nights, but you were still waking up tired and fatigued.

So now the question is: What can you do to help teach your body to allow itself to fall asleep with a six foot hose attached to your nose?

My guess is that that shortening your latency to sleep would help: Falling asleep quickly with the mask minimizes the chances of lying in bed for hours waiting or fighting for sleep to come. (But if anybody had told me six years ago that I'd be capable of teaching my body to consistently fall asleep within 15 minutes of going to bed, I would have laughed right in their face. Still, that was the most important thing I had to do in order to make CPAP therapy work for me.)

I'd also like to know a bit more about what's currently going on each night when you find yourself unable to got to sleep with the CPAP mask on. I presume that you go through your usual bedtime routine, take the supplements at the appropriate time, climb in bed, put the mask on, and turn the lights out. And then you find that while you're exceptionally tired and fatigued, your brain refuses to slip off into sleep.

And then what happens? Do you toss and turn, continually look at the clock, and start worrying about what time it is and how little sleep you're going to get? Do you start focusing so much on the sound of your own breathing that it keeps you awake? Do you start focusing on how uncomfortable some aspect of the whole CPAP set up is? (That was a biggie for me: Air in my stomach noticeably grows if I use the PAP while awake.)

And final question: What does the phrase a good night's sleep mean to you? In other words, describe what you want your sleep to look like.

Subject: Insomnia + new Cpap

robysue wrote:almondcake,

What does the phrase a good night's sleep mean?

Dear robysue,

Great question no easy to answer ... Day dream and Night mare ?

are those the Niagara falls in winter ? Nice picture.

I like your posts and often go back through them. Still learning Thanks

I noticed you are using a BiPAP. Have you ever tried ASV ?

I have a history of mood disorder, the Dr. calls it ADD (attention deficit disorder) without hyperactivity it was diagnosed when I turned 40. My sleep apnea was found out las year, and me 56.
Insomnia is a problem for me. Using CPAP is not fun but not a major problem.

I have been on CPAP for 3.5 month and since on ASV now for almost one year. Changes using CPAP are small, so small that I wonder if it is worth it or if I have the wrong setting or wrong machine. My mood and insomnia are not affected by CPAP. My trouble with ASV is that the variation in additional pressure is jumping too much and likely wakes me up.



I would like to reduce IPAP Max to 9 and keep EPAP Min at 5. This seems not possible on the machine I have.
Would a BiPAP be more appropriate?

Has any one tried Didgeridoo ? http://www.DidgeForSleep.com

esel wrote:Subject: Insomnia + new Cpap

robysue wrote:almondcake,

What does the phrase a good night's sleep mean?

Dear robysue,

Great question no easy to answer ... Day dream and Night mare ?

There's no right answer to "What does the phrase a good night's sleep mean to you?" But it's a critically important question for any insomniac to ask themselves. Because there are a lot of unreasonable answers to that question. And if you're going to do CBT-I or go the route of supplements or sleeping medication or try a mixture, it's important to have reasonable and attainable goals for what you expect a good night's sleep to look like and feel like.

are those the Niagara falls in winter ? Nice picture.

Yep. I live in Buffalo and the Falls are about 30 minutes from my front door in normal traffic. In 2015 we had a substantial cold snap and the Falls actually froze. Hubby and I went up just as they were starting to thaw out and I took a huge number of pictures. I posted the best of the best on this OT thread here at cpap if you want a good look at them: viewtopic.php?f=1&t=104241&st=0&sk=t&sd=a&

I noticed you are using a BiPAP. Have you ever tried ASV ?

Never had the chance. My current insurance would not pay for an ASV with my diagnosis, my sleep doc has not suggested one, and I'm not willing to do the self-pay, get an ASV without a script route.

And quite frankly, I'm not sure that the additional pressure an ASV uses when the ASV routine kicks in and starts trying to normalize breathing by "triggering breaths" would agree with my stomach. Right now, my biggest sleep problem seems to be more middle of the night wakes than is normal for me (sleep doc and I are working on this) combined with my bedtime being far more irregular and drifting far later than is good for me (and I know what I need to do to fix this problem, but I'm having motivation problems)

I have a history of mood disorder, the Dr. calls it ADD (attention deficit disorder) without hyperactivity it was diagnosed when I turned 40. My sleep apnea was found out las year, and me 56.
Insomnia is a problem for me. Using CPAP is not fun but not a major problem.

Good to hear that using the CPAP is not a major problem. In my case, my insomina was well controlled before starting CPAP, but it exploded less than a week after I started CPAP. And the reason the insomnia became such a huge issue in my first year of PAPing was that I was dealing with major aerophagia problems at low pressures and experiencing many more spontaneous arousals on CPAP, and the number of those arousals lead to lots more middle of the night wakes, usually accompanied by more aerophagia and a tremendous amount of anger directed at the CPAP machine and my own body for having this stupid disease in the first place.

I have been on CPAP for 3.5 month and since on ASV now for almost one year. Changes using CPAP are small, so small that I wonder if it is worth it or if I have the wrong setting or wrong machine. My mood and insomnia are not affected by CPAP. My trouble with ASV is that the variation in additional pressure is jumping too much and likely wakes me up.

What was your official diagnosis that lead to your being on the ASV machine? And why were you switched back to CPAP? That's an unusual pattern: Most people are started out using a CPAP/APAP. If that doesn't work, they get moved to BiPAP/VPAP. If that doesn't work, they get moved to a bi-level ST machine or an ASV machine. The major exception to that pattern is when it's clear that central sleep apnea or complex sleep apnea is a significant problem right from the get-go.

I would like to reduce IPAP Max to 9 and keep EPAP Min at 5. This seems not possible on the machine I have.
Would a BiPAP be more appropriate?

I don't know enough about ASV machines to answer your question. It depends on what modes of therapy you have available on your machine.

Whether a BiPAP would be more appropriate than your current Resmed AirCurve 10 ASVauto is a question that is above my pay scale.

I would suggest that when you need help with an ASV that you get ASV into the title of the thread. You would attract folks who use and are knowledgeable about ASVs to read this thread if you changed its title to "Insomnia + ASV"

Has any one tried Didgeridoo ? http://www.DidgeForSleep.com

I'm skeptical that playing a Didgeridoo will fix a sleep apnea problem.

robysue wrote:And quite frankly, I'm not sure that the additional pressure an ASV uses when the ASV routine kicks in and starts trying to normalize breathing by "triggering breaths" would agree with my stomach.

There's good and bad with the way ASV can increase the pressure and I don't know if the good would still be bad for you in terms of the line where your aerophagia acts up.
Yes, the ASV will increase and can increase the pressure significant but it does it faster...so it goes up and comes back down quicker. It doesn't normally stay "up there" as long because it responds faster. Would the potential less time at the higher pressure stand a chance of not triggering the aerophagia??? That's a question that I just don't know the answer to. So the good is that it goes up and comes back down faster...the bad is that it goes up and with the up could potentially cause your aerophagia issues to rear their ugly head.
Since you don't seem to need ASV and your current bilevel is doing a good job and it's a very expensive experiment to do when there's really no reason to use the higher pressures in your situation. I am afraid that you would have to tie its little hands in such a manner that you would end up with an ASV pretty much functioning like the BiPap you are using. Making it a pretty expensive bipap.

The rather rapid pressure response to obstructive stuff is one of the things I like about the ASV and why I use it. I can get by with less EPAP for the bulk of the night than I would/could get by with using apap or even regular auto bilevel. Makes for starting out the night and awake being a whole lot more comfortable. Once I go to sleep it doesn't really matter and I am lucky in that aerophagia hasn't been something I have had to deal with very often.
Comes in handy since it's REM stage where I have the greatest pressure needs and with REM being about 20% of the night that means I can use lower for the bulk of the night and if the machine needs to go to the upper teens (often it does) then I don't spend much time up there.

Pugsy wrote:

robysue wrote:And quite frankly, I'm not sure that the additional pressure an ASV uses when the ASV routine kicks in and starts trying to normalize breathing by "triggering breaths" would agree with my stomach.

...
Since you don't seem to need ASV and your current bilevel is doing a good job and it's a very expensive experiment to do when there's really no reason to use the higher pressures in your situation. I am afraid that you would have to tie its little hands in such a manner that you would end up with an ASV pretty much functioning like the BiPap you are using. Making it a pretty expensive bipap.

Exactly! That's why I'm not particularly eager to try to randomly experiment with an ASV: My BiPAP works well for me at pressures my poor, pressure intolerant stomach can handle.

Ask your doctor and google valdoxan, it works on mood and resetting your circadian rhythm. My sleep doctor recommended it to me.

robysue wrote:

esel wrote:
I have been on CPAP for 3.5 month and since on ASV now for almost one year. Changes using CPAP are small, so small that I wonder if it is worth it or if I have the wrong setting or wrong machine. My mood and insomnia are not affected by CPAP. My trouble with ASV is that the variation in additional pressure is jumping too much and likely wakes me up.

What was your official diagnosis that lead to your being on the ASV machine? And why were you switched back to CPAP? That's an unusual pattern: Most people are started out using a CPAP/APAP. If that doesn't work, they get moved to BiPAP/VPAP. If that doesn't work, they get moved to a bi-level ST machine or an ASV machine. The major exception to that pattern is when it's clear that central sleep apnea or complex sleep apnea is a significant problem right from the get-go.

I was first put on CPAP/APAP having mostly obstructive apnea. The CPAP worked fine. It reduced my events from 40 to 10 AHI. Obstructive events were very well taken care of, however central events turned up. I don't know why my Doc then decided to switch me to the Resmed AirCurve 10 ASVauto. The thing is that with the ASV machine the AHI index came down to around 1. My trouble is that also having AHI at 1 I do not feel any real improvement. I am still on ASV, I did not switch back to CPAP. I am only thinking that a BiPAP/VPAP may be better for me ?

I would suggest that when you need help with an ASV that you get ASV into the title of the thread. You would attract folks who use and are knowledgeable about ASVs to read this thread if you changed its title to "Insomnia + ASV"

Yes, thanks, should do that too. Just have to word it right as to not offend the CPAP gurus.

Pugsy wrote:

robysue wrote:And quite frankly, I'm not sure that the additional pressure an ASV uses when the ASV routine kicks in and starts trying to normalize breathing by "triggering breaths" would agree with my stomach.

... Would the potential less time at the higher pressure stand a chance of not triggering the aerophagia???

For me the switch to ASV has drastically increase my aerophagia and with it the gastroesophageal reflux. When the reflux start I give up and stop it for the night. I learned to release the air forcing burps but then I am awake and that does not help for a good night sleep.

I am afraid that you would have to tie its little hands in such a manner that you would end up with an ASV pretty much functioning like the BiPap you are using. Making it a pretty expensive bipap.

Yes, indeed but I am not even able to do it...

esel wrote: I don't know why my Doc then decided to switch me to the Resmed AirCurve 10 ASVauto. The thing is that with the ASV machine the AHI index came down to around 1. My trouble is that also having AHI at 1 I do not feel any real improvement. I am still on ASV, I did not switch back to CPAP. I am only thinking that a BiPAP/VPAP may be better for me ?

He switched to the ASV because it can treat both the obstructive apneas and the central apnea. The centrals need a rather brief but high burst of pressure to get you to breathing again. Cpap/apap can't do that and neither can the plain BiPap/VPAP.
Your ASV is a bilevel device...just a high end very special bilevel machine. If you were to go to the bilevel like RobySue uses or the ResMed equivalent it couldn't give you that burst of high pressure you need to breathe for you.

If your AHI is around 1...and you still don't feel the good numbers then maybe the answer is elsewhere. I assume you are monitoring your leak rate and it isn't a factor. Maybe your problem isn't related to the sleep apnea alone. Maybe there are other factors unrelated to sleep apnea causing you to not feel the good numbers. A nice low AHI doesn't guarantee that you will feel like Superman....wish it did because getting a nice low AHI is fairly easy.

You can start a new thread to get ideas from people about why you may not feel the good numbers. If you do I will respond with the usual speech that I give people when they are complaining that they are getting good numbers but feel like crap.
And that speech is... which you can answer the questions in your new thread so I won't have to type it all out again.

Do you take any medications, if so what?

What exactly is the complaint that you are having where you don't feel the good numbers...is it fatigue, excessive sleepiness during the day...whatever. Just saying "I don't feel good" isn't enough...be specific about what isn't feeling so great.

How many hours of hours of sleep are you averaging and are those hours of sleep fragmented with multiple wake ups...if so, how many and any idea why?

Have any other health issues going on? Pain?

So that's a starting point on doing some detective work. The answers to those questions might lead to other questions but we need to have some idea what your history is to be able to help.
If there isn't anything in your software reports screaming out "fix me"...like massive leaks impacting therapy...then it's time to dig deeper and see if maybe something else is going on.
Remember these machines fix one problem and that problem is sleep apnea. If you have bad sleep caused by something else...they can't fix it..if you have other issues going on they can't fix stuff unrelated to sleep apnea despite us putting all our unwanted symptoms in the sleep apnea basket.

Example...yesterday I messed my back up...worse than usual. I slept fitfully last night due to the back pain. I got around 8 hours but it wasn't a good 8 hours. I feel like crap this morning...not only does my back still hurt like hell I am worn out before the day begins.
Here's the deal...I would feel this way even if I didn't have sleep apnea. I simply got crappy sleep that was totally unrelated to sleep apnea.

esel wrote:Yes, indeed but I am not even able to do it...

And why not? We could tie your machines little hands and make it work like a regular bilevel machine but it won't be able to breathe for you like you need for the treatment of the centrals.

It's easily done...just set some of the parameters so the machine functions like a regular auto bilevel device.
I have the S9 Adapt which is the prior model to your AirCurve 10 ASV...and there's no real difference in the setting options...so I know it can be done.

If the aerophagia is a big issue causing lots of distress (not just annoying burps and farts) we can maybe tie the machine's hands just a little and not compromise the central therapy too much.

Or is the "I can't do it" because your medical care team would pitch a hissy fit if you messed with the settings? I know you live in Switzerland but I don't know how much of a control freak your doctor/team might be.