The Good, The Bad & The Ugly, a Tale of two Charts

Since I have the charts now, I thought I'd post this in it's own thread. Wednesday night I was out running errands with the wife, had to go pick out my first pair of glasses, dinner, shopping, felt really sleepy the whole time we out & about, way more so than normal. Get in at 9:30pm and take care of the critters. Wow, I'm really tired, google eyed tired, just gonna shower and go to bed, skip the Ambien no way I'll need it. Was I ever wrong! Didn't sleep a wink!, went past the point of no return for the Ambien, I just had to suffer. Read the card the next morning, over 8.25hours I had a grand total of 4 AI's, 1H, & 1VS. Oh what a bad day Thursday was. BP was way up too. Beautiful misery isn't it?



Took an Ambien Thursday nite, one day of being tired plus one day being sleep deprived, no way I could suffer another sleepless nite. Slept well, woke up a little foggy but it was a good nite for me, no disturbances. Wife said she thought I was snoring.



This might not be the best looking night to some of you but it actually represents a good nite for me because I actually went into a deep sleep. On Wednesday nite, every time I would just drift off, I'd jolt awake. I did that all nite long until 5:30 AM where I just stared at the alarm clock till it went off at 6:30. Wednesday's chart is more typical of my sleep pattern leading up to my first step into getting help.

Still waiting on the sleep study results and so far all I know is there was an issue with "Alpha Intrusions" in both cases. I didn't sleep worth a hoot during either study, tech. told me so. I'm know the PSG showed more significant data than the first chart above but if that was all I had to rely on, I would say I was in good shape, no CPAP needed.

The pulm. doc obviously prescibed CPAP therapy because he saw enough data to indicate apnea events, don't think I spoke with him more than 5 minutes tops after each study. Obviously a good call on his part on the CPAP. I really had my doubts until I got the software and saw for myself. I'm going to have to presume with the snoring, the AI's are likely OSA events & not centrals, wish I knew of a way to be certain. What's interesting to note, when I do take my Ambien & actually sleep, the two distinct groupings of AI's later in the night are consistant with other nights though this is by far the most tightly defined example.

At this point what I can only hope to do is solve the insomnia problem preferably without drugs, that's my quest at the moment. I'm convinced my high BP is a result of my poor sleep. If I can actually get myself to sleep, consistantly, CPAP should do it's job, and I'll be on the way to being a new person.

Rustyolddude wrote:...what a bad day...BP was way up too...

Visit with my cardio doc today, told 'em about my theory that my daytime systolic only rises following a night with events that wake me up. If it's actually up, I take my ARB (down to 1/2 of the smallest pill-dosage they make) for just that day as the next day if I don't have events that night that wake me up my systolic is back down to A-OK. He agrees that this is a good theory at least for me but he wants me to ck BP every morning esp 'cause I have a dumb CPAP & can't ID events. Gotta go buy a gadget as I don't own one ...grumble grumble spend more $.

Rusty, I agree if you can just find a way to get to sleep and not have events, your daytime BP is sure to come down. I had a poll about that Apnea and BP and many said they had improvements. My 205/110 reading when I was diagnosed with apnea is gone; now I just have a bouncing systolic: 120s that go to 140s following those wake up during events nights.

Wish I had some good suggestions but falling sleep is not an issue since I started using topical progesterone: cherries, cool body prior to sleep, warm feet in bed, dark room (block/cover all light sources), bright light early in the day, the sleep entrainment CDs are all that helped me prior to the progesterone cream. Melatonin is supposed to help but I've ever used it.

Paradoxically, if I'm really tired going to bed, I sleep worse. Maybe the tiredness messes with the central nervous system which regulates sleep.

Muse-Inc wrote:

Rustyolddude wrote:...what a bad day...BP was way up too...

Visit with my cardio doc today, told 'em about my theory that my daytime systolic only rises following a night with events that wake me up. If it's actually up, I take my ARB (down to 1/2 of the smallest pill-dosage they make) for just that day as the next day if I don't have events that night that wake me up my systolic is back down to A-OK. He agrees that this is a good theory at least for me but he wants me to ck BP every morning esp 'cause I have a dumb CPAP & can't ID events. Gotta go buy a gadget as I don't own one ...grumble grumble spend more $.

Rusty, I agree if you can just find a way to get to sleep and not have events, your daytime BP is sure to come down. I had a poll about that Apnea and BP and many said they had improvements. My 205/110 reading when I was diagnosed with apnea is gone; now I just have a bouncing systolic: 120s that go to 140s following those wake up during events nights.

Wish I had some good suggestions but falling sleep is not an issue since I started using topical progesterone: cherries, cool body prior to sleep, warm feet in bed, dark room (block/cover all light sources), bright light early in the day, the sleep entrainment CDs are all that helped me prior to the progesterone cream. Melatonin is supposed to help but I've ever used it.

Paradoxically, if I'm really tired going to bed, I sleep worse. Maybe the tiredness messes with the central nervous system which regulates sleep.

My sleep hygiene is spot on, I've been following all the same rules, no stimulants, only thing I'm missing is the progesterone creme

Raj suggested a site with MP3 iso-tones for sleep entrainment, downloaded a few last nite & played them with ear buds, it seemed to help but hard to tell for certain since I took Ambien. Had a really good night though, at least that's how I feel this morning, have to pull the card later and see how I looked. My BP looked great this morning but I've taken my BP pill 2 days in a row because the BP had creeped back up there and I was dealing with the resulting headache. What need is some kind of mini PSG/biofeedack type thingy I could run on the laptop at nite so I could see cause & effect of my actions.

Most likely sleep position made the difference. Sleeping on side one night and then sleeping on back the next night can make those kinds of stats.

Rustyolddude wrote: I'm going to have to presume with the snoring, the AI's are likely OSA events & not centrals, wish I knew of a way to be certain.

One way to tell is to increase your pressure while monitoring the data. If pressure increases decrease your AHI, the the events are obstructive. If your AHI goes up, then you are experiencing pressure-induced centrals.

You have look at each pressure change for at least a week. You can't draw accurate conclusions from a night or two.

DreamStalker wrote:Most likely sleep position made the difference. Sleeping on side one night and then sleeping on back the next night can make those kinds of stats.

Good point. As I get it all sorted out, I might come down to setting up a camera to see if I can make a connection to sleeping positions & events. Can't imagine feeling even better than I do after that apnea & snore pocked night.

I can't adjust my pressure or my DME will get her nose all out of joint. I have to send her my card at the end of the month, she's already tweaked over the fact that I have the Encore Viewer. I had to visit her a few days ago and was able to get a spare card so I don't have to go cardless when I mail the other in. One thing she told me was depending on what the card showed, she might have to mail me another card to adjust my pressures, she said that she could change the machine settings via the card.

As a side note & ponderance, the Doc. specified a straight CPAP the morning following my titration study, the DME had brought a APAP and had to go back and get the CPAP. Second guessing the doc here, but what are the chances the APAP may have been a better choice? Would it have taken care of the events if they are caused by sleeping position changes?

Rustyolddude wrote:

DreamStalker wrote:Most likely sleep position made the difference. Sleeping on side one night and then sleeping on back the next night can make those kinds of stats.

Good point. As I get it all sorted out, I might come down to setting up a camera to see if I can make a connection to sleeping positions & events. Can't imagine feeling even better than I do after that apnea & snore pocked night.

I can't adjust my pressure or my DME will get her nose all out of joint. I have to send her my card at the end of the month, she's already tweaked over the fact that I have the Encore Viewer. I had to visit her a few days ago and was able to get a spare card so I don't have to go cardless when I mail the other in. One thing she told me was depending on what the card showed, she might have to mail me another card to adjust my pressures, she said that she could change the machine settings via the card.

As a side note & ponderance, the Doc. specified a straight CPAP the morning following my titration study, the DME had brought a APAP and had to go back and get the CPAP. Second guessing the doc here, but what are the chances the APAP may have been a better choice? Would it have taken care of the events if they are caused by sleeping position changes?

APAP is ALWAYS a better choice because even if you don't use APAP mode ... the APAP machine can be set in straight CPAP mode ... two machines in one ... can't do that with a CPAP only machine.

Yes, APAP may take care of events due to sleep position .... but until YOU test it out on YOUR unique sleep characterisitcs, you won't know.

APAP ... more options ... more better!

Rustyoldude,

Insomnia and apnea are a poor combination to say the least and I feel for you. I have the same problem from time to time. As far as the Ambien, I wanted to ask if you have ever tried Melatonin 3mg extended release tabs made by Natrol? As a pharmacist I have seen 100's or even 1000's of patients get trapped in the Ambien cycle. I have taken Ambien on rare occasions mainly to at sleep studies since my doc know I will never go to sleep in a strange setting with all the wiring etc. (bet I have had at least 10 studies over the years) This leads me to my next point about APAP vs. CPAP. For the life of me I cannot figure out why doctors still prescribe basic CPAP ?? I guess it gives job security to the respiratory nurses especially when they use an APAP to do these sleep studies to determine your pressure range.

If you took a sleep study for 10 nights in a row I bet you would come out with 10 different pressure readings as in my case. The technology is there with APAP to adjust to these different conditions daily. Just because one sleep study may come out with a pressure reading of say 9 in my case on my very first SS does not mean you will need that pressure each and every night. My pressure readings range from 7 to 12.5 if I look back over a 3 month recent history. There are just too many factors that are at play daily in our lives that causes these pressures to change nightly. Since switching to an APAP when they were first available, I have had much better sleep and as someone else in this thread mentioned, most if not all of the APAP machines have the option of setting them as a CPAP if you would rather go to straight CPAP as many people still do to this date in increasing technology.

Since I don't know your background and have been away from this site for some time, these are just my thoughts on your situation. I have been a OSA patient since the dark ages (30+ years) and have gone through 2 surgical procedures to correct the problem, but am now back on the hose. My comment are worth what most free advice is worth, but I thought I would throw them your way to try to help. I try not to take anything to get to sleep, but when I do I take the Melatonin I take 1 tab about 1 hour prior to sleep time. Good Luck!!
RUDYRX

Sheesh, a BP of 205/110 is an eyebrow raiser. Glad you got it fixed.

rudyrx wrote:Rustyoldude,

I wanted to ask if you have ever tried Melatonin 3mg extended release tabs made by Natrol?

Yes, I have along with Valerian. It hasn't helped. In addition, I limited my caffeine intake to one cup of coffee in the morning. I quit taking Lisinopril for my BP while monitoring my BP to see if it had any effect. I resumed the lisinopril about a week later after my BP began to climb, there was no difference. Likewise I discontinued my Nasonex for a week or more with no effect. That was the extent of all drugs & stimulants including OTC stuff, vitamins etc. ** I don't want to be stuck in some Ambien cycle, though it does work and I haven't experienced any of the side effects. I'm activily seeking a solution, someone else here suggested brain entrainment & isotones and I'm giving that a try right now as well.

This leads me to my next point about APAP vs. CPAP. For the life of me I cannot figure out why doctors still prescribe basic CPAP ?? I guess it gives job security to the respiratory nurses especially when they use an APAP to do these sleep studies to determine your pressure range.

This puzzled me as well since several patients the morning of my titration received APAP machines and the same Doc. specifically prescribed a CPAP for me. The DME had to make a trip to exchange the APAP for the CPAP. I had both a sleep study & a titration study. Both were difficult. Copies of my studies should be in my hands in a day or so, had to call again yesterday. All I know at the moment is the key issue in both studies were alpha intrusions.

If you took a sleep study for 10 nights in a row I bet you would come out with 10 different pressure readings as in my case.

I agree with you. I will have a follow up apt. with the pulmonologist in 2 weeks, I'll ask him the reasoning behind CPAP. He is board certified in sleep disorders.

Since I don't know your background and have been away from this site for some time, these are just my thoughts on your situation. My comment are worth what most free advice is worth, but I thought I would throw them your way to try to help.

I appreciate any and all input.

**I was contemplating the insomnia issue just the other day and trying to come up with any other ideas that might be the cause. My sleep hygene is as good as it gets, I go to bed the same time now, I don't have any snacks after dinner & drink only water, etc. etc. Model sleep citizen. Food allergy? None of the typical symptoms.

I've been having a long term issue with muscle pain & cramping in my shoulders, & arms. It's been going on for a year or more. I attributed it to poor posture at work. Some days better than others, not much relief from OTC pain relievers. The pain was actually a factor in my first sleep study.

Then it struck me, the only thing "drug" related or unnatural thing I've been consuming has been diet drinks containing aspartame. 2-3 diet lemonades or caffeine free sodas during the work day, then about 2 qts of Wylers or Crystal Lite in the evening. I cut out all the artificial sweetners few days ago. It's too soon to tell but early indications are that I may have found the cause of my pain. I know there are tons of bad holistic & tin-foil-hat stuff out there on aspartame (including some article linking Donald Rumsfeld to aspertame & intentionally poisoning Americans ) and I don't get caught up in the hokum side of things. WebMD has some data linking aspartame & Fibromyalgia. And as you might know Fibromyalgia is often linked to insomnia, depression and has come up in general sleep apnea discussions. On top of it, I have Gilbert's Syndrome which is just a benign hereditary liver enzyme issue but it can have other effects on how things are processed thru the liver including Tylenol. So, to sum it up, I'm waiting to see how things go over the next two weeks or so without aspartame. (the nominal time it takes to clear your system) With any luck........ Sorry for the long post.

Rusty - cutting out the Aspartame may also help your insomnia. Aspartame is converted in part to phenalalyline, an amino acid that can be stimulating!

In response to why you got CPAP instead of the auto-PAP other patients got... I hate to be so cynical, but I expect it may have to do with levels of reimbursement by the various insurance companies.

In response to why you got CPAP instead of the auto-PAP other patients got... I hate to be so cynical, but I expect it may have to do with levels of reimbursement by the various insurance companies.

Rustyoldude,

The previous posters comments are spot on. Great comment !!

Most insurance companies want you to get the cheapest form of therapy they can give you. Your doctor may have had one of his staff call and ask if they would pay for an APAP and the brainwashed verbatum that the person answering the phone at the insurance company spouted was NO! (the standard answer unless challenged)
Interestingly, I run into the same thing daily in the world of pharmacy and insurance companies with my techs calling for an override on a drug not covered under a patient's plan. Here are a couple ways to beat the system that may be of help. If I get a NO, I have the techs call back 2 minutes later often get a different person that says YES. The other option if the insurance company is the one blocking the road, is have your doctor insist on an APAP by letter or filling out a PA (prior authorization) form which most doctors don't even know exist but all insurance companies have them and then they will rollover. Hope this helps
Rudyrx

millich wrote: In response to why you got CPAP instead of the auto-PAP other patients got... I hate to be so cynical, but I expect it may have to do with levels of reimbursement by the various insurance companies.

That's a possibility but my ins co. BCBS, has been pretty good so far. They covered two studies without argument. When I initially asked the RT she said the Doc. specifically asked for a straight CPAP, and that she had an APAP with her and had to return to the vehicle and get the CPAP. The Doc. was really pretty brief after each study, and about all I can recall him saying was that I didn't sleep much in both cases but they saw enough events that he felt like apnea was present. Which again, if the data during my studies were anything like that first chart, I can see his hesitation in prescribing xPAP therapy. My present AHI has been running 5-6 and my daily data resembles the second chart so perhaps after the next Doc. visit, and 2 months worth of data, things might change.

As a side note, I have backed my C-Flex setting down to 1 to see if there might be any positive change in the AHI, haven't seen any change yet. Don't want to change pressues until the Doc. & DME turn me loose on my own.

Got an answer today, received copies of both studies. Wow, I'm a mess when it comes to sleep Moderately severe alpha intrusive sleep, %50 sleep efficiency each time, no REM the first go around, 31 minutes the next time. First time was with 6.25mg AmbienCR, second time was with 12.5mg AmbienCR My AHI was less than 1 the first go around but RDI was 38.5. AHI 2 the second go around and RDI dropped to 9 with CPAP. Not going to bother with all the data unless someone wants me to.

Pretty much both studies mirror the first chart in regards to apneas, as long as I don't sleep, no apneas. I'm really surprised that I wasn't given some other medication. I had to follow up on the Ambien Rx after the study.

Anyway the sleep Doc. specifed CPAP based on the findings and "if I continue to be symptomatic then...... a trial with Auto-CPAP is recommended"

Once the current data from my machine makes it in his hands, I suspect I may be looking at APAP. They titrated me at 8-12cm and settled for 10cm. Based on what I've read, I'll probably end up on some TCA if I can't lick this insomnia. rudyrx, if you have any input on the medication option, I'd really appreciate it. If I'm stuck with meds, I'd like the best possible option with the least side effects. From what I've been reading, it seems a low dose of amitriptyline has been a common Rx in situations like mine. You can PM me with your input if you like.

I really want to lick the insomnia without meds. but at this point, other than the final results of being off aspartame after a couple of weeks, I don't know what more I can do. APAP might help me sleep better & lower my AHI but if I can't get to sleep in the first place, it won't be of much benefit.

Hi Rustyolddude,
wow, your problem seems similar to mine. My perception of what is a good night and a bad night seem to differ with the results from my apap reports. I have been toying with the idea that I am suffering from UARS and events that occur force me out of sleep before registering as anything on the machine (or in my sleep study for that matter). However I do drink a lot of aspartame. I'll cut that out right away! Here is an example of what some might consider a good night (from the report) however from my point of view it wasn't anywhere near good. I woke up just too many times.


I am however finding some relief taking a Claratyn before bed every night following this guys advice http://www.uarsrelief.com/sales.html. I haven't actually purchased his ebook yet because I haven't had time to rationally consider whether he is taking me for a ride or not. I'm also pretty sure that sleeping on my back makes things way worse.

I have a good F&P apap and I fiddle with the settings with impunity. Drubin007 passed me the software to read my data stick. It's priceless.

Mcduff