just another newbie

[kathyc33]

I have been using a cpap for about 2 months. Still not sure if I am doing things right. I average about 4 hours per night before I wake up and have to take it off for awhile. Some nights I am able to leave it on all night. But even when I do leave it on, I really don't see much of a difference in my rest. I know I might be opening a can of worms here, but I do enjoy a couple of drinks in the evening and I know that will have an effect on my sleep, but I was hoping the cpap would compensate for this?

[Julie]

Cpap can't compensate for a 'drug' (alcohol) that relaxes your tissues so that OSA gets worse and your brain's instincts (to breathe) are suppressed... One glass of wine at dinner is one thing, but a couple of highballs later on... not so good.

[Newbie Woman]

I don't know the answer but welcome Newbie!

[kathyc33]

Thank you for the welcome. As for the "drugs" as I mentioned I do enjoy a few drinks in the evening and when I mentioned that to my sleep doctor he kind of frowned. I did notice a difference when I attended the sleep study and did not have any drinks that night. But I was somewhat hoping that the cpap would make up for it somehow because I am not ready to give it up. I hope I am not making myself sound like an alcoholic or anything. It is just a few social drinks in the evening with friends.

[josh73]

Kathy, I dont think you sound like an alcoholic at all. Once upon a time I partook in such activities but now I'm a husband/dad so only on weekends. That said, maybe try a different kind of mask? I'm only a month in myself, so I'm also a newbie but that would be my first guess. Are you tracking your data also? I do every few days on my computer withSleepyhead or after a night when my AHI ticks higher than usual. Just some thoughts, good luck going forward!

Josh

[kathyc33]

From what I read josh, it looks like we have the same type of cpap machine and masks? I had a little trouble with just the nose mask at first. I like the full face mask much better. I don't know yet what type of software my machine uses? I am still working on all that stuff. Lots of details to sift through?

[archangle]

Get the free SleepyHead software and look at your data to see if you can find any problems with your therapy.

Try to not take the mask off and go back to sleep. If you have to take it off, get out of bed until you can face it again. Taking it off can easily become a bad habit you can't break.

You may need to get 4 hours a night of usage in order to get your machine paid for by insurance.

What specifically is bothering you when you have to take it off?

[Julie]

Hi - I don't want to sound like the 'heavy' about your drinking, but it is a concern if you're not ready to give it up (before bed) to maximize life saving treatment... you might want to reconsider.

[kathyc33]

Hi julie, no, you don't sound like a "heavy about drinking" to me. I know what you are saying about the alcohol and how it relates to sleeping with the cpap. I work the evening shift and after work I enjoy a few drinks with friends. That is my social life. When I mentioned this to my sleep doctor he frowned and gave me a lecture and explained how alcohol effected sleep. So I came here to learn whatever I am able to learn and I keep an open mind. My question right now is how to keep my mask on all night. I started out with the nasal mask but did not tolerate that very well. So am now using a full face mask, which I like much better. But I find myself waking up after 2-4 hours and taking it off. I can't really say why? It just feels uncomfortable at that point? I am able to go to sleep with it on and do not mind that. Some nights I will sleep right through and keep the mask on all night. But that is only once in awhile. Since I have come to this forum, I am now learning to read the history that the machine keeps. I downloaded sleepyhead and am learning how to read the information that is available. I stopped seeing my sleep doctor shortly after getting my machine, so I have been on my own as to how to use it properly. I see a wealth of information in this forum so I am relieved and happy that I now have answers to all my questions.
So, I have now introduced myself and I look forward to meeting new friends and learning new things.
Thank you for taking the time to answer my posts.

[josh73]

Kathy, like you I feel like I'm on my own also. Seems like most health professionals be it doctors, sleep techs, pcps, health insurance only care about compliance with your machine in the early going to see who's going to pay for it. I think it's up to all of us as individuals to learn as much as possible to make sure our cpap therapy is working bc really, no one else cares. It would be nice to have a follow up with my sleep lab in a couple months but they only do that if there's a problem.

[kathyc33]

My insurance only covered the basic and it wasn't very much. And I will let it go at that. Once the coverage stopped, well,I'm on my own. But I am ok with that part. I am happy because I am here and I love the wealth of information that is available here for everyone. But there is a lot to learn.

[robysue]

Kathy,

First welcome to the forum.

You've asked this question twice:

I know I might be opening a can of worms here, but I do enjoy a couple of drinks in the evening and I know that will have an effect on my sleep, but I was hoping the cpap would compensate for this?

and

But I was somewhat hoping that the cpap would make up for it (a few drinks in the evening) somehow because I am not ready to give it up.

Unfortunately cpap can't "make up" for anything if you only use it part-time. And you also say:

I have been using a cpap for about 2 months. Still not sure if I am doing things right. I average about 4 hours per night before I wake up and have to take it off for awhile. Some nights I am able to leave it on all night.

Until you are consistently using the CPAP every night all night long, it is NOT sufficiently controlling your apnea. And the drinks with friends every night only adds to the tendency for your airway to collapse.

So---first you have to figure out how to keep the mask on all night instead of taking it off "for a while". And if you wake up feeling like you can't stand to have the mask on your nose for one more minute, it's time get out of bed, do something relaxing and soothing (but having another drink is NOT a good idea!) and go back to bed only when you are calm enough and sleepy enough to mask up when you go back to bed. In other words, make a commitment to yourself that you will not consciously fall asleep without the mask on your nose.

You also write:

But even when I do leave it on, I really don't see much of a difference in my rest.

Two months of inconsistent use of CPAP is not enough tell much of a difference. For most of us, it takes several weeks to several months of consistently using the CPAP all night long, every single night before we start to feel much of a difference. And very, very few of us notice a sudden improvement. Rather, the improvement comes slowly and subtly and only when we use the machine every single night. And some of us are unlucky enough to have to use the machine for many, many months before we notice any improvement.

Finally, you need to be honest with yourself about how much you are drinking and whether it is slightly, moderately, or severely affecting your sleep. And note that alcohol negatively affects your sleep in more ways than simply aggravating your OSA: Alcohol plays havoc with the sleep cycles as well. And if you're drinking enough on a nightly basis to aggravate the OSA, then you are likely drinking enough to affect your sleep in other ways as well. And the CPAP cannot "compensate" for the disruptions to your sleep cycles that are caused by the alcohol consumption even if the OSA is well controlled by the CPAP on the nights when you consume several alcoholic drinks.

So: Define "a few drinks". Two small glasses of wine over the course of three or four hours is one thing---particularly if there are several hours between the last glass and bedtime. Four or five extra large margaritas is something else altogether. And yet I've known folks who would describe both as "a few drinks".

And how often you socialize with the "few drinks with friends" is also important. A couple of times a week is one thing. Seven nights a week of having three or four drinks is something else.

So---if you can tell a difference between nights where you don't drink or drink less than normal, then you know the answer is You are drinking enough to make your sleep worse. What you choose to do about it is up to you.

[Newbie Woman]

I wonder if it's the decompression time with friends that you enjoy so much, not necessarily the drinks.

[kathyc33]

robysue, thank you for taking the time to write such a wonderful response. I agree, I guess I expected too much from cpap if I am not willing to do my part? And Newbie Woman, I am not real sure I would enjoy my after-hours with drinking kool-aid while everyone else is drinking alcohol. All day long I am sleepy and tired. But around 10 pm I start to come alive. When my work day ends at 11 I am fully awake and alive. I enjoy the next few hours at my neighborhood bar. When it closes at 2, several of us will go to an all night diner and have our coffee and a quick bite to eat and by 3 we call it a night. When I get home I am in bed by 4 and will sleep soundly until 10:30. Without the alcohol, I do not sleep well and will wake up continuously. At least with the alcohol, I get the hours of rest. Poor rest it is, I agree, but none the less, it is continuous sleep. So, I thought with CPAP, it would be BETTER continuous sleep and that would be the answer. But alas, it doesn't seem to work that way. I look forward all day long to the end of my work day so I may stop off for drinks afterwards. One time the bar was closed for renovations and I was forced to live on nothing but food and water. Terrible situation. I will get this worked out. If I can keep the mask on all night, every night, it just seems as though the sleep would have to improve? The should be a happy medium here somehow?

[robysue]

robysue, thank you for taking the time to write such a wonderful response. I agree, I guess I expected too much from cpap if I am not willing to do my part?

Your part is three fold:

(1) Wear the mask for the full sleep period EVERY time you sleep.

(2) Set reasonable expectations for what CPAP can do: CPAP will keep you from having apneas and hypopneas and the associated O2 desats and arousals. It will NOT fix any other problem with your sleep. By preventing the apneas and hypopneas, you should be able to eventually get better quality sleep---provided nothing else is interfering with your sleep. Once you are fully adjusted, the CPAP should give you more energy----provided there are no other health issues or sleep issues going on.

(3) Clean up your sleep hygiene enough so that it is possible to get a really decent night's sleep on the schedule you're living your life. Sleep hygiene will help make sure that things OTHER than the OSA do not continue to rob you of high quality, restorative sleep.

And Newbie Woman, I am not real sure I would enjoy my after-hours with drinking kool-aid while everyone else is drinking alcohol.

You don't have to give up drinking entirely. But you do need to be honest with yourself: If you're knocking back four or five drinks every night between 11pm and 2am, then you need to realize that's not "a few" drinks: The commonly accepted definition for binge drinking for women is four or more (standard) drinks within a 2-3 hour period. And in that case, you really need to cut the drinking back to no more than two or three drinks with your friends for example. (And even at that level, the CDC would consider your drinking to be "heavy" not moderate.)

All day long I am sleepy and tired. But around 10 pm I start to come alive. When my work day ends at 11 I am fully awake and alive. I enjoy the next few hours at my neighborhood bar. When it closes at 2, several of us will go to an all night diner and have our coffee and a quick bite to eat and by 3 we call it a night. When I get home I am in bed by 4 and will sleep soundly until 10:30.

Sounds like you work an evening shift and then stay up most of the night? You might have a shift-worker circadian rhythm problem going on as well as the apnea. But it could be that your current sleep schedule works fine with your work and the circadian rhythm stuff is not an issue for you.

So I have to ask: When you say that you are sleepy and tired "all day long", can you give us a bit more detail about your typical daily schedule? Near as I can tell this is what "a 24 hour day" looks like for you---where I'm running the day Bedtime to Bedtime:

4:00 am: Get to bed and go to sleep (without many problems?)

10:30 am: Wake up. How do you feel when you wake up? Rested? Refresed? Exhausted? Still Sleepy? Feel like something the cat upchucked?

10:30 am until ????: Drag around the house and try to run necessary errands until it's time for work? Is this when you are "sleepy and tired" all day? How much coffee and other caffeine do you drink during this part of the day?

3:00 pm??? Report to work? Are you tired when you first get to work? Sleepy when you first get to work? Or are you ready for work and alert and awake? How much coffee and other caffeine do you drink during this part of the day?

10:00 pm: You start to "come alive"---finally feeling awake and alert for the first time since getting up? Still drinking coffee? Or is this partly anticipating getting off work and meeting your friends at the bar? Do you like your job? Or do you just tolerate it because you need the money?

11:00 pm until 2:00 am: Hit the bar and start having a few drinks with friends. Do you smoke cigarettes while at the bar? (And is the bar smokey?) Or is it just alcohol? And how many drinks in the three hours you're with your friends? Two? Three? Four? Five? Six? It makes a big, big difference.

2:00 am: Hit the diner for food and coffee. Caffeinated coffee? How much caffeinated coffee? How much food in that "bite to eat"? A full meal? How balanced is that food in terms of diet? Is it sugary baked goodies that go with coffee? Or is there some real nutrition?

3:00 am: Call it a night and head home. Unwind a bit when you get home? If so how? And then go to bed at 4:00 am and the cycle starts over.

Without the alcohol, I do not sleep well and will wake up continuously. At least with the alcohol, I get the hours of rest. Poor rest it is, I agree, but none the less, it is continuous sleep.

Alcohol is a sedative. And so it can help some people get to sleep. But the sleep architecture---particularly in the second half of the sleep period---is negatively affected by alcohol. Your sleep may seem continuous, but my guess is that because of the alcohol you are NOT getting sufficient quantities of the restorative sleep that you need even when you do use the CPAP all night. And the late night coffee may be what makes you "not sleep well and wake up continuously" when you don't have the alcohol by the way. Or it could be too much caffeine during the whole day that makes it difficult for you to both get to sleep and stay asleep when you don't have your normal number of alcoholic drinks between 11pm and 2am.

And whenever you allow yourself to sleep without the mask on, your OSA comes back and then you are trapped in a cycle of constantly arousing yourself just enough to start the breathing even though you do not remember waking up.

So, I thought with CPAP, it would be BETTER continuous sleep and that would be the answer. But alas, it doesn't seem to work that way.

CPAP manages the apnea. But CPAP cannot undo all the other things that your rather poor sleep hygiene is doing to you. In order for you to get BETTER continuous sleep, you need to be able to get enough restorative sleep every night. And the alcohol and caffeine are likely the culprits that explain why you are not getting enough restorative sleep even when you use the CPAP. And that explains why CPAP is not doing more for you in terms of daytime energy and wakefulness.

I look forward all day long to the end of my work day so I may stop off for drinks afterwards. One time the bar was closed for renovations and I was forced to live on nothing but food and water. Terrible situation. I will get this worked out. If I can keep the mask on all night, every night, it just seems as though the sleep would have to improve? The should be a happy medium here somehow?

Keeping the mask on all night will help give things the chance to improve. But you've also got to be able to get into deep sleep and REM sleep as well. And your current lifestyle does seem to include habits that discourage quality sleep architecture.

There IS a happy medium that will let you get the deep sleep and REM sleep that you seem to be missing right now. But it will require you to make some compromises in your current life style.

My advice as a 54-year old college professor who remembers being young and carefree and loving staying up all night (but not partying all night):

0) Make a commitment to NEVER allow yourself to sleep without the mask. Every time you allow yourself to sleep without the mask, you allow your unconscious mind, your conscious mind, and your body to continue to believe that you don't actually have to do this. And that will make your adjustment period take even longer and it will set you up for failure. So JUST DON'T SLEEP WITHOUT THE MASK---EVER.

1) Limit, but don't eliminate your drinks with your friends. Start by simply having one or two FEWER drinks per night. Then when you're comfortable with that, cut out another one or two drinks. The goal is to get to where you're comfortable socializing with your friends, but limiting yourself to no more than one or two (small) drinks during the three hours between 11:00 and 2:00am.

2) Cut back on the coffee---especially at that 2:00 AM meal at the all night diner: Either drink decaf or cut it out entirely. And don't switch to some other caffeinated drink. I strongly suspect that you are getting through your day on caffeine. (And boy do I miss my caffeine even now, a full year after I had to give it up to tame my insomnia and migraines.) There is a high probability that caffeine is adversely affecting the quality of your sleep---particularly since you say you can't fall asleep unless you've had "a few drinks". If you absolutely cannot cut caffeine out completely, then limit it to the first two hours after you get up.

3) Get some outside time during the daytime. Try to get some outside exercise. Take a 30 minute walk every day sometime after you get up and before you go to work. Make yourself take the walk even when you don't want to.

4) Read up on sleep hygeine and find a few things that you are willing to work on. Your overall sleep will improve when your sleep hygiene improves. Once your overall sleep starts to improve, your CPAP will be able to actually help you.