Brand New User: APAP makes me MORE Tired!!

Pugsy wrote:

Mozart22 wrote:After my
10 hour sleep last, all with the APAP, and a low AHI and low leak rates, I wake up feeling worse than before.

We sure don't expect to feel worse.
Did you sleep the entire 10 hours without waking up at all? Did you have trouble going to sleep? Did you wake frequently for whatever reason? Are you taking any meds now at all?

I don't take any meds. I did sleep for 10 hours, but about 4 or 5 of those hours are not a very deep sleep. My eyes are closed and I'm in bed, but I'm still
conscious. The actual deep sleep where I'm dreaming and unaware of the real world only lasts 5 hours, sometimes 6, and sometimes less.

I realize deep sleep is very important, but I don't know what I can do to change. I've already cut out caffeine completely.
I try to relax and rest. Yes sometimes I go to sleep but it can take more than an hour to start dreaming. Having a mask on your
face, a hose by your side, and a machine blowing air into you certainly does not help with falling and staying in a deep sleep state
with dreams. Don't know if I can actually really change that in any significant way. I'm happy with the mask choice though. But yeah
my sleep is not always deep and sometimes its fragmented. (this has always been the case. this isn't a new development. so it shouldn't
explain why I'm feeling more tired)

DoriC wrote:

Guest wrote:The pressure changes are wrecking your sleep. THAT'S why you're not feeling rested.
Try setting your machine to CPAP mode and a straight pressure for awhile and see how that goes. (maybe at about 10 cm.)

.

I agree, your wide open pressure range is most likely disturbing your sleep big time and is a recipe for disaster. To remove all the variables for now I would switch to straight Cpap . A pressure of 10cm can usually handle most apneas at least as a starting place. There's also a good possibility you're mouth breathing which would make any data unreliable. In that case you might want to consider a full face mask. Keep us posted.

I might change the range to 2 above and 2 below the 95% pressure, but I don't think I should go for a straight 10 cm CPAP pressure.
That sounds a bit extreme to me. 10cm might not be the right pressure for me, I can't assume I can handle one set pressure. Also what's the point
of getting an APAP if I'm going to randomly choose one set pressure. If 10, why not 9 or 8.

I also plan to wait another 7 days to have more data before deciding to change the range.

If I were to do 2 above and 2 below, it will probably be a range of 5 to 9 cm H2O, but more data is needed.
I might post screenshots of my data next week.

Mozart22 wrote:I have heard of sleep debt, but didn't realize sleep debt can increase fatigue. If you had an illness, and a doctor prescribed a pill, and after taking that pill for several days, your illness got worse, would you continue taking that pill?

You've had apnea for years.

Suppose you had been smoking for years and your health was bad. Then your doctor told you to quit because it's bad for your health. If you quit and felt worse after not smoking for 5 days, would you decide the doctor was wrong?

Or play the same scenario with your problem being that you were drinking too much. You might feel bad for a long time, but you'll live longer and eventually be healthier.

Or you had been sedentary all your life and your doctor told you to start exercising.

Mozart22 wrote:Can you please help a total newbie out? I have done a fair amount of reading on this forum. I was shocked to read that some users have been using
their APAP or CPAP for MONTHS and still feel tired. I think I even read about someone who found no improvement after a full year of CPAP!
I don't know if I want to wait that long. If sleeping with a mask on my face and air blown into me does nothing to help my energy levels, and sometimes
makes them worse, then count me out! I'd rather be tired but sleeping naturally instead of being tired and sleeping unnaturally on top of that.

Well, you can wait until you're in the hospital or nursing home because of the stroke or heart attack and they'll put a mask on you then.

Or you can wait until your health is much worse and try CPAP again.

Mozart22 wrote:4. There was no titration, the APAP has a range of 4 - 20 cm H20. I talked to the sleep technician and told him maybe this range is too large. He said it doesn't matter,
the APAP will use whichever pressure is most suitable at the time. He did say that he might be open to pressure changes in the future, but he wants to wait and see.
(I've only used it for 5 days, he said patients often need 2 weeks to feel better). I know I can change the pressure range myself, but don't want to do this yet. Too soon.

Once you find out what pressure you need, it would be a good idea to raise the minimum pressure.


Re: SleepyHead inconsistencies.

Yes, there are some bugs to be fixed in SH. Just for grins, read the 90% pressure off the machine, not SleepyHead and tell us what it says. You can also eyeball the pressure on the graphs in SH. Or better yet, post your graphs.

You could also get Encore Basic.

Mozart22 wrote:
I might change the range to 2 above and 2 below the 95% pressure, but I don't think I should go for a straight 10 cm CPAP pressure.
That sounds a bit extreme to me. 10cm might not be the right pressure for me, I can't assume I can handle one set pressure. Also what's the point
of getting an APAP if I'm going to randomly choose one set pressure. If 10, why not 9 or 8.

If I were to do 2 above and 2 below, it will probably be a range of 5 to 9 cm H2O, but more data is needed.
I might post screenshots of my data next week.

Can you post the report that showed the 16 average and 6.6 95% number? They don't make sense, and if your pressure is really going up to 16, then you shouldn't set it for 5-9. That would be too low.

I would not way another week to move the minimum up. 4 and 5 is often too low for people to feel comfortable, and if it needs to get up to 16, you will be having problems while it works to get up that high.

You also mentioned that you were awake for 4-5 hours of the 10 hours in bed. That means you are only getting 5-6 hours of sleep. That is NOT a good night of sleep at all. That's a very short night of sleep with a bunch of awake time in the middle, possibly frustration as well. That could also be messing up your data. If you are awake and not having apneas for half the time, that will lower the average of the overall night. We really need to see the graphs that show your pressure, events, leak, etc.

Suppose you had been smoking for years and your health was bad. Then your doctor told you to quit because it's bad for your health. If you quit and felt worse after not smoking for 5 days, would you decide the doctor was wrong?

I like your logic! When I tell my BF I just have mild sleep apnea and do I really need CPAP she replies "How much brain damage is ok with you? Just a little?" Ouch

I have been trying to help my Father who lost his wife (my Mom) last year and has been quite depressed. First I tell him to open those blinds (Dr. Oz says so) and let in the light to help with depression - do it even if you don't feel like it. Get out there first thing in the morning and let the light hit your eye to help make natural melatonin at the right time of day. Take your Vit. D in the AM because it is the sunshine vitamin and doesn't it just make sense that it might help wake you up? True or not couldn't hurt (Dr. Oz says it will) And lastly, I tell my Dad to get out there and exercise even if he doesn't feel like it. Doesn't matter what Doctor I have been to - GP, Back, GYN, Bruxism specialist, pulmonologist - they all give me one piece of advice that I just hate and that is to get your half hour of walking in each and every day. Drives me nuts! WHY WHY WHY - well, just helps to get your blood circulating, cleans out the cobwebs, makes you sleep better at night, etc. etc. Got to get out there and make those feel good chemicals (hormones) for your brain.

Oh, there is also the issue of alcohol. My Dad likes to have a couple of glasses of wine in the evening and then can't understand why he is awake in the middle of the night. I also find my husband's sleep apnea is worse the more he drinks. Guess that is why the pulmonologist says no alcohol whatsoever. I simply cannot loose weight if I have anything to drink. Just empty calories and messes with your brain chemistry.

Fragmented sleep for any reason will just let you have a crappy day.
Sleeping with a mask and machine can and will cause more sleep fragmentation....so yes...good chance of a more crappy day. If you already have had past problems with sleep fragmentation (you said this isn't new) then there is a good chance that sleeping with the mask and machine can make sleep fragmentation worse.

Sounds like you have some insomnia issues...trouble going to sleep and staying asleep.
Sounds like it isn't new and if the cause is unrelated to sleep apnea then the machine can't fix it.
We tend to want to blame all insomnia issues on sleep apnea and expect the machine (once we have optimal pressure and reports which you don't yet) to fix all those insomnia issues. Unfortunately it doesn't work that way easily.

If you use the machine for 10 hours but by your own admission maybe only sleep for 5 or 6 hours (and a fragmented 5 or 6 hours) there is not much hope of feeling better. If the machine is causing the insomnia to be worse then yes...using the machine will make you feel more crappy because your sleep quality is bad.
5 or 6 hours of sleep even unfragmented with great AHI...is not enough to expect to get rid of the crappy daytime feeling.

You have lots of work to do. The AHI can't be trusted if you are spending half your time on the machine being awake or semi awake. The machine can and will flag awake/semi awake breathing irregularities as events of some sort and totally skew the AHI.
You will need to work on getting to sleep and staying asleep...easier said than done.
Work on sleep hygiene for sure and work on limiting the factors with the mask and machine that might be contributing to the insomnia...and proper pressure selection is the first one to work on. The wide range can disrupt sleep...some people are highly sensitive to pressure changes...especially if they are prone to the least little thing waking them up and they have trouble going back to sleep. Using the machine with a really tight range to mimic cpap mode is one option and a good place to start if you don't want to try straight cpap mode.

We really need to see a couple of detailed nightly reports to have an idea what is going on with your pressures.

I just want to chime in as another newb here. I have had insomnia issues my whole life. Always been a night owl/3rd shift worker. For the last seven years, my wife told me that I would snore loudly and stop breathing for long periods of time. She would actually have to bump me to restart my breathing. I was always tired... Always.... This summer I was hospitalized with a bad bacterial pnuemonia. I actually died and had to be brought back and ended up on a vent in ICU. When they moved me to a regular room, the nurses would come in several times a night and wake me up. My o2 sats would drop to the 60's and my heart rate would go as low as 40 for almost 2 minutes. They immediately fitted me with a CPAP, the big hospital version. It fixed that problem. When I was released, I did the 2 night sleep study. I had an AHI of 84/96 supine.

My feelings about the whole CPAP craziness is this: Yes, it's quite annoying to get used to. No, results don't happen quickly for most of us. I personally feel a sense of security when I put on my mask and hit the go button. At least I have a better chance of not incurring brain damage from lack of o2, or even worse, further damage to my heart. Some days I feel better rested, some days I don't. I do have at least a little peace of mind that I probably won't die in my sleep. My wife now sleeps better now too.

You seem like a well educated, responsible young man. You are about the same age as my son. If you were my son, I would beg you to stick with it. It can save your life. There are great people on this forum with massive knowledge about this therapy. They have helped me immensely. They will help you too.

Hang in there, you have my prayers...

Let me give you an example of what happened last night.

I went to bed, spent about an hour and a half trying to get to sleep. By sleep I mean dreaming. At first my eyes are closed and I'm resting,
but still aware of things around me. Then I'll dream for about 3 hours, then get out of the dream stage. Might have to adjust the mask or cough or
use the bathroom. Then I'll dream again for maybe 2 or 3 hours, then I remain in bed another 2 hours or so, eyes closed but not dreaming.

It is indeed true that for about 30 or 40 percent of the night I'm not dreaming. My eyes are closed and things slow down but I'm not in a deep sleep.
I do wake up a couple times in a night.

But I don't know what I can do to change that. The temperature in my room is comfortable, there is no noise to bother me, my mattress and pillow
are comfortable, I'm satisfied with my mask, I do not use caffeine or alcohol.

I don't think I've ever been able to just get in bed, sleep for 8 hours straight, then wake up the next morning. That's almost never been the case
for me. I do have some insomnia and my sleep is fragmented. I dream at different points of then night, it's never one single long dream.

I'm very aware of the problem, it's finding a solution that I need.

By the way, I decided to change my pressure range last night. Instead of 4-20, I went with 6 to 10 cm H2O. I plan on keeping it there for a while
to see how I adjust. Several people on this forum advised me not to have a wide open 4-20 CM H20 range.

Pugsy wrote: The AHI can't be trusted if you are spending half your time on the machine being awake or semi awake. The machine can and will flag awake/semi awake breathing irregularities as events of some sort and totally skew the AHI.

When I had my home sleep study done, I must have been at the dream stage for maybe 3.5 hours tops.
With wires all over me and the small box strapped to the middle of my chest, I was NOT comfortable.
I would say maybe 60 percent of the time I was not dreaming, feeling uncomfortable and semi-awake.

Nonetheless, they were apparently satisfied with the sleep study and the diagnostics box said it had all the info
it needed.

Anyway, about this whole APAP thing... you said that fragmented sleep and insomnia will give me a crappy day the following morning, and APAP can't do anything
to stop that. If this is true, then shouldn't I be focusing more on falling asleep and staying asleep, instead of using and tweaking an APAP machine?

Yes I know that proper breathing is important for the heart and body, but the number one reason I got an APAP was to have normal energy levels.
I want to be able to work full time and have a social life and not spending my days feeling tired and sluggish all the time. If APAP isn't helping me with
that, then I might be wasting my time. Maybe what I need to do is deal with insomnia instead of this whole apnea stuff. My point is that sleeping with a mask
and a machine is not natural, it's just not. It can be justified if it gives an otherwise exhausted person plenty of energy, but if it doesn't, then why bother?
I see some success stories on this forum, but I also see a lot of people not feeling refreshed even after several months. I'm gonna stick to it, but only to
a certain point. If in 4 or 5 months I still feel tired, then I see no reason to continue sleeping like Darth Vader. Sure the APAP may good for the heart and brain,
but there are so many other factors too. You could be using an APAP but still have a heart attack or stroke due to second hand smoking, alcohol, a stressful event
in your life, pesticides in food, impurities in water, chemicals in the environment, unknown reasons, etc.

I'm glad the APAP is good for the heart and brain, but it's that refreshing feeling I want, full of energy. I'll keep at it, and maybe my new pressure range will help.
But if it doesn't, I see no good reason to keep using this mask and machine

Mozart22 wrote: If APAP isn't helping me with
that, then I might be wasting my time. Maybe what I need to do is deal with insomnia instead of this whole apnea stuff.

You haven't used the therapy long enough to make that kind of decision. You obviously have sleep apnea. You probably also have insomnia. CPAP therapy won't cure insomnia. Look into the subject of "sleep hygiene". According to your home sleep study, you have severe OSA when you sleep on your back. Yeah, you can quit the therapy. You'll just be taking some serious risks each and every night you sleep on your back. That's a gamble my friend. Good Luck...

Mozart22 wrote: When I had my home sleep study done, I must have been at the dream stage for maybe 3.5 hours tops.
With wires all over me and the small box strapped to the middle of my chest, I was NOT comfortable.
I would say maybe 60 percent of the time I was not dreaming, feeling uncomfortable and semi-awake.

Nonetheless, they were apparently satisfied with the sleep study and the diagnostics box said it had all the info
it needed.

My statement was in reference to the AHI that your machine shows. Not in reference to your sleep study at all. If you are evaluating your AHI from your machine and thinking it is high...those high numbers can't be trusted if half the time you were on the machine you weren't asleep.
Again...you need to post some images of your detailed reports. We can't see what you are seeing.

Mozart22 wrote: If APAP isn't helping me with
that, then I might be wasting my time. Maybe what I need to do is deal with insomnia instead of this whole apnea stuff.

If you have obstructive sleep apnea then you need to deal with it. Doesn't matter if you had/have insomnia or not.

If your insomnia is totally related to obstructive sleep apnea dealing with the OSA should help the insomnia..but obstructive sleep apnea doesn't prevent someone from falling asleep (at least most people).
If you didn't have insomnia issues you would still have to deal with OSA.

In other words..you are going to have to deal with both. If you fixed your insomnia issues (whatever they are) that still leaves you with OSA to deal with. You likely have both problems and are going to have to try to fix 2 things.

You can start by googling "good sleep hygiene" and see what areas may need improvement.
You can also start by optimizing your cpap therapy.
It isn't going to be an overnight miracle.

This reading might help you understand you aren't alone.
http://adventures-in-hosehead-land.blog ... er_19.html

Thanks for your help everyone.

Just another thing you may want to consider....you may want to look into a pillows style of nasal mask. Much less "Darth Vaderish"

Last night, my AHI was 5.5 according to the LCD screen. I slept kinda decently. Briefly opened my mouth a few times.
Had some insomnia, not too much. Arm was sore in the morning so the end of my sleep was poor.

However, today I feel better than I did yesterday. A bit more refreshed. Still tired of course, not a normal energy level,
but better than yesterday.

Go figure. Maybe the new 6-10 pressure range helped a bit. Will have to wait several more nights to know whether
this is a trend or an outlier. My energy levels are still at an unacceptable level tho. I am nowhere near what I should be,
so I'll have to wait and see. The fact that I'm eating very healthy and exercising can't hurt. The past 2 weeks it's been
nothing but salads, non-fried fish, chicken breast, green beans, egg whites, apples, grapes, oranges, and water.

UPDATE: Just imported new Sleepyhead Data for last night. For the second night in a row, the pressure figures seem wrong.

95% pressure is 7.50 which sounds about right. Average pressure is 18.40 which is impossible because I narrowed down the range
from 4-20 CM to 6-10 cm H20. This is the second night the average pressure is wrong.

This leads me to believe the average pressure is maybe 8.40, and that "1" digit is wrongly placed. Just like on Sunday
where it said average pressure was 16 something, but I think it was probably 6 something.

Maybe this a bug related to SH and my new 60 series machine. I don't know.
I will upload graphs and charts like you all requested, but not today, I have some work to do and not much energy.
Goodbye and thanks everyone!

Mozart22 wrote: Maybe this a bug related to SH and my new 60 series machine.

Very likely the pressure discrepancy may be related to the 60 series patch. The Patch new and may be buggy.
Are you using a Mac computer?
If not you could use EncoreBasic and see what it shows.