Breathing Wrong?

[Julie]

Sure, but I think he was fussing because he felt tired after a workout, not necessarily 'sleepier'.

[palerider]

Sure, but I think he was fussing because he felt tired after a workout, not necessarily 'sleepier'.

ah, yes, sorry... valid point on your part

[phonebeard]

Look at your Sleepyhead report and see what your pressures are doing through the night.

I haven't worked out how to post images yet, but to describe last night, my pressure went from 8 to 11 in 30 mins, then decayed back down to 7 in 60 mins, then jumped to 10 and wiggled between 10 and 11 for 30 mins, peaked to 12 then decayed back to 9 over 30 mins, wiggled around there for 30 mins, decayed back to 8 in 30 mins then jumped to 11, wiggled around 11 for 30 mins then decayed back to 8 over 90 mins.

What is it supposed to do?

[phonebeard]

Apnea doesn't cause 'tiredness' (fatigue), but sleepiness, which is not quite the same.

I am sorry, I haven't got the terminology down pat yet. I need to learn not to use tired and sleepy as synonyms. Let me try that one again.

Something doesn't seem right to me. If sleep apnea was causing me to feel sleepy all the time, and AHI was correlated with sleep apnea, then a currently low AHI should mean I don't have much of a sleep apnea problem so the sleep apnea can't be causing my sleepiness; something else is. What's wrong with that logic?

[Pugsy]

Some questions to help maybe better understand some general history.

1..How many hours of sleep are you averaging each night using the mask and machine?
2..Of those hours you use the mask and machine...do you wake often during the night? If so, approx how often and any idea why?
3..Do you ever take the mask off in the wee hours of the morning and go back to sleep without the mask?
4..Do you take any medications of any kind? If so, what?
5..Do you have any other physical or mental health issues going on?
6..Is excessive sleepiness your primary complaint?

While sleep apnea often causes excessive sleepiness...it isn't the only cause of excessive sleepiness and if you have other issues that could be causing or contributing to excessive sleepiness the machine can't fix stuff unrelated to sleep apnea.

[Julie]

Well it does make sense now... but I'll see if others can answer it, though my question remains about other things in your (medical) life.

[Wulfman...]

Look at your Sleepyhead report and see what your pressures are doing through the night.

I haven't worked out how to post images yet, but to describe last night, my pressure went from 8 to 11 in 30 mins, then decayed back down to 7 in 60 mins, then jumped to 10 and wiggled between 10 and 11 for 30 mins, peaked to 12 then decayed back to 9 over 30 mins, wiggled around there for 30 mins, decayed back to 8 in 30 mins then jumped to 11, wiggled around 11 for 30 mins then decayed back to 8 over 90 mins.

What is it supposed to do?

Hard to tell without looking at a report. A number of things cause pressures to increase and decrease.
A flatter pressure line is usually more desirable. Fewer pressure changes indicate that the minimum pressure is preventing most of the events and if it doesn't climb too high, then it's potentially not having an effect on sleep quality, leaks and other things.

But, from your description, I'd suggest bumping the minimum pressure up to 9 or 10 and see what it looks like.
It sort of sounds like your minimum is a little too low at this point.


Den

.

[palerider]

[quote="phonebeard"I haven't worked out how to post images yet, [/quote]

https://sleep.tnet.com/resources/sleepyhead/shorganize

follow the links at the bottom of the first two pages, read and follow all three.

[phonebeard]

1..How many hours of sleep are you averaging each night using the mask and machine?

6.5, but I am trying to do better. 8.5 last night.

2..Of those hours you use the mask and machine...do you wake often during the night? If so, approx how often and any idea why?

Early on I'd wake up because the machine would wake me up. I am very sensitive to noises, and the noise of tiny leaks would drive me nuts. I have the mask clamped on tight these days. I'd also wrap the hose around my neck a couple of times. Fixed that with a clamp and sock on the bookshelf above my head through which the hose runs.

Last night I woke 4 or 5 times. Once to go to the bathroom, second time because I was cold, third because of strange noises in the room, the others I don't know.

3..Do you ever take the mask off in the wee hours of the morning and go back to sleep without the mask?

Once or twice, no more.

4..Do you take any medications of any kind? If so, what?

This may be the key question. See next answer.

5..Do you have any other physical or mental health issues going on?
6..Is excessive sleepiness your primary complaint?

Yes (5. )and no (6.). My primary complaint is intractable headache, for which I am undergoing a renewed attempt at finding an effective treatment, getting better sleep being one part. My doctor put me on topiramate at about the same time I started on the CPAP machine. I have a suspicion that it disagrees with me and sleepiness is a noted side effect. I also have lower back pain, which mean I can't sleep for long on my back in bed, but I manage on my side.

I should also add that I have a case of very extremely mild Asperger syndrome -- I am an engineer (OK, I'll admit it, now I know it can be done, I am writing my own Python script to open and analyze the time series .edf files on the SD card in my machine to see what SleepyHead does and misses) and have trouble with some social interaction skills, particularly on social media (which I mostly avoid). I also suffer from headache induced grumpiness and probably have alexithymia and aphantasia too.

[story1267]

Hi phonebeard,

Both aspergians and engineers are very near and dear to my heart. Thank you for your disclosure because it helps with communication.

If you haven't already done so you might want to explore the structure of your nose as a contributor to your headaches. Deviated septums and hypertrophic turbinates can cause headaches which behave like migraines and can be difficult to treat.

You are likely correct that your medication is contributing to your sleepiness. There may be alternatives...maybe....that won't have that effect. Worth discussing with your doctor.

Take care and good luck.

[Pugsy]

You had a home study....do you have a copy of those results?
Especially the part about oxygen levels and whatever AHI they came up with. Just how bad is the OSA per the home study? How low did your O2 go?...and how long?

Did they then do an in lab sleep study with the mask and machine to figure out a suitable pressure or did they give you the machine with the range of pressures and tell you the machine would sort it all out?

Why was the home study ordered in the first place? Was it again the primary complaint which we now know could have been the headaches because headaches are also a symptom of sleep apnea? Or more than one symptom?

Are you still having trouble "breathing" with the mask on at times? If so, what is the EPR setting?

It's not so much SleepyHead that has its limits as it is the machine can only gather so much and SH just reports what the machine gathers. To earn an apnea even flag of some sort certain criteria must be met or there is no flag. So SH doesn't "miss" events...the machine makes the evaluation and flags or doesn't flag the air flow change based on criteria. To earn an apnea flag or hyponea flag the air flow reduction has to last at least 10 seconds. Also the air flow reduction has to meet certain percentage of flow reduction criteria. Hyponeas are mainly air flow reduced to 40 or 50 % or more that may not quite be a `100% blockage.
Apneas require a higher % of reduction (I forget exact but 80% sticks in my mind) to 100 % stoppage.

So first thing is the 10 second requirement....if you don't/can't breathe for 9 seconds and things are even totally 100% no air moving..it still doesn't earn a flag of any sort. They had to come up with a line in the sand somewhere and 10 seconds is it.
Also if the air flow is reduced to say 30% and lasts maybe 30 seconds....it doesn't earn a hyponea flag because it doesn't meet the % line in the sand despite it lasting longer than 30 seconds.
Now it might earn a flow limitation designation but FLs aren't part of the AHI and we have to evaluate FLs separately to see if there is a potential for FLs maybe impacting things.

So...you can reconstruct SH all you want but you are still ultimately going to be working with what the machine flags and the criteria that is used for those flags. It's not SH "missing" something...it's the machine "missing" it because for some reason flagging criteria wasn't met.
Now there is a way in SH for you to customize the flagging and get some flags for those less than 10 second potential events or flow limitations but I don't really recommend that newbies play with this area all that much because I am not so sure it really helps all that much.
It might be useful for UARS patients (Upper Airway Resistance Syndrome) to have some sort of value to identify with and monitor because their diagnostic AHI probably was never than high/bad to start with.

I know we like to look for a numerical standard to go by in telling us how we are doing but going by just the AHI doesn't really guarantee much......especially when there is other stuff going on that is probably messing with how we feel in general and how we sleep.
AHI of 0.0 doesn't guarantee that we will sleep great or feel great. It's nice to see so we can pat ourselves on the back but it doesn't guarantee anything like we might hope it does.

We all like to blame everything unwanted on sleep apnea and then expect cpap to fix it and a nice low AHI is "proof" that everything was "fixed" and if we still feel like crap then it's the machine's fault and it's "not working" and then comes the "why should I continue to mess with this crap when it's not working" question because we really don't like wearing the mask all night. The cold hard fact of life is that not everything can be blamed on sleep apnea and the machine can't even begin to fix problems that aren't related to sleep apnea no matter how much we want to blame sleep apnea for all our problems. It just doesn't work that way.

That's why I always ask the "do you take any meds" question...see if there is a potential med side effect that might explain some of the unwanted symptoms. Might not be 100% totally med related but meds can play a huge part in those unwanted symptoms.

The "other physical/mental health" question....that's to get an idea if something else could also be a factor.
Some lucky people might only have the sleep apnea thing but I think that there is a substantial majority that likely has some other health issues that can also impact how we sleep and how we feel during the day.
I can personally relate to the back pain issue and how it impacts sleep quality which in turn impacts how I feel during the day. It's totally separate from my sleep apnea issues and the best AHI in the world can't fix my back issues. Sure wish it would but it doesn't.

I just wanted to get you thinking outside the box a little to see if there were other factors that could also be a part of your unwanted daytime symptoms. Not everything can be fixed by tweaking some little setting on the machine but it hurts nothing to try tweaking a little setting to see if it helps or not.
I would really like to see the detailed graphs (only the events, flow rate, pressure, leak and flow limitation on your machine) along with the AHI stuff on the left side...to get a better feel for what is going on during the night in terms of your pressures moving all around.
This thread has some examples
viewtopic/t103468/Need-help-with-screen-shots.html
I don't need or want all the graphs that SH offers.

It's possible that the changing pressures themselves are a factor in your sleep quality...it's also possible they aren't a factor but it hurts nothing to try maybe a much tighter range or even fixed pressure just to see if it helps or not. I can sleep through some pretty massive/remarkable pressure changes that occur in about 30 seconds but others have trouble with a small 1 or 2 cm change that is very gradual and take several minutes to change. We are all different and have different things that can help or hurt our own situation and may not help or hurt someone else.

It's unfortunate that a new medication was started at the same time as cpap therapy...2 big changes done at the same time makes it kinda hard to know if unwanted results are from the meds or from cpap therapy.
The headache med....well known for cause extreme sleepiness in a lot of people plus it could potentially be a factor in sleep architecture not being optimal which might also account for excessive sleepiness.
Hours of sleep is also critical. I have learned that my butt is dragging and I will almost certainly have a nap in my future if I get less than 7 hours of "decent" sleep. My definition of "decent" has had to be modified a bit for my personal situation because I also have some serious back/pelvic pain issues that would destroy my sleep and make me feel like crap even without sleep apnea rearing its ugly head too.

So how about the sleep study results??? Let's see just how "bad" your sleep apnea is/was in the first place.
Especially the oxygen levels to see if oxygen/carbon dioxide levels possibly could be a culprit in those headaches.
Get us an image of the detailed report from a recent typical night. Let's see what is going on that SH can show us. Might be something there that stands out as worth investigating.

I had to google your last two "probable" mental health issues as they were new to me and I don't know that I fully understand them but I get the sense that patience probably is something that you don't have an abundant supply of. If that is correct then that is also something that is going to be needed to "work" on.

[otrpu1]

For me, a headache usually means low oxygen.
Cheers,
otrpu