CPAP troubleshooting and REM sleep behaviour disorder

[thesleepermustawake]

hi

I've been on CPAP for a few years now. my current CPAP is a Philips Respironics System One (60 Series) RemStar Pro with C-Flex+ and its set to 10
the tiredness never really went away, but recently I've been feeling it more, needing afternoon naps and going to bed at 8pm. I know it's partly due to the fact that my wife has to get up around 4.30 am and that wakes me up ( I have very light sleep) . I had a thyroid test and it's all normal.
I went to the sleep specialist because my wife was complaining about me acting out my dreams in a violent manner like punching her and scratching and kicking. she'd wake me up like WTF are you doing???
the doctor just seemed to ignore those details and said it might be restless leg, but I know it's different. has anyone used melatonin effectively for this?

I can share my sleepyhead reports if anyone wants to take a look, I don't have apneas anymore but maybe it could show something? Also, I've started needing to get up during the night to go to the bathroom.

thanks

[Julie]

Few things... what makes you think you don't have apneas any more?

Second, it sounds like you well might have them from the general nature of your symptoms, but maybe either need a new test or show us the SH reports using Imgur to DL and post the link in this thread. Also, if I were you, I'd sleep in another room as your wife's schedule may well be impacting your therapy, quite possibly right in the middle of your REM sleep at that hour, not a good thing to happen.

I also see you're on straight Cpap, but if you can get hold of an Apap, if only to experiment with for a few wks, it might be very worthwhile to really see what's going on as Cpap (esp. on your older model of machine) does not give the kind of results you want to look at now to see what's going on... and it may be as simple as needing to raise your min. pressure (on an Apap) but you won't know unless you try. The acting out stuff may also just be your body wanting more treatment... so call it a red herring for the moment until you know more.

Have you gained weight recently - even the smallest amount can make quite a difference to what you need pressure-wise.

[thesleepermustawake]

thanks for your reply

what makes you think you don't have apneas any more?

the sleepyhead data

I had a home sleep study quite recently and the doctor said it was treated.

I'm already sleeping in another room,

my CPAP does APAP ... I think. it's not the easiest to change settings

I've actually lost quite a lot of weight and considerably reduced alcohol intake to like 1 or 2 drinks per week

http://imgur.com/a/hhI1u

[Pugsy]

Sure. Plant one of your typical night SleepyHead detailed daily reports on the forum so we can see it.

Don't want all the graphs...just the basics.
Hide the calendar and turn off the pie chart (Preferences/appearance tab) so that the statistics are easily seen on the left side along with AHI bar graphs.
On the right side...Events, Flow rate, pressure (even though it is fixed) and leak graphs...don't need all those other graphs.

You won't have any FL (flow limitation flags) because in cpap mode it doesn't turn on FL flagging but maybe there is something else like snores or something that might point to sub optimal therapy. One of the things I dislike about Respironics and fixed mode...no FL flagging and they are kinda important.

Some of the PR System One 60 Series Pro models had a brief apap trial mode. Do you know if yours does or not? It would be in the clinical setup menu area. Do you know how to get to that area?
If not you can go here and scroll till you find your machine
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

If you have a trial period of apap mode you could try apap mode and see if the machine wants to do anything when given a chance.

I don't know about REM behavior disorder and it's relationship, if any, to sleep apnea but I don't think there is much of one.
The frequent bathroom trips in the night...might be sleep apnea related and might also be related to something else and since you are a guy the prostate gland comes to the top of the line. Have you had it checked lately? What is your age...are of you of an age where it is fairly common for the prostate to start causing the bathroom trips during the night?

[Pugsy]

I don't see anything on the report that is just standing there screaming "fix me".
One very minor short lived leak that made it to large leak territory but barely.
That time over red line threshold statistic of 13% is incorrect because it is using a ResMed leak number to calculate from and that number doesn't work for Respironics machine.
Looks like your threshold might be just below 70 L/min.

Go to Preferences then cpap tab and on the right change the 24 L/min threshold number to 65 L/min...then the statistics for time over red line threshold will be more accurate. It's still not perfect because Respironics never gives us an exact red line threshold number because it can vary so much between masks and pressures used. Using 65 as the threshold is close enough. Or you can just turn that statistic off and just eyeball the events graph for large leak.

[thesleepermustawake]

ah - I used to have a resmed - well I still have it, is it better?

[Pugsy]

ah - I used to have a resmed - well I still have it, is it better?

Not necessarily. Which ResMed model do you have?

[thesleepermustawake]

an autoset s9

I will try your suggestion of setting it to APAP - should I set a max of 10 and what should the min be?

[Pugsy]

I will try your suggestion of setting it to APAP - should I set a max of 10 and what should the min be?

Max needs to be more than 10 in case the machine wants to go higher. It won't go there unless it has a good reason.
If it were me and based on the one report you shared...I think I would try the minimum of 9 or 10 and set the max to 20 and just see if the machine wants to increase the pressure.

[thesleepermustawake]

hi again, so I switched back to my APAP machine, and set the pressure between 9 and 18. according to these statistics the pressure on my CPAP seems correct. the only issue I'm having is that I wake up around 3-4am and then I have to remove the mask because I can't fall back asleep and so I sleep without the machine for a few hours.
I'm trying different doses of melatonin to see if it improves my sleep.

http://imgur.com/a/SPOJW

[Julie]

Melatonin will make you crazy - at least I found out to only use it at certain times... I use only a tiny amt - 1.5 mg (cut a 3 mg tab) and it works for 1-2 nites, but if I use it more often it backfires and wakes me at some time overnight, worse if I take a stronger dose, so only use when necessary (maybe due to a combo of late nights beforehand with too-early rises, appts to keep, too much coffee too late in the day, etc.... in other words I use it only to regulate, or reset, normal times.

[thesleepermustawake]

that's a bit of an extreme thing to say - I took 6mg last night and mostly slept through the night although I think I woke up briefly around 3-4 am again.
after lunch I get really sleepy, so I'll go for a bike ride and I'll feel better but when I get back, the sleepiness comes back. I'm on a low carb diet, so I don't get the sugar crashes like I used to.
I'm going to have a blood test for vitamin b12 deficiency next week, other than that, I don't know what else it could be or how to make it better. I usually go cycling for 20 minutes 3 times a week and one longer ride once a week.
I'm on one blood pressure med - losartan but that doesn't cause drowsiness as far as I know. I do have more energy when my blood pressure is high but I know it's dangerous...