CorvidLover's Therapy Thread, or, why can't I go to sleep and stay asleep?

[corvidlover]

Hey, all -

I've been reading here a long time, and have finally decided to come out of the shadows and ask for help. Sorry this is so long!

I started cpap therapy initially in January 2018 after a home sleep study. After just a couple of weeks, I suffered a neck injury that required surgery and a very long recovery period (infections are no joke). I started therapy again in October of 2018, with the machine in my signature, but with a ResMed Airfit F20 mask. Therapy was kind of a struggle, went back to the DME folks for some adjustments to the mask, fought with aerophagia, but otherwise soldiered on. Found this place and tried to implement some of the suggestions I read, AHI was sometimes under 5, usually under 7, but I rarely woke refreshed and always had repeated night wakings (something I've had most of my life).

About a month ago, I was at the dentist and complained that my TMJ pain was worse than it's ever been. Lo and behold, he is a cpap user and after a ton of questions, told me to get myself a mask that doesn't put any pressure on my jaw and use a soft Scunci headband as a chin strap. I got an appointment with the DME folks the next day, and went home with the Dreamwear nasal mask and the Dreamwear nasal pillows in case I wanted to try them. I did try the nasal pillows, but the nasal mask has proven to be incredibly comfortable and easy for me to wear.

After a month, my jaw pain has all but disappeared with this mask. It's glorious. But I still don't sleep anywhere close to what I'd consider "well." I wake up frequently, sleep lightly, and dream vividly all night long. It's pretty much the same pattern I've had since childhood, and while I don't expect that cpap will solve all of that, it would be nice to bring my AHI down consistently (it's been all over the place) and know that when I AM asleep, I'm getting the most out of therapy that I can.

So I downloaded Oscar, have been reading documentation and therapy threads until my eyes are bleary, but I just can't seem to dig through this on my own. Would love some input and any suggestions you wise folks have to offer. FWIW, I am trying to get in to see my sleep dr, but it's been a struggle due to conflicting schedules.

I've attached my Oscar data from the last three nights - please let me know if it's not the right data or if I've screenshotted it wrong! Kind of new to this stuff. Thanks!

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[Pugsy]

Have you tried regular auto mode instead of the for Her mode? If not, try it.

Do you take any meds of any kind? If so, what?
Any other health issues going on?

Your machine is going up and pretty much staying up fairly quickly. You might want to increase the minimum to around 9 or 10 if you can.
Make use of the ramp if you need it. It's going up anyway and doesn't ever really come back down much.

[zonker]

Hey, all -

I've been reading here a long time, and have finally decided to come out of the shadows and ask for help. Sorry this is so long!

welcome to the zoo! not only have you read all the things, but you are actually posting the way you should for maximum benefit to you and the experts. so congrats on that.

don't worry about not understanding the graphs. ask as many questions as you need to until you feel like you understand. me, i don't have any understanding so i just take the expert's word on it.

i also love that you've titled your post as your therapy thread. shows that you are paying attention.

i think you are going to make it fine. besides, you've got pugsy helping you out.

good luck!

[corvidlover]

Hi, Pugsy - I have not tried the regular auto mode, I will give that a try tonight. Will hold off on changing anything else so I can figure out if something works.

As far as meds, I take levothyroxine, which I take for Hashimoto’s thyroiditis, an SSRI, metoprolol for a tachycardia condition I developed after my neck surgery, and gabapentin for leftover nerve pain from the same surgery. Oh, and omeprazole for reflux.

Thanks for the welcome, Zonker - your long treatment thread is what convinced me to finally ask for help!

***Edited to add that I also take 5mg of melatonin at bedtime to get to sleep, started on it when I couldn’t sleep from the pain of my neck injury and have kept using it because it works well for me.

[zonker]

Thanks for the welcome, Zonker - your long treatment thread is what convinced me to finally ask for help!

you figured if i could blather nonsense, then you could talk sense?


glad to be a good example!

[Pugsy]

SSRI medication is well known to mess with sleep architecture/quality.
It may be a factor in your sleep issues.
Google "SSRI and sleep" and start reading. It can cause us to not get enough REM and it can cause us to wake up more easily during the night (which we of course don't want).

[corvidlover]

Wow - I've been on an SSRI of some sort for 25 years due to generalized anxiety disorder and multiple severe depressive episodes, and not one dr has ever mentioned that it could affect sleep. Called my sleep dr's office and got an appointment for next week, will discuss this with her then.

In the meantime, here is last night's Oscar data. I turned off the "For Her" setting, and made no other changes. AHI was up a bit - how on earth do people get their AHI down to 1 or less? I think the lowest I've been is 2, and that was a one-off that I've never been able to replicate.

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[Pugsy]

Didn't really changed that much. I didn't know if it would be more aggressive enough for it to impact the numbers.
Apparently not.
The fact that it is a bit higher doesn't mean much. We can have that much variance and not change anything. We simply don't sleep the same each night.

I don't know if the higher AHI is a factor in the wake ups or not but it sure could be and apparently the machine won't go higher on its own so you are going to need to set it higher to help it out.

I am thinking probably 12 cm minimum...big jump I know. Maybe go up in small increments that are easier to adjust to and watch the results. You might get lucky and not need as much as I am thinking you are going to need.

[corvidlover]

Thanks for the input, Pugsy. I didn't make any changes last night, and looking at the Oscar data (which I've been reading about and trying to learn to interpret) the only difference I see is that my pressure actually decreased toward morning - that graph looks very different from the days before. I did start coming down with a cold yesterday, haven't had one since I started therapy so it will be interesting to see how nasal congestion affects my numbers. Hoping it stays mild instead of ramping up.

Here's last night's data; I am planning to go ahead and up my minimum pressure by .5 tonight as suggested and leave it there for a couple days before moving up again.

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