Question on how 'compliance' should progress

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
sleepy4466
Posts: 13
Joined: Thu Feb 13, 2020 8:45 am

Question on how 'compliance' should progress

Post by sleepy4466 » Mon Mar 30, 2020 5:35 pm

I've been on CPAP for a few months now, and the most common advice I've seen in the literature is that 'CPAP can take time to adjust to'. That is, for people like me with 'residual sleepiness after CPAP treatment', there appears to be a large percentage of patients that see results after several months of continued use. I'm seeking advice about how I should go about experimenting with this time. Do I try to continually decrease my AHI every month? Should I expect to see gradual gains somewhere in my sleep, or does it work all of a sudden?

As can be seen from my screenshot below, My AHI is relatively low (below 5, down from +10). But, I don't wake up feeling any better and my sleep tracker (the DREEM device) shows frequent wakeups that have no relation to the respiratory events on my CPAP reading. CPAP is reduing my respiratory events but I'm still waking up.

I've tried different minimum and max settings. I'm trying melatonin and other supplements, as well as meditation before bed. All the literature says is that through "compliance" more patients see results. But, does that mean I should do the same thing every night? Or, for people who eventually found progress after several months of use, did you start to see incremental results in your AHI? I'm trying to understand more about whether compliance will work for me or what I should be doing during the months that I acclimate to CPAP. I hope this question is cogent. Let me know if i can make it any more clear. Thank you!
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Pugsy
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Re: Question on how 'compliance' should progress

Post by Pugsy » Mon Mar 30, 2020 6:22 pm

Some people report that it took months before they felt better...some people say they never really felt better...some people say they noticed improvement fairly quickly.

I personally noticed marked improvement in a couple of areas fairly quickly....reduction in those killer morning headaches and the needing to pee ever hour on the hour all night long with a full bladder each time ceased.
Energy levels really didn't change much or as much as I had hoped I guess but then I realized after a bit of studying that I was expecting the cpap machine to fix a problem that was simply unrelated to sleep apnea and it just can't fix a problem if the problem isn't related to the airway closing off. I have other health issues that impact my sleep quality...make me wake up often or sometimes keep me from falling asleep easily or waking up too many times during the night or waking too early and not be able to go back to sleep.
I would have these same sleep issues if I didn't have OSA. I was wanting the machine to fix a problem that it couldn't fix.

Fragmented sleep will destroy good sleep quality because it keeps us from getting the nice normal progression of sleep through all the sleep stages and thus the needed percentage of sleep in the various sleep stages. It's a big puzzle that has to have all the puzzle pieces in place to stand any chance of feeling better.

Often people have more than one health problem besides OSA....those other problems can end up causing poor sleep or fatigue or the various complaints we wish that cpap would fix.
Medication side effects is a big culprit...
I have high blood pressure so I take a little pill for it and it does a good job with the BP but a little known side effect of that medication is fatigue...duh. Who would have thought but it's quite common. So common that my sister thought she had OSA and was screened for it and didn't have it. Bad fatigue...she happened upon some literature about her BP meds that said it was known to have a side effect of causing fatigue. So she got her doctor to prescribe a different BP med and low and behold her fatigue symptoms markedly reduced.
I have bad arthritis...one of my pain meds causes insomnia despite the "may cause drowsiness" sticker on it. I can sleep maybe 2 hours and then I am wide awake the rest of the night and of course feel like crap the entire next day.
That same arthritis wakes me up often during the night because of pain...I have to change position a lot...so my sleep quality gets messed up from those wake ups as well and sometimes I just end up getting out of bed because it hurts so much to lay in bed anymore....short night...night enough hours of sleep is going to equal butt dragging the next day. There is no way around it.

So what to do when we don't feel as good as we hoped to feel with cpap therapy...
Make sure your cpap therapy is optimal first. If your therapy could stand improving...try to improve it. That under 5.0 AHI goal doesn't mean much for a lot of people. A lot of people need an AHI of 2.0 or less to feel decent. It's just what their body needs.
Do some investigative work...are you getting enough hours of sleep? If I don't get near 8 hours of sleep I can pretty much guarantee a nap in the afternoon. 6 hours of sleep isn't enough for most people....between 7 and 8 is what most people are going to need.
Are the hours of sleep fragmented with a lot of wake ups? If so, try to figure out why. Again check those meds because often meds are well known to mess with sleep quality....medications for mood disorders are well known to really mess with the sleep stages...some even reduce the amount of REM people can get and remember...we need all the sleep stages in the needed quantities for the restorative powers of sleep to work their magic.

Read this article...substitute anything for alcohol because it's not limited to alcohol. Anything that disturbs our sleep will mess with how we feel during the day even if we didn't have OSA.
https://www.sleepfoundation.org/article ... tity-sleep

It is normal to wake up after a REM sleep stage cycle...normally we aren't awake long enough to remember it but a post REM wake up is considered normal. So to expect to never wake up is an unrealistic goal.

Your AHI is barely under 5...technically acceptable by the 5 standard but maybe it isn't what your body needs. Maybe you need a lower AHI.
It's primarily obstructive in nature...it's entirely possible that your sleep is disturbed 3 to 4 times each hour because of what you see...multiply that over the 7 or 8 hour night and that's a substantial number of awakenings and that's not counting the normal post REM wakening or the spontaneous arousals we might be having (and we all will have some anyway) that aren't related to airway issues.
Crappy sleep quality is the end result and with crappy sleep we can expect to feel crappy the next day....fact of life.

So what to do in your situation?
First thing I would do is try to clean up the report a little more and see if that helps...reduce the AHI more...that means more minimum pressure because that's how we deal with obstructive apneas and hyponeas. Ignore the clear airway events because we can't fix them with more pressure and some of them likely could be related to arousals anyway. Reduce the arousals and some of those CAs/centrals might reduce a bit.
Second thing...take a hard look at your sleep hygiene to see if you are doing the bad things that can mess with sleep.
Take a look at any medications that you might take to see if the meds can affect sleep or energy levels. Even some OTC meds can cause drowsiness so look at OTC stuff also.
Take a look at any other physical or mental issues that could be a factor....

Often we have more than just sleep apnea going on and how we feel is a combination of several things that impact sleep and how we feel. If it is just sleep apnea...that's fairly easy to deal with but most of the time people will have more than just one health issue like apnea.

People want cpap to fix bad sleep....but it can't fix bad sleep when the bad sleep is caused by something other than the airway trying to close up.
Sleep apnea is just one item on a mile long list for potential culprits for crappy sleep quality.

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