Still tired.

[sullivan.t]

I've been using my machine (outlined in the sig below, I believe) for a while now. About a month or so. I think I need to put more focus, at this time, on the time I go to bed, wake, what I *do* in bed (read, snack?!, watch TV, be "close" to my wife...) and how that changes my sleep.

Because I'm still quite tired. I'm on a medication, too, that may make me either tired or have energy; if you read the paperwork that comes with it.

I've got DR appts to follow up on all of this, but does anyone have any tips? Do CPAP Pillows (with the cutouts, etc) really help? I have a mouth-nose mask. I remember at my 2nd titration test, I slept *SO* well. I haven't been able to replicate that at home, and maybe it's because I'm using a different mask. I have both. Is switching masks here/there ok? Does it change/effect therapy much/at all? According to the machine, my AHI is about 3.5. It's under 4. I'm a programmer by trade, so I may take a look at the open source options out there for reading Encore data.

Just some "newbie" questions I suppose. I already feel so attached to the machine in general though. I can tell that when I sleep, I enjoy it again. I'm eager to sleep, get into bed, and know that I'm not going to snore and wake my wife for instance. (She's a stage IV cancer survivor and sleep is important to her, too!)

Just a few rambles. I appreciate any insight. Thank you! Great forum, by the way!

[cowlypso]

Have you looked at your data at all? How is your leak? You have a great machine that records all of this data for you, although it doesn't do the best job of displaying it. There are several options for viewing your data: viewtopic/t64906/PR-S1-software-options ... Novel.html

An AHI under 4 is good, but some people are sensitive and feel better with an AHI even lower, around 1 or 2. You may need a pressure adjustment.

If your leak is high, then the air from the cpap is leaking out somewhere and not doing its job. If you fix the leak, your AHI may improve.

Are you running the machine in auto mode or cpap mode? If you are in auto mode, what is your pressure range? A lot of doctors set the pressure wide open on auto machines, and this can cause problems. First, if the machine starts out at a pressure of 4, and you really need a pressure of at least 10 to keep your airway open, then it takes the machine a while to catch up treat you effectively. Second, some people are sensitive to the pressure changes throughout the night and it wakes them up. Once you've found your ideal pressure, it's better to either run the machine in straight cpap mode or at least to narrow down the range significantly.

Is your mask comfortable? If you are constantly waking up to fiddle with the mask, then you aren't sleeping well. You can change masks as often as you want. Keep trying until you find one that is comfortable and works for you.

[avi123]

I've been using my machine (outlined in the sig below, I believe) for a while now. About a month or so. I think I need to put more focus, at this time, on the time I go to bed, wake, what I *do* in bed (read, snack?!, watch TV, be "close" to my wife...) and how that changes my sleep.

Because I'm still quite tired. I'm on a medication, too, that may make me either tired or have energy; if you read the paperwork that comes with it.

I've got DR appts to follow up on all of this, but does anyone have any tips? Do CPAP Pillows (with the cutouts, etc) really help? I have a mouth-nose mask. I remember at my 2nd titration test, I slept *SO* well. I haven't been able to replicate that at home, and maybe it's because I'm using a different mask. I have both. Is switching masks here/there ok? Does it change/effect therapy much/at all? According to the machine, my AHI is about 3.5. It's under 4. I'm a programmer by trade, so I may take a look at the open source options out there for reading Encore data.

Just some "newbie" questions I suppose. I already feel so attached to the machine in general though. I can tell that when I sleep, I enjoy it again. I'm eager to sleep, get into bed, and know that I'm not going to snore and wake my wife for instance. (She's a stage IV cancer survivor and sleep is important to her, too!)

Just a few rambles. I appreciate any insight. Thank you! Great forum, by the way!

Sullivan, since you have a DR. appointment soon I would try to control the leak but not take any advice from posters about changing the pressure on the machine.

For myself, it took me 3 month to find a suitable mask ( I tried six masks) and feel comfortable with the machine. I never managed to get my AHI below 7. It usually around 10. But I sleep with no problems for 7 hours now. I still have a residual daytime sleepiness. So I take an hour nap during the day. At the beginning of CPAPing 6 mos ago I took 10 mg Zolpidem (generic Ambien) while putting the mask on. But stopped it 3 mo ago. The only Rx that I take for anxiety is 0.5 mg Xanax twice daily.

[sullivan.t]

Thanks for the advice, guys.

I'm going to try my other, "backup/different" mask tonight and see how it feels. It's got that part that goes up toward my forehead, etc. I wear an SCBA mask in the fire department all the time and so, usually once I get the straps set right, I just put it on and forget about it. Thinking back, though, yeah sometimes I fidget with it.

It's got 2 or 3 little holes at the top of my nose, sort of as a makeshift exhale valve. That's the only spot I get leaks unless I smile or pinch my cheeks in like a fishy-face.

I think my machine is setup for auto - and it's got a ramp feature. A tinker type of person I may be, I'm going to let the Dr tell me what's what. I'm hoping tweaks and med changes will help - my hour-long commute to/from work sometimes really stinks if I'm tried.

Thanks again!

[nanwilson]

If you are talking about the tiny holes at the nose bridge I would assume you are using the Ulgtra Mirage...if that is so ...those holes ARE for exhaust. Do NOT cover up those holes as you will be re-breathing your own exhaled breath.

[robysue]

I've been using my machine (outlined in the sig below, I believe) for a while now. About a month or so. I think I need to put more focus, at this time, on the time I go to bed, wake, what I *do* in bed (read, snack?!, watch TV, be "close" to my wife...) and how that changes my sleep.

Yes, focusing on your sleep-related behavior patterns is critically important---particularly if you are prone to insomnia or if you are finding sleeping with the mask much, much more difficult than you think it should be. There are many common behaviors (including snacking in bed, watching tv in bed, and reading in bed) that tend to aggravate insomnia (particularly once it starts) and sleep hygiene is all about replacing those behaviors with ones that will help tame the insomnia rather than feeding it. A typical set of good sleep hygiene guidelines can be found at http://www.umm.edu/sleep/sleep_hyg.htm . Notably cuddling with your spouse in bed before going to sleep is part of GOOD sleep hygiene.

Because I'm still quite tired. I'm on a medication, too, that may make me either tired or have energy; if you read the paperwork that comes with it.

If the tired feeling is beginning to border on exhaustion or fatigue that is adversely affecting your daytime functioning, I'd report that to the doctor who prescribed the medicine. He may just recommend prudent watchfulness and waiting to see if this really is a side effect of the medication and whether it is mild enough for you tolerate the medicine. But if there are other alternative drugs to try for your condition and if the fatigue is indeed adversely affecting your life, then a switch in medication may be in order. But the only one who can really make an informed decision about this is you and your doctor working together.

I've got DR appts to follow up on all of this, but does anyone have any tips?

You need to think carefully about what YOU want to get out of this meeting with the sleep doctor. Because if all you say is "I already feel so attached to the machine in general.. I can tell that when I sleep, I enjoy it again. I'm eager to sleep, get into bed, and know that I'm not going to snore and wake my wife for instance. But I'm still tired" there's a high probability that all you will be told is "You've got great compliance and it's fantastic that you now enjoy sleeping again. That means you've adjusted really well to therapy. But it takes some people a couple of months to start feeling better. So keep trying for another month and maybe you'll start to feel better by then." And if nothing changes during that month, what then?

So do some soul searching: What do YOU want to come away with from this meeting? Once you know what you want out of this meeting, write it down on paper. Write your questions down on paper. Write your concerns down on paper. And bring the papers with you so you don't forget something that's important to you to discuss in the meeting. It might even help to bring a second copy of what you've written down so you can give one to the doctor and keep the other for yourself. And bring a pen and some paper to write on---particularly if you find it hard to remember what you've been told at a doctor's office.

As to what to expect at the meeting: The doctor will likely start out by asking you whether you're feeling any better during the daytime and whether you think the quality of your sleep has improved. He'll then start talking about your compliance in language that either praises you (You really are doing a good job of wearing the mask every night.) or encourages you to do better as far as compliance (You really need to work on getting in at least four hours every night). And he may want to talk about leaks and what to do about them (even if you DON'T have any leaks). It will be up to you to ask whether the therapy is actually taking care of the apnea sufficiently well. And if your AHI is always below 5, the doc will probably say that your AHI is fine and that you don't need to worry about it and that you don't need to track it. (But since you're here at cpaptalk, you probably are more comfortable tracking your data than functioning in the dark, so ignore that advice about not looking at the data if you think knowing the data helps you.) And then, unless you bring up specific questions or concerns or problems, you'll likely be told that the doc doesn't need to see you again for months or even not for a full year (or more) unless you start having trouble.

Do CPAP Pillows (with the cutouts, etc) really help? I have a mouth-nose mask. I remember at my 2nd titration test, I slept *SO* well. I haven't been able to replicate that at home, and maybe it's because I'm using a different mask. I have both.

Learning how to sleep with the hose on your nose every night in your own bed is a process, and for many people is is not a trivial process. Look at your data: Does it appear that leaks are a problem? Then post here and get some suggestions. Are you conscious of negative changes in your sleep patterns, even though you say you now enjoy sleeping again? If so, post here and you'll get suggestions. Can you tell if you feel much better on days when your AHI is particularly low or not? If so, and you want additional ideas on what might bring the AHI's down to where you want them to be (as opposed to simply "below 5"), then post here.

Is switching masks here/there ok? Does it change/effect therapy much/at all? According to the machine, my AHI is about 3.5. It's under 4.

Maybe yes, maybe no. Theoretically speaking if you are using Mask A and Mask B and both are correctly fitted, comfortable enough for you to sleep soundly in, and do NOT leak excessively during the night, the your overall results with Mask A and Mask B should be similar.

But: For most people, mask choice is highly personal and no two masks fit equally well. There are still plenty of valid reasons for switching masks around, sometimes every night or every few nights. Some good reasons for switching masks include:

• You're still looking for the mask. Finding a good mask is similar to finding a good pair of shoes. Some people have to try out lots and lots of masks before finding one or more they genuinely can tolerate. Others are lucky with the first mask they try on. All has to do with the shape of your face and how the mask feels on your face at your pressure.
• Having a spare mask in an alternate style around for nights when your "go to" mask just isn't going to work anyway. Many nasal mask and nasal pillows users have a FFM around for those days when the congestion from colds, flu, hay fever and other allergies is just too much and they know they're going to want to mouth breathe at night.
• Sensitive skin issues. Different masks rub and irritate your facial skin in different places. Ideally no mask should ever make your face sore or give you pressure bumps. But we don't live in an ideal world, and particularly for newbies with very sensitive skin, swapping between two masks that cause irritation in different spots allows the sore spots time to heal.

So switching masks is not that uncommon. But several things need to be kept in mind concerning how switching masks might affect your therapy:

• The Resmed S9 machines need to be told what style mask you are using in order to correctly record all the efficacy data. So if you're an S9 user, be sure to set the mask type correctly if you are switching from a FFM to a nasal pillows, for example.
• Comfort of the mask directly affects the quality of your sleep. It might not show up in the data. But using a less comfortable mask might be reflected in the data as better AHI numbers if your apnea is worse in slow wave (Stage 3) sleep and REM sleep since a less comfortable mask may prevent you from getting as much Stage 3 or REM sleep as you do with the more comfortable mask.
• Leaks. Some masks are inherently harder to seal well for some people than others are. But the "leakier" mask may still be useful at times for one reason or another. But when you're using the leaky mask, you are apt to have more comfort issues and (perhaps) less effective therapy.

I'm a programmer by trade, so I may take a look at the open source options out there for reading Encore data.

SleepyHead is really impressive for alpha-ware.

[sullivan.t]

Thanks again! That was a great reply (they all have been!)

I slept this weekend with my "backup" mask that I used at the titration test and the hospital gave me. (Or let me steal, who knows... the tech told me to. I work here, so I'll probably pay for it somehow. lol!)

I also stuck to getting up at 5:30 this morning, because I had to walk to the bus. A side effect of leaving my car at work when leaving on a weekend away and my wife picking me up. So not only did I get up early, I went to bed at an "ok" time and I got some walk-exercise on the way to the bus stop. All good things, imho.

Not feeling too exhausted today, so that too is a bonus!

I'm going to write thing down before my next visit. I always forget stuff, and that's a great idea.