Need Help On What To Try Next

[forgetcolor]

Do you normally go to sleep right away when you mask up or do you spend some time awake?

Ever since CPAP my fall asleep time isn't too bad (I generally suffer from sleep-onset insomnia, sometimes severely so). I'd say I my average fall asleep time is 30 min.

Do you remember waking up for any reason during the night? Once, twice, three times..etc? Any reason even if just turn over in bed?

Every night this happens. Usually I recall at least 2 wakes/night, but believe there are more happening. Often the wakes are enough that I feel an urge to urinate, and when I do that I turn off the machine. This allows me to use session data to plot the times I wake up that much:



This plot is current as of a few weeks ago, before I started increasing pressure. I also have some mild awakenings due to hip bursitis, trying to get me to turn over. I've done everything I can for sleep environment such as earplugs, temp, darkness, etc.

[Pugsy]

My gut feeling is that the bulk of those "central" clusters are either while you are awake or sleep onset/stage transition.
We have to totally toss out any "awake" events. Our awake breathing is much more ragged and the machine is easily confused and will flag false positives which totally mess up our data reports.

If you wake during the night...you again have sleep onset and sleep stage transition to go through and it is common to see centrals during those times and in a sleep lab they would be tossed out the window but the machine doesn't have access to all the data that the sleep tech has. There is more to identifying a central (like EEG brain waves to confirm actually asleep and thoracic effort belts) and we just don't have that additional data.

You are male? Is the nighttime need to urinate related to prostate by any chance?
If you are female then we can't use prostate excuse.
The next likely culprit for nocturia is sleep apnea events themselves and the stress hormone that is produced which makes the kidneys go into over drive. It is possible that the OSA events that are still occurring are culprits in the need to urinate in the middle of the night. Fix them and the need to urinate may decrease and thus decrease the possible times of awakening and those sleep onset times...see where I am going with this. Maybe decreasing the obstructive events will lessen awake time and thus maybe reduce chance for centrals (if they are sleep onset centrals or awake centrals) to get flagged.

I would be talking to the doctor about at least increasing that 6 cm pressure a little to see if the obstructive apneas and hyponeas reduced....or going to APAP mode and with a little range see what the machine thinks it needs to use to fix those events. That is of course if those centrals aren't real...if you had centrals present in your original diagnostic sleep study then you need to talk to your doctor for sure right now about what is going on.

[forgetcolor]

Pugsy,

Your guesses are similar to mine.

First, I am male, but younger than I'd expect prostate-related problems (41 yrs).

I'm really thinking that the urination need is simply a response to becoming awake enough to notice the need. First, if I awake 4 times then I have to pee four times. If I awake 1 then it's one. They map precisely. All this is predicated on another guess, which is that if any of us were awoken in the middle of the night (after a few hours) we might all feel a need to urinate...but since we don't awake the brain suppresses the need until we are.

I tried increasing my pressure to 7 last night. Haven't looked at the data yet but I don't feel much different. Just ordered a copy of the sleep studies. Probably won't see them until next week.

Sounds like it's not advisable to try APAP on my own until determining the extent of real centrals by looking at the study?

I'm wanting to do the experimentation myself---not consulting w/ the doc every time. Partially for efficiency, and partially b/c of his surprise that this isn't just all fixed by now. I get the read from him that CPAP should just fix the prob, but as with all my other health issues, they never seem to follow what the docs expect. Any big danger in this?

thx

[Sir NoddinOff]

The next likely culprit for nocturia is sleep apnea events themselves and the stress hormone that is produced which makes the kidneys go into over drive. It is possible that the OSA events that are still occurring are culprits in the need to urinate in the middle of the night. Fix them and the need to urinate may decrease and thus decrease the possible times of awakening and those sleep onset times...see where I am going with this.

Once again Pugsy hit on a biggie: Pre-XPAP I was peeing 3 to 4 times a night, literally. Post-XPAP I get up once at 2:AM and that's it for the rest of the night. I didn't realize what was happening to my kidneys until I just read Pugsy's post. Hmmm, makes sense to me, because I don't know what else can explain my overnight change in urinary habits. A very positive change, I might add.

[Pugsy]

Sounds like it's not advisable to try APAP on my own until determining the extent of real centrals by looking at the study?

If you can explain away enough of those "centrals" as false positive "awake or sleep onset" events and are willing to try APAP on your own without the doctor's blessing...hey I won't tell you not to do it. What I would do myself is often a lot different than what I would offer as an idea for someone else to do...especially when I see centrals that I don't know where they are coming from. Those at bedtime...that cluster very likely sleep onset or even awake events. I know they get scored because I have seen it personally myself. Telling you to blatantly go against your doctor...well...I don't feel that is my place but 6 cm is very low pressure and if you wanted to try APAP with a modest range just to see what happens then......that is of course up to you but I probably would give it a go if it were me. Something like 6 min and maybe 10 maximum...see what happens. Your doctor will know if he looks at the reports though....

Can you spot the awake time here in this report below? I know for sure I was awake because I woke up with extreme nausea and lay there thinking "do I get up to puke or not".

[ChicagoGranny]

It’s been shown in numerous studies that the reason why you wake up is not because your bladder is too full—it’s because you’ve stopped breathing and you think your bladder is full, but it’s not. Here’s what happens: Every time you stop breathing, blood flow to the heart diminishes, but once you start breathing again, blood rushes back in your heart which dilates the heart chambers, making your heart think that you’re fluid overloaded. The heart then makes a hormone called atrial natriuretic hormone (or peptide), which makes your kidneys make more urine. At a certain point, with even a small amount of urine, you’ll feel like you have to go but only after you’ve woken up after an apnea event. Notice too, that urine volumes are typically not that large.

http://doctorstevenpark.com/too-many-ba ... ctor-first

[forgetcolor]

I took a closer look at my CA patterns and they do often correlate with two time periods: sleep onset and the last 30-45 minutes before final wake. Often have of them will be in the final 30 minutes.

I wouldn't characterize my doc as against APAP, just more interested in the holy grail of a singular CPAP pressure keeping my events suppressed, and, as you suggested earlier, possibly unaware of the best ways of setting an APAP up. As I said earlier, he's already surprised that I, after 4 months of CPAP, am not feeling great. But then I get this from a lot of specialists on my many nagging health problems.

Took a look at last night's data (I raised pressure to 7cm) and the numbers look decent. I still don't feel great, but it's nice enough that I'll stick with 7 for a bit and see how I feel and how the numbers trend. If it doesn't hold, I'll try a modest APAP setting like 6 or 7-10.

And i presume your wake time was 1-1:45?

[Pugsy]

And i presume your wake time was 1-1:45?

Yep. It was kinda hard to miss.
I have other times when I am awake and may not see much in the way of events but that particular time frame I know I was breathing really weird. I don't handle nausea well at all and I was trying to do some breathing exercises to lessen the urge to go throw up. The machine got totally weirded out and flagged my awake breathing.

[greg-g]

Unless you have a good reason not to, I would like to see you try running the machine in it's auto mode. Your pressure of 6 is low by most standards.
Anytime the flow limitation curve increases it's generally an indication that the machine sees a reduction in flow and it would normally respond if allowed and increase the pressure.
I would personally try 6 - 10.
As has been said above, auto can cause issues if the minimum pressure is way below the required pressure, but a setting 6 - 10 allows the machine to increase if it sees its necessary, but maintains your original minimum pressure.
Are you using EPR?, its meant to be a comfort only feature, but I do like it. I use 2.
I just realized there is a second page of posts, the above was written before reading them.
Personally I disagree with your doctor thinking CPAP is the holy grail. For a lot of people apneas are positional and vary with sleep stages. Why pick a pressure that's high enough to control all events when for most of the night a lower pressure is adequate and more comfortable, but then others can't stand the pressure variations.