How long did it take before you knew cpap worked?

[kbobtn]

When I went in for my sleep study, it was not supposed to be a split, but the tech put a mask on me half-way through, saying she didn't feel like doing CPR that night. I could hardly wait for the Dr to contact me after the study, and the first night at home sealed the deal! The night before was also the last night I haven't used it (except for the 4 nights in surgical ICU when I had a respirator).

[2 B Sleeping Soundly]

I think my very first post here on the forum about my 3 day home titration said it best for me...

John

viewtopic.php?f=1&t=70699&p=653361#p653361

[lorraineg57]

No, I'd just wake up...I mean like wide awake...pee if I was up but I don't think that's what was waking me. I'd be up for 10-15 minutes, go back to bed and go right back to sleep , but an hour and a half later, I'd be back up. That's another thing that makes me think something is awry, I'm out (pre-cpap) within 5 minutes of hitting the pillow. Is that normal?

Since your OSA is worse on your back maybe since you don't spend any time on your back it just hasn't been bad enough to produce much of the stress hormone. Not sure though since it isn't clear cut...just tossing out ideas and stuff to think about.

Something is waking you up though. During your trial period if you can get to the point where you are sleeping through the night comfortably with the mask and machine you might have your wake up why question answered.
Of course there are also other things that wake us up during the night.
The fact that you have multiple wake ups being reported tells us that your sleep architecture is being messed with. Of course anything that messes with sleep architecture is unwanted because we just feel like crap the next day since we didn't get the normal cycles and normal amount of time in each cycle.

I think if it was me I would still try to get the cpap thing sorted out to see if by any chance the fragmented sleep improves.
Try to isolate what is causing the wake ups. Any meds that might have an insomnia side effect? I take a pain pill during the day that actually has a may cause drowsiness sticker on it but there are a few people who it causes insomnia. I am one of those people. If I take that pain pill after 6 PM I am wide awake at 2 AM after only a couple of hours of sleep.

Something is waking you up and something is messing with your sleep architecture and causing reductions in some sleep stages and increases in the other sleep stage. So something is going on. Sounds like your doctor is hoping that whatever is going on is related to sleep apnea and hoping it will improve with cpap. It might and it might not but I think it is worth investigating.

What other things would cause the messed up sleep architecture? If the cpap would solve it, I'll gladly wear it. I don't take any meds at all so that's not it. I've tried eliminating caffeine which had no effect whatsoever. I'm wondering what the next step will be if the cpap doesn't help and how long do I try it before deciding it doesn't help? I see posts here where people have used it for months and aren't sure if it's helping. ( I know a week and a half in really isn't much of an indicator.)

[Pugsy]

What other things would cause the messed up sleep architecture?

Lot of stuff. Google Sleep Maintenance Insomnia to start with. People have fragmented sleep all the time and they don't have sleep apnea. We like to blame OSA for all our problems but often we have problems with sleep that are totally unrelated to OSA.
Pain, meds, bed comfort, external stimuli, bed room temp, anxiety, depression, general health issues just to name a few things that can mess with our sleep.
Not saying that is what is going on with you but something is waking you up and those are some things that do mess with sleep architecture.
Is this new problem or old problem?
Fragmented sleep for any reason simply can make us feel like crap the next day. Doesn't have to be solely blamed on OSA diagnosis.

[lorraineg57]

What other things would cause the messed up sleep architecture?

Lot of stuff. Google Sleep Maintenance Insomnia to start with. People have fragmented sleep all the time and they don't have sleep apnea. We like to blame OSA for all our problems but often we have problems with sleep that are totally unrelated to OSA.
Pain, meds, bed comfort, external stimuli, bed room temp, anxiety, depression, general health issues just to name a few things that can mess with our sleep.
Not saying that is what is going on with you but something is waking you up.
Is this new problem or old problem?
Fragmented sleep for any reason simply will make us feel like crap the next day. Doesn't have to be solely blamed on OSA diagnosis.

Hit about the same time as menopause. I kept figuring it'd go away when my menopause stopped being so symptomatic. It never did. It's been about 3.5 years since it started. I have no other health issues to speak of. Random elevated bp which I largely blame on the insomnia. Oh, and mitral valve prolapse, which my cardiologist assures me is pretty benign. I normally work out at least 3x week, not overweight, eat healthy, don't drink, blah, blah...

Most of the research I've done on SMI hasn't been very helpful as far a solutions. Hence, the pcp visit, the sleep study and my appearance here!
I've tried Ambien (not much help other than putting me to sleep quickly, which wasn't an issue to start with, along with a few other Rx's, to no avail. I don't like meds
anyway. Especially something for sleep due to the dependence issues.

[lorraineg57]

Interesting snippet:

Why Do Snoring and Sleep Apnea Become more Prevalent in Post-Menopausal Women?

The decreased levels of Estrogen and Progesterone during menopause are known to affect muscle tone in the upper airway making the muscles more collapsible.

Sleep Disordered Breathing (SDB) has also been found to be linked to fluctuating hormone levels in women. Snoring and Sleep Apnea occur due to the collapsibility of the upper airway muscle tissue. The tone, or strength, of the muscle tissue is related to the levels of these hormones. When muscle tone diminishes, the upper airway becomes more collapsible, which can lead to snoring and sleep apnea. Additionally, hormonal changes can also lead to weight gain, which is known to increase the presence of Snoring and Sleep Apnea.

[Pugsy]

Menopause may have had something to do with my OSA also. When I met my now husband in 2002 he said I never snored or stopped breathing. Those symptoms of OSA didn't seem to show up until maybe 2005 and I was 3 years into the menopausal hot flashes.
I didn't do any hormone replacement therapy due to strong history of breast cancer in my family.

Have you read RobySue's blog about her insomnia?
She would be the best person to maybe come up with some ideas to help you deal with the wake ups and insomnia since she has dealt with it first hand. When I had the fragmented sleep and minor sleep maintenance insomnia I knew what was causing it.
In my case it was pain from some old injuries and arthritis. Still hard enough to figure out a way to manage it but I at least had a name and face to my problem.

Have we seen any of your cpap software reports to even know if what sleep you are getting is even doing what it is supposed to do?
I don't remember if I have seen any of your reports.

[KEQ5]

I was one of those lucky ones. While I slept horribly at the sleep lab, they were still able to titrate me a pressure. But I had extra energy the next two days and got lots of stuff done. Then I had to wait 3-4 weeks for them to review the results, order a machine, deal with the DME, force the DME to go back and give me the right machine which was another week delay.

Getting a better mask fit was the goal of the first month and figuring out the machine and how to read the data and adjust my own settings.

I'm about 2 1/2 months in now. My energy was pretty much up from week 1. But I'll still have good weeks / bad weeks. AHI from severe to below 2.0 most nights.

Within the first two weeks I stopped having to get up 3-5 times each night in the early AM hours to go piddle.

Mask / pressure / aerophagia issues are minimal enough that I feel like I'm getting good rest each night. About once a week, I'll do something like take the mask off and sleep without it for a few hours, but it's not frequent and when I wake up again I just put the mask back on.

I always mask up when I lay down for a quick nap. The interesting thing is that a 30-40 minute nap now feels refreshing. Prior to CPAP, I'd lay down for 40 minutes and wake up even more tired. Which would then cause me to turn over and go back to sleep for 2-3 more hours and I'd still wake up feeling like a zombie.

I no longer have to take a nap every day during the lunch hour, plus another nap at 5pm after work is over.

[lorraineg57]

Menopause may have had something to do with my OSA also. When I met my now husband in 2002 he said I never snored or stopped breathing. Those symptoms of OSA didn't seem to show up until maybe 2005 and I was 3 years into the menopausal hot flashes.
I didn't do any hormone replacement therapy due to strong history of breast cancer in my family.

Have you read RobySue's blog about her insomnia?
She would be the best person to maybe come up with some ideas to help you deal with the wake ups and insomnia since she has dealt with it first hand. When I had the fragmented sleep and minor sleep maintenance inso

mnia I knew what was causing it.
In my case it was pain from some old injuries and arthritis. Still hard enough to figure out a way to manage it but I at least had a name and face to my problem.

Have we seen any of your cpap software reports to even know if what sleep you are getting is even doing what it is supposed to do?
I don't remember if I have seen any of your reports.

I've not seen RobySue's blog, is it on this site or can you give me a link?

I downloaded the Sleepyhead software but have yet to attempt to use it. How in the world can the cpap tell what you're doing? That just seems crazy to me that it can detect anything except maybe your respiration since there isn't anything "attaching" you to the machine...how does that work?

[lorraineg57]

Menopause may have had something to do with my OSA also. When I met my now husband in 2002 he said I never snored or stopped breathing. Those symptoms of OSA didn't seem to show up until maybe 2005 and I was 3 years into the menopausal hot flashes.
I didn't do any hormone replacement therapy due to strong history of breast cancer in my family.

Have you read RobySue's blog about her insomnia?
She would be the best person to maybe come up with some ideas to help you deal with the wake ups and insomnia since she has dealt with it first hand. When I had the fragmented sleep and minor sleep maintenance insomnia I knew what was causing it.
In my case it was pain from some old injuries and arthritis. Still hard enough to figure out a way to manage it but I at least had a name and face to my problem.

Have we seen any of your cpap software reports to even know if what sleep you are getting is even doing what it is supposed to do?
I don't remember if I have seen any of your reports.

Forgot, I tried HRT just to see if it would help me sleep....no love there either. Interesting that your sx showed up at about the same time into menopause as mine, 3+ years in.

[lorraineg57]

I was one of those lucky ones. While I slept horribly at the sleep lab, they were still able to titrate me a pressure. But I had extra energy the next two days and got lots of stuff done. Then I had to wait 3-4 weeks for them to review the results, order a machine, deal with the DME, force the DME to go back and give me the right machine which was another week delay.

Getting a better mask fit was the goal of the first month and figuring out the machine and how to read the data and adjust my own settings.

I'm about 2 1/2 months in now. My energy was pretty much up from week 1. But I'll still have good weeks / bad weeks. AHI from severe to below 2.0 most nights.

Within the first two weeks I stopped having to get up 3-5 times each night in the early AM hours to go piddle.

Mask / pressure / aerophagia issues are minimal enough that I feel like I'm getting good rest each night. About once a week, I'll do something like take the mask off and sleep without it for a few hours, but it's not frequent and when I wake up again I just put the mask back on.

I always mask up when I lay down for a quick nap. The interesting thing is that a 30-40 minute nap now feels refreshing. Prior to CPAP, I'd lay down for 40 minutes and wake up even more tired. Which would then cause me to turn over and go back to sleep for 2-3 more hours and I'd still wake up feeling like a zombie.

I no longer have to take a nap every day during the lunch hour, plus another nap at 5pm after work is over.

I'd be thrilled if I just felt like I wasn't going to fall asleep driving home from work. Massive bags under my eyes...lol. I actually look forward to going to bed, hoping this is going to be the night I sleep through the night. The excitement wears off quickly after lying there for an hour or so and not falling asleep....

[SleepyToo2]

What other things would cause the messed up sleep architecture?

Lot of stuff. Google Sleep Maintenance Insomnia to start with. People have fragmented sleep all the time and they don't have sleep apnea. We like to blame OSA for all our problems but often we have problems with sleep that are totally unrelated to OSA.
Pain, meds, bed comfort, external stimuli, bed room temp, anxiety, depression, general health issues just to name a few things that can mess with our sleep.
Not saying that is what is going on with you but something is waking you up and those are some things that do mess with sleep architecture.
Is this new problem or old problem?
Fragmented sleep for any reason simply can make us feel like crap the next day. Doesn't have to be solely blamed on OSA diagnosis.

Can I add/clarify a couple of things?
Thyroid function
Colds/allergies
Room humidity
Newness/hardness of the mattress and/or pillow? This is one I am currently exploring ...
I am getting a lot of spikes in my tidal volume/minute vent charts - definitely challenging to sort out!

[Pugsy]

Robysue's blog
http://adventures-in-hosehead-land.blog ... er_19.html

Why look at your software reports now? Well, maybe it would show us something that needs work that might help you.
When I first started this therapy I felt horrible. Not one whit better. Back then getting the software and card readers for those older machines wasn't so easy so it took me a bit of time. After about 2 weeks had the software and it was real obvious that the pressure was quite getting the job done. Long story that I won't go into about my titration study but let's just say I didn't get much sleep and not the best chances to find optimal pressure.

I am REM stage sleep worse...more events during REM...lots more. I also woke up around 90 minutes into sleep because that is when REM typically starts. Once I increased my pressure just a little the events dramatically reduced and I started sleeping finally on the machine.
I don't know if that is your situation but all we have to go on is what we have available to use and since you are having problems that may or may not be related to OSA and/or your therapy let's at least look at what therapy you are getting to see if something is screaming "fix me". Gotta start somewhere when we feel like crap....might as well make sure that the reports don't show anything before looking elsewhere. Do the easy detective work first.

[robysue]

lorraineg57,

How long before I could tell CPAP was working?

In terms of data: Immediately.

In terms of how I felt (during the daytime OR when going to sleep OR immediately upon waking): Four or five months. And the first three months were a living hell of growing insomnia and growing daytime dysfunctionality---as in fatigue, sleepiness, and general non-alertness during the daytime and what felt like a complete inability to get to sleep with the mask on anywhere near a reasonable, normal bedtime.

The first sign that CPAP was doing me some good was extremely subtle---to the point where I would have missed it had I not been keeping a sleep log as part of my War on Insomnia. About four months after starting therapy I began to notice the phrase "Woke up with no hand or foot pain today" was appearing in my sleep log notices several times a week. By month five, I was noticing that the hand and foot pain had disappeared completely.

I'd also like to bring up a couple of ideas regarding your sleep study information:

Hypopnea is defined as a 30-80% reduction in airflow from
baseline. Hypopneas must be associated with a 4% desaturation to be counted as part of the apnea +
hypopnea index (AHI). . (emphasis added)

So your sleep study was done using the Medicare standard for scoring Hypopneas instead of the so-called Alternative standard for scoring Hypopneas. In other words, a hypopnea was only scored if there was a 4% drop in O2 saturation; if your airflow dropped by 50-80% and there was an associated EEG arousal, but the O2 did not drop by at least 4%, the arousal was apparently NOT counted as respiratory related. This is significant because:

Sleep fragmentation: There was moderate sleep fragmentation with 126 arousals and 5 awakenings greater
than one minute to yield an arousal +awakening index of 22.8 events per hour.
Respiratory parameters: The oxygen saturation on room air was 98 %. There were 6 apneas and 30
hypopneas yielding an apnea + hypopnea index (AHI) of 6.3 events per hour. Of the 6 apneas counted, 1 of
these apneas was a central event.

So there are some 90-95 arousals that were not counted towards the AHI because they did NOT involve an oxygen desaturation of 4% or more. The pertinent questions are: How many of those 90-95 arousals would have been scored as "hypopneas with arousal under the Alternative standard? How many of those 90-95 arousals would have been labeled as RERAs if the lab were looking for RERAs?

While the "definition of hypopnea" doesn't lead to drastically different diagnoses for most people tested for OSA, it can and does affect a small number of those tested. In my case, had the lab only been testing for hypopneas under the Medicare (Recommended) standard, I would have been sent on my way with a "You don't have OSA because your overall AHI = 3.5; your REM AHI = 0.0, and your supine AHI = 4.0." (Supine sleep was only about 30 minutes out of a four-hour sleep window; and I seldom sleep on my back at home.) But with the Alternative standard hypopneas, my overall AHI jumps from the acceptable 3.5 to the unacceptable 23.1 (with REM and supine AHI being less than that.)

So given that your pre-diagnostic Epworth Sleepiness Scale score is 14, something is going on. You've got lots of arousals that were scored in the sleep study. The parts of the sleep test report you quoted seem to imply that these arousals were not counted towards the AHI and, indeed that they were essentially ignored because they did not meet the Medicare standard. Did the lab count Alternative hypopneas or RERAs at all? We don't know. But if there is no so-called RDI listed on your report, then it's a fair bet that they did not attempt to score these two types of sleep disordered breathing at all.

So given the fact that you've had lots of other diagnostic stuff done, the fact that HRT didn't help, and the fact that your pre-sleep test Epworth Sleepiness score is excessively high, I think it's a reasonable hypothesis that you do have some sleep disordered breathing going on, but it has not yet deteriorated to the point of having the vast majority of your events count as hypopneas under the Medicare guidelines. In other words, I think your OSA-type events lead to arousals before the expected O2 desaturation occurs---in other words, you're "waking yourself up" or "arousing" before the desat gets bad enough to make the event count as a hypopnea under the standard used by your lab.

[lorraineg57]

What other things would cause the messed up sleep architecture?

Lot of stuff. Google Sleep Maintenance Insomnia to start with. People have fragmented sleep all the time and they don't have sleep apnea. We like to blame OSA for all our problems but often we have problems with sleep that are totally unrelated to OSA.
Pain, meds, bed comfort, external stimuli, bed room temp, anxiety, depression, general health issues just to name a few things that can mess with our sleep.
Not saying that is what is going on with you but something is waking you up and those are some things that do mess with sleep architecture.
Is this new problem or old problem?
Fragmented sleep for any reason simply can make us feel like crap the next day. Doesn't have to be solely blamed on OSA diagnosis.

Can I add/clarify a couple of things?
Thyroid function
Colds/allergies
Room humidity
Newness/hardness of the mattress and/or pillow? This is one I am currently exploring ...
I am getting a lot of spikes in my tidal volume/minute vent charts - definitely challenging to sort out!

Thyroid function checked,
chronic congestion (nasal) due to inflammation

Mattress and pillow are fine as far as I know.

I just downloaded my data, now all I have to do is find a tutorial as to what all the spikeys and pretty colors mean! The help section isn't very in depth?