What's going on?

[roslynr]

Think I was asleep most of time prior to 7am; probably fell asleep at 6am, wokeup at 8ish.

[roslynr]

Well, another restless insomniac night. Clear airways are high again. Also see leaks were much higher than normal; probably because of restlessness. Not sure what to make of it. I can't tell if CAs are awake or not; I did try turning machine on/off but don;t see much of that on graph. All I know is that my body needs some restful sleep......

Here's the Sleephead story board: http://s1289.photobucket.com/user/rozr1 ... 8315565063

Any input welcome......

[Pugsy]

After the 1:00 time frame I can see 3 breaks in the therapy line. So yeah, looks like a poor sleep quality night for sure.

Is the insomnia something you have had long term problems with or just since cpap therapy start?
Trouble getting to sleep? Staying asleep? Both?
Do you take any meds...even OTC? If so what are they and dosage and when you take them.

[roslynr]

Light sleeper forever, insomnia chronic, but worse since back on cpap.
I have trouble both falling asleep and getting back to sleep when i awaken during the night.
I have used various aids for insomnia. Zolpidem 5gm seems to work the best; I do sleep through the night. However, I don't want to get hooked on it. Also now with CAs I'm more concerned about taking any type of narcotizing medication at night. Is this a valid concern?
I do take a lot of other meds for rheumatoid arthritis and other conditions.
After dinner: Sulfasalazine two 500mg tabs, hydroxychloroquine half 200 mg tab
Before bed: Simvastatin 20mg tab, 81 mg aspirin, Methotrexate five 2.5 mg tabs once a week
Others in the morning and lunch time.

[Pugsy]

Zolpidem is generic Ambien. While it is a controlled substance it isn't the type of narcotic that normally would make centrals worse.
If it was it wouldn't be given so commonly for people undergoing a sleep study.

Are the above meds the only ones you take?
With the RA it's obvious that you have quite a bit of pain and that is going to make sleep fragile...add that into chronic insomnia and it just makes a bad problem worse.
I do have plain old osteoarthritis and have to take pain meds for this or I wouldn't get any decent sleep from waking up a gazillion times a night due pain every time I move. When I discussed this problem with my sleep doctor we decided that Ambien was a better solution than something like the Tylenol #3 meds with codeine because of those potential problems.

Have you researched thoroughly all the meds that you do take to see if any of them are known to mess with sleep? I don't have the time right now to do it but sometimes you have to did deep. We aren't looking to change meds...just try to figure out if there's something there that might be a factor in your insomnia.
You would be surprised how many meds affect sleep. My daytime pain med is tramadol (generic Ultram) and while it comes with a may cause drowsiness sticker there are a few people who it actually causes insomnia and I happen to be one of them. It I take it after 6 PM in the evening I am wide awake at 1 AM.
This is why the discussion with the doctor about finding something to help me deal with the pain during the night. The tramadol works great during the day for pain control but if I take it at night I don't sleep so I need something to help me sleep through the pain.

For the past couple of years I have been taking a really small dose of amitryptiline at bedtime to help with the sleeping and the pain.
In really small doses (10 or 20 mg) they have had good results with it helping pain not to mention the may cause drowsiness part of it. You might talk to your doctor about it to see if it would work okay with your other meds to see if it was a viable option to help with getting better sleep.

Do you still have some ambien you could take so we could maybe get you to have a good night's sleep where we could have a better idea if the clutter we see on your reports is awake/semi awake clutter or stuff we need to be really concerned about.
Your report last night...it could be ugly from awake/semi awake clutter or just the possible complexSA. It would be really good to have 4 or 5 hours of uninterrupted sleep (I know that's asking a lot) but then we would have a better idea just how scary those centrals really are.

[roslynr]

I'll be happy to do the Ambien tonight so i can get a good night's sleep.
Forgot to mention I also take melatonin at night as suggested by my doctor; obviously not working so well.
I do not have much pain from the RA so don't think it's impacting my sleep. all the RA meds are mostly to prevent further damage.
I do take some other meds in the morning and will do some research on all the meds to see which may impact sleep.
Again, many thanks for your support. It's good to talk to someone who understands.

P. S. Interestingly, I just did some research on apnea and Ambien and it appears that Ambien seems to be useful in reducing both central and obstructive apneas. Maybe worth getting hooked on Ambien if I can get some good sleep. Will do some more research.

[roslynr]

Morning Pugsy. Here's my info from last night with Ambien. I did have some abdominal pains that were bothering me so sleep was not as pure as other nights on Ambien. I did fall asleep pretty soon after machine on, within 15 minutes I think. Same after bathroom break and later break to deal with abdominal pain.

http://s1289.photobucket.com/user/rozr1 ... 2388157316

Do you see anything of interest? Are there any setting adjustments I shoud be making? Thx.

[Pugsy]

How come we can't get that last hour, where things are great, all night long?
If you notice during that last hour the pressure didn't want to go up either. Makes me wonder what changed during that last part of the night. How come you need more pressure earlier and not later.
How about opening the maximum a little? Max 14 instead of 13.

[roslynr]

It might be the abdominal pain that was disturbing my sleep earlier and setlled fown towards morning. I'll try the 14cm setting and report back on Tuesday morning. Have a great weekend.....

[robysue]

roslynr,

I'm sorry it's taken me so long to get back to you. But you're in good hands with Pugsy.

Some random seeming questions and comments:

1) What kind of abdominal pain? Aerophagia or something else? In other words, did it start after you put the mask on or did it precede going to bed? Abdomonial pain can certainly wreck havoc on the quality of sleep.

2) I want to make sure I have a reasonable synoposis of you situation: You report a history of both sleep onset insomnia and sleep maintenance insomnia that predates CPAP, but has been aggravated by PAPing. You've taken Ambien in the past intermittently with some luck, you're currently taking melatonin and the melatonin doesn't seem particularly effective. You're also on a bunch of meds for RA. The pain from the RA is not too much of a problem for you, but the meds are needed to prevent further deterioration of your joints. You don't currently think the meds may be aggravating the insomnia. Does this seem like a reasonable synopsis?

3) You're starting to have a few hours of sleep here and there---mostly late in the night---that with PAP are looking apnea free and that you believe you are sleeping reasonably soundly. But the beginning of the nights are still rough---both in terms of insonmia (at least sometimes) and in terms of the numbers of OAs and CAs. Is that also correct?

So---if I have an accurate picture of what's going on, here are my comments.

A) Continue to try out Pugsy's ideas in terms of tweaking the settings. If you can get the number of OAs to decrease, its possible that the CAs will also decrease if they're post arousal CAs.. If you can get the number of OAs to decrease, but the CAs remain unacceptably high, then we'll need to look much more closely at them and the possibility of CompSA or a combination of OSA and CSA. But worry about that later---right now the focus needs to be on increasing the (subjective) quality of your current sleep and trying to get the obstructive events under control.

B) Start doing some serious work on the insomnia. Since you don't mind taking the Ambien and it works for you, you can start there. If you are comfortable with the idea of taking the Ambien every night for a week or so, then consider doing that. But if you really don't want to take the Ambien every single night, you could take it in a way to try to prevent too many sleepless nights in a row: In other words, instead of taking Ambien every night, you could take the Ambien as follows:

• If you DON'T take the Ambien on Tuesday night and you sleep "ok", then DON'T take the Ambien on Wednesday night.
• If you DON'T take the Ambien on Tuesday night and you have serious problems with the insomnia, then TAKE the Ambien at the beginning of the night on Wednesday. This should prevent two really bad nights in a row.
• If you TAKE the Ambien on Tuesday night (because Monday night was a disaster) and you sleep "ok", then DON'T take the Ambien on Wednesday night.
• If you TAKE the Ambien on Tuesday night (because Monday night was a disaster) and you still have serious problems with insomnia, the TAKE the Ambien at the beginning of the night on Wednesday. But if you find yourself taking it every night for six or seven days in a row because it's NOT helping the insomnia, then it's time to call the prescribing doc and let him/her know what's going on.

C) But in addition to taking the Ambien (either every night if you're comfortable with that or using the kind of schedule I proposed above), you ought to consider what kinds of things you can do in terms of behavior that may help starve the insomnia monster. In particular, if you spend a lot of time clock watching when you are in bed and you're not sleeping well, you need to turn the clock around or put it on the other side of the room to make it harder to watch the clock. Also make sure you are sleepy instead of just tired or exhausted when you go to bed. And as hard as it is to do, you may need to get out of bed if you find yourself lying awake for extended periods of time. If you do get out of bed, go to a different room and do something soothing, relaxing, and (hopefully) sleep inducing. Go back to bed when you start to feel like you're going to fall asleep anyway.

If you've never considered behavioral approaches to helping manage the insomnia, consider buying a copy of Sound Sleep, Sound Mind by Dr. Barry Krakow. He's got a large number of very practical ideas how to train your body to understand that being in bed means it's time to be asleep.

[Pugsy]

Question...I don't know if this has been covered before but do you sleep in any one position for the bulk of the night?
Is there a chance that the position you end up with during that last good hour of sleep is different from the first part of the night?
Just wondering if sleep position is what changed or maybe you just finally get into good solid sleep state at the end of the night.

[roslynr]

Hi Folks,

First let me answer your last posts:

a)Pugsy - I don't seem to be able to remember what position I wake up in. I do know that after the initial apnea diagnosis in 2008ish, I trained myself to sleep on my side. That's where I usually am most comfortable and most likely spend most of night in that position. I will see if I can start remembering position at each arousal point.

b) Robysue - Your syspnosis is right on. I have worked on insomnia in many forms such as Delta wave sound (Dr. Jeffrey Thompson), Sleep Doctor program (Dr. Rubin Naiman), music audios, hypnosis ausio, etc. I do not stay in bed if I can't fall asleep or go back to sleep within a reasonable time. I'll try your Ambien regimen. Abdominal pain has disappeared over this weekend. Hopefully it was a temporary 2 week episode.
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Last night's sleep was very interesting. I woke up this morning feeling rested. I had a really stuffy nose last night so I used a full face mask, with which I always have leakage problems. I took an antihistamine tab before I went to sleep at about 1:30. Looks like I had no clear aiway events at all. I did have a bathroom break early on and went back to bed with mask on immediately thereafter. The graphs are showing an hour and half break from machine. That was not the case; I fell back to sleep with mask on right after bathroom break and woke up with mask on. Very strange indee.d

My real question is what happened to centrals? I have an appointment with my primary care doc tomorrow and want to be able to talk to her abount CAs if they're really an issue. Think I'll take an Ambien tonight and see what happens.

here's the sh data:
http://s1289.photobucket.com/user/rozr1 ... 2755178955

Justed checked Encore for last night and it's showing the 1.5 hour break as well. Wow, i have no idea what happened. I do know I went right back to bed after bathroom, and i do remember puttin the mask back on immediately. I have my machine set to automatic on. Very strange indeed and a bit scary since I have no idea what happened.

[Pugsy]

Let me put the images here.
Do you have EncoreBasic software? From 5AM to wake the leaks were massive. The missing time...maybe the machine shut off due to leaks???

[khauser]

That's weird ... I don't understand the leaks graph. Why would Total Leaks be so high when Leaks is low???

Pugsy, in your (very excellent) writeup on the subject of leaks, I think you only talk about Total Leaks for Respironics machines. I understand that ResMed systems only report excessive leaks while Respironics reports the total (which for everyone else's benefit is the EXPECTED leak from the vent on the mask PLUS additional leaks).

What is the Leak (not Total Leak) line supposed to indicate?

Thanks!

[roslynr]

Just added Encore graphs: http://s1289.photobucket.com/user/rozr1 ... 0710175735