Do I Really Need CPAP?

[Laurora]

Let me start off this topic by saying if you all think I'm in the bargaining stage, or delusional, feel free to tell me! But somewhat nicely, if you please. Basically, I'm not sure if CPAP is any real benefit to me, and something worth continuing.

So here's the facts: I've been using the CPAP machine for about a month. I found a mask that works well for me, and I tape my mouth close at night with great success. Sometimes I wake up and briefly forget I have the mask on--so I'd say I'm acclimated to it. When I initially did my sleep study, the numbers the doctor gave me meant nothing, but I reviewed my paperwork over the weekend and found that my overall AHI was fairly low--5.5. The reason they recommended the CPAP was due to an incident on my back; during that incident my AHI was 29. According to SleepyHead, most nights my AHI is between 1.5 and 2.

With the CPAP machine, I only sleep about 2 hours and wake up. So most nights, I have 3 sessions of about 2-2.5 hours. I have horrible nightmares all night long, and every time I wake up, I have to get up to use the bathroom. (I made an appointment to see my doctor about needing to use the bathroom all night long, so hopefully she will be able to help with that). I can barely drag myself out of bed in the morning, and I find myself more and more frustrated. I'm starting to wonder if it would just be better to do the tennis balls on the back trick and avoid sleeping on my back. Last night I decided to experiment and purposefully did not use my machine. I fell asleep much quicker than usual, and slept through the night! I felt rested and actually got up when my alarm went off (unheard of this past month). I even got to work on time, like I used to. This past month I've seemed like the worst employee ever, arriving about 10 minutes late every day because I simply couldn't get out of bed due to being so exhausted.

Today I feel like how everyone else feels when they use the machine with success--excited and with a new outlook on life. I realize this was just one night, so it doesn't mean much, but I fully expected to feel miserable this morning, not amazing. I'm perfectly willing to continue using the machine and see what happens, but this has honestly been the longest month of my life, and I don't understand why I'm getting worse sleep (and feeling worse) when using the machine. Anyone have a similar experience? Or anyone care to say what they would do in my shoes?

[ChicagoGranny]

The reason they recommended the CPAP was due to an incident on my back; during that incident my AHI was 29.

You need to look at your sleep study for a few things. How long (minutes) did you sleep on your sides? How long in each sleep stage while on your side? In each sleep stage, what was your AHI? What was your RDI in each sleep stage?

All of this information should be on your sleep study summary.

[Julie]

Stay off your machine for a week (one night won't do it because you still have residual effects from the previous ones) and see how you feel. I normally hesitate to tell anyone to stop using the machine and I'm not really serious about this time, but trying to make a point... if your Cpap experience is not yet ideal, work on the problems, don't decide this early to quit, to encourage strokes etc. down the road. We'll help you to fix things, but not to just quit.

[Laurora]

CG, I'll have to check my paperwork when I get home!

Julie, I have to admit I might be too chicken to stop using it for a week I know all too well all of the bad things that go along with apnea, and I certainly don't want to court any trouble in my life. One night is definitely not enough to tell anything much of value...I guess I was just surprised to have such a good night, when I hear so many people say how miserable they are without their machine, even for a night.

[ChicagoGranny]

With the CPAP machine, I only sleep about 2 hours and wake up. So most nights, I have 3 sessions of about 2-2.5 hours. I have horrible nightmares all night long

Please clarify if you have many nightmares while using CPAP. If so, this is an indication of REM rebound.

REM rebound is the lengthening and increasing frequency and depth of rapid eye movement (REM) sleep which occurs after periods of sleep deprivation.

New CPAPers will eventually see the nightmares decline sharply or even go away completely once their brain has "caught up" on REM sleep.

This can be a period of hell for weeks, but it is necessary to get through it.

[Laurora]

Yes, the nightmares happen while using the CPAP. I sleep about 2 hours, wake up, use the bathroom, go back to sleep and right back to the horrible nightmares. My daughter is in danger, things like that. Not pleasant, and sometimes makes it difficult to fall back to sleep after waking.

[purple]

Curious about the settings on your machine? What first comes to mind is, are you one of those people who was sent home with a machine on auto, with its settings wide open. This is the group who have problems in, using machine, and not getting enough true rest. I bet you have a soon appointment to again see Sleep Doc.

What I am thinking is that, One: You are not getting effective sleep (Yeah, you said it) Getting up at night to go to the bathroom is a sign to me that your sleep apnea treatment is not as effective as it should be. Hard to say, you might have another issue with that. OR put another way. Most of us, when we start having effective Sleep Apnea treatment find that we do not need to get up at night to go to the bathroom, or not nearly as often.

Did you dream before you started treatment? Many of us, before treatment did not dream any more. To dream we needed to reach a deeper level of sleep than we had been getting before. I know I had nightmares starting in my second year of treatment (and so have others on that same time frame, the second year) which were ugly, not helpful to how I felt when I was awake, but were maybe positive to where my treatment was going.

My first Sleep Doc told me that he felt dreams were often like what was going on in our lives at the moment of the dream. Such as, once I woke up thinking I was in the artic as an explorer and had been forced out of the shelter without my Parka. Turns out, I had pushed off the blanket, and it was below freezing in my bedroom. It was how my dreaming brain interpreted my being really cold at that moment. I have had times of financial poverty and stress, when some of the worst of my nightmares happened. "As they say, Your Mileage may vary," Is there some way you can feel better about other things going on in your life? Like convincing yourself that you are really doing heroic things despite whatever negative forces are going on? and No , I do not know anything about you or your circumstances, it is just how I would approach the night mare problem.

I bet if you go to see your doc, he will make some changes to the settings, which can make all the difference in the world.

The standard can say, for simple Obstructive Apnea, the patient is getting rest if their AHI is less than five. Personally, I needed to get my AHI down to about .2 (yes I said POINT 2, less than one) to wake up refreshed. A lot of us are different.

I do congratulate you on being able to withstand the first month without creating a crises for yourself. Some people are so anxious to quit, they take the first station off treatment. You have courage, and stamina. You rock.

[ChicagoGranny]

y daughter is in danger, things like that. Not pleasant,

This clearly sounds like REM rebound. It may be hard to believe, but it is a good indication that you are "catching up" on REM sleep and eventually the nightmares will subside.

The caveat is that awakenings during the night make the nightmares seem worse. (If you sleep completely through any dream, you never are aware of it.)

After you look again at the sleep study summary, there should be further discussions here.

[ChicagoGranny]

a sign to me that your sleep apnea treatment is not as effective as it should be.

Do you read what people post?

According to SleepyHead, most nights my AHI is between 1.5 and 2.

[archangle]

The AHI reported by your CPAP machine is the AHI with treatment, not what it would be without CPAP. You may know that, but it confuses many people.

Any particular type of nightmares? Any other problems other than the bathroom?

What's your pressure range on your machine and what range does the APAP adjust to? You might want to post a screenshot of your daily results page for one night on the machine. Turn off the right sidebar so you have more data showing. imgur.com is a good place to upload the picture to.

[Jake1]

I'm having much the same experience, and the question and responses are very helpful.

[Macpage]

I see that you are really on top of things at the present. I remember posting when you were starting and working on the interface and ways to keep the mouth closed. I also see you looked at your sleep test and gave some thought to the positional aspect of your treatment. You've really made a lot of advancememt in a short time!

I am sorry that the wake ups are getting in the way of a speedy recovery. I am on 6 months and am still working out the kinks. There really is a lot of adjustment to this process. I would say give it at least 6 months of experimenting with all aspects you can and then revisit the decision. One month really is short in making some big life changes. My tested numbers are similar to yours and I have young children. I never really had any signs of OSA except snoring until I got really ill out of the blue. Most of my issues came from the low O2, and my OSA is worse in supine and in REM. I jokingly say that all my OSA symptoms started after the treatment, so I know where you are coming from! Everything wakes me up now where before I strung together some decent sleep stages through 100 events a night. I think some of us reach a tipping point where the body can no longer handle the disturbances. If events or O2 desaturations on your side aren't affecting you more than the treatment at this "point" in your life, then you may indeed feel better for a period...

However, we know that we have OSA from our supine numbers. Thus, it is possible that you have it on your side in REM to some degree. If not at the moment, you may develop it or have an increase as you age. At some point, you may have numbers or a judgement on how you feel that requires you to use Pap. Do you really want to start all over again down the road after investing what you have already? I can honestly say that at 44 I wish I had startred all this back when I clearly had OSA but didn't know it. I imagine it would have been much easier. We get more set in our ways as the years pass and change is harder. We have other issues of health and stress. We get less sleep anyway and going without in the adjustment phase is easier when younger. Lastly, there's always the chance that waiting it out might result in more illness symptoms than tired symptoms when it advances. Trust me, no fun!

If you really do want to think about positional treatment without Pap, you must do as Granny stated and verify that you spent time in REM on your side while acheiving that mild AHI. This may require an additional sleep study. I still have events on my side when in REM. It's not uncommon and even a mild AHI in any position can result in lower O2 levels. At the very least, you will want to verify your O2 levels periodically if off the machine. There are many posts on oximeter use and interpretation. You also must be able to stay on your side and know that you are staying on your side. The tennis ball trick for 4 weeks worked for me, and I have the benefit of Sleepyhead to know I'm staying there. You will need a partner or friend to watch you closely or use a monitor. They do make a monitor that will report sleep position much like our machines report SDB with nice software to boot. If going off the machine with any level of OSA, I personally would opt for the oximeter and sleep position monitor.

I know that you are now successfully using the nasal mask in your profile, but I didn't note if you have tried or are now using pillows? My last thought would be that if you haven't tried the P10 or maybe one other pillow interface, please give it a try! They are really quite nice! Might make all the difference, as could any number of other tricks you can try with time. I wish you all the best in deciding the path that works best for you.

Best,

Mike

[ClassicsMom]

I am thinking your set-up may be the problem. Have you tried Swift Fx nasal pillows? I would definitely give them a try since they are very comfortable. I cannot imagine wearing a nsal mask since it seems very uncomfortable. It did take me about 2 months to get used to cpap and to get the nasal pillows right. Resmed has videos on proper application of nasal pillows which is critical for a good night sleep. You have to take care and not apply too tight. Also, I was an extreme mouth breather prior to cpap but the halo chin strap solved all of my problems and now I breathe through my nose at night. I have a back up Quatro FX face mask for when I am very congested nasally. I would not tape since it is a safety issue and must be very uncomfortable. There are manny different chin straps and I recommend starting with the halo chin strap.

[zoocrewphoto]

a sign to me that your sleep apnea treatment is not as effective as it should be.

Do you read what people post?

According to SleepyHead, most nights my AHI is between 1.5 and 2.

Some of us interpret things differently. Her nightmares sound like apnea event nightmares to me. And that leads me to believe that her settings are not optimized for her. Not even close. And while her ahi might be low, that doesn't mean that she isn't having few, but LONG events. When my mom was using a straight pressure of 10, she had an event 62 seconds long after a cluster of events, all over 30 seconds each. That is really bad, yet her ahi was only 3.4. Looked good to the doctor.

Also, we have not seen any graphs or even know her settings. It could easily be set wide open at 4-20. With a low ahi on her side, the machine could easily be at 4 or 5 when she rolls onto her back, and the machine can't get up to the needed pressure in time to prevent the events. Essentially untreated. She could be waking up each time she rolls onto her back because the machine is not set up to help her properly.

We need to see the graphs to get a better idea of what is going on.

[Julie]

I agree about the nightmares - those are not normal treated-sleep dreams, but more likely untreated ones.