Worse off using my CPAP (depression/lethargy amplified)

[Spreech]

I've been using a CPAP for about three months now. My original in-clinic sleep study (<1 hour ["REM was not recorded" the tech noted]) indicated an AHI of 10, so I was given the F&P ICON Auto CPAP machine & the Pilairo Q Nasal Pillow mask. I was highly optimistic once I got the machine, as I have maladaptive depression and unprecedented lethargy--thought I found a good treatment for these ailments!

I responded positively for the first few weeks I was on it, then I became depressed and lethargic again. As if that wasn't hard enough, I lost my insurance--so now I can't see my sleep specialist! Hopefully this is just temporary until I find a new job. Getting a job is rather hard to do when I'm too tired to get out of bed (sleeping 13 hours doesn't give me much time to job hunt!).

I have taken the liberty of adjusting my CPAP in hopes that I can ameliorate the situation. My machine originally had a pressure set as "Min 5 Max 10 (cmH2O);" I'm not sure this is even a good pressure for me!

Below is a collection of NOTEWORTHY Sleepyhead data over the past MONTH. If you notice an anomaly, please enlighten me! I know it's a lot of data to review, but it's greatly appreciated--thank you!


Averages for March:
Compliance: 42%
AHI: 7.29
Obstructive Index: 2.17
Hypopnea Index : 5.12
Flow Limitation Index: 1.75


March 5th (cmH20 5-10)



March 23rd (cmH20 5-10)



March 25th (cmH20 5-7) (first time ever changing my pressure)



March 26th (cmH20 5-7)



March 27th (cmH20 5-7)



March 30th (cmH20 5-7)



March 29th (cmH20 5-8)



March 31st (cmH20 5) (I set a fixed pressure)



April 1st (cmH20 5-13)

[Julie]

You said you chose 'noteworthy' nights to show us... does that mean all are anomalous, or are they typical? Over any given time (e.g. weeks, months) anyone can have odd nights where things look off, strange, etc, but it's the overall picture that counts, and how you feel, not the one-in-15 night where you leaked a lot because you mask got out of place, or you forgetfully ate something acidic before bed and silent GERD kept you from decent sleep.

[Spreech]

You said you chose 'noteworthy' nights to show us... does that mean all are anomalous, or are they typical? Over any given time (e.g. weeks, months) anyone can have odd nights where things look off, strange, etc, but it's the overall picture that counts, and how you feel, not the one-in-15 night where you leaked a lot because you mask got out of place, or you forgetfully ate something acidic before bed and silent GERD kept you from decent sleep.

Thanks for the response. Below is an excerpt from my (recently edited) original post:

Averages for March:
Compliance: 42%
AHI: 7.29
Obstructive Index: 2.17
Hypopnea Index : 5.12
Flow Limitation Index: 1.75

[Morchella]

Well, I will let the experts handle the subject of your graphs, but it seems to me that if you're only using it for 4 or more hours per night 42% of the time, and your average AHI is nearly as bad as the AHI you were diagnosed with, it's not at all surprising that you're not feeling better!

What's happening during all those night time hours that you're not using it? Are you awake with insomnia, or are you sleeping without the CPAP? I've only been using CPAP for a month, but I didn't start feeling any mood benefits until I managed to cut the CPAP-less sleep down to one hour per night or less (ideally zero). The stress hormones being created by the suffocation were REALLY messing with my brain.

[Julie]

I would change your settings to e.g. 7 and 12 to see if it improves anything, and make a serious effort to get more hours of using the machine... right now there isn't enough consistency in any parameter to make decisions on.

[robysue]

Spreech,

You write:

Below is a collection of NOTEWORTHY Sleepyhead data over the past MONTH. If you notice an anomaly, please enlighten me! I know it's a lot of data to review, but it's greatly appreciated--thank you!

Averages for March:
Compliance: 42%
AHI: 7.29
Obstructive Index: 2.17
Hypopnea Index : 5.12
Flow Limitation Index: 1.75

The thing that immediately jumps out is that compliance figure. It means that you have used the CPAP for at least 4 hours on only 13 of the 31 days in March.

For CPAP to work, you have to use it every night, all night long. You ought to use it for all naps as well.

You also write:

I responded positively for the first few weeks I was on it, then I became depressed and lethargic again. As if that wasn't hard enough, I lost my insurance--so now I can't see my sleep specialist! Hopefully this is just temporary until I find a new job. Getting a job is rather hard to do when I'm too tired to get out of bed (sleeping 13 hours doesn't give me much time to job hunt!).

If you are sleeping 13 hours a day, but you're using your machine less than 4 hours a night on most nights, that's a big problem. As in a big enough problem to explain why you are once again depressed and lethargic.

When you first started PAPing, was your compliance far better by any chance? If so, the lack of compliance is the most likely reason you are now back to where you started.

Until you deal with the compliance problem, CPAP is not going to do much for you.

You also included a bunch of daily data screen shots that look funky, for lack of a better word. I see that you are using SH 1.0-beta. The usage data on all the selected days ranges from just under 2 hours to one night with about 7 hours. Which is consistent with the summary compliance data presented earlier.

But there are no tables that show the nightly AHI and other summary data for each night. You should not be getting those 0.0 Happy Faces in the left side bar. The event table is also missing. I'm aware that there have been issues with SH not showing the flow rate data for the F&P Icons, but this goes well beyond that problem.

Have you ever seen the event table at the top of the daily detailed data in SH? Have you ever gotten a list of summary data instead of the Happy Face in the left side bar?

Without the event table we're all flying blind in terms of whether your pressure settings are way off or pretty decent.

[Spreech]

Thanks for the replies so far! To answer some of the questions you had I'll post the data from my "Overview" tab. You may need to actually zoom out (holding "Cntrl" & "-" usually zooms out) to see the entire graph on here.

[robysue]

Spreech,

The overview data confirms what I said about your usage.

In the last 31 days you have:

• not used the machine at all on 10 days
• used the machine less than 4 hours on 10 days
• used the machine at least 4 hours on 11 days

The longest stretch of non-use or low use is a 10 day stretch from March 5 to March 21 (inclusive).

The longest stretch of fully compliant use is a 4 day stretch from March 28 to March 31 (inclusive). But the longest actual usage on any of those days is bit less than 6 hours. But you tell us that you are sleeping 13+ hours a day. That's a lot of time sleeping without the CPAP on, even on the days when you are technically "in compliance".

On the days when you attempt to use the machine, the beginning of "therapy" is highly inconsistent. Some nights you turn the machine on at roughly 1:00-2:00am. Other nights you turn it on as early as 8:00 or 9:00pm

All of which means that you are not using the CPAP as it is designed to be used. CPAP is supposed to be a full time thing: You are supposed to use it every time you sleep for the full duration of the sleep period. In other words, if you are sleeping 13+ hours a day, the usage should be 13+ hours a day. And it isn't.

The most likely reason that your depression and lethargy symptoms have returned is that you are not using the CPAP enough to make a difference.

When did you first start PAPing? What did your usage look like then?

I'll reiterate what I said before: There is no evidence in the data you post that you need to tweak the machine's settings. The data suggests that in order to fix your daytime symptoms, you need to work on fixing your compliance. You will only feel better long term when you start using the machine every time you sleep for the full duration of your sleep. Until you are consistently using the machine every time you sleep for the full duration of your sleep you most likely will NOT see any improvement in your depression adn lethargy.

So I'll end with this: Why are you not using the machine consistently? What is preventing you from putting the mask on when you choose not to use it? What is making you take the mask off before you are done sleeping on the days you do use the machine?

[BlackSpinner]

Putting a condom on your night stand will not prevent pregnancy or STD's. It has to be where it will do the actual work.

[Mudrock63]

Every time you sleep without treatment, your body incurs damage. Let's say you cut yourself with a knife. That wound heals a little every day until everything is back to normal. Unless you keep cutting the same place with the knife. Then it not only does not improve, it gets worse, maybe infected, and you end up dead. Yeah, it's an analogy, but I think it is on point as to why you need consistent therapy to treat OSA. It takes many people months to the greater part of a year to feel markedly better. And that is with constant treatment, every time they sleep.

So, commit to the therapy, take charge, or frankly, why bother? I am telling you that six months in, I feel like a new man. But I also put in the work to study the condition, learn how to monitor my therapy, and learn how to adjust my machine.