new user = walking dead

[jasont]

Just began CPAP therapy last Thursday, using PR System One 60 Series Auto CPAP with PR System One heated humidifier and Pico nasal mask. So far I appear to be tolerating the therapy very well; however, I now feel like I have been hit by a mack truck of exhaustion every day. I have read a ton of posts about sleep debt and about how long it may take new users to feel better; however, in almost every case the sleep debt and/or continued exhaustion appears closely related to issues with the new user still needing to find the 'right' equipment, the right pressure, the proper mask, etc. In my case, that doesn't appear to be an issue.

Quick background:
I never felt much in the way of 'excessive daytime sleepiness', but I have also carried a pocketful of caffeine and Adderall for years, so I have likely been self-treating fatigue for quite some time.
My sudden development of high blood pressure over the past few years, coupled with snoring, led my wife to suggest exploring this solution.
Sleep studies showed mild apnea (only 6-7 AHI, 10 RDI) but with moderate desaturation down near 80%. Titration study showed therapeutic dose of only 6cm pressure needed, so the MD felt I would tolerate therapy easily.

Results of the first four nights:
7 hours of sleep per night with only 1-2 awakenings/night (to use the restroom or adjust the mask).
I appear to be tolerating the mask/machine very well and leaving it on all night. No mask leaks showing in the data.
The data shows the machine appears to be doing its job and prevent hypopnea episodes.
I wear a fitness monitor that monitors my sleep as well and it has been showing ostensibly twice as much restful sleep compared to before therapy (1.5 hours restful/night before vs 3 hours+ restful on the machine)
Titration study appears to have undershot the pressure. Actual 90% pressure has been: 9.5, 11.0, 9.5, 10.5 with corresponding AHI of 2.4, 1.5, 1.7, 2.4

So, why do I feel worse now, like I have been hit with the fatigue stick? Again, almost everything I have read about sleep debt seems correlated to the fact that the CPAP was actually making things worse at first, but in my case, it appears to be doing the job. Or is it possible that I am actually getting worse sleep now even though everything I can monitor appears to say otherwise?

Thanks in advance for any/all help.

[jasont]

Side note - I have a pretty good employer-provided healthplan with United Healthcare. My understanding is PR System One Series 60 Auto is a pretty good machine; however, my DME provider gave me a used model with 1750+ hours. Shouldn't I have received a new product? This is not a rental, it is to be my personal machine.

[ChicagoGranny]

So, why do I feel worse now

I would like to see some SleepyHead detail of a typical night before commenting - https://sleep.tnet.com/resources/sleepyhead

however, my DME provider gave me a used model with 1750+ hours.

I would not tolerate this. It's been used 200+ days.

If you do trade it back to them for a new machine, make sure you get a ResMed or Philips Respironics machine that is an auto and says, "Data Yes", on this page - https://sleep.tnet.com/cmd

[jasont]

So, why do I feel worse now

I would like to see some SleepyHead detail of a typical night before commenting - https://sleep.tnet.com/resources/sleepyhead

I will download the data and update tonight.

however, my DME provider gave me a used model with 1750+ hours.

I would not tolerate this. It's been used 200+ days.

If you do trade it back to them for a new machine, make sure you get a ResMed or Philips Respironics machine that is an auto and says, "Data Yes", on this page - https://sleep.tnet.com/cmd

I updated my posts to change the name of the current machine from REMstar to Respironics (didn't realize REMstar was the old name). I am using the full data capable Series 60 auto now.

But yes, I agree a 200+ day used machine is unacceptable - wanted to make sure used wasn't typical of what people receive. I'm not sure how that is even legal - nothing in my paperwork mentioned it was a 'used' machine and the the list rate they are billing insurance ($1596 before insurance discounting) is more than it would cost me to pay cash out of pocket for a brand new one online...

[Gasper62]

"But yes, I agree a 200+ day used machine is unacceptable - wanted to make sure used wasn't typical of what people receive. I'm not sure how that is even legal - nothing in my paperwork mentioned it was a 'used' machine and the list rate they are billing insurance ($1596 before insurance discounting) is more than it would cost me to pay cash out of pocket for a brand new one online..."


I'd inform them that they're playing a dangerous game if they're representing a used machine as being new, and charging for it as such. (Fraud) Also inform them that your insurance company might frown on the practice. (unless they're in cahoots and kickbacks are involved) How much will your co-pay be, if any ?

[Morchella]

For me, pre-CPAP I was "tired but wired" -- so mentally foggy that I could hardly concentrate, but not falling asleep at my desk or taking naps or any of that. I was also having a lot of problems with anxiety. Once I hit 6-7 hours per night with the CPAP, my mood became markedly calmer, and I suddenly felt sleepy all afternoon. Sleepy in a "mmm, I wish I could cuddle up with a big fluffy blanket" sort of way.

So for me, the stress hormones circulating through my body all night from the repeated suffocation events were preventing me from feeling relaxed enough to perceive my fatigue as "sleepiness". Once that nightly ordeal of stress went away, my body absolutely craved more of that safe, healthy, cozy sleep. That lasted for several weeks, and it's still hitting me a few days a week now (I think I'm around 6 weeks into CPAP).

[jasont]

So, why do I feel worse now

I would like to see some SleepyHead detail of a typical night before commenting - https://sleep.tnet.com/resources/sleepyhead

I've got the data downloaded to sleepyhead - what's the best way to present it here?

[jasont]

For me, pre-CPAP I was "tired but wired" -- so mentally foggy that I could hardly concentrate, but not falling asleep at my desk or taking naps or any of that. I was also having a lot of problems with anxiety. Once I hit 6-7 hours per night with the CPAP, my mood became markedly calmer, and I suddenly felt sleepy all afternoon. Sleepy in a "mmm, I wish I could cuddle up with a big fluffy blanket" sort of way.

So for me, the stress hormones circulating through my body all night from the repeated suffocation events were preventing me from feeling relaxed enough to perceive my fatigue as "sleepiness". Once that nightly ordeal of stress went away, my body absolutely craved more of that safe, healthy, cozy sleep. That lasted for several weeks, and it's still hitting me a few days a week now (I think I'm around 6 weeks into CPAP).

Thanks - that's kind of what I am thinking might be occurring. And if that is the case, how long it would take to feel 'normal' was a concern - so your anecdotal results help!

[palerider]

So, why do I feel worse now

I would like to see some SleepyHead detail of a typical night before commenting - https://sleep.tnet.com/resources/sleepyhead

I've got the data downloaded to sleepyhead - what's the best way to present it here?

there's a link on the web page you just posted above....

[Jay Aitchsee]

there's a link on the web page you just posted above....

under Docs and tips, I think
https://sleep.tnet.com/reference/tips/imgur

[ChicagoGranny]

I've got the data downloaded to sleepyhead - what's the best way to present it here?

---------------------------------> Have a look at these instructions:

On the left side turn off the calendar by clicking on the triangle by the date.
Also the pie chart doesn't give us very much info so you can turn it off by going to File - Preferences -Appearance - Uncheck Show event break down pie chart
That allows us to see the machine details on the left.

The graphs that are usually helpful are:
1. Event Flags
2. Flow Rate
3. Pressure (not mask pressure)
4. Leak
5. Flow Limit (only with Resmed machine)
Put your graph in that order by grabbing, by the labels, with your mouse and dragging it where you want it.
Now grab the line between the graphs and resize them until you get them in one screenshot.

Take a screen shot after you organize your graphs.
F10 will close the right sidebar ( or click file - view - uncheck right side bar).
F11 ( or click file - view - check fullscreen toggle) on your keyboard before you take your screenshot and it makes it full screen with no ID info.
Take a screenshot by pushing F12 or under View - click on Screenshot
Screenshots are found on my computer under Documents - SleepyHeadData-Testing - Screenshots

Then at Imgur you have to sign up for an account then sign in. upload your pic.
Click on the triangle by your ID in the upper right corner and a menu will drop down.
Choose Images this will take you to a screen with your uploaded images on it. Click on the image you want.
Click on Large thumbnail then copy the Linked BB code into your reply. Here is an uploaded screenshot for example.

Ask questions, if needed. If you get a chart up, and it is not quite right, plenty of critics (lol) here to help you.

[jasont]

Thank you for detail on which statistics to upload! Here are the past four days

[palerider]

there's a link on the web page you just posted above....

under Docs and tips, I think
https://sleep.tnet.com/reference/tips/imgur

I was thinking about the one "Organize your SleepyHead Charts"

[jasont]

I should also mention that the first two nights I was using a nuance pro nasal pillow; however, when the pressure ramped up a bit on night two I found that I tended to dislodge the nasal pillow more than the prior evening. So, nights 3-4 I switched back to the Pico nasal mask I had used in my sleep study and I think I like that better since it remains more firmly seated on my face if I move around.

[Holden4th]

I've been on 'effective' CPAP therapy for about 6 weeks now and I know it's working as my mood and attitude have changed. The sleep debt issue is the one thing that makes the difference. Over the weekend I woke up during the night for a 'constitutional' and went back to bed, forgetting to put the mask back on before I went to sleep. I zombied through a woolly fog all the next day.

Last night I got 7 hours sleep with the machine last night and it wasn't quite enough. I didn't have a great day but it wasn't like the day before. I was far more chilled and lucid but felt like I'd missed out on sleep. To me this means I am still paying off my sleep debt and will be for a while. My scores are always under 5 and go down to the low 1s. I think I will suddenly wake up one day and realise that the sleep debt is gone and that raises a new question. At this point, how many hours sleep will I need per night.