Still fighting with sleep and CPAP after many years

[otterley]

Hello, I am back here after a few months. Sorry but my problems are not really resolved...

Reminder : french man 52 years old, no risk factor but anxiety disorder, diagnosed with moderate sleep apnea (AHI 27) few years ago, on CPAP machine for about 3 years. Whatever I tried with CPAP machines until now, I feel exhausted (and depressed) minimum 50% of times.

Last six month I was under dental appliance instead of CPAP with exactly the same results : exhausted minimum 50% of the time. I am using Sleep Analyzer (which does claim to have medical-grade sleep apnea detection) for 2 years, it says low apnea, even with dental appliance... But it detects severe apnea without any aid.

So last week I made a reboot !! I retried the CPAP with EPR 3, and I feel better these few days. It works better but far from perfect... Always very random sleep.

Here are some Oscar screens of last nights for advice :

https://imgur.com/a/Am9BuDr

This morning I had an appointment with a sleep Doctor I've never met. She said maybe my anxiety is causing breath disorder and I don't have really sleep apnea !!
She asked me to try to sleep without any device. She did not want to be told about home sleep analyzer (bullshits...).

I am disappointed. I've recently red that article : http://www.apneaboard.com/wiki/index.ph ... _and_BiPAP
It says anxiety and apnea can be resolved by Bilevel.

That was my hope before. Now I am confused.

[Dog Slobber]

I am using Sleep Analyzer (which does claim to have medical-grade sleep apnea detection) for 2 years, it says low apnea, even with dental appliance... But it detects severe apnea without any aid.

What is the name of this medical-grade, Sleep Analyzer?

[otterley]

Withings Sleep Analyzer

[ChicagoGranny]

She said maybe my anxiety is causing breath disorder and I don't have really sleep apnea !!

She might be an idiot. Untreated sleep apnea is well known to cause anxiety.

She said maybe my anxiety is causing breath disorder and I don't have really sleep apnea !!

Did you tell the moron about this:

diagnosed with moderate sleep apnea (AHI 27) few years ago

[ChicagoGranny]

Here are some Oscar screens of last nights for advice :

https://imgur.com/a/Am9BuDr

Not a bad night. Mask leaks are under control. Which model mask are you using?

There is a good chance that your CPAP therapy combined with a good sleep hygiene program could resolve your anxiety.

[otterley]

I use full face mask.

What do you think about Bilevel to treat my flow limits ?

[ChicagoGranny]

What do you think about Bilevel to treat my flow limits ?

Which position(s) do you sleep in?

Where you see the pressure spikes, I suspect you rolled onto your back or tucked your chin. A firm foam cervical collar will prevent the chin from dropping toward the chest. When the chin drops, it tends to crimp the airway.

In the meantime, you could raise the minimum pressure to 10.0 and see what happens.

I don't think bilevel is called for at this time.

[otterley]

I sleep on the side.

I am not fan of the idea of sleeping with a collar because it adds again something

Ok to set min pressure higher but I want to go step by step, maybe 9 ?

[robysue1]

Reminder : french man 52 years old, no risk factor but anxiety disorder, diagnosed with moderate sleep apnea (AHI 27) few years ago, on CPAP machine for about 3 years. Whatever I tried with CPAP machines until now, I feel exhausted (and depressed) minimum 50% of times.

...

So last week I made a reboot !! I retried the CPAP with EPR 3, and I feel better these few days. It works better but far from perfect... Always very random sleep.

Here are some Oscar screens of last nights for advice :

https://imgur.com/a/Am9BuDr

How much actual sleep do you think you got during the 8 hours you were using the APAP?

I ask because there's a lot of jaggedness + CAs in that flow rate graph, even at this scale. And the question is just how much of it is sleep-wake-junk breathing? And you turned the machine off and back on a total of 3 times during the night, and two of those "turn the machine off and back on" times occur within a 30 minute period, which also begs the question of whether you were actually asleep during that half hour or so.

Next, what seems to be driving those pressure spikes is a lot of activity in the flow limitation graph. A modest increase in minimum pressure might help quite a bit.

You also write:

I am not fan of the idea of sleeping with a collar because it adds again something

My advice is to put off adding a collar precisely because it adds something else that you have to get used to. In other words, my guess is that your sleep is fragile for reasons other than your well treated OSA when you are using the CPAP (or the oral appliance), and that to go from "feeling exhausted and depressed a minimum 50% of times", you need to work on fixing the bad sleep---i.e. you need to consider whether you are so restless during the night that the restlessness itself is what is causing the daytime sleepiness and exhaustion.

Anxiety (and depression) can also cause sleep problems. In other words, there can be a viscous feed back loop: Bad sleep can cause more anxiety and more anxiety can cause even worse sleep. And pretty soon, the whole thing can escalate because the two feed off each other:

... > more anxiety > more bad sleep > more anxiety > more bad sleep > more anxiety > more bad sleep > ....

So it's also worth thinking about whether your anxiety disorder is well controlled or not.

Ok to set min pressure higher but I want to go step by step, maybe 9 ?

Yes, you should go step by step. While many people have not real issues with increasing the min pressure by several cm in one fell swoop, other people do find that the increase in pressure adds to any anxiety problems they're dealing with.

Worth noting: Your Resmed APAP allows you to increase the minimum pressure in increments as small as 0.2 cm. You might want to go very slowly and increase the min pressure by 0.2cm every 2 or 3 days as long as the overall quality of your sleep is not getting any worse.

[otterley]

You're right and I set min pressure at 8.6 tonight, we'll see if it helps.

About my sleep I know I fight against insomnia and OSA. And there is a lot of junk sleep of course during 8h of this recording. And I went to bathroom two times I think.
But in fact it was not a bad night and today I did not feel exhausted, just a bit tired but bearable.

I have treatment for anxiety, but it is difficult.

[ChicagoGranny]

I set min pressure at 8.6 tonight, we'll see if it helps.

Going to 8.6 from 8.4 is not going to help anything.

[robysue1]

I set min pressure at 8.6 tonight, we'll see if it helps.

Going to 8.6 from 8.4 is not going to help anything.

No it's not going to fix the flow limitations, but it's also not going to break anything.

Not everyone can handle a big jump in pressure, and otterley's sleep is already fragile. Moreover, in his current data, there are a lot of CAs as well as flow limitations. The flow limitations do mean he will eventually need to get the min pressure up around 10cm, but all those CAs point to a potential problem with plain old bad sleep where he's spending a lot of the night in sleep-wake-junk. A bigger increase in pressure could very well increase the amount of SWJ, which by itself may be why he's not yet feeling better on a lot of days.

[robysue1]

About my sleep I know I fight against insomnia and OSA. And there is a lot of junk sleep of course during 8h of this recording. And I went to bathroom two times I think.
But in fact it was not a bad night and today I did not feel exhausted, just a bit tired but bearable.

If this is "not a bad night", then no wonder you do feel exhausted on nights that do meet your definition of a bad night.

You will feel better only when you get both the insomnia and the OSA under control. Even with all those flow limitations in the data you posted, I think your bigger problem is the insomnia.

As for the bathroom trips: Did you wake up with an urgent need to go? Or did you wake up and then decide to go simply because you were awake anyway?

I have treatment for anxiety, but it is difficult.

It is worth talking with the doc who is treating the anxiety about the difficulties you are having. As I said before, I think the anxiety and the bad sleep are working together to cause your daytime exhaustion when you are using the APAP.

[otterley]

Hi today I think a little better than yesterday.
Note that if anxiety was the main problem it was unlikely to have a good sleep !!

Here are the Oscar results : (with SPO2 datas)
https://imgur.com/a/OwQUhFU

As usual mainly CA which seem to be false and junk sleep only ?

Question is to know if using Bilevel could may me feeling less anxyous during sleep like it is mentioned here http://www.apneaboard.com/wiki/index.ph ... _and_BiPAP

Have a nice day !

[ChicagoGranny]

Here are the Oscar results : (with SPO2 datas)
https://imgur.com/a/OwQUhFU

I don't see the pressure graph. Here are instructions for standard formatting - http://www.apneaboard.com/wiki/index.ph ... ganization

Question is to know if using Bilevel could may me feeling less anxyous during sleep like it is mentioned here http://www.apneaboard.com/wiki/index.ph ... _and_BiPAP

You skipped over the part where Dr. Krakow says, "Remarkably, many sleep lab techs do not push forward with the titration at this point, believing that their job is done. Even some proportion of sleep medicine physicians do not mandate that their sleep techs increase pressure for flow limitation."

I would increase the pressure to see how things go. (Still would like to see your latest chart in the proper format.) This is an easy experiment for a night or two. You don't have to go through the trouble and expense of procuring a bilevel machine at this point.

But yes, if you are sensitive to pressure on exhale, a bilevel machine could help. We just don't know whether you have this sensitivity. You would have to procure a bilevel machine and experiment.