Can You Fix Bad Sleep With A CPAP Machine?

[rocklin]

I know DD might have an opinion on this.

But for everyone else, are you able to separate the results of your sleep hygiene from the trial and tribulations of your nightly titrations?

When you wake up in the middle of the night: was it that can of soda at lunch, or an understented HA?

[Kody]

I've figured out if I don't get at least 7 hours sleep, even if the numbers look good I'll still get tired in the afternoons.

Man I miss the day's as a teenager when I could drink half the night away, sleep for 4 hours, get up and go to work feeling great! These days if I tried that they'd have to call an ambulance.

[greatunclebill]

I've figured out if I don't get at least 7 hours sleep, even if the numbers look good I'll still get tired in the afternoons.

Man I miss the day's as a teenager when I could drink half the night away, sleep for 4 hours, get up and go to work feeling great! These days if I tried that they'd have to call an ambulance.

i hear ya. 40 years ago in the military in japan and korea. get off work and hit the village. run the bars til 2 or 3 in japan and til curfew in korea. sleep a few hours and be to work at 7. next night same, etc, etc,etc. one long party. now i get tired just thinking about those days and nights. i average 5 or 6 hours a night. maybe i need a little more.

[robysue]

I know DD might have an opinion on this.

I've learned the hard way to agree with DD on this: You can't fix inherently bad sleep with just a CPAP machine.

But for everyone else, are you able to separate the results of your sleep hygiene from the trial and tribulations of your nightly titrations?

When you wake up in the middle of the night: was it that can of soda at lunch, or an understented HA?

When I wake up in the middle of the night it could be a cluster of events that snuck through or, more likely, snoring IF its the OSA that's the cause of the wake.

But it's just as likely or perhaps more likely that the wake was triggered by any one of the following:

• Too much TV or web browsing too close to bed time. Clearly Kaa can't prevent me from staying up too late doing things I shouldn't be doing.
• Nose feeling wet, drippy, or congested. Could be a bit of rainout (blame Kaa for this one) or it could be doing the sinus rinse to close to bedtime or it could be not doing the sinus rinse at all.
• Aerophagia (blame Kaa) or indigestion as in: I ate something I shouldn't (blame the pizza and beer) or I ate too late (blame my night class).
• Pain. Perhaps from a headache that's caused by TMJ or a migraine or allergies now that spring is here. Perhaps from the torn MCL. Perhaps from not turning around enough in bed and then waking up really needing to move around a bit because something got sore. Except for the MCL-related pain, wakes caused by pain have gone down since the migraines and TMJ have both been brought under control through the use of Deplin, riboflavin, and magnesium for the migre
• Hubby turning over and "ruining" the spot where I had my nose snuggled into his side.
• Waking up TOO HOT. Well, I am menopausal after all. Or it could be our silly heater kicking in an overheating stuff before turning itself off---particularly if I wake up and hubby's sweating buckets too.
• Waking up TOO COLD. Usually because I kicked all the covers off at the last "woke up TOO HOT" wake up.
• One of many other things that slips my mind right now

Now if the question is: Can I tell what caused the wake in the middle of the night at the time it happens rather than waiting until morning when I look at the data?

The answer is sometimes. Congestion wakes are pretty easy to distinguish. As are pain related wakes. Right now with the torn MCL, if I turn over "wrong" in bed, I'll wake up with real MCL pain. Hubby turning over wakes are easy to distinguish because those are the ones that I have to figure out what to do with the pillow and covers to get comfortable again.

As for wakes caused by apneas/hypopneas that sneak by Kaa: Sometimes I can tell that's probably what happened and sometimes I can't. For example, sometimes I simply wake up feeling "yucky" in a non-descript way, and I think these are probably apnea-related arousals. And sometimes I wake up noticing the machine is pumping air at 8/6, a sure sign of recent snoring or a cluster of events. Or I'll "jolt" or "jerk" awake rather suddenly. Not with a sense of choking or a sense of not breathing----just a sudden whole body jerk that jolts me awake. And these most often happen when I'm just beginning to fall into real sleep and I know from my diagnostic study, that's one of the times when I seem to be more prone to having events---I think DD called it "sleep instability" periods when he was analyzing the graphs in my sleep studies back in April 2011 under the guise of NotMuffy and Muffy.

And if you let me look at the data in the morning, it becomes very clear that the majority of my wakes are NOT caused by an OSA event in the last 4 or 5 minutes preceeding the wake. So it's hard to blame them on the OSA.

[BlackSpinner]

No. I was sleeping fine before and after cpap.
The last year - not so much - however when i do sleep it is good sleep with my cpap machine.

Now back to my regularly scheduled dose of chips and dip.

[ems]

I'm guessing you have "bad sleep". I know... I'm such a genius.

I ditto every word that Robysue said. I will add one more... when I wake during the nite, do I wake b/c I have to go to the bathroom - or, do I wake b/c of one of the reasons that Robysue mentioned? My doctor suggests that I wake up due to one of the reasons Rs mentioned... and then decide I have to go. Is she right... who knows. Getting up during the nite to go to the bathroom (4/5 times) was one of the reasons my doctor picked up on sleep apnea. I don't wake as often now... sometimes once during the nite, sometimes twice, sometimes not at all. Now, the other morning (about 5:30) my bed started shaking slightly - that woke me up since it was a 4.0 earthquake! Another thing to add to Rs's list of why we wake up.

I don't think bad sleep can be cured with CPAP or BPAP, altho people have written that it does. If one is afraid to go to sleep b/c of complications resulting from sleep apnea, then maybe once you have the mask on you can allow yourself to relax and fall asleep. I still have a problem falling asleep... getting back to sleep is much easier for me.

For many of us, sleep evades us as we get older... even if we do practice good sleep habits.

[NightMonkey]

I know DD might have an opinion on this.

But for everyone else, are you able to separate the results of your sleep hygiene from the trial and tribulations of your nightly titrations?

When you wake up in the middle of the night: was it that can of soda at lunch, or an understented HA?

Critical Path

1. You know well that CPAP machines (in the case of OSA) are to fix collapsing airways. Use CPAP software to give an indication that the airway issue is indeed resolved.

2. Beyond that the sleep study may have identified other problems that need attention.

3. If these problems are adequately addressed and there are still problems then institute strict sleep hygiene. (A basic sleep hygiene program is good for anyone.)

4. If there are still problems then a discussion with a GP and a fresh and thorough physical are a good idea.

5. If issues still remain then a journal and some introspection might be revealing.

6. If still unresolved then the sleep doc should be consulted and another PSG should be considered.

[ems]

Rather interesting link...

http://www.familypracticenews.com/news/ ... 47cc3.html

[rocklin]

Seeing D's post:

Upon further review, my main point may not have been entirely clear. Towards that goal, I might offer the following supplemental information:

YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!

Thank you.

Made me review my sleep doctor's current push for me to try ASV.

My problem, is indeed, that I can't sleep.

.
____________________________________________________________________________________
.

Despite what K seems to say ("Can't sleep? Come to our mountaintop resort, sample our rarefied air at 3 to 30cm, and you will!"), and my ancient, atavistic male desire to try the newest Sharper Image toys . . . that ASV is looking like a potential Sleep Vietnam every time I read a new thread here.

I'm beginning to think that since I undoubted violate a number of The Rules of Sleep Hygiene (ROSH) as expressed by DD:

viewtopic.php?f=1&t=42266&p=372562&hili ... ne#p372562

I should go for the obvious, low tech solution first.

.
____________________________________________________________________________________
.

But some of the sleep hygene seems chicken or egg:

If I drop my BMI, will I sleep better for reasons other than it might reduce my OSA?

Won't using a CPAP ultimately help me to (exercise more, reduce binge eating, etc.) and, thus cut my BMI?

.
_____________________________________________________________________________________
.

I was sleeping fine before and after cpap.

I slept way, way better before CPAP.

But my ResScan score are one and zeros, with a diagnosed AHI of 70+, so how can I even consider stopping?

.
_____________________________________________________________________________________
.

Man I miss the day's as a teenager when I could drink half the night away, sleep for 4 hours, get up and go to work feeling great!

40 years ago in the military in japan and korea. get off work and hit the village. run the bars til 2 or 3 in japan and til curfew in korea. sleep a few hours and be to work at 7. next night same

It seems that youth is wasted on the (often wasted) young, yes?

.

[MaxDarkside]

But some of the sleep hygene seems chicken or egg: If I drop my BMI, will I sleep better for reasons other than it might reduce my OSA? Won't using a CPAP ultimately help me to (exercise more, reduce binge eating, etc.) and, thus cut my BMI?

There's nothing wrong with marching Escher's stairs, so long as you are going upward, forever. Actually, if you use CPAP and cut your BMI and your reduced BMI cuts your OSA, and your reduced OSA cuts your use of CPAP, I do think you will oscillate to an optimal equilibrium, just so long as you reach it before your BMI goes to zero. (LOL)

[napstress]

I use CPAP to improve sleep quality. I try everything else under the sun (or should I say moon?) to improve sleep quantity.

I was hoping that when the CPAP reduced the number of microarousals, then I would no longer pop out of sleep completely in the middle of the night. Or that if CPAP therapy improved the quality of the insufficient number of hours of sleep I do get, I would at least feel a bit better. My AHI has been 1.7, 3.9, 2.7, 1.1, 1.0, 1.9, and 1.2 for the past seven days. Like RobySue, the data shows that I rarely have an event just before my complete awakenings, so I conclude that the UARS is likely not the culprit. Also, I often wake up unaware of the mask for a while; other times, it's huffing on my face: so I doubt therapy is the culprit 100% of the time.

I think I'm zeroing in on gluten and/or hormones as likely causes of my sleep-maintenance insomnia.

Thanks for your question; it's exactly what I'm focusing on these days and I'm glad to have a chance to articulate my thinking on the subject.

[robysue]

Rocklin,

I apologize in advance for the length of this reply. But you bring up a number of important issues for those who struggle to make this crazy therapy work---in the sense of feeling a subjective improvement in the quality of one's life.

CPAP can't fix bad sleep

Seeing D's post:

Upon further review, my main point may not have been entirely clear. Towards that goal, I might offer the following supplemental information:

YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!

Thank you.

....
My problem, is indeed, that I can't sleep.

The question that needs to be addressed is: Why can't you sleep?

And deltadave's point that YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE is all about addressing the question of why you can't sleep. All too often the assumption by PAPers is "If I can't sleep, there must be something wrong with my therapy"---as in "wrong with the machine settings" or as in "CPAP just doesn't work for me". Deltadave simply points out---repeatedly---that sleep issues go beyond the sleep disordered breathing that our machines are designed to treat.

So a real analysis needs to be done: Why can't you sleep?

If there are concrete identifiable reasons for not sleeping---serious pain issues; medicine with insomnia as a side effect; RLS, PLMD, ineffective PAP therapy in the sense of way too many events sneaking through; or significant comfort issues (with CPAP or the bed or anything else), then those issues must be addressed before you're likely to get decent quality sleep, let alone high quality sleep.

And when the PAP therapy is effective (in terms of reducing the AHI to less than 5) and all other identifiable causes of fragmented sleep have been dealt with appropriately, that's where deltadave's mantra of good sleep hygiene comes into play . In other words, if the sleep is bad and there's no apparent cause, the sleep itself is just bad. And the sleep is probably "just bad" because of lifestyle choices---i.e. bad sleep hygiene. And the fix for this problem is to reteach the body how to sleep well by cleaning up the sleep hygiene.


Sleep hygiene or push for an ASV?

Despite what K seems to say ("Can't sleep? Come to our mountaintop resort, sample our rarefied air at 3 to 30cm, and you will!"), and my ancient, atavistic male desire to try the newest Sharper Image toys . . . that ASV is looking like a potential Sleep Vietnam every time I read a new thread here.

I'm beginning to think that since I undoubted violate a number of The Rules of Sleep Hygiene (ROSH) as expressed by DD:

viewtopic.php?f=1&t=42266&p=372562&hili ... ne#p372562

I should go for the obvious, low tech solution first.

And a bit later in your post you write:

my ResScan score are one and zeros, with a diagnosed AHI of 70+

Since your AHI < 2 every night, it doesn't seem particularly likely that a machine that's been designed to tackle the complex situations of central and complex sleep apnea that don't resolve (in the sense of AHI) with CPAP will allow you to sleep any better: The OSA is no longer what's causing the bad sleep and the ASV won't manage the OSA any better than your current machine does.

So if I were you, I'd start working harder on good sleep hygiene instead of pinning my hopes on a different machine being a magic bullet---particularly when it's known that the different machine is much more expensive, can be difficult adjust to, and is designed to treat a problem that you don't seem to have.


CPAP and weight loss

Won't using a CPAP ultimately help me to (exercise more, reduce binge eating, etc.) and, thus cut my BMI?

No. Alas, the CPAP won't "help" you to exercise more, reduce binge eating, or anything else concerning what you do with your life in the daytime. The CPAP fixes the OSA, and thus makes it easier to breathe at night when you are asleep.

Now, the hope is that if you ever train your body to accept the CPAP as the new normal for nighttime sleeping, that the body will then start sleeping better with the CPAP than it did without the CPAP. So you should eventually wake up feeling a bit better and with a bit more energy with the CPAP than before.

But what you choose to do during the daytime remains up to you. And it is those daytime choices that ultimately matter:

The way to "exercise more" is to make a conscious decision to "exercise more". And to design something that is reasonable in terms of what you are capable of physically and what you're willing to do mentally.

The way to "reduce binge eating" is to decide to stop doing it. If need be, you quite buying the foods you binge on. If they're not in the house, you're less likely to binge.

The way you cut your BMI is through hard work. You have to have a sensible way of cutting the total calories you consume each day to less than you burn each day (diet). You have to have a sensible way of increasing the total number of calories you burn each day (exercise). And you have to do the work long enough for results to come. And you have to do this in such a way that you don't encourage the body to become even more efficient at extracting energy from the food you eat---in other words, you have to keep your body's metabolism from believing it is starving so that it extracts as much energy as possible out of every calorie it burns and stores as many calories as possible as body fat. And then you have to not revert back to the bad habits that lead to the weight gain in the first place.

In the grand scheme of things, the CPAP is a tool in a battle to lose weight. The CPAP will manage the OSA and hence it can help reverse some of the metabolic changes in how your body burns calories, which should make it easier to lose weight by actually burning more calories when you actually do physical things. But your conscious mind still must make the difficult choices every day, all day long to keep you on course in the battle to lose the weight.


A case study of my Sleep Quality: The conundrum of I slept better without the machine and the connection to You can't fix bad sleep with a CPAP machine

I slept way, way better before CPAP.

But my ResScan score are one and zeros, with a diagnosed AHI of 70+, so how can I even consider stopping

It took me over a year of PAPing before my sleep felt better with CPAP than without. And for a significant chunk of that time, I said, many many times, I slept way, way better pre-PAP.

And now that I'm finally, at long last sleeping better with the BiPAP than I did before starting my crazy adventure, I've done some serious reflecting on why my sleep quality deteriorated so rapidly right after I started CPAP and on why it took me so long to start sleeping better with Kaa than I slept before I started this crazy therapy. I'm not a doctor. And so I haven't the foggiest idea of whether any of my conclusions about what happened to me has any real medical validity. But I think that since you are still trapped in the stage of knowing your current sleep feels worse subjectively than it did pre-CPAP and knowing that you can't just give CPAP up because of the severity of your OSA, you might benefit by seeing what I think of my own long battle now that I've finally conquered the issue of not sleeping as well with the machine as I slept without it.

In looking back at my early trials and tribulations, I think my subjective feelings about the quality of my sleep pre-PAP and with PAP for the first 8 months with PAP were caused by a complex web of interactions.

First, pre-CPAP both my migraining and my TMJ problems posed what I thought were only intermittent problems with my sleep. Although I frequently had migraine-type head ache pain, it was not the at severe stereotypical blinding migraine pain that incapacitates you. I was familiar with that kind of migraine pain, but typically only had one of those severe headaches a few times a year. Rather, what I was discounting was the fact that more days than not, I'd have a low grade migraine-type headache: Low grade pain on one-side of my head with additional sensitivity to noise and light. And the TMJ was "under control" in the sense that I slept with a night guard and usually woke with little or no TMJ pain. But I also chewed through the night guards at an alarming rate and had substantial loud popping when I would chew things.

And pre-CPAP my sleep hygiene was very good in some respects, but very poor in regard to two of the major Good Sleep Hygiene Rules: (1)Caffeine, caffeine, caffeine that seemed to have no serious implications for my sleep and (2) Irregular wake-up times and even more irregular bedtimes.

Pre-CPAP these two big violations of Good Sleep Hygiene Rules didn't seem to much matter because my overall sleep quality was "fair" (subjectively speaking) regardless of whether I paid attention to these rules or not. And I think in both cases, these bad sleep habits helped mask the larger problem that my real sleep quality was actually on the "poor" side of "fair" because of the SDB-related arousals that I never remembered. Indeed, I now believe these two big violations of Good Sleep Hygiene Rules masked my genuinely poor sleep quality because I was running on caffeine and all the stress-related hormones during the daytime and crashing (as best as possible, given the SDB) on weekend mornings. And hence my daytime functioning was not yet being severely affected by the OSA and I woke up feeling normal enough---for me---each morning. I'd come to accept the morning hand and foot pain as "minor arthritis" and the sense of being "sort of rested" as good enough.

Once I started sleeping with the PAP, the OSA arousals went away. But other arousals and restlessness resulted in major insomnia and a serious deterioration in the subjective quality of my sleep. Much of my insomnia problem seemed, on the surface, to be related to discomfort issues concerning the PAP. And so I and the PA tackled the aerophagia with both dial-winging and changes of machines: First from CPAP to APAP and then to fixed BiPAP to Auto BiPAP. And that helped---some. But fixing most of the other CPAP-discomfort issues really involved nothing more than giving my highly sensitive body enough time to accept the PAP machine as the new normal and to learn how to live with all the new sensory stuff emanating from the machine.

But that still left some latent problems with sleep quality that had became obvious only after starting CPAP: It turns out that caffeine does severely and adversely affect the quality of my sleep far more than I realized. It turns out that my body craves a more regular schedule than my mind wants. And the migraines needed to be controlled better. And the TMJ had to be addressed more completely than with just another mouth guard to chew through.

And I also think that in the early days of PAPing, my mind missed those OSA-related stress hormones. In other words, I think that in some weird way my mind missed the cortisol and adrenaline being pumped into my body by the hidden nighttime battle to breathe well each night. And these things, aided and abetted by both the discomfort of using the CPAP AND the fact that the CPAP was managing the OSA very well (and hence reducing the nightly cortisol and adrenaline doses) all came together in the perfect storm of my CPAP-induced insomnia.

So---between the cortisol/adrenaline withdrawal, the continued use of caffeine (although in lower amounts than before CPAP), the irregular sleep schedule, and the unresolved pain issues from the migraines and TMJ, the insomnia monster continued to grow. And as the insomnia grew, both the migraines and the TMJ issues became worse as well, both in terms of daytime symptoms and their affect on my sleep. So it's no surprise that I continued to complain that I slept so much better before PAP than with it.

But with the hard CBT work for the insomnia, getting the chronic migraines under control, undergoing some long term TMJ ptreatment/therapy from a specialist in TMJ and facial pain, AND giving my body the time it needed to adjust to all the PAP-stimuli, very slowly the quality of my sleep started to improve. First, after about 8 months of PAPing and 5 months of work on the insomnia and migraines, I got to where I was able to admit that I was consistently feeling as rested with the BiPAP as I had felt before starting PAP therapy. And then, with continued CBT and light therapy, a real TMJ therapy program, and even more time for my body to adjust to the PAP-stimuli, this past winter I finally got to the point where I am now: I usually feel much more rested with my BiPAP than I did before starting PAP therapy. And even on my bad nights now, I feel no worse than I felt on my typical (good) pre-PAP nights.

In other words, now that I've "fixed" the other non-SDB causes of my bad sleep through treating my chronic migraines, treating my TMJ, AND cleaning up my sleep hygiene, my sleep is now pretty good night after night while using my BiPAP. In other words, my pretty good sleep is not due to using the PAP and nothing else; my pretty good sleep is the result of both well managed OSA AND pretty good sleep itself. The PAP manages the OSA and the combination of good sleep hygiene and appropriate treatment of my migraines and TMJ insures the "pretty good sleep" itself.

So, of course, the big point of my reflections is: Deltadave is right: You can't fix bad sleep with a CPAP machine. But if you have OSA, then you have to fix both the OSA and the bad sleep at the same time. And it's hard work. *sigh*

Chicken and egg issues: Or how to break a self-reinforcing negative feed back loop

But some of the sleep hygiene seems chicken or egg:

If I drop my BMI, will I sleep better for reasons other than it might reduce my OSA?

Yes, there's a nasty feedback loop between weight and untreated OSA. And it is a chicken-and-egg question of which came first. But it doesn't really matter "which came first" because the only way of treating both problems is indeed to treat both problems simultaneously.

And if both problems can be treated successfully at the same time you replace the negative feed back loop with a positive one. In other words, instead of both conditions feeding each other leading you to feel as though you are forever DESCENDING that infinite loop of Escher's staircase, successful treatment allows you to turn around and start ASCENDING Escher's staircase to be start eventually feeling better and better.

And since weight problems are connected to a whole host of non-OSA problems that affect the sleep, losing weight could indeed help you sleep better even f it does diddly-squat for the (untreated) OSA.

Less weight in and of itself can lead to more energy to do things. More time spent doing things leads to a better sense of being appropriately tired and sleepy at night. Which helps with the sleep problem.

And then there's the whole "chicken and egg" relationship between weight and exercise (and "getting exercise" is part of good sleep hygiene). The downwards direction on Escher's staircase is: I feel to tired to exercise, so I don't. Which aggravates the weight and sleep problems. Which leads to more fatigue. Which leads to less exercise. Which leads to ...

The only way to turn it around is to make the conscious choice to start somewhere: Some light exercise typically leads to feeling better (eventually) and possibly makes it easier to sleep and possibly provides some motivation to control the weight, both of which tend to lead to a bit more energy that makes it a bit easier to be active, and so on.

[deltadave]

As always, an excellent summary, RS.

I would offer the sister of

YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!
YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!

which would be

A CPAP MACHINE MAKES BAD SLEEP WORSE!!!
A CPAP MACHINE MAKES BAD SLEEP WORSE!!!
A CPAP MACHINE MAKES BAD SLEEP WORSE!!!
A CPAP MACHINE MAKES BAD SLEEP WORSE!!!
A CPAP MACHINE MAKES BAD SLEEP WORSE!!!
A CPAP MACHINE MAKES BAD SLEEP WORSE!!!
A CPAP MACHINE MAKES BAD SLEEP WORSE!!!

[Drowsy Dancer]

Something that took me a rather embarrassingly long time to notice was that over the years pre-CPAP my sleep habits had deteriorated significantly, perhaps in response to worsening OSA over time. The CPAP machine did not make the habits go away when it reduced my AHI. Six hours a night of high-quality sleep was a substantial improvement over six hours a night of fragmented sleep, but it wasn't all I needed to do. Imagine my horror to discover about a month ago that eliminating caffeine entirely produced a substantial improvement in my sleep. I really, really didn't want that to be my reality, but the data is too clear for me to believe it's just a post hoc fallacy.

I have been equally horrified to observe how much better I feel with more regular bedtimes and arising times.

Expressed in formal logic, the CPAP was necessary but not sufficient.

[NightMonkey]

As one who has no sleep problems except SDB, this thread has opened my eyes a great bit. It has made me think about the many people who have unresolved sleep problems in addition to SDB. No doubt this is a major factor in the high CPAP compliance failure rate.