OK after 3 years, Back to CPAP

[Pugsy]

Did you know you could look at the events tab in SleepyHead and click on the type of event and that takes you to each event and the time it happened and the number in parentheses is the duration of the event in seconds? If they are barely making the 10 second flag criteria it is unlikely that those centrals (real or not) are causing in desats unless there is a huge dense cluster. We can hold our breath a lot longer than 10 seconds without any drop in oxygen.

Regarding feeling better despite the not so pretty report (which it really isn't all that ugly)...about 3 months into my therapy I woken up feeling amazing and felt awesome all day long. Back then I made a point to not check my data until the evening because I didn't want to make one of those self fulfilling prophecies come to light. So I finally checked my reports and was thinking "I bet I had a really low or 0.0 AHI"...boy did I get a rude awakening...it was 10.4 or something like that..over 10 I am sure.
It's not all about the AHI and actually the AHI is only a small part of it but we use it because we seem to need validation by numbers.

A nice low AHI and a nice pretty report doesn't guarantee anything other than we can give ourselves a nice pat on the back. Wish it were that easy to feel the good numbers.

[FUQE3]

Here's the event report so we can all see how clustered the CAs are and what kind of duration:

[Pugsy]

The clustering isn't as dense as the report might lead us to believe.
The bulk of the events are short lived...if we look at say the 6:35 time frame there's about 4 or 5 within a few minutes of each other and they are short lived. I doubt it causes any O2 drop.

I once had 17 centrals within 17 minutes...have no idea what happened and I didn't think that I was awake but I might have been. It happened like yours..in the hour preceding final wake up and get out of bed.
I blamed the aliens. They get blamed for stuff I can't explain.

[FUQE3]

Aliens or not , here's an interesting wiki post aboit REM sleep and how it affects our breathing:

Steady REM Sleep[edit]
Ventilation[edit]
Irregular breathing with sudden changes in both amplitude and frequency at times interrupted by central apneas lasting 10–30 seconds are noted in Rapid Eye Movement (REM) sleep. (These are physiologic changes and are different from abnormal breathing patterns noted in sleep disordered breathing). These breathing irregularities are not random, but correspond to bursts of eye movements. This breathing pattern is not controlled by the chemoreceptors, but is due to the activation of behavioral respiratory control system by REM sleep processes. Quantitative measure of airflow is quite variable in this sleep stage and has been shown to be increased, decreased or unchanged. Tidal volume has also been shown to be increased, decreased or unchanged by quantitative measures in REM sleep. So breathing during REM sleep is somewhat discordant.

In a study of 19 healthy adults, the minute ventilation in REM sleep was 6.46 +/- 0.29(SEM) liters/minute compared to 7.66 +/- 0.34 liters/minute when awake.[1]

here's the link https://en.wikipedia.org/wiki/Sleep_and_breathing

This might explain why I tend to have higher CAs in the final stages of sleep and why not getting that full final stage leaves me feeling so dreadful!

Any thoughts?

[Pugsy]

Those wee hours of the morning right before we normally wake up is when we typically will have more REM sleep so it's very possible that is what is going on here.
It's also possible that the final sleep stage is being interrupted and that accounts for some days feeling worse than others. Maybe we complete the cycles and wake up after the cycle is completed instead of in the middle of it.
I think mollete hits upon this in the CPAP Basics threads in the Announcements section. I don't remember exactly where this was mentioned though.

[FUQE3]

Is this the page you were talking about?

viewtopic.php?f=1&t=88696&hilit=+CPAP+Basics+re%3A

[Pugsy]

No, I don't think that is what I was thinking about. What I was thinking about was a discussion about what happens when we wake up in the middle of a sleep cycle...like wake up in the middle of REM and have great difficulty being fully awake vs other times we wake up bright eyed and bushy tailed. I wish I could remember where that discussion was....or heck, maybe I dreamed it

[FUQE3]

I haven't posted for a couple of days in order to allow more data to gather and the more Sleepyhead data I see, the more I am seeing that CPAP has my OAs and Hypopneas under control; WELL under control.
However, my nights are clearly littered with sleep maintenance problems and the quality, duration of the critical last couple of hours are clearly the determining factor in whether or not my day is a disaster.

I spoke to my doctor about trying 10mg of Amitriptyline, and he was happy to give it a go. Unfortunately, I don't think this is going to work for me. The half life is so long that no matter how early I take it, I am still at its mercy until the early afternoon. I haven't felt any specific benefit from taking it either. But hey, you have to be willing to experiment and my doctor is fortunately along for the ride (as long as it makes sense). I can't imagine what the much larger doses would feel like. For me, this is just another failed attempt to find the sleep holy grail.

So what am I learning here? Well, I am learning that you can have mild apnea but it means nothing if you still can't stay asleep when it's most beneficial to do so, that the quality of sleep can depend on a whole host of challenges that have to be addressed one by one.

So here are the Sleepyhead charts for the last three nights:

Three nights ago was a great night. This is how my charts look when I can rule the world.



Note the low number of centrals. I only used ambien that night and in small amounts.
The next night was a disaster. Note the same looking fragmentation as the night before but much larger clusters of centrals in the final hours of sleep:



It looks like a great night's sleep, but I had the most awful day afterwards. I did note that my chronic back pain played a role that had me sleeping on my back in the final segment of sleep.

Last night I took Amitriptyline again (around 9pm) and had a good night until the early hours where once again, I flipped onto my back out of pain and used ambien to knock myself out. My charts at this point look like someone else started using my CPAP machine. Apart from the Amitriptyline hangover, I feel like I was able to force myself back to sleep just enough to not lose the day despite the long sleep hours.



I am beginning to wonder what on earth is going on in the latter stages of sleep. Perhaps my problem is not for this forum as it's pretty clear that my CPAP therapy is having the desired effect while I feel no different.

@Pugsy, you mentioned sleep maintenance insomnia. It looks like that is exactly what is happening here.

If flipping on to my back in the final hours due to pain is causing centrals, why would that be? What on earth can I do to fix my broken sleep patterns if I am compliant with my CPAP therapy and it appears to be working yet, I can't on a regular basis eek out a full restful night's sleep?

Does anyone have any advice?

[lindalam89]

I have the same questions too about centrals on supine position.

It looks like we both followed the same routes... struggling with cpap, abandoning, resuming, and trying with medication. FUQE3, could you make a bullet point of things that worked for you? even if not significant?

As for amitriptyline and ambien. I found ambien made me drowsy but didnt put me to sleep. Amitriptyline according to my basis watch, increased my deep sleep but the body quickly adjusts to the dosage. You said 10mg made you drowsy, and you have pain problems. To this day, even though amitriptyline stopped having any effect on my sleep, it does very well for pain management. I have fibromylagia like symptoms and this is the only drug that helped my pain without cutting out my REM sleep. You can research about it. Most drugs are notorious for cutting out REM but amitriptyline for whatever reason increases slow wave sleep and helps with pain. Might be worth a try to continue the amitriptyline in low dosages for a longer period to collect more consistent data.

[FUQE3]

I have the same questions too about centrals on supine position.

It looks like we both followed the same routes... struggling with cpap, abandoning, resuming, and trying with medication. FUQE3, could you make a bullet point of things that worked for you? even if not significant?

It's hard to say as it's really too soon to tell. My issue is that while I am compliant with the CPAP treatment, I am not feeling any better on a good days vs bad days per week basis. I see my Sleepyhead charts and see that both obstructive apneas and hypopneas are well under control, but now I am seeing what appears to be CPAP induced centrals late in my sleep cycle (I may well be wrong in my assumption), particularly when in the supine position. It also appears to be directly related with just how dreadful I feel that day. So I am not sure I can make bullet points of what has worked for me given that I really feel no better than I was prior to CPAP therapy. I always had good days and bad days and I still do. Maybe my expectation of how I would feel once I was compliant was over optimistic.

As @Pugsy pointed out earlier in the thread, I have an issue with sleep fragmentation which appears to be interrupting the REM sleep at the end of my sleep cycle.. So I need to find a way to not wake up prematurely so that I feel energized the next day and this for me is a work in progress. The difference between the old me and the new is that I am willing to experiment with both drugs and healthier habits as well as CPAP compliance in order to try and get this taken care of. I'd rather not take any drugs but for now ambien helps. So if I had a list of things I need to do to help myself, it would look like this:

• Sleep Hygiene - Going to bed earlier, avoiding caffeine and alcohol, keeping the room cool and dark etc.
• Staying Healthy - Getting to the gym every morning ensuring that my weight remains in a healthy range and that I feel really tired come bedtime.
• CPAP Therapy - Keep using my CPAP machine to eliminate OAs and hypopneas.
• Drug Therapy - This is a tough one for me as I hate to use drugs. But OTOH, small doses of ambien have been helpful with getting back to sleep after frequent arousals

As for amitriptyline and ambien. I found ambien made me drowsy but didnt put me to sleep. Amitriptyline according to my basis watch, increased my deep sleep but the body quickly adjusts to the dosage. You said 10mg made you drowsy, and you have pain problems. To this day, even though amitriptyline stopped having any effect on my sleep, it does very well for pain management. I have fibromylagia like symptoms and this is the only drug that helped my pain without cutting out my REM sleep. You can research about it. Most drugs are notorious for cutting out REM but amitriptyline for whatever reason increases slow wave sleep and helps with pain. Might be worth a try to continue the amitriptyline in low dosages for a longer period to collect more consistent data.

I take very small doses of ambien and I find it helpful. Amitriptyline so far has been awful. I don't feel it has helped with my sleep at all and I have the worst hangover the next day lasting most of the day. My pain issues are from arthritic discs in my lower back that have always been painful for me. It appears they are causing me to eventually lay on my back in the wee hours and that is when my sleep quality is at its worst. I really don't want to take any drugs and clearly, any drug that affects the quality of REM sleep is one to avoid. If things don't improve, I'll have to go back to the Dr. and try and figure this out. I wish I had a magic formula for you and I am sorry you are having challenges too.

Any and ALL suggestions are welcome!

[lindalam89]

Don't want to interrupt your thread but you sound a lot like me. I'm not feeling that fantastic on cpap but then again I haven't used it long enough because I have trouble sleeping and maintaining sleep on it. Glad ambien works for you. It's true everyone has a different body chemistry.

I did not know sleeping on your back causes more central apneas. I might have understood that incorrectly. But although cpap is meant to put events under control whether side or back... I would be curious as to why the supine position would induce centrals. If you have a bad back, like another member mentioned in my thread, it might be better to stay on your back as not to aggravate the problems by sleeping on your side.

If you find something that helps with sleep maintenance, do share on your thread. My doctor said the cpap was suppose to help with maintenance but I find it has fragmented it more. Can't give up though as the machine is doing something good by keeping you AHI under normal numbers.

[FUQE3]

Don't want to interrupt your thread but you sound a lot like me. I'm not feeling that fantastic on cpap but then again I haven't used it long enough because I have trouble sleeping and maintaining sleep on it. Glad ambien works for you. It's true everyone has a different body chemistry.

I did not know sleeping on your back causes more central apneas. I might have understood that incorrectly. But although cpap is meant to put events under control whether side or back... I would be curious as to why the supine position would induce centrals. If you have a bad back, like another member mentioned in my thread, it might be better to stay on your back as not to aggravate the problems by sleeping on your side.

If you find something that helps with sleep maintenance, do share on your thread. My doctor said the cpap was suppose to help with maintenance but I find it has fragmented it more. Can't give up though as the machine is doing something good by keeping you AHI under normal numbers.

No interruption at all. I welcome all comments as we both appear to be at a loss.

I am not saying sleeping on your back causes more centrals, I am merely hypothesizing that there might be (probably not) a correlation to my clusters of centrals. I really don't want anyone to think that this is a statement of fact or even scientifically concluded. it's merely a potentially far fetched opinion.

Last night I had 23 centrals in the last 3 hours of sleep alone. I have written to my Doctor and copied him my charts. I will get back to you with his response.

Does anyone else have any ideas as to what might be happening and what to do?