Falling asleep every morning after mask off

[thumperbill2]

I have had this problem for a long time and am quite frustrated which is why I am asking for help.

I have an S9 which I've used for a couple years and I find myself awake enough after 8 hours sleep and take my mask off to get up. Then I find I've fallen asleep again once the mask is off and had many short dreams showing that I've had apneas during this time which can be 30 - 60 minutes. I then force myself up and am totally beat. Either that or I force myself up as soon as I take the mask off without falling back to sleep and then have breakfast. After breakfast I find myself falling asleep in the chair in front of my computer desk. I often sleep 30 minutes or more with my feel up on the desk in an office chair and again with all of the apneas.

Checked my readings on the S9 and normally have no mask leaks but AHI ranges from 5-9. I've had sleep tests done and been told my machine is set properly or to the best that it can be but I still feel so tired in the morning as well as afternoon and evening. I also have RLS and take meds for that as well as zopiclone and melatonin to put me to sleep each night.

Any suggestions would be appreciated.

[Goofproof]

Get the free software, find out the truth of what's going on. Jim

Do not sleep without the mask ever, stand up when you remove it, then keep moving.

[Pugsy]

Checked my readings on the S9 and normally have no mask leaks but AHI ranges from 5-9.

Your AHI points to sub optimal therapy. Too many events.
Get the software so you can see what kind of apnea events and not just overall number.
Also look for clustering of events which can compound the problem.

Don't know about the software? Check this out.
https://sleep.tnet.com/equipment

[Wulfman...]

I have had this problem for a long time and am quite frustrated which is why I am asking for help.

I have an S9 which I've used for a couple years and I find myself awake enough after 8 hours sleep and take my mask off to get up. Then I find I've fallen asleep again once the mask is off and had many short dreams showing that I've had apneas during this time which can be 30 - 60 minutes. I then force myself up and am totally beat. Either that or I force myself up as soon as I take the mask off without falling back to sleep and then have breakfast. After breakfast I find myself falling asleep in the chair in front of my computer desk. I often sleep 30 minutes or more with my feel up on the desk in an office chair and again with all of the apneas.

Checked my readings on the S9 and normally have no mask leaks but AHI ranges from 5-9. I've had sleep tests done and been told my machine is set properly or to the best that it can be but I still feel so tired in the morning as well as afternoon and evening. I also have RLS and take meds for that as well as zopiclone and melatonin to put me to sleep each night.

Any suggestions would be appreciated.

I agree with the others. Get the software and see what is happening during the night. Your comments point to suboptimal therapy. Also, how much sleep do you actually get at night? That may be another issue you need to work on if it's too little.

And, don't let yourself sleep without the mask and machine.

What mask? If it's a nasal mask, are you leaking your therapy air out your mouth?


Den

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[LSAT]

Do you realize that with an AHI of 5-9 and sleeping with the CPAP for 8 hours, you stop breathing 45-70 time a night? I agree that you need the software to see specifically when the events are happening, what kind of events and how long the events last.

[Thumperbill2]

Thanks for all of the advice. To answer some of the questions I was asked:

I have a nasal mask that I've used for years and fits better than anything else I've tried. I've tried several full face masks but they all leak on my face worse than the nasal. I used to lose a lot of air at my mouth and ground my teeth but got a guard that fits my lower teeth and that has helped a lot but still wake occasionally needing water for the dry mouth. I've tried taping my lips in the past but that has its own problems and didn't really help. I have a deviated nasal septum which has been operated on twice without success and have used Avamys spray for many years to help keep it open. I sleep between 8 - 9 hours each night but have actually sometimes felt better in the morning by getting up after 7 hours but then of course get worn out through the day. My sleep specialist told me this summer after my last overnight study that he didn't think my S9 could be adjusted further to make things any better.

I have the software and have read through Pugsy's description of what to look for in the app but other than seeing that things aren't good I don't really know how bad it really is or what else to make of it. The following are some of the results from last night. Thanks again for any advice you can give. I appreciate you looking at this for me.
CPAP Statistics
AHI 9.03
Obstructive Index 2.51
Hypopnea Index 1.88
Clear Airway Index 4.64
Average Leak 14.55
Daily Results:
AHI 9.03
Resp. Rate Med 13.6 95% 18.2 Max 48
Insp. Time Min .2 Med 2.24 95% 3.42 Max 10.2
Exp. Time Min .04 Med 1.8 95% 3.04 Max 5.12

AHI graph up to 4.0 first over first 90 minutes then up to 8 during next 30 minutes where it sat for 3 hours then gradually down over next hour until I got up to use bathroom.
After that AHI climbed to 14 within first half hour then up to 18 over next half hour then down to 7 over next half hour, back up to 10 for another hour and must have woken briefly as it dropped to zero then over next half hour climbed gradually again up to 17 and at that point I took the mask off.

[Wulfman...]

What are your pressure settings?


Den

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[Pugsy]

Do you spend much time awake when using the machine?
How many times a night do you normally wake up? How long does it take you to get back to sleep?
Do you take any meds of any kind? If so, what?

[Guest]

Pressure is set 9.6-12

Due to the meds I take I usually fall asleep within ten minutes
In bed 11:30 pm - 12:00 am. I usually wake once around 4:30 for the bathroom and fall right to sleep after and again around 7 am and don't always fall asleep right away but often don't get up until 8 or 9 am as I try to get more sleep while mask is on or if I take it off sometimes fall asleep before I can get up and sleep 30-60 minutes. Have occasional nights where it takes over an hour to get to sleep and I have to get up for at least a half hour before trying again.

Meds which I have taken for years:- except for beta blocker since April open heart surgery.

pramipexole .37 mg - RLS
Gabapentin 1200 mg - RLS
zopiclone - 15 mg - sleep
melatonin 10 mg - sleep

wellbutrin 150 mg - depression
citalopram 40 mg - depression
kepra 500 mg 2x/day - tardive disconesia
bisoprolol 2.5 mg - heart beta blocker
aspirin 81 mg - heart (repaired aortic ascending aneurism in April)

rosuvastatin 2 12 mg - cholesterol

[kteague]

Here's my take on it:

1. Follow suggestions to optimize CPAP treatment through data

2. Stop allowing yourself to take the mask off - whatever it takes. I have a feeling that your sleep meds could be why you are struggling so much with this. Hard to wake up enough to stop a behavior when one is sedated. Maybe a stronger tape or super strength bandaids that would cause pain when removed could help pierce the fog and help you stop taking it off.

3. Re-evaluate your medication needs with your prescribing doctors with the goal of reducing or eliminating where possible, especially where there is overlap of side effects. You are on multiple meds that could contribute to your daytime symptoms. Was your diagonosis of tardive dyskinesia determined by a neurologist? Was it caused by a med you are now off of? There are so many movement disorders they can easily be mislabeled. I had movements one doctor suggested could be tardive dyskenesia. Turns out I was having augmentation on a med, and once I weaned off the med the extreme movements resolved. Some of your meds may actually be causing or worsening your RLS. (Were you also diagnosed with PLMD during your sleep study by any chance? The dopamine agonist makes me ask that. If so, are your movements therapeutically treated or are you just sedated and sleep through them?) To be honest, your list of meds raises some concerns. I wouldn't even think of suggesting specifics of what you should do about the boat-load of meds - I'm not a doctor. I can only say efforts toward more investigation of root causes might be more productive than medicating symptoms. Maybe everything that could be done has been done and every med is necessary. If so, I apologize for the implication otherwise. Best wishes in finding out how you can feel better.

[49er]

Here's my take on it:

1. Follow suggestions to optimize CPAP treatment through data

2. Stop allowing yourself to take the mask off - whatever it takes. I have a feeling that your sleep meds could be why you are struggling so much with this. Hard to wake up enough to stop a behavior when one is sedated. Maybe a stronger tape or super strength bandaids that would cause pain when removed could help pierce the fog and help you stop taking it off.

3. Re-evaluate your medication needs with your prescribing doctors with the goal of reducing or eliminating where possible, especially where there is overlap of side effects. You are on multiple meds that could contribute to your daytime symptoms. Was your diagonosis of tardive dyskinesia determined by a neurologist? Was it caused by a med you are now off of? There are so many movement disorders they can easily be mislabeled. I had movements one doctor suggested could be tardive dyskenesia. Turns out I was having augmentation on a med, and once I weaned off the med the extreme movements resolved. Some of your meds may actually be causing or worsening your RLS. (Were you also diagnosed with PLMD during your sleep study by any chance? The dopamine agonist makes me ask that. If so, are your movements therapeutically treated or are you just sedated and sleep through them?) To be honest, your list of meds raises some concerns. I wouldn't even think of suggesting specifics of what you should do about the boat-load of meds - I'm not a doctor. I can only say efforts toward more investigation of root causes might be more productive than medicating symptoms. Maybe everything that could be done has been done and every med is necessary. If so, I apologize for the implication otherwise. Best wishes in finding out how you can feel better.

I also have the same concerns about the list of meds and strongly agree with KT's advice to review this list with the doctors with the goal of reducing or eliminating them whenever possible.

[Julie]

And don't forget (it almost seems too obvious ) that some of those meds might not be needed now if you get more productive sleep on Cpap, but right now they're fighting each other (cpap+meds) which can't be helpful.

[Pugsy]

wellbutrin 150 mg - depression
citalopram 40 mg - depression

Research the side effects (dig deep on the google searches at multiple websites) all of your meds but pay special attention to the 2 above.

Not only do they have side effects of fatigue and drowsiness...those type of meds (SSRIs) have a history of messing with sleep architecture so that you don't get the needed percentage of each normal sleep cycle.

Either one of those could be a primary suspect with your falling asleep and needing to sleep...both of them together...man I would be a total zombie.

Definitely talk to your doctor about your meds and possible side effects and/or interactions.

CPAP machines do a great job fixing sleep apnea related issues but they can't overcome meds side effects.
The best cpap therapy in the world with the optimal hours of sleep can't make a person be wide awake when meds are likely a sizable culprit in unwanted daytime symptoms.

[thumperbill2]

Thanks for all of your thoughts on my situation. Unfortunately I can't change the meds. It took me a few years to find this combination of antidepressants that rescued me from a serious burnout with anxiety attacks and clinical depression. I can't try experimenting with new ones again in the hope that they will work as well as these plus help make sleep better. The tardive dyskinesia is the type that causes freezing of a person without them being aware of it. This happened several times and the dose of kepra stopped it. I will be on it for life.

So I guess I will just have to suck it up and carry on the best I can.
Thanks for your advice. This is a great forum.

[Wulfman...]

Thanks for all of your thoughts on my situation. Unfortunately I can't change the meds. It took me a few years to find this combination of antidepressants that rescued me from a serious burnout with anxiety attacks and clinical depression. I can't try experimenting with new ones again in the hope that they will work as well as these plus help make sleep better. The tardive dyskinesia is the type that causes freezing of a person without them being aware of it. This happened several times and the dose of kepra stopped it. I will be on it for life.

So I guess I will just have to suck it up and carry on the best I can.
Thanks for your advice. This is a great forum.

For what it's worth, Sleep Apnea has been know to cause depression. Many XPAP users had been treated for depression until someone finally put 2 and 2 together and sent them for a sleep study........BINGO........Sleep Apnea. Once they got on XPAP therapy and got their therapy optimized, it went away. The stories are here in the forum archives.

Just sayin'.......

Den

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