feedback please

[darco]

Can someone give me feedback on last nites session? I woke up today like I do most days, feeling tired even tho my numbers look good (?)...Been on therapy for 659 days. I have heard of sleep debt but this is crazy. I have had insomnia/sleep issues for most of my life, I would say since my early 20's and I am now in my early 50's. I am not overweight, I am generally in good health. In a typical week , Ill have maybe one to two nites of insomnia but other nites I usually sleep solid but regardless I always wake up tired. I have used the community's feedback in past and have made adjustments to my machine...just looking for that light at then end of the tunnel
thxs

[JDS74]

Looking at your SH data, it is really odd. Your machine is reporting that it is not detecting breathing 92% or so of the time. This may be real or it may be an error in the SH display.

The leak rate graph shows periodic significant leaks that mostly correspond with spikes in pressure.

Leaks and pressure spikes can sometimes result in disturbed sleep, hence feeling tired in the morning.
First thing is to get the leaks under control and then see what is actually happening.

Since the reported pressure range is quite narrow, it might be worthwhile setting the machine to CPAP mode with a single pressure of, say, 9.5 cmH2O for a couple of nights to see if that helps.

With the "breathing not detected" flags all night long, I would not trust the event reporting and the low AHI.

How old is your mask?
How do you adjust the fit? Do you do the adjustment while lying down in sleeping position and with the pressure set to the maximum (14 cmH2O)?

Do you remember frequent awakenings during the night? Any?

[darco]

Looking at your SH data, it is really odd. Your machine is reporting that it is not detecting breathing 92% or so of the time. This may be real or it may be an error in the SH display.

**well its still in Beta....

The leak rate graph shows periodic significant leaks that mostly correspond with spikes in pressure.

Leaks and pressure spikes can sometimes result in disturbed sleep, hence feeling tired in the morning.
First thing is to get the leaks under control and then see what is actually happening.

** Ive always had leaks no matter what type of gear im using...sigh

Since the reported pressure range is quite narrow, it might be worthwhile setting the machine to CPAP mode with a single pressure of, say, 9.5 cmH2O for a couple of nights to see if that helps.

**I did try that recently, using 12 pressure, ahi was slightly up....I dont think there was any change it my tiredness

With the "breathing not detected" flags all night long, I would not trust the event reporting and the low AHI.

How old is your mask?

**I am ordering a new one now, I believe its more than a year old

How do you adjust the fit? Do you do the adjustment while lying down in sleeping position and with the pressure set to the maximum (14 cmH2O)?

**I usually adjust before the machine kicks in....

Do you remember frequent awakenings during the night? Any?
**well last nite, I didnt recall any awakenings but other nites I do , not alot but go right back to sleep

thxs

[CPAP Sarge]

This may be real or it may be an error in the SH display.

Begs the question: Does SH have an official QA/testing department? The software seems to be useful to many people and I'm not bashing it, but on one hand it would be bad if there was a bug in it's interpretation of the machine manufacturer's data, and as a result a patient incorrectly thought X when it was truly Y, went online, and made some changes resulting in potentially serious side effects. Yes, there are dangers everywhere in life but SH is medical software, and not a trivial one. Personally I think any medical software used by people to make serious medical decisions (CPAP included) should have a very stringent QA testing process, to the same level that goes into making the actual product (the machine) or other drugs and medical procedures. Accuracy of the data presented to the user is the highest importance. SH is great but we the general public are the QA department for it, it appears. It might be a good idea to keep an installed copy of the original manufacturer's software, in addition to SH, and compare them periodically -- in particular if there are any "anomalies". Just for sanity sake to make sure SH is reporting the right thing.

[robysue]

darco,

The Breathing Not Detected flag appears to be a SH bug. Usually when there's a Breathing Not Detected flag, there is a gap in the flow rate curve, but not in the pressure or leak curves. Your SH data shows a perfectly normal looking flow rate curve throughout the night.

I would report this as a SH bug if I were you. (Unfortunately I don't know the best way to file a bug report.)

Now for the rest of your post:

Can someone give me feedback on last nites session? I woke up today like I do most days, feeling tired even tho my numbers look good (?)...Been on therapy for 659 days. I have heard of sleep debt but this is crazy. I have had insomnia/sleep issues for most of my life, I would say since my early 20's and I am now in my early 50's. I am not overweight, I am generally in good health. In a typical week , Ill have maybe one to two nites of insomnia but other nites I usually sleep solid but regardless I always wake up tired. I have used the community's feedback in past and have made adjustments to my machine...just looking for that light at then end of the tunnel

First and foremost: Was this an "insomina" night or not?

Next, how do you define an "insomnia" night?

And, how do you define a "non-insomina" night?

I strongly suspect that your OSA is being well managed by your APAP if this data is typical. That means that your continuing problems with non-restorative sleep most likely come from a different sleep problem. Since you have a longterm history of insomina problems, my guess is that it's the insomnia that's the cause of your on-going problems with non-restorative sleep. CPAP does not fix insomina, it only fixes sleep disordered breathing.

So, what do you do to try to manage your insomnia? Have you ever tried to "fix" the insomina itself? If so, what kinds of things have you tried and how well did they work?

Some questions to think about:

1) What is your desired sleep schedule? When would you like to go to bed each night? When would you like to get up each morning?

2) How long does it take you to get to sleep at the beginning of the night? Does this vary significantly between insomnia nights and noninsomnia nights? How comfortable or uncomfortable are you when you are wearing the mask while trying to get to sleep?

3) On an insomina night, do you wake up frequently? If so, when you wake up in the middle of the night, what's the first thing you do? What's the first thing that goes through your mind when you wake up in the middle of the night? How long does it typically take you to get back to sleep after you wake up in the middle of the night?

4) What do you think triggers an insomnia night? Just can't get comfortable? (Is the mask or the air pressure an issue?) Legs too restless? Too hot? Too cold? Stress? Worrying about too many things? Your mind just won't shut up and let you go to sleep? Watch too much TV? Stay up too late trying to get something done?

5) What do you think the phrase "a good night's sleep" means?

[darco]

darco,

The Breathing Not Detected flag appears to be a SH bug. Usually when there's a Breathing Not Detected flag, there is a gap in the flow rate curve, but not in the pressure or leak curves. Your SH data shows a perfectly normal looking flow rate curve throughout the night.

I would report this as a SH bug if I were you. (Unfortunately I don't know the best way to file a bug report.)

Now for the rest of your post:

Can someone give me feedback on last nites session? I woke up today like I do most days, feeling tired even tho my numbers look good (?)...Been on therapy for 659 days. I have heard of sleep debt but this is crazy. I have had insomnia/sleep issues for most of my life, I would say since my early 20's and I am now in my early 50's. I am not overweight, I am generally in good health. In a typical week , Ill have maybe one to two nites of insomnia but other nites I usually sleep solid but regardless I always wake up tired. I have used the community's feedback in past and have made adjustments to my machine...just looking for that light at then end of the tunnel

First and foremost: Was this an "insomina" night or not?

**no I slept the whole nite, woke up around 0730 then slept in a little longer than usual since Im just got back from a trip

Next, how do you define an "insomnia" night?

**more difficult to fall asleep, usually followed by an after midnite wake up.....may take up to 2 hrs before I fall asleep

And, how do you define a "non-insomina" night?

**a few wake ups but fall back asleep quickly but still feel tired in morning

I strongly suspect that your OSA is being well managed by your APAP if this data is typical. That means that your continuing problems with non-restorative sleep most likely come from a different sleep problem. Since you have a longterm history of insomina problems, my guess is that it's the insomnia that's the cause of your on-going problems with non-restorative sleep. CPAP does not fix insomina, it only fixes sleep disordered breathing.


So, what do you do to try to manage your insomnia? Have you ever tried to "fix" the insomina itself? If so, what kinds of things have you tried and how well did they work?

**I have tried ambien, would take a 1/4 of tablet since taking the entire pill does let me sleep but I look and feel worse when I wake up plus I would only take this small amount when I wake up in middle of nite.

Some questions to think about:

1) What is your desired sleep schedule? When would you like to go to bed each night? When would you like to get up each morning?

**Not sure what you mean about "desired"? Maybe if I didnt have to work then I would have a desired schedule. I do have a regular shed that I stick to religiously ..this morning I overslept because I just got back from a trip up north and worked a nite shift, which is not common for me to alter my sleep schedule so drastically.

2) How long does it take you to get to sleep at the beginning of the night?

**90% of the time I fall asleep quickly

Does this vary significantly between insomnia nights and noninsomnia nights?

**yes, insomnia nites, takes longer, I eventually fall asleep (maybe 45-60mins) but then will wake up 3hrs later

How comfortable or uncomfortable are you when you are wearing the mask while trying to get to sleep?

**very comfortable..still having leak issues...tried multiple mask and no I am not a mouth breather

3) On an insomina night, do you wake up frequently?
If so, when you wake up in the middle of the night, what's the first thing you do?

** Most of my bad nites is either I just wake up a few hours after falling asleep wide awake!...or im in and out of sleep

What's the first thing that goes through your mind when you wake up in the middle of the night?

**I used to fill my head with negative thoughts like " oh great, I am going to see my customers looking dead tired again!" but now I just try not to think negatively

How long does it typically take you to get back to sleep after you wake up in the middle of the night?

**a few months back I would just get up and sleep on couch, some nites I would fall asleep within an hour, other times I would really not sleep at all ( I dont do this anymore, Ill read something till I feel tired again and that takes about an hour then Ill go back to bed)

4) What do you think triggers an insomnia night?

**I think its just the smallest amount of stress,,,,

Just can't get comfortable? (Is the mask or the air pressure an issue?) Legs too restless? Too hot? Too cold? Stress? Worrying about too many things? Your mind just won't shut up and let you go to sleep? Watch too much TV? Stay up too late trying to get something done?

**mask is fine, I tend to sleep better when its cold...I do breathing exercises before I go to bed to relax me...also I stay away from my PC after 8pm. I go to bed at 1000


5) What do you think the phrase "a good night's sleep" means?

**sleep through out the nite w/no distrubancesand feeling energetic....

thxs for your response

[Wulfman...]

Try straight pressure for awhile and see if that helps.


Den

.

[robysue]

First and foremost: Was this an "insomina" night or not?

**no I slept the whole nite, woke up around 0730 then slept in a little longer than usual since Im just got back from a trip

Well there's nothing in this night's data that screams fix me. You say you slept the whole night and there's nothing here that points to a clearly identifiable problem.

Although there is one thing that might point to your being restless: The PR search algorithm was suspended for quite a bit of this night. The usual reasons the search algorithm will be suspended are Large Leaks or ragged breathing that does not meet the criteria for being scored as FLs, RERAs, snoring, OAs, Hs, or CAs. The search algorithm gets suspended for ragged breathing when the machine is worried that increasing the pressure may increase the seeming instability in the breathing. There are a lot of potential "causes" for the kind of ragged breathing that the machine's programming interprets as "unstable enough to suspend the search algorithm". One possible cause is a lot of restlessness with dozing in and out of sleep.

So it's just possible that the flow rate may be indicating that something was disruptive enough to your sleep to prevent you from establishing nice sound deep sleep on this night. But please note: That's just a pretty wild guess on my part.

Next, how do you define an "insomnia" night?

**more difficult to fall asleep, usually followed by an after midnite wake up.....may take up to 2 hrs before I fall asleep

Two hours at the beginning of the night? Or two hours after you wake up to get back to sleep?

And, how do you define a "non-insomina" night?

**a few wake ups but fall back asleep quickly but still feel tired in morning

How many wakes is "a few wakes"? How long does it take you to get back to sleep?

So, what do you do to try to manage your insomnia? Have you ever tried to "fix" the insomina itself? If so, what kinds of things have you tried and how well did they work?

**I have tried ambien, would take a 1/4 of tablet since taking the entire pill does let me sleep but I look and feel worse when I wake up plus I would only take this small amount when I wake up in middle of nite.

What dose of ambien? I'm pretty sensitive to ambien myself and at one point was taking 2.5mg at the beginning of the night and still dealing with Ambien hangover and constipation in the morning.

Have you tried any other prescription sleeping meds?

Have you tried a cognitive behavior approach with or without the sleeping pills?

1) What is your desired sleep schedule? When would you like to go to bed each night? When would you like to get up each morning?

**Not sure what you mean about "desired"? Maybe if I didnt have to work then I would have a desired schedule. I do have a regular shed that I stick to religiously ..this morning I overslept because I just got back from a trip up north and worked a nite shift, which is not common for me to alter my sleep schedule so drastically

Desired means: When do you want or need to go to bed and fall asleep given your daytime obligations such as work schedule? And when do you want or need to get up each day given your daytime obligations?

2) How long does it take you to get to sleep at the beginning of the night?

**90% of the time I fall asleep quickly

How quick is quick? 5 minutes? 10 minutes? 20 minutes?

Does this vary significantly between insomnia nights and noninsomnia nights?

**yes, insomnia nites, takes longer, I eventually fall asleep (maybe 45-60mins) but then will wake up 3hrs later

Are you genuinely sleepy when you go to bed on an insomnia night? There's a difference between being sleepy and tired/exhausted. Do you get uncomfortable lying in bed waiting to fall asleep? Is your mind very, very actively thinking of things?

How comfortable or uncomfortable are you when you are wearing the mask while trying to get to sleep?

**very comfortable..still having leak issues...tried multiple mask and no I am not a mouth breather

When you say you still have leak issues, do you mean that leaks either wake you up or keep you up?

By the way, there is some evidence that you may be doing a bit of intermittent mouth breathing. Probably not enough to worry about, but there are a couple of stretches in the leak line that look like they may be mouth breathing.

3) On an insomina night, do you wake up frequently?
If so, when you wake up in the middle of the night, what's the first thing you do?

** Most of my bad nites is either I just wake up a few hours after falling asleep wide awake!...or im in and out of sleep

Do you look at the clock as soon as you wake up?

What's the first thing that goes through your mind when you wake up in the middle of the night?

**I used to fill my head with negative thoughts like " oh great, I am going to see my customers looking dead tired again!" but now I just try not to think negatively

Good, you understand that dwelling on the wake is counter productive. How successful do you think you are when it comes to "I just try not to think negatively"?

I would suggest that you try to do the following when you wake up in the middle of the night: First, do NOT look at the clock no matter how tempted you are to do that. Next quickly assess your comfort level. If there's an obvious comfort problem, deal with it. Comfort problems can be PAP related (leaks, pressure, dry nose or mouth) but they can also just be sleep related (stiffness from sleeping in an awkward position, too hot, too cold, thirsty, etc). If there's nothing obviously wrong in terms of comfort, then assume the wake is a normal post-REM wake and allow yourself to snuggle back down and get comfortable. If the mind starts to race with thinking (about anything), do your best to shut the brain up. If you really can't "stop thinking", get up for a few minutes to clear your head and come back to bed only after you start to feel sleepy again.

How long does it typically take you to get back to sleep after you wake up in the middle of the night?

**a few months back I would just get up and sleep on couch, some nites I would fall asleep within an hour, other times I would really not sleep at all ( I dont do this anymore, Ill read something till I feel tired again and that takes about an hour then Ill go back to bed)

The problem with getting up and then falling asleep on the couch is that you're not using the CPAP when you're on the couch.

It's not a bad idea to just get up, however. Go into the living room and just sit quietly for a while trying to not think of anything. Play some soft music in the background. If you are tempted to lie down on the couch, that's a sign that you're ready to go back to bed and mask up. Once you are sleepy enough to fall asleep on the couch, you should be sleepy enough to fall asleep in your bed with the mask on.

4) What do you think triggers an insomnia night?

**I think its just the smallest amount of stress,,,,

You may want to work on stress management. Not easy, but if the smallest amount of stress triggers the insomnia, you need to have strategies for dealing with the stress.

Just can't get comfortable? (Is the mask or the air pressure an issue?) Legs too restless? Too hot? Too cold? Stress? Worrying about too many things? Your mind just won't shut up and let you go to sleep? Watch too much TV? Stay up too late trying to get something done?

**mask is fine, I tend to sleep better when its cold...I do breathing exercises before I go to bed to relax me...also I stay away from my PC after 8pm. I go to bed at 1000

5) What do you think the phrase "a good night's sleep" means?

**sleep through out the nite w/no distrubancesand feeling energetic....

What if you woke up feeling somewhat more rested than when you went to bed, but not completely "energetic"? Would that be a good night's sleep or mediocre night's sleep?

What if you woke up several times during the night, but got back to sleep within 5-10 minutes and then woke up in the morning feeling more rested than when you went to bed and even somewhat refreshed in the morning, but not completely "energetic"? Would that be a good night's sleep or a mediocre night's sleep?

What if you woke up feeling somewhat more rested than when you went to bed, but not "energetic". But as the day wore on, you didn't get to the point where you felt utterly exhausted well before bedtime? In other words, what if you were able to get through the day with the sense of some energy as opposed to the way you feel now? Would that count as a good night's sleep or a mediocre night's sleep?

Finally I'll end with this: If you think that the pressure increases might be disturbing your sleep, Den's idea of switching to straight CPAP for a week or so is worth trying. Not everybody does better on APAP than CPAP and some people are very sensitive to the pressure increases. If you do decide to switch to CPAP, however, you need to give it a full week trial before deciding that the change is not helping: Your sleep is rather fragile right now and any change can temporarily increase that fragility. In other words, if you do switch to straight CPAP, the change itself may trigger a couple of insomnia nights before your body settles down enough to actually sleep decently with the new settings.