Tyrone747's therapy

[JayDee]

Once you get your pressures adjusted correctly for you, If you are not already doing so, I would consider a sleep diary, even if all you write down are your "good" nights/days.

After dialing in my machine pressures and settings and finding the right mask for me, another tactic that seems to have had a *HUGE* impact towards getting that "good night sleep" feeling was taking a few notes when I had "good" days. My notes showed me that when I went to sleep before 10:30pm and got about 7 hrs of sleep, the odds were better I was going to have a good day where I didn't feel ready to nap at the drop of a hat. Less than 6 hrs and I feel tired all day. More than 8hrs and I feel tired all day. Now I *really* try to be diligent and consistent with my 10:30pm bedtime and I set my alarm so that I do not sleep more than 7.5 hrs.

So perhaps, try to find your Goldilocks zone for A). when to go to sleep and B). for how long.

The only other issue I have now is lower back pain and I am working on that. A mattress too soft kills my lower back, too hard kills my upper back and shoulders. But despite my back pain, with my PAP therapy handling my apneas and my consistent sleep time/duration, I am far better off than I was before I started down this road. I'm just a "Goldilocks mattress" away from not giving a hoot about any other sleep issues I may have...

Good luck on your journey! You will get there!

-JD

[Jay Aitchsee]

Well my treatment definitely seems to be improving. Here's the last three nights. I'm sleeping looong. Centrals are still a bit of a concern since it looks like I'm not breathing for up to 15 seconds. But like many have said those will go away with time. I managed to get up to 9 cmH20 last night with no aerophagia I believe this is due to upping EPR to 3. I'll continue at this setting for now since it feels good and eliminates all apneas but the centrals. I imagine I'm now paying off sleep debt that's why I'm sleeping so long. Though some experts no say that's not a thing. Hopefully my sleep becomes more efficient with time. It's nicer to be over sleeping than under sleeping like I was in the beginning. Kind regards.

Hopefully, you're feeling better? If so, maybe backing off the melatonin helped? Good advice from JD above. Some of that "Sleep Hygiene" stuff I keep yappin' about.

[zonker]

Well my treatment definitely seems to be improving. Here's the last three nights. I'm sleeping looong.

well, will you look at that!

tapdancing.gif

most excellent.

[tyrone747]

Interesting double Central last night. Stopped breathing for 15 seconds, breathed for 20 seconds, stopped for another 15 seconds. I hope this doesn't indicate a problem.

[Pugsy]

IMHO....Looks like post arousal breathing to me those 2 flagged events. Not fully asleep and thus they don't mean anything except you maybe woke up slightly and you may or may not remember doing it. I see those all the time.
Now when I see a lot of probable arousal breathing then I wonder why I had so many arousals and that's not always related to airway issues. It's related to sleep in general. For all we know you had a REM stage sleep end right before that big gulp of air you see at around 03:17:04 and it's entirely normal to wake up after the end of a REM sleep cycle. That big gulp tells me you weren't asleep when that happened and makes me suspect anything that gets flagged right after that big gulp. You don't do those big gulps like that when you are asleep.

[tyrone747]

Thanks Pugsy. That is reassuring that it's likely not anything serious.

Hopefully, you're feeling better? If so, maybe backing off the melatonin helped? Good advice from JD above. Some of that "Sleep Hygiene" stuff I keep yappin' about.

I wish I could say that I am but I'm still very fatigued during the day. Though sometimes that fatigue is replaced by sleepiness which is more pleasant so that could be a positive sign. Now that I'm sleeping 9-11 hours per night consistently I feel like I should be making significant progress soon. I will say my libido has returned with a vengeance so that's interesting. I didn't expect that to come back before fatigue was reduced.

The melatonin didn't seem to have any positive effect but if I took too much it did cause me to wake up too early. I may try microdosing it in the 150mcg range, more for the potential acid reflux benefits than for sleep. Melatonin production does diminish significantly with age.
I find I sleep best with no supplements what so ever. I feel even a multi-vitamin in the morning harms my sleep.

[linagee]

If there are too many fluctuations on APAP, and you have a "for her", why not enable ResMed's super-secret mode called.... "for her"? (Which all it really does is has a slower adjustment pressure over time.) It's weird they had to put a feminine spin on it when it's just a different APAP mode.

[tyrone747]

A pretty good night of sleep last night after I'm getting over a cold. I'm still getting a decent number of centrals but most of them are arousal related. Sometimes they aren't though so I'm wondering if perhaps I might have a case of mixed apnea? Or if these more true centrals may go away with time? The first image is the whole night and the second is zoomed in on a section that concerns me. My centrals are starting to be more clustered like this also. Where as they used to be a one off no I get two or three back to back.

[ChicagoGranny]

How is possible to have a great night on paper and still feel like garbage?

Try sleeping on 100% Egyptian extra-long-staple cotton sheets. Paper is uncomfortable and makes a crinkling noise when you move.

[Dog Slobber]

How is possible to have a great night on paper and still feel like garbage?

Try sleeping on 100% Egyptian extra-long-staple cotton sheets. Paper is uncomfortable and makes a crinkling noise when you move.

[Pugsy]

It's normal to have an occasional "real asleep" central. Entirely normal and seeing a handful of them doesn't qualify for central or mixed apnea diagnosis.
People who don't have sleep apnea will have a random central ...it's normal.

Centrals are only a problem when they are present in large numbers, bouncing us out of sleep or causing desats.

Even if every single one of your flagged centrals was the real deal...you aren't having nearly enough of them for doctors to want to do anything about them. You would pretty much need at least 5 real ones per hour average every night before they would even raise an eyebrow.

Now when you see central flags that are obviously arousal related...the central isn't the problem..it's whatever that caused the arousal in the first place that is the problem. The central is nothing more than a byproduct of the arousal.

[linagee]

How is possible to have a great night on paper and still feel like garbage?

Try sleeping on 100% Egyptian extra-long-staple cotton sheets. Paper is uncomfortable and makes a crinkling noise when you move.

Maybe I'm reading into this too far, but once an AHI is below 5, it should be ignored as a factor for bad sleep. (Because the average population has AHI under 5 and there are average people who wake up not feeling like crap.) If you still feel like crap, then definitely still work at improving your sleep. But it might not be apnea related. You might need to go to sleep at consistent times, or cut vices (alcohol/smoking), or exercise more, or eat less. (It's entirely possible you're doing all of these but there is still some environmental factor you've overlooked.) There's only so much our magical CPAP machines can do. An EEG sleep study can tell you if your body is going through all the right phases for sleep, but all of us don't have going through more sleep studies at our disposal. (Sleeping on a bed of paper and examining an EEG/sound would probably show you a correlation of the crinkle waking you. This would happen even if you had your CPAP going.)

[tyrone747]

It's normal to have an occasional "real asleep" central. Entirely normal and seeing a handful of them doesn't qualify for central or mixed apnea diagnosis.
People who don't have sleep apnea will have a random central ...it's normal.

Centrals are only a problem when they are present in large numbers, bouncing us out of sleep or causing desats.

Even if every single one of your flagged centrals was the real deal...you aren't having nearly enough of them for doctors to want to do anything about them. You would pretty much need at least 5 real ones per hour average every night before they would even raise an eyebrow.

Now when you see central flags that are obviously arousal related...the central isn't the problem..it's whatever that caused the arousal in the first place that is the problem. The central is nothing more than a byproduct of the arousal.

Thanks Pugsy. That is very reassuring.

[ChicagoGranny]

You might need to go to sleep at consistent times, or cut vices (alcohol/smoking), or exercise more, or eat less.

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Good Sleep for CPAPers

- Practice good sleep hygiene (Google it and read several sources; ignore extreme advice.)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Do not listen to your breathing or the sound of the machine as you are falling asleep. (Some people, including me, actually find listening to their breathing and the sound of the machine to be relaxing.)
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy.
- If you are awakening at night, do not be too concerned. It is actually a normal part of sleep. (It does become a problem though for people who, when they awaken, become frustrated and have difficulty returning to sleep.)
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

This is a checklist. Some of the things you already do. Some are easy and can be done right away. Others you can work at over time.

CG

[palerider]

Maybe I'm reading into this too far, but once an AHI is below 5, it should be ignored as a factor for bad sleep. (Because the average population has AHI under 5 and there are average people who wake up not feeling like crap.)

This is patently bad advice, but it IS a significant part of the reason that we're all here, because an AHI of 5 is crap.

It's the equivalent of being woke up every 12 minutes, ALL NIGHT LONG.

Personally, I feel worse during the day if my AHI is over 1.5-2.

"under 2" is a more effective goal to shoot for. Mine is rarely over 0.5.