5 months later..

[Pugsy]

Yes sleeping pills of some sort but of the over the counter variety because those are very mild.
Something to help you stay asleep and not necessarily fall asleep.
There is sleep onset insomnia or trouble falling asleep and there is sleep maintenance insomnia....trouble staying asleep.
You've got the sleep maintenance insomnia type.
I am familiar with that myself except I know what causes mine. I also get more arousals than I would like but nothing compared to what you are getting. It's no wonder you feel like crap.

You would feel like crap even without OSA added into the mix.

I am a big fan of plain old benadryl as a sleep aid...diphenhydramine.
Most of the OTC meds that say they will help you sleep will contain diphenhydramine as the active ingredient.
I prefer just taking the plain active ingredient without the filler.
It's safe unless you have high blood pressure or some other reason where antihistamines are prohibited.
Morning hang over effect is minimal especially in small doses. 25 mg to start with...that's a teeny tiny dose.
How do I know...I have been known to take 100 mg at bedtime.
When I worked in the medical field we would routinely give 100 mg when someone needed an antihistamine.

[huydts]

Hi.


Got myself a herb mixture with added doxylmine.

But first I'll try CBD oil together with melatonine in 1 tablet.

I decided to stop looking at my AHI, it will just make me crazy.

Last night I woke up several times again, think that's was causing the tiredness....

I sleep verrry shallow. Aware of most things around me.

So, if thise OTC meds won't work, I might try some real sleeping pills ..

[huydts]

Hello again..

Today i looked at my stats of the past 3 days

Friday night 3.94 AHI @ 9 - 12.5 pressure woke up alot
Saturday night 3.86 AHI @ 8.5 - 12.5 pressure woke up alot
Sunday night 8.96 AHI @ 9 pressure straight woke up alot + i took OTC sleeping aid.

Will be keeping the 8.5 - 12.5 pressure for next week.
Meanwhile i need to figure out why my sleep quality is so bad.

Would it be an option to ask for a Mandibulair device? Or should i stay with cpap and wait/hope/pray for compliance.

[Pugsy]

Those oral devices come with their own baggage when it comes to sleeping with them plus they aren't always effective enough to be a viable solution. They aren't always very comfortable.

About 50% reduction in apneas on a good day and while that might be okay if your diagnostic AHI was below 10...not so great if it was 30 or 40. Even 75% reduction of 40 AHI is still a fairly bad AHI.

I have been trying to plug your data into my Encore Pro software but Encore doesn't like it that I cobbled together a SD card.
It keeps telling me the data is corrupted and won't take it...and I can't seem to fix it. I am pretty sure that my Encore version will work with your model machine because I have used it on other DreamStation machines.....unless your Dutch machine has a slightly different file structure and that is maybe causing the problem.

When you wake up during the night you can reach over and turn the machine off and right back on again. This will give you a reference point to see any flagged events and help you sort out which are SWJ flagged events. Pretty easy to spot flags immediately prior to the break in therapy or immediately after it and you know you were awake.

[Pugsy]

I went back and looked at one of your old nights with a nice low AHI...Aug 8 I think it was.
Fixed cpap at 8.5. Roughly around 9 hours of data.

It's fairly obvious from the data that you need 8.5....marked change in results from the 7.5
Even if we discount the SWJ stuff...7.5 simply allows too many real asleep events.

On Aug 8 with AHI a little over 2....I can count on one hand the number of real asleep events. I think I spotted 3 OAs and 1 hyponea that was likely real asleep events... The rest were SWJ and I stopped counting at 30 plus arousal flow rate changes that were blatant in your face arousal breathing. Confirmation of the really crappy sleep quality. The majority of the arousal breathing seemed to come out of nowhere. There were a few instances of it maybe being related to a minor reduction in the flow rate but it was very rare. Big maybe though...they weren't clear cut at all.

My best guess...a truckload of spontaneous arousals and we don't know the cause. I thought my sleep maintenance insomnia was bad with 15 to 20 arousals but yours take the cake for sure. It's no wonder you feel like crap. I am betting you are bouncing around all night in the light sleep stages and getting very little deep restorative sleep.
Again...confirmation of what we already know.

In terms of the OSA therapy though...it's well treated and I don't see the need to continue to try to get you using more pressure.
Apnea isn't your problem now.
You did have 2 problems...sleep apnea and the crappy sleep problem but the crappy sleep problem isn't really related to the apnea problem. We fixed the apnea problem well enough but the crappy sleep problem remains.
So you still have one problem remaining and unfortunately...the harder problem to fix IMHO.
Crappy sleep is hard to fix even when we know the cause and of course much harder to fix when we don't know the cause.

[Pugsy]

I looked at those sleep study reports as best I could. Some terminology is universal and I could understand it well enough.

I couldn't spot sleep stages though...is there a breakdown into sleep stages somewhere?

It did answer one question for me though...I was wondering about maybe a strong underlying UARS component to your situation but with the extremely low RERA numbers then I seriously doubt it. You gotta have RERAs on a real sleep study to have UARS. I think at least 15 per hour is needed to really suspect UARS. You had zero on one report and barely over 1 on another report.

Confirms what we already suspect...high number of arousals not related to apneas. What we call spontaneous arousals.

How much of a pain in the butt would be be for you to try to sleep on your side? Would it likely cause more sleep quality issues???

[huydts]

Good evening Pugsy,

Thank you very much for all the effort and the help. I learned a lot from it.

You ask what causes the arousals right? Well I think at the beginning it was due to the mask not fitting/ being comfy, irritation, air noises, blown up feeling, discomfort etcetera.
and now the arousals are coming from stress, related to all this insomnia. '' will I sleep; can I function at work'' how high will my AHI be'' etc.

My resume is as following:

Before starting CPAP I slept like a rose for long hours, even while I had untreated OSA. I didn't wake up at night several times, and I suppose I got more into deeper sleep stages then I do now.

-before cpap I was tired cause of untreated osas.
-I started cpap and couldn't really get used to the machine
-This started to become an obsession
-Cause of the obsession i'm 24/7 focused on my sleeping, AHI, arousals, Energy , irritations etc.
-This causes me to not get in my deeper sleep stages anymore, while the apneas are mostly treated,i still have higher ahi cause of arousals ( stress ).
-Now the circle is round, continually focusing on sleeping makes me stressed out, as stressed as I am I cant sleep good anymore cause i'm continuously wondering if ill sleep good this night..

So, what can pull me out of this vicious circle? I think: use a sleeping aid for a relatively short period of time. If I then can get into deeper sleep stages and notice I'm more revived the next day ill start to believe in therapy and my body again.. Which will hypothetically result in sleeping all right even without medicines.

How does this sound? does it sound plausible to you?

I need a few more last answers from you pugsy..

1 What settings and pressure do you advice, min and max or fixed?
2 is a prescription sleeping aid like '' zolpidem'' safe to use with apnea?

My gratitude is for ever!!!

[Pugsy]

How does this sound? does it sound plausible to you?

Sounds like a very plausible plan. You remind me of another person that I helped over on another forum.
His reports looked a lot like yours and he was worrying himself crazy about sleeping and AHI and this or that.
It was hard work getting him to quite worrying so much but once he did his sleep quality began improving some. It's still not perfect all the time but it's a lot better than it was.

As to what settings...considering the fact that we have the aerophagia monster looming in the back ground and the fact that the machine will sometimes what to increase the pressure for SWJ stuff....I think a really tight range...not quite fixed though.
Minimum 8.5 Max 11 and Flex of your choice on or off or whatever feels the best to you. Anything that helps with comfort potentially helps with sleep.

Zolpidem is safe to use with sleep apnea....short term.
Here in the US it is commonly prescribed for people undergoing an in lab sleep study to help them sleep. It doesn't mess up anything in terms of results. My sleep doctor told me that she would rather someone take Zolpidem than muscle relaxer kinds of meds.
I will take it on a rare occasion when I have so much pain and I know that my pain meds aren't going to be enough....
It is potentially habit forming though and you don't want to go down that road if at all possible. Do discuss it with your doctor for sure.
It's not going to be a problem if someone takes it on a rare occasion but taking it every night for months...definitely a potential problem in terms of dependency.

I did take it for about a month when I first started therapy...between the newness of cpap therapy and my own other health issues making for poor sleep...I just needed some help getting over the hurdle.

There is a time and place for sleep aids...either OTC or RX. That final decision I have always felt it best left up to the patient and his doctor.

Stress....the mind...it's a powerful drug that sometimes doesn't work in our best interest. That old insomnia monster is easily fed and kept alive. He's hard to kill.

Even now I often have nights where the AHI is higher than usual. They usually coincide with poor sleep quality nights and when I go look at the events I usually see 90% SWJ stuff. I just shrug my shoulders and move on and try not to dwell on it. I have enough life stressors going on in my life as it is but I know that at least my cpap therapy is pretty darn well managed.
I try really hard to not dwell on the stuff that I really don't have much control over.

RobySue has some good thoughts here...as well as she mentions a couple of really good books that you might read.
http://adventures-in-hosehead-land.blog ... er_19.html
She's fought insomnia issues of some sort all her life and she finally ended up accepting the fact that sometimes she needed RX help.
She fought it hard though and even now only resorts to RX sleep aids after a couple of nights of the insomnia monster winning the battle.
She also battled the aerophagia monster at pressures less than yours.

We are here for you though...anytime you want to bounce ideas off myself or the others.
Or if you just want to vent frustrations.... We all sometimes need to relieve stress by venting...and what better place than here with people who actually have been in your shoes.

[huydts]

Hello...

Few days later..

i slept some nights with medicine ( zolpidem ) i slept very good on it. I only woke up 1 or 2 times.

However the AHI simply doesnt want to drop.. and i feel bad during the day.
So probably the remaining apneas are causing my sleepyness during daytime.

Average AHI of 6.5 . It doesnt matter if i open up the cpap to for example 10 to 18cm. or 9.5 fixed or 9.5 to 12.5cm

Last night i started to write down when i woke up, and or toss or turn... those moments werent flagged as events.

I really want less apneas cause im starting to feel more crappy each day.

Are there other things i can try?

Why is the machine not reaching max pressure ( 18 ) to prevent my apneas? It is simply trying to catch up and fails doing that cause its too late and then drops pressure again.

Do i need way more pressure then what my doc prescribed? He started with 7.5, and we stopped at 9.5 - 12.5

I'm losing my hope.

Should i give my FF mask another try?

[Pugsy]

The machine doesn't go higher even though it can because of the auto adjusting algorithm.
It just needs certain other stuff to also happen besides the flagged event .....like snores and more FLs than you are having.

Some things you can try.

Maybe a fixed pressure on the chance that the auto adjusting pressures are a factor in your poor sleep quality.
Still use auto mode but have minimum equal maximum so you don't lose the FL flagging.

More minimum pressure....but be aware that more minimum may cause aerophagia issues.

ResMed APAP machine. The auto adjusting algorithm is different and it might work better for you.