Possible Complex sleep apnea?

[Krpepe]

I don't believe there is any reason I couldn't take a otc sleep aid. Isn't that masking the real problem though and not getting the answer to what is really going on? I do understand it is to get some sleep. If this sounds mean it isn't meant that way! My brain right now isn't giving me much in the way of choices of words. My best nights sleep were Tuesday night and Friday night and for the life of me I cant see what is different from any other night. I am willing to try increasing the pressure. To be honest I willing to try just about anything! As I am sure anyone with sleep apnea would say, I'm tired of being tired!

Are you inferring in your last post that it would be in my best interest to get another sleep study done? Maybe that would answer some questions? I for one would like to know why my breathing is so jagged.

I have had an MRI of my brain, cervical, thoracic and lumbar spine done within the last year looking for causes of urine retention. Everything came back normal except for lumbar but that is a whole other story. But one that I don't believe is related to what we are currently seeing and didn't come back with answers to the urine retention. The current thinking is the sleep apnea may have a hand in some of the odd stuff that has been going on for awhile now. So my primary wants to correct the sleep apnea and then see what is remaining that has to be dealt with, which I am on board with. But like most things that I deal with there are more questions than answers. Not a simple fix. Thanks again for taking the time to look over my stuff. I am very grateful!

If at any point this sounds mean or ungrateful that was not at all how it is meant. I am very tired right now. It took me an hour to compose this. Sad I know.

[Pugsy]

I would be really surprised if your sleep doctor did NOT want to do an in lab sleep study with you on the machine.
While it might not give us all the answers we are looking for...it's the best chance we have.
I am particularly interested in how your actual sleep stages progress and are you getting the nice normal progression or are you getting stuck in light sleep more where the chances of some sort of spontaneous arousal thing might be happening.
Things where I might sleep through something but you don't kind of thing.

Just being on cpap itself is a potential sleep disturbing factor. Heck it was at least 3 months before my brain quit waking me up just to tell me that I had this weird "thing" on my face blowing air up my nose and I had a nice normal OSA diagnosis without any complicating factors going on. I had no mask issues or leak issues or pressure issues but I had a lot of wake ups just for no apparent reason. All I could blame it on was my brain just not coming to grips yet with the alien on my face. It's very possible that this is what is going on in your situation. I know this seems like it has been going on forever but in real life time...it's not very long and there is some truth to the "give it time" thing..

Are you just super sensitive to the least little stimuli? It wouldn't be impossible. You've had months probably years with OSA stuff going on and your body developed its own defenses and while we expect the body to readjust quickly.....it often just isn't able to do an about face like that.
Also...while we tamed the centrals to a big extent by removing Flex exhale relief...your breathing still looks like it has a lot of waxing and waning and while not bad enough for event flagging...it's not entirely normal either.
If I feel like it today I may try to plug your stuff into my Encore software to get a better overall picture of the flow rate that makes it much easier to spot breathing changes....I haven't had much luck lately when I try that. For some reason Encore Pro doesn't like it when I make copies of SD cards. SleepyHead/OSCAR is a lot easier to work with. Encore tends to give me "file corrupt" messages and I don't know why and I can't direct import to Encore.....it just won't let me.

As far as using an OTC sleep aid....sometimes we just need to get the sleep and if you are indeed simply having a lot of spontaneous arousals it just lets you sleep slightly deeper so less chance of those arousals happening. There's a time and place for all meds IMHO and this might be the time.....at least for a short term experiment anyway.
My own sleep doctor gave me a RX for Ambien which is a more powerful sleep aid. I have some pain issues that cause me to wake up a LOT and she told me that she would rather me take Ambien than a muscle relaxer. It's not a perfect solution but given the options...we choose the lessor of the 2 evils. I have since moved away from the Ambien because it's not good long term and moved on to something else to help me sleep through the pain a little better.

You have a doctor that cares....by all means run all your thoughts by her and get her input.

[Pugsy]

One other thought and I am going out on a long skinny limb with this one....
Treatment emergent central apnea can happen just from cpap pressure itself...any pressure. While commonly thought of as being more associated with higher pressures...it really can happen with any pressure. I have seen it very severe with as little as 5 cm pressure.
It's not always just related to bilevel pressures (which is what using exhale relief creates)...it can be fixed pressures as well.
There are some that feel apap mode isn't a good choice for people with central apnea...that the change in pressures to deal with the obstructive stuff can make centrals worse even if the pressure it goes to isn't all that high.

I can't seem to spot a correlation in your ragged breathing to the pressures responses...doesn't mean it isn't happening but I can't spot it myself.

My point to all this....it's not totally impossible that a lot of the raggedness which points to not so great sleep to be simply from cpap pressure itself. Maybe what I am seeing is a "pre central apnea" breathing response that just doesn't quite grow up to be full centrals.
Maybe the exhale relief bilevel thing wasn't the sole cause of your central apnea.

That's the long skinny limb I am out on....what iffing kind of thing.

[Krpepe]

Pugsy,

Thank you for all of the thought you have put into this. Sorry I didn't respond sooner but today is my crazy day with the kids. I also do the school kits for our local pto. Today was nuts and really not a day for being tired. I personally am concerned about the raggedness of the flow rate, just seems off. but I also don't know much about this. With your help though I have learned a lot! Thank you for that! Ok so what do you think is the next move?

[Pugsy]

Next move is to ask the doctor what her next move is.
Ask her if it would be okay to take an OTC sleep aid as a short term experiment.

I have mainly been thinking out loud trying to come up with potential reasons for what is seen....I never wanted to take the place of your doctor. Throwing some crap up on the walls and seeing if anything sticks.
It would be different if you didn't have a doctor but you do and one that cares and I always defer to the doctors until it's proven that they are either idiots or non existent.

[Krpepe]

By no means do I think you are taking the place of my doctor. I do value or opinion though. You are a very smart individual on this subject! You have shown me that and have my utmost respect for it! You obviously have training in this field. I have a feeling my doctor is probably going to want to wait till next week to make a decision but I will give her a call and let her know that I am not getting any relief and see what happens. Thank you for all you have done for me! You are a wonderful caring person whom this world needs a lot more like you! From the bottom of my heart thank you!

Kevin

[Pugsy]

I would pop a couple of Benadryl if it were me.
That's mainly what is in those OTC sleep aids. I always have some laying around because I had a dog that needed it for grass allergies.

And you are probably correct...she is probably going to want to wait until next week and I would also be antsy if I were in your shoes which is why I would pop the Benadryl.

[Krpepe]

As soon as I have new information I will post an update.

[Krpepe]

Pugsy,

Here is last nights sleep with a zolpidem 5mg. Thoughts?

[Pugsy]

How would you rate your sleep last night?
How do you feel today?
The first break in therapy I understand....what about the one much later in the night? How come? Any idea?

[Krpepe]

I don't feel any better today, foggy as usual. Could very easily fall back asleep right now. Very weird dreams last night. I normally don't dream or at least don't remember them if I do. Not sure what woke me about about 3:15. But had to use the bathroom after waking. First one forgot to put water in the humidifier so had to get up.

[Pugsy]

See how you feel later.
Ambien will give you a morning hangover effect initially....one of the reasons I don't like to take it myself unless I just have to ...which sometimes I realize I do have to. I have come to realize that I have a choice between how bad I might feel with medication side effects and the effects of simply not enough sleep...which is worse kind of thing.
Lets see how long it lasts with you.

Can you email me the files in your P0 folder associated with last night's sleep sessions?
If not, do another zip of the entire SD card and send it. Let me look at the overall pattern up close. Can't tell much by this big picture.

[Krpepe]

Pretty sure I can handle that. Will do it about 9 after the kids are on the bus.

[Krpepe]

Files sent!

[Krpepe]

So I noticed something last night. I guess I was awake enough to figure out what was going on.

I woke up with a dry mouth last night. Obviously mouth breathing. I rolled over on my side and when I did I felt a slight leak at my nose within a few seconds I had Chipmunk cheecks and my mouth opened. So I am guessing that the slight pressure lose from from the leak at my nose is enough to allow my throat to open so my mouth fills up and wind up with a dry mouth and large leak. Guessing I need to stay on my back. Or would a slight bump in min pressure help this?