Just got AHI (24), waiting on CPAP

[ozij]

Question for you all. The respiratory therapist also said that I wouldn’t feel better right away because of sleep debt. Is that a real thing?

The respiratory therapist also said that I wouldn’t feel better right away --- That's real. You have the feeling of a mask on your face to get used to. You have pressure to get used to. You have a hose you have to handle. You have to learn to change position in bed without dislodging your mask, without causing leaks. And in your case, you probably need a full face mask to avoid cotton mouth.

because of sleep debt
All those things yoiu have to learn, and that's the only reason the therapist can think of? Did he or she ever try to sleep with CPAP? Did they spend a whole night watching a person try to sleep with CPAP?

It's not just sleep apnea...it's totally crappy sleep quality in general as well.

Totally crappy sleep quality.
And your aim is to get good sleep quality.

[Billymadison420]

Question for you all. The respiratory therapist also said that I wouldn’t feel better right away because of sleep debt. Is that a real thing?

The respiratory therapist also said that I wouldn’t feel better right away --- That's real. You have the feeling of a mask on your face to get used to. You have pressure to get used to. You have a hose you have to handle. You have to learn to change position in bed without dislodging your mask, without causing leaks. And in your case, you probably need a full face mask to avoid cotton mouth.

because of sleep debt
All those things yoiu have to learn, and that's the only reason the therapist can think of? Did he or she ever try to sleep with CPAP? Did they spend a whole night watching a person try to sleep with CPAP?

It's not just sleep apnea...it's totally crappy sleep quality in general as well.

Totally crappy sleep quality.
And your aim is to get good sleep quality.

All noted. Thank you:-)


Speaking of which, I got an AHI of 1.24 on about 9 hours of sleep. Feeling groggy this morning. But I had 0 obstructive apneas. Thats great.

Ironically I remember waking up at 3 AM to Turn down the humidifier because mine was gurgling. I remember feeling very well rested at that moment. But not now. I feel like dead tired.

So the question is.

1. Like to find folks here mentioned is it simply just more time.
2. Is it more time plus my mirtazapine making me less tired. I don’t think it’s the mirtazapine because I feel tired without it.
3. Was Bozo Dr. number one right about narcolepsy. Hard for me to let go of that thoughts. Since it’s been in my head for a year.

Anyway less obstructive apnea is good regardless. And I’m using the CPAP which means that I am closer to being able to get it to further testing that could uncover other things if they are there. Regardless it’s progress.\

Edit: after an iced coffee with an extra shot I feel somewhat alive lol! I have taken your advice, and not taking any of the stimulants.

https://www.dropbox.com/s/opx88i81jtda1 ... M.png?dl=0

[Pugsy]

Put your SD card contents on your dropbox account like you did yesterday and let me pull the data and look through last night's flow rate please.

I don't know if you have narcoleopsy or not....Friggin Moron doc number 1 did you a severe disservice putting that thought in your head without proper testing. You can't seem to get past that thought in your head.
I suggest that you convey these thoughts to the current doctor. You need some help getting past these thoughts and I don't know how to help in that area. The mind is a powerful tool but sometimes it just isn't a good tool to be using or it needs some tweaking. I don't know what...if anything... at this point so early in cpap therapy the new non moron doctor will want to do but I do think you need to be talking to your doctor about these concerns. Hell maybe he/she will be willing to maybe schedule a MSLT to resolve the issue with certainty one way or the other for you or maybe say give cpap X amount of time and then look at MSLT.

Did you schedule a follow up appt with the current doc to discuss the cpap results? If not, make that appt.

Tell me what you expected cpap to do and in what time frame you expected (or wanted) it to happen in.

Are we going to need a refill on the bottle of nasty tasting patience pills?

[Billymadison420]

Put your SD card contents on your dropbox account like you did yesterday and let me pull the data and look through last night's flow rate please.

I don't know if you have narcoleopsy or not....Friggin Moron doc number 1 did you a severe disservice putting that thought in your head without proper testing. You can't seem to get past that thought in your head.
I suggest that you convey these thoughts to the current doctor. You need some help getting past these thoughts and I don't know how to help in that area. The mind is a powerful tool but sometimes it just isn't a good tool to be using or it needs some tweaking. I don't know what...if anything... at this point so early in cpap therapy the new non moron doctor will want to do but I do think you need to be talking to your doctor about these concerns. Hell maybe he/she will be willing to maybe schedule a MSLT to resolve the issue with certainty one way or the other for you or maybe say give cpap X amount of time and then look at MSLT.

Did you schedule a follow up appt with the current doc to discuss the cpap results? If not, make that appt.

Tell me what you expected cpap to do and in what time frame you expected (or wanted) it to happen in.

Are we going to need a refill on the bottle of nasty tasting patience pills?

PM'ed you the OSCAR data. This morning I got the new folks my CPAP Serial # so they can read the data. And I will call now and make an appointment. I agree, I am having a lot of trouble shaking that thought.

As far as my (obviously unrealistic) expectations are concerned. I thought that maybe I wouldn't feel so exhausted. Then maybe I would just feel tired. Then ok. Then like the "old" (whatever that means") me felt like. I remember a time in my life where I would zip out of bed and have tremendous energy. So, with the Narc thought in my head, I immediately go to "well, CPAP is doing what it is supposed to, and I feel like this, has to be Narc". I mean if it is, it is. There are drugs for that that can help. But I have to do the CPAP first. Then MSLT. And then hope that is shows up on that. And if it doesn't, I either really don't have Narc, or I do and can't get a positive diagnosis. I want whatever gets me to relief. Whatever that is.

I would love if its just apnea, and over time, months, I start to get that old Billy back.

-B

[ChicagoGranny]

Edit: after an iced coffee with an extra shot I feel somewhat alive lol! I have taken your advice, and not taking any of the stimulants.

An iced coffee with an extra shot is a stimulant. How much caffeine are you drinking for the day?

[Billymadison420]

Edit: after an iced coffee with an extra shot I feel somewhat alive lol! I have taken your advice, and not taking any of the stimulants.

An iced coffee with an extra shot is a stimulant. How much caffeine are you drinking for the day?

I generally would require about two french presses of coffee, a day, to remain functional. I am not joking. I stop drinking any caffeine after 3:30PM.

[ChicagoGranny]

I generally would require about two french presses of coffee, a day, to remain functional. I am not joking. I stop drinking any caffeine after 3:30PM.

If I were having the problems sleeping that you are having, I would taper off all caffeine except early morning. Eventually, I tapered off all caffeine. It makes a difference.

The mean half-life of caffeine in plasma of healthy individuals is about 5 hours. However, caffeine's elimination half-life may range between 1.5 and 9.5 hours, while the total plasma clearance rate for caffeine is estimated to be 0.078 L/h/kg (Brachtel and Richter, 1992; Busto et al., 1989).

Calculate, if your caffeine half-life is 9.5 hours, you will have one quarter of your consumption in your body for 19 hours.

[Billymadison420]

I generally would require about two french presses of coffee, a day, to remain functional. I am not joking. I stop drinking any caffeine after 3:30PM.

If I were having the problems sleeping that you are having, I would taper off all caffeine except early morning. Eventually, I tapered off all caffeine. It makes a difference.

The mean half-life of caffeine in plasma of healthy individuals is about 5 hours. However, caffeine's elimination half-life may range between 1.5 and 9.5 hours, while the total plasma clearance rate for caffeine is estimated to be 0.078 L/h/kg (Brachtel and Richter, 1992; Busto et al., 1989).

Calculate, if your caffeine half-life is 9.5 hours, you will have one quarter of your consumption in your body for 19 hours.

I’m trying to make sure I understand what you’re saying clearly. I slept nine hours last night, uninterrupted except for having to adjust the CPAP mask one time. It doesn’t seem to be affecting me staying asleep. Are you saying it could still be affecting me even though I don’t know it?

And a good point, on the half-life of coffee.

I guess what I’m trying to understand is, what can I do to make it through my life right now while I get these challenges sorted out? I have a dying mother that I have to take care of, my job, and my marriage. I’m not trying to go into woe is me territory, because we all have our own challenges. And we all have our own pain. I just wish I felt more capable, I know who I can be. And I feel like I’m being held back right now.

Thank you Chicago Granny

[Pugsy]

I slept nine hours last night, uninterrupted except for having to adjust the CPAP mask one time. It doesn’t seem to be affecting me staying asleep.

What you THINK happened in terms of sleep quality and what actually happened in terms of sleep quality can't be further apart. You don't have memory of a lot more arousals but you had them.

All of the CAs/centrals were arousal/awake breathing false positives...so 11 arousals right there. Every single flagged central was so obviously arousal/awake related that a blind man could see it.

Then there were 31 more arousal segments where it wasn't just a blip but anywhere from 30 seconds to several minutes where your flow rate shows you weren't sound asleep....these arousal segments didn't have any sort of flag associated with it.

So 40 plus for sure arousals/awakenings last night ....no wonder you aren't feeling as chipper as you hoped.

I went through the entire flow rate and looked at every breath. When you turned the machine off and then back on again in the middle of the night....turned it back on again at 3:41...you didn't actually get back to real asleep breathing until 4:05.
And similar time frame for falling asleep at the beginning of the night...plus it wasn't 9 hours it was 8 hours and 18 minutes of the long night time segment....the other 2 little whatevers earlier in the day are in your overall total but didn't occur last night. I turned those off and only evaluated the night time data....and it's 8 hours and 18 minutes with over 40 very obvious arousals plus the break in therapy arousal.

You got a little less than 8 hours of actual sleep (we remove the 20 minutes or so at the beginning and middle where you didn't sleep soundly) and those little less than 8 hours was highly fragmented with at least 40 plus arousals.

A little later I will post some screen shots to clarify things...hopefully.

So the short version of all this....you aren't actually sleeping as soundly as you think you are. This is quite common because we don't always remember awakenings but they still screw up sleep quality and mess with your sleep stages/cycles and ultimately....how you feel or don't feel the next day.

Sleep maintenance insomnia...that's what you got. That means trouble staying asleep for sure and maybe a little bit of sleep onset insomnia thrown in.
As to why....don't know but you got it. Part we can very likely blame on the adjustment process in general. The brain just isn't thinking the mask and machine use is a good thing and could be a factor.

We all have arousals that we don't remember...and a handful isn't going to be that big of a problem but 40 plus...that's a problem.

Think about it...how well do you think you would feel if I came over to your house and poked you 40 plus times with a pin and cause a slight arousal/awakening that sometimes was 30 seconds and sometimes the awake part lasted several minutes?

You most likely aren't getting the needed amount of sleep in EACH sleep stage for the restorative powers of sleep to work their magic.

During the arousals that I saw....I didn't see anything that made me think that the arousal was airway related. No flow reduction...no snore...no flow limitation of any real significance and most of the time no flow limitations at all.
You got bad sleep from something but it isn't airway related that I could see. Most likely would fall in the category of spontaneous arousals.

Your OSA....it's being very effectively dealt with.
Now to figure out how to fix the bad sleep that the cpap machine can't fix...when part of the bad sleep could simply be from the newness and adjustment process needed for using cpap. In other words...the cpap use itself could be part of the problem....that's to be expected. It won't be easy...figuring out causes of spontaneous arousals is extremely difficult.

Let me go do some screen shots so you can see what I mean and learn to identify arousal breathing on your own.
It will take me some time...so more later.

[Pugsy]

Please read this document.
https://thesleepdoctor.com/alcohol-and-sleep/
I know alcohol use isn't your issue but the doctor does a very good job explaining the importance of ALL the stages/cycles of sleep and how coming up short anywhere ends up affecting our sleep and thus how we feel during the day.

Just every time you see the word "alcohol" substitute the word "anything" in your mind.

[Billymadison420]

I slept nine hours last night, uninterrupted except for having to adjust the CPAP mask one time. It doesn’t seem to be affecting me staying asleep.

What you THINK happened in terms of sleep quality and what actually happened in terms of sleep quality can't be further apart. You don't have memory of a lot more arousals but you had them.

All of the CAs/centrals were arousal/awake breathing false positives...so 11 arousals right there. Every single flagged central was so obviously arousal/awake related that a blind man could see it.

Then there were 31 more arousal segments where it wasn't just a blip but anywhere from 30 seconds to several minutes where your flow rate shows you weren't sound asleep....these arousal segments didn't have any sort of flag associated with it.

So 40 plus for sure arousals/awakenings last night ....no wonder you aren't feeling as chipper as you hoped.

I went through the entire flow rate and looked at every breath. When you turned the machine off and then back on again in the middle of the night....turned it back on again at 3:41...you didn't actually get back to real asleep breathing until 4:05.
And similar time frame for falling asleep at the beginning of the night...plus it wasn't 9 hours it was 8 hours and 18 minutes of the long night time segment....the other 2 little whatevers earlier in the day are in your overall total but didn't occur last night. I turned those off and only evaluated the night time data....and it's 8 hours and 18 minutes with over 40 very obvious arousals plus the break in therapy arousal.

You got a little less than 8 hours of actual sleep (we remove the 20 minutes or so at the beginning and middle where you didn't sleep soundly) and those little less than 8 hours was highly fragmented with at least 40 plus arousals.

A little later I will post some screen shots to clarify things...hopefully.

So the short version of all this....you aren't actually sleeping as soundly as you think you are. This is quite common because we don't always remember awakenings but they still screw up sleep quality and mess with your sleep stages/cycles and ultimately....how you feel or don't feel the next day.

Sleep maintenance insomnia...that's what you got. That means trouble staying asleep for sure and maybe a little bit of sleep onset insomnia thrown in.
As to why....don't know but you got it. Part we can very likely blame on the adjustment process in general. The brain just isn't thinking the mask and machine use is a good thing and could be a factor.

We all have arousals that we don't remember...and a handful isn't going to be that big of a problem but 40 plus...that's a problem.

Think about it...how well do you think you would feel if I came over to your house and poked you 40 plus times with a pin and cause a slight arousal/awakening that sometimes was 30 seconds and sometimes the awake part lasted several minutes?

You most likely aren't getting the needed amount of sleep in EACH sleep stage for the restorative powers of sleep to work their magic.

During the arousals that I saw....I didn't see anything that made me think that the arousal was airway related. No flow reduction...no snore...no flow limitation of any real significance and most of the time no flow limitations at all.
You got bad sleep from something but it isn't airway related that I could see. Most likely would fall in the category of spontaneous arousals.

Your OSA....it's being very effectively dealt with.
Now to figure out how to fix the bad sleep that the cpap machine can't fix...when part of the bad sleep could simply be from the newness and adjustment process needed for using cpap. In other words...the cpap use itself could be part of the problem....that's to be expected. It won't be easy...figuring out causes of spontaneous arousals is extremely difficult.

Let me go do some screen shots so you can see what I mean and learn to identify arousal breathing on your own.
It will take me some time...so more later.

That is very interesting because I don’t see any central apneas on my Oscar or my machine. It shows as 1.2. And no obstructive apnea. Maybe you’re talking about different data.

Other than everything else going on my life and that stress, my tinnitus of course bugs me. And that interferes with sleep. There’s nothing I can really do about that though.

Thank you so much for that data! This is stuff I just absolutely wouldn’t know without other people telling me to my knowledge I was fully asleep until adjusting the CPAP at around 3:50 AM. Then I was fully asleep again until around 730. And that is with taking the mirtazapine. If I didn’t take that. It would be much worse. I would be awake half the night.

[Pugsy]

Clear Airway....OSCARS term for central apneas. Long story why it is called CA/clear airway but where you see CA they are centrals.

You had 11 flagged by your machine. Over on the left side of OSCAR detailed report look at the "events" tab...click on it.
It will tell you how many were flagged in each category and if you click on it again it will tell you when they occurred and how long they lasted. The number in parentheses by the time is the duration in seconds.

And the sleep report on the LCD machine does indeed tell you central index...you just have to look a little deeper to see it.

[Billymadison420]

Clear Airway....OSCARS term for central apneas. Long story why it is called CA/clear airway but where you see CA they are centrals.

You had 11 flagged by your machine. Over on the left side of OSCAR detailed report look at the "events" tab...click on it.
It will tell you how many were flagged in each category and if you click on it again it will tell you when they occurred and how long they lasted. The number in parentheses by the time is the duration in seconds.

And the sleep report on the LCD machine does indeed tell you central index...you just have to look a little deeper to see it.

Gotttcha. Ok yes I see that for sure. I guess I thought since I had significantly less of them, then I would feel better. the AHI takes into account, Obstructive + Central , correct? I think I had about a 1 AHI.

As far as quality of sleep, like I mentioned, the Tinnitus is the major thing that spurred me even getting a sleep test in the first place. I never had much "trouble" sleeping before that. It's been about 16 months. In the beginning I couldn't sleep at all. I was a wreck. It was horrifying. I have habituated quite a bit. I can perform all the duties of my life, and there are times I am unaware of it, and even when aware I am not totally freaked anymore. I can have days where when busy I hear it maybe 15% of the day. But when resting or "relaxing' I hear it.

I of course sleep with sound at night (Air conditioning + white noise) and it masks the T to a degree, but other than that there is not just else I can do to become not bothered by it during the sleep process.

If I never got the T, I probably wouldn't even be on this forum. Of course I would have still had sleep apnea, but I probably wouldn't have looked for an answer.

[Pugsy]

Yes...AHI takes into account all the 3 categories of events associated with the airway...either collapsing tissues (OAs and hyponeas are obstructive in nature) and central apneas which is just a cessation of breathing and the airway is open...we just don't make an effort to breathe.

Your AHI last night would have been 0.0 on the 8 hours I examined if it hadn't been for the 11 false positive awake flagged centrals.

This session is what I examined...the other sessions I turned off so I wouldn't see them. They were too short and didn't reflect night time sleeping anyway. I looked at every single breath zoomed in enough for me to get a decent idea as to awake vs asleep. Some awake breathing is VERY obvious...easy to spot...but other times it isn't always so easy. I ONLY counted the irregularities that were obvious awake breathing. I didn't count the "maybes".



I don't have time right now to go through all of the examples I wanted to share but I thought I would do at least a couple.
One with a flagged central and one with no flag.
When evaluating real asleep flagging...we look at the pattern of breaths preceding the flag.

I drew a line where the asleep flow rate starts to change to awake/arousal flow rate and then I think you will see how obvious the breathing near the flagged events was so obviously not asleep breathing that a blind man could see it.



and here's some arousal breathing but without any flagging. I circled the arousal related breathing in red. It's very brief and I don't know how much of any impact it actually causes but it's there.



Now most of your non flagged arousal breathing was much longer in duration and very well could impact the sleep cycles themselves. Here's one that lasted about a minute. I didn't count the little blip in breathing that occurred at 03:02:30...it's a "maybe" and too brief to be sure of.



And this one...prolonged irregular breathing...not sound asleep...again not sound asleep breathing circled in red...
I had to scrunch the breaths together a bit to give you a perspective as to duration...it actually went on a bit longer but this is the best I can do to show asleep breathing on the left side and when the changes started to occur and how long they lastet.



This is all I have time to do right now. Got some place hubby wants to go to and I got some chores to do first before we can go. More later.

[earlvillestu]

I'm a CPAP newby, and I've read through this entire thread twice. There is an amazing amount of knowledge here, and it has cleared up a number of confusions and misunderstandings I had about CPAP, and it has given me a lot of information that I can use to interpret my OSCAR results. Thank you so much to Pugsy and the other knowledgeable folks who have contributed!