On BiPAP for almost 3 weeks, but still sleeping 11-12 hours a day?

[niurefine]

Hi everyone, I am a 24 year old man who recently started BiPAP therapy for a combination of obstructive and central sleep apnea. I have the AirCurve 10 and wear the AirFit F20 full face mask. Untreated, I have sleep apnea on what I think is the low end of severe with a typical AHI in the 40s. According to my last sleep study, when I'm on the bipap, I have an AHI around 18-20 on my back (so I try very hard not to sleep on my back) and around 5-8 on my side, though my machine often puts me lower than that. The lowest my AHI gets according to my machine is around 2. A typical day is around 4-5 AHI, I think. I'm not sure exactly what pressure I'm on, but the doctor I saw said something along the lines of it starting high and going up to the highest pressure. (Fortunately I don't find it uncomfortable )

The AHI thing bothers me less than the amount I sleep, although I know they're connected. Since I was in my late teens, I feel pretty exhausted unless I get at least 11 hours of sleep (on a good day) up to 13-14 hours of sleep (on a bad day). Being on the bipap has made me have a lot more good days, but my dream is to feel rested after only 8 or 9 hours of sleep, and I'm pretty far off from there. I'm a college student, so I formed my class schedule around only being in class on alternating days so I can get my 12 hours in on the days I don't have school, and on the days I have class, I have to have an energy drink or I can't keep my eyes open. When I don't have class (like right now, winter break) I tend to move towards a schedule of being awake from 4pm to 4 or 5 am, which as you can imagine isn't great for most purposes, and my sleep schedule certainly confuses myAir

So my main question is:

When should I expect to see improvement in the amount I need to sleep? Is it possible I'm just hardwired to always need at least 11-12 hours of sleep? That would really not be great. Is it just a time thing? Also, I haven't set up OSCAR yet, but I'm willing to do that if people think it would be a good idea. Thanks so much for any insight

[niurefine]

Ah, sorry, just read the information for newbies more carefully and saw that it's asked of us not to ask how long things will take to improve lol. In that case, I would like to amend my question to: Has anyone else experienced similar sleep problems and did it improve after starting therapy? Apologies!

[Pugsy]

The most frequently asked question is "when will I feel better or sleep better" and unfortunately there is no clear cut one answer that works for all people.
There are simply too many variables to the equation to be able to give that sort of answer. Everyone is different and respond differently plus there are often other factors at play that we can't know about or even see on the reports the machines give us.

Do you take any medications (even OTC) of any kind and if so...what?

Any other physical or mental health issues going on?

Do you wake often during the night?

And yes....get OSCAR up and running and get familiar with it.

[niurefine]

Hi Pugsy, I take a fair deal of medications as I have several health conditions, mostly well-managed - depression (very well-treated now fortunately ), ADHD, and a thyroid disorder (Hashimoto's). Off the top of my head (there may be one or two more that I've forgotten), I take levothyroxine (thyroid), lurasidone (depression), and atomoxetine (ADHD), as well as the supplement N-Acetyl Cysteine - without that last one I tend to pick at my skin pretty badly when I get anxious. I also have asthma, but haven't had any symptoms of that for several months. I do know that my thyroid disorder isn't well-managed right now according to my last bloodwork, which is probably making me a bit sleepier, and the dose of levothyroxine I'm on will probably be increased within the month, which ought to fix things on that front. I'm also on the lower end of obese - I weigh about 190lb and am 5'3.

I do wake several times during the night (or day, lol) and I notice it more now that I am on the bipap as I usually move in bed and sometimes my mask starts leaking and I have to readjust it. I've just ordered an SD card for OSCAR and that will hopefully arrive in a few days. Thank you for the response!

[niurefine]

Hi everyone! I'm back with some OSCAR stuff! I apologize for the weird times of day this was taken! Here is what today's data looks like (lol - 12pm to 2pm - I slept from around 2am to 2pm)! Please ignore the crazy leak - that's not normal for me. I think my mouth just fell open while I was asleep a few times, which doesn't usually happen
https://i.imgur.com/Yh4w9HW.png
Here is something I'm interested in, in the next image: It looks like I had a couple central apneas before taking my mask off while I was still half-asleep, but it doesn't seem like the second one was detected and I don't see any pressure increase. Is the bipap supposed to increase the pressure in response to central apneas or just obstructive ones?
https://i.imgur.com/njcjDyo.png

Also, with regards to how I'm feeling: I had a couple days this week where I was able to get up after about 7 hours of sleep, but on one of them I had an energy drink and on the other one I had a nap. Fingers crossed it will get better I'm just glad I was able to get up for once!

PS: Looking at OSCAR it looks like my maximum pressure is actually 22.0! I thought it would be 25.0, but I guess not.

[Pugsy]

Is the bipap supposed to increase the pressure in response to central apneas or just obstructive ones?

The machine will NOT increase the pressure in response to central apneas because it wouldn't help anyway.
They only respond with an increase in pressure to obstructive events (OAs, hyponeas, Flow limitations, snores).


Get all your meds out and start looking at all the known side effects.

[niurefine]

Hi everyone, just wanted to update. I have been using the bipap for a few months now and I am starting to get better. I'm also making some medication changes, albeit very slowly - titrating takes a long time! I have a long train commute to my university, but I'm noticing that I usually don't sleep on the train now - I used to fall asleep almost every time. Sometimes on my days off I get up after only 7-8 hours of sleep and I don't end up having to take a nap. It's not so unbearable anymore. I still sleep for long periods of time a lot, but I haven't had any really bad days where I lose 16 hours in a while. I'm also less irritable in the mornings. I guess I just hadn't given it enough time

[Miss Emerita]

This is excellent news! Many thanks for coming back to tell us how you're doing.

[niurefine]

Hello everyone! I'm back again because I was looking at my OSCAR data recently (I was debating whether I should talk to my pulmonologist about looking into an ASV at my next visit since my machine says my AHI in the morning is usually around 8 or 9, sometimes higher, even if I make sure to sleep on my side) and I was curious about why my normal respiration has this shape (see attached screenshot). The apneaboard OSCAR guide says this isn't normal respiration and classifies it as "Class 6" here: https://www.apneaboard.com/wiki/index.p ... lasses.png

I'm not exactly worried about it but I am curious - what does it mean? All my non-apnea breathing while I'm asleep has that approximate shape (though it seems to get a little wacky shortly before a CA or OA - I can send pictures if requested). Also, my sleep schedule is pretty strange, hence the weird times - I'm on summer break from college and only work a few days a week! (In addition to that, I think my machine's time is an hour off, but that's not a big deal to me.)

[robysue1]

Hello everyone! I'm back again because I was looking at my OSCAR data recently (I was debating whether I should talk to my pulmonologist about looking into an ASV at my next visit since my machine says my AHI in the morning is usually around 8 or 9, sometimes higher, even if I make sure to sleep on my side) and I was curious about why my normal respiration has this shape (see attached screenshot). The apneaboard OSCAR guide says this isn't normal respiration and classifies it as "Class 6" here: https://www.apneaboard.com/wiki/index.p ... lasses.png

Those shapes are only the inspiration part of the flow rate curve. In other words, the folks who created that image did not put the 0-line on the picture, and that's confusing you. Here's the same image with the 0-line added:


Now when you look at the snippet of your breathing in your Oscar data, you will notice that the plateau occurs just before your inspiration starts. And that's actually a normal, sleep breathing pattern.

In the Oscar curve: When the flow is above the 0-line, you are actively inhaling. When the flow is below the 0-line, you are actively exhaling. And it's normal to have a small plateau of no air movement between the end of the exhalation and the beginning of the inhalation.

Also, my sleep schedule is pretty strange, hence the weird times - I'm on summer break from college and only work a few days a week! (In addition to that, I think my machine's time is an hour off, but that's not a big deal to me.)

It's no weirder than my own sleep schedule as a (not yet retired) college professor who is on summer break from college, but preparing for a class I've not taught before in the fall.

[niurefine]

Oh, thank you! I didn't read closely enough - I should have realized! I appreciate the explanation. I'm glad my breathing is normal I appreciate the answer!

[niurefine]

Hello! Back once again after realizing my treated AHI is really not great and pretty unusual for someone with sleep apnea because I saw a post on /r/cpap asking people what they had before treatment and after treatment - most people were under 2! Even when I sleep on my side (at least, I think I'm sleeping on my side) I tend to be around 6-10. What are my next steps? I have OSCAR - is there anything people on here'd like to see? It seems to be a mix of obstructive and central apneas.

Edit: Also wanted to add for context that my BiPAP titration did record an AHI of like 8 even when I slept exclusively on my side, so I don't think it is just that I'm rolling onto my back. When I do that sometimes I get an AHI in like the 20s, which is also corroborated by the titration results. That's crazy right? It doesn't seem normal.

[niurefine]

Oh, one more thing! I don't think it is a mask leak thing either - my machine and OSCAR both show me as having quite a low leak rate and my seal feels good. I guess maybe it's just an anatomical thing?

Edit: Wait, actually, another thing I want to add! (Promise this is the last one lol) OSCAR says my treated apneas aren't all centrals! About half and half if I remember correctly.

[robysue1]

Oh, one more thing! I don't think it is a mask leak thing either - my machine and OSCAR both show me as having quite a low leak rate and my seal feels good. I guess maybe it's just an anatomical thing?

Edit: Wait, actually, another thing I want to add! (Promise this is the last one lol) OSCAR says my treated apneas aren't all centrals! About half and half if I remember correctly.

How restless are you as a sleeper? In other words, would you say you're a light sleeper prone to waking up somewhat frequently at night?

If so, there's a good chance that many of those CAs the machine is scoring are post arousal "events" that are not real---as in they would not be scored on an in-lab sleep test because the EEG data would reflect that you were not actually fully asleep when they occurred. For some people, it's normal to have some "glitches" in the breathing occur as we transition from wake to sleep and the control of our breathing is reset---different parts of the nervous system control wake versus sleep breathing. And part of the reset is also a change in the CO2 level needed to trigger the brain to send a message saying "inhale now" to the lungs. That can cause a momentary pause in breathing that can fool an xPAP machine into scoring an event---most likely a CA, but depending on you "hold your breath", it could also be scored as an OA.

A few posts back you write:

All my non-apnea breathing while I'm asleep has that approximate shape (though it seems to get a little wacky shortly before a CA or OA - I can send pictures if requested).

Depending on what you mean by your breathing gets "a little wacky shortly before a CA or OA", this could just be an indication that you aroused before the event was scored, and in that case, the event is most likely a post-arousal "false positive" that would not have been scored on an in-lab sleep test.

Can you zoom in on an example or two of the "wacky" breathing shortly before a CA and also shortly before an OA so we can see the individual breaths for maybe a minute before the event as well as a minute or so after the event? That's the only way to sort out if a lot of the events that continue to be scored by your machine are likely related to spontaneous arousals where the arousal came first.

[niurefine]

How restless are you as a sleeper? In other words, would you say you're a light sleeper prone to waking up somewhat frequently at night?

I don't really think of myself as a light sleeper - I wake up maybe three or four times at most during the night (at least that I can remember), and only very briefly. My parents say that's normal for adults, but they both have their own sleep problems. But I also remember quite a few of my dreams, often in a lot of detail, basically every night, which I've heard means you're waking up frequently.

Here are some examples of what my breathing sometimes looks like shortly before an event or multiple events (yes, I know I sometimes sleep at weird times, lol):







As for how I feel... I guess I feel fine. Much less tired than I did when I was sleeping 12-14 hours a day. I just still sometimes find myself falling asleep on the subway. If I don't have caffeine and I'm waiting for something for awhile while sitting down, I will probably fall asleep. Stuff like that.

There are also times when my breathing goes from normal-looking into an apnea. Maybe those are the real apneas? Like this:



As you can see I breathe weirdly after that for a bit but maybe it's just that the apnea woke me up a little.

Sorry if this is too many examples! I thought it would be better to have too many than not enough.