CPAP journey starts but still high Central Events

[johncray]

Good morning,

Here's the data from last night: https://sleephq.com/public/7630b488-fdc ... bd7a20b83d

The change of EPR to full time (3) made it way worse. I'm disabling it and will increase to 9.0 tonight.
I think the variability in pressure, wether because of Auto PAP or EPR makes it worse.

Let me know what you think!

Thanks

[Pugsy]

Okay....I suspect that since increasing EPR didn't help reduce the FLs then most likely that FL graph activity is more related to nasal congestion because if it had just been the airway then the FL graph should have shown at least minimal reduction.
Nasal congestion needs to be addressed in the traditional ways.....meds, rinses, sprays or whatever helps open up the nose.
Fiddling with pressure changes doesn't help reduce FL activity that is nasal congestion related.

Again the bulk of the flagged events are either post arousal or full arousal.

You did have some chunks of sleep but you also had a lot of evidence of arousal/awake breathing.

You need to figure out some way of sleeping more soundly and while you can try your pressure changes slowly....I have my doubts as to whether you will get the results you want.

I have doctors' appointment today so will be out of touch for a while.

Perhaps someone else has some thoughts????
Nocibur...???? Are you interested in looking?

[johncray]

Thanks for looking again!

Nasal congestion needs to be addressed in the traditional ways.....meds, rinses, sprays or whatever helps open up the nose.

I do all of those things: sinus rinse, neilmed moisturizing gel, breathe right strip and if it gets really bad - ryaltris spray
Last night it felt pretty open and I could breathe normally.

You need to figure out some way of sleeping more soundly and while you can try your pressure changes slowly....I have my doubts as to whether you will get the results you want.

I'll close the gap to 11.0 so that I can present this data to the sleep clinic but yeah I also doubt things will change much.

Now the real question is: how do I sleep more soundly? What comes to mind is ask my doctor to send me to an in-lab PSG test so that more data comes out and confirm your theory. If confirmed we can then discuss that it might be because of the Zoloft. I am afraid what he'd suggest in response would be to either change the dose (probably increase it since he's been saying this for a while) or to change it altogether with another medication. I am afraid of a pill change because that could bring with itself different side-effects and the change itself might be difficult after so many years on Zoloft.

Cheers

[Pugsy]

Now the real question is: how do I sleep more soundly?

Yeah...million dollar question isn't it? Hard to answer and even harder to implement even if we knew for sure what the cause was.

It's really hard to fix a problem especially when we don't know what is causing the problem.

What kind of unwanted symptoms are you having during the day (that you say hasn't changed any with cpap use)??

Gotta go get ready for doctor appointment. Sigh....I hate doctors.

[johncray]

It's really hard to fix a problem especially when we don't know what is causing the problem.

I am hoping a PSG study would confirm/reject this hypothesis so that we know for sure if this is indeed rooted in bad sleep to begin with.

What kind of unwanted symptoms are you having during the day (that you say hasn't changed any with cpap use)??

Tired all the time, a little dizzy/brain fog, mixing up words, forgetting more.

Gotta go get ready for doctor appointment. Sigh....I hate doctors.

Good luck!

[johncray]

I wonder if it's also a matter of *increasing* the current dose of Zoloft. After so many years maybe the body has adapted. Bumping it to 100mg might be worth discussing with the doctor. Have you got any knowledge with similar cases where people needed to increase the dose to stabilize their sleep?

[Pugsy]

Have you got any knowledge with similar cases where people needed to increase the dose to stabilize their sleep?

No. Sorry. I have zero experience in this area.

[johncray]

I think this is worth pointing out here: https://www.youtube.com/watch?v=-aHlhnh0xG4 in case someone else is in the same boat as me

Here are the relevant notes I took:

* Deviated septum might cause allergic and non-allergic rhinitis and interfere with the ability to use PAP therapy
* Deviated septum can be a risk factor to trigger central sleep apnea. A person tries to use CPAP therapy and for some reason with this obstruction it triggers the brain to shut down momentarily
* Requires surgery: septoplasty to fix the deviated septum and turbinoplasty to reduce the turbinates. Do NOT remove the turbinates altogether (turbinectomy). This will lead to empty nose syndrome

I do have both a deviated septum and enlarged turbinates as I pointed out earlier and my ENT has been reducing the turbinates with RF waves for many years until one day I'll need to do the surgery along with fixing the septum. Maybe that day will come sooner rather than later!

[ChicagoGranny]

I'll need to do the surgery (turbinate surgery) along with fixing the septum.

Gramps had that done years ago. Not only did it make it easier to use CPAP, his daytime breathing is also healthier.

[johncray]

I'll need to do the surgery (turbinate surgery) along with fixing the septum.

Gramps had that done years ago. Not only did it make it easier to use CPAP, his daytime breathing is also healthier.

Thank you for sharing that. I'll start collecting more information on this subject soon to try and gauge risks.
Did he do both septum and turbinate reduction? Any problems/side effects afterwards?

[Pugsy]

You know I have been doing some thinking on your situation and I have come to the conclusion that if I were in your shoes I would be pushing for an in lab, attended by tech, sleep study just so we can know when you were asleep or not and more accurate flagging.
Home studies don't do so great in terms of accuracy of anything when we have a lot of awake/arousal breathing or not breathing going on.

and your question about increasing the dosage to maybe increase sleep....I just don't see how increasing a medication dosage because it gives an unwanted side effect is going to help. In my mind it will make the side effect worse.
Assuming of course that the bulk of your sleep issues is related to medication side effects.

Right now we just don't have enough clear cut knowledge as to just what is causing your crappy sleep. Might be the meds but might be something else. The list for potential causes of crappy sleep is miles long...meds for one and sleep apnea for another but many, many other potential culprits on that list.

I would push for another diagnostic sleep study (no cpap use for at least 3 or 4 days before the in lab sleep study) if it were me.

BTW...survived the doctor appt yesterday. I am a pin cushion. 3 joint injections.

[johncray]

You know I have been doing some thinking on your situation and I have come to the conclusion that if I were in your shoes I would be pushing for an in lab, attended by tech, sleep study just so we can know when you were asleep or not and more accurate flagging.
Home studies don't do so great in terms of accuracy of anything when we have a lot of awake/arousal breathing or not breathing going on.

Absolutely. I'll ask for that.

and your question about increasing the dosage to maybe increase sleep....I just don't see how increasing a medication dosage because it gives an unwanted side effect isn't going to help. In my mind it will make the side effect worse.
Assuming of course that the bulk of your sleep issues is related to medication side effects.

Right now we just don't have enough clear cut knowledge as to just what is causing your crappy sleep. Might be the meds but might be something else. The list for potential causes of crappy sleep is miles long...meds for one and sleep apnea for another but many, many other potential culprits on that list.

I would push for another diagnostic sleep study (no cpap use for at least 3 or 4 days before the in lab sleep study) if it were me.

My list of follow up actions is as follows:
1. In-lab PSG
2. Cardiologist / echo cardiogram to rule any potential heart issues. I have family history or arrhythmia although I don't think I do but want to rule it our
3. Neurologist to rule out brain issues - MRI/CTScan whatever
4. Psychiatrist to discuss the Zoloft, dose, effects, changes
5. ENT - deviated septum and turbinate reduction

I need to get to the bottom/root of the problem. I'll try to get as many of those done in parallel as possible and collect better information. Unfortunately I'm in Canada and the health-case system here is overloaded and extremely slow. It could be a year or more until I can get them done. Private options are limited. Might consider going to the US or in Europe to do some/all of them.

[Pugsy]

Unfortunately I'm in Canada and the health-case system here is overloaded and extremely slow.

Ahh...that confounds the problem for sure. It's a well know problem in the Canadian health system....delays for specialists.

Concentrate on getting the push for in lab sleep study first. You need to get it figured out whether you really have OSA or not and then proceed. It wouldn't be impossible for you to not have OSA to the point of needing any machine.
I haven't heard of very many false positives for OSA home studies but I have heard of them.

Either that or a much more detailed home study where they can actually measure sleep. They cost more money though.
More data means more money.

There are several types of sleep studies....explained at one place I know of. The guy that runs this place I know him.
https://axgsleepdiagnostics.com/

You would need a type 2 home study to get sleep status data and like everything else....the price has doubled from the last time I checked his company.
https://axgsleepdiagnostics.com/product ... nattended/

I don't know if there is some sort of company in Canada that will do the Type 2 home sleep study. Normally what you get is a type 3 or 4 that just gives basic data.
Even here in the USA they all seem to start with a type 3 or 4 bare bones test. Cost is probably a third. That's why they do it...most of the time they are accurate enough to get a person started but sometimes accuracy sucks.

[johncray]

Ahh...that confounds the problem for sure. It's a well know problem in the Canadian health system....delays for specialists.

It sure does. My wife is on the waiting list for the UBC sleep clinic for an unrelated problem to mine and she was told 6 - 18 months of waiting. Everything is like that. There are other PSG labs around here but I don't know how much faster they could do it. We'll see.

Concentrate on getting the push for in lab sleep study first. You need to get it figured out whether you really have OSA or not and then proceed. It wouldn't be impossible for you to not have OSA to the point of needing any machine.
I haven't heard of very many false positives for OSA home studies but I have heard of them.

Roger

Either that or a much more detailed home study where they can actually measure sleep. They cost more money though.
More data means more money.

There are several types of sleep studies....explained at one place I know of. The guy that runs this place I know him.
https://axgsleepdiagnostics.com/

$1200 USD seems like it

I'll talk to my GP in 2 weeks to see where we can go from here.

Thanks for the information and support! Highly appreciated

[johncray]

I forgot to mention that last night I could not use the machine at all because I went for a run after work and my nose got really congested, runny, sneezing. Experienced allergy-like symptoms. I get this every now and then after a run. Not sure if it's something in the air or a non-alergic rhinitis / vasomotor related to my nose problems and the breathing during running. It was interesting how I was watching (https://www.youtube.com/watch?v=-aHlhnh0xG4) which talked just about that. I tried sinus rinse, moisturizing gel, Ryaltris (steroid + antihistamine) - nothing helped.

Anyway, I slept without the machine at all but did wear my O2 ring. Here's the chart https://sleephq.com/public/c052476b-566 ... c87c9d82f2
As far as I can tell my saturation and pulse were overall worse than the previous nights when I used the machine. Perhaps this is expected because of the small obstructive apnea component that I have as well