Diminishing Returns - Any Thoughts or Advice?

[Robbie]

Aloha,

I've been on CPAP since October of last year. My primary sympton prior to my sleep study was excessive daytime sleepiness (My wife was also getting occasional excessive daytime sleepiness from staying awake to jab me with her elbow when I quit breathing at night).

Initially CPAP was life changing. I felt better than I had in years. The dreaded afternoon heavy fog/walking dead feeling went away. It's now coming back. My leak rates are steady and fairly low, my AHI according to the LED readout runs anywhere from 3 - 5 with the HI making up the lion's share of that number. I use Poligrip strips and am reasonably certain that mouth breathing isn't an issue.

The only physical change I've noticed that might be negative since I started CPAP is I have a subtle feeling of always being a little congested. Sometimes I feel like I can't breathe in enough air through my nose while the hose is connected (pressure is set at 9). I have the humidifier attached and filled with (distilled) water, but rarely turn the heat element on.

I'm guessing this experience isn't unique. Is it time to call the sleep doc for a follow up? is there anything I can try to alleviate that mildy congested feeling (Any satisfied NetiPot users out there?) My family doc has suggested a trial of Provigil - anybody have any feedback on this?

Finally, I am aware that my biggest benefit from CPAP therapy has more to do with avoiding health problems that can arise from apnea .. feeling better is a side benefit. label me greedy

Gracias !

[kteague]

Just a couple thoughts... Do you have access to how long you spend in apnea? Your number of events might not be excessive by general standards, but if they last long or your oxygen drops a lot, it would seem they would have more impact on your well being than the same number of brief events. Maybe monitoring your oxygen overnight wouldn't hurt.

Has anything changed, such as your weight, medications, etc. that could be affecting your pressure needs or even your sleep in general?

Hope you're back on track soon.

Kathy

P.S. Provigil may meet a need right now, but not as a replacement to figuring out if something needs addressed. I use a neti-pot when congested. Gives good temporary relief.

[Wulfman]

Hi Robbie,

Maybe some more pressure would help.....?

Make sure you're getting ENOUGH sleep, too.

Den

[amos]

Robbie,

Here are a couple of thoughts as well. I am able to deal with mild nasal congestion by using a saline nasal spray ("Ocean") before bedtime. Also, if I wake up and have mild congestion, I turn the humidifier up a notch. These two things work for me.

If you are more than mildly congested, you might try a medicinal nasal spray, such as "Afrin."

As to how you feel: I found that along the way would I reach plateaus where I did not feel any improvement for weeks at the time; and, the suddenly, one morning I felt better. This continued for several months. Perhaps you are on one of those plateaus.

If none of the above works for you, it may indeed be time to see your sleep doc. He/she may want to increase your pressure a bit.

Amos

[cflame1]

Afrin's not good to take for more than 3 days at a time.

[rhowald]

Couple things... You may have already thought of them...

1 - Check to ensure that your not having some other environmental issue that is causing arousals or poor quality of sleep. This could be something that is keeping you awake like a sound, light or even feeling - like the heater turning on and slightly startling you, to emotional or stress related issues.

2 - Additionally, make sure you aren't burning the candle more now that your quality of sleep has gone up. This is a mistake I made and realized that too little sleep is also bad for you, just like poor quality sleep.

3 - Check to ensure that your filters are clear and that you are changing them in a timely fashion. I let mine run over the recommendation by just a week or so and noticed a difference for the better the night I changed it for a clean one. If yours has a two part filter (I am not familiar with the non Respironics machines), make sure not to dismiss cleaning or changing the bigger cover filter.

4 - You may want to turn the humidifier up. The dry air this time of year could be causing issues.

5 - You may be having the additional stuffiness with a slight cold or bronchial issue affecting your breathing and quality of sleep. Again this is going around really heavily now since just before Christmas.

The most important thing is to stick with it. And if some investigation on your own doesn't shed light on the issue, by all means talk to the sleepdoc.

[Snoredog]

where are those doctors that argue why you shouldn't have an apap because they don't believe in their algorithms?

Oh that's right they are off peddling books.

but if you had an apap now, you wouldn't be wondering about your OSA therapy. With the apap at least you would know if the machine was addressing all your OSA, if AHI is at 5 or below and you are still tired there is something else overlooked or not being addressed.

of course we all know what they will say when you ask them,

you need to go have another titration and spend $3-5k on another wasted sleep study and still they will deny you the apap,

yet they have no problem whipping out their pad to write you a script for Zoloft or some other drug that later gets found to be totally ineffective like has happened in recent days.

You need to drag out your original PSG and read it yourself, look for other items on the report that CPAP may not address like CA or MA events, spontaneous arousals, PLM etc. Then go ask that doctor why they didn't address those other aspects of your disorder.

[jupmalis]

The same as you, my biggest complaint was sleepy fatigue during the day. I have been on a CPAP machine since last October, at a pressure of 8.

I have a big chest, and sometimes feel that the machine can not supply as big a supply of air through the hose as I want when I first put it on, after being active. I find the machine is OK when I am in a resting state.

I love that generous supply of air when I am sleeping. Of course congestion can get in the way, so all I do is take off the mask and clear my nose, and then put it back on. This does not happen that often

I also like the humidification, despite the few drops of water in the mask at night. It leaves me with moist sinuses in the morning, and lessens my congestion during the day. I wonder why you do not turn on the heating feature of the humidifier, even if you live in a warm and humid climate.

I sleep better and more with the CPAP, and do not snooze during the day. But I do not count myself among those who feel that they got instantaneous relief of all of their ills. I must have gone several years with apnea, and now I have to hopefully learn a better way of life.

[TerryB]

Hi Robbie,
I have been on the hose since Feb 06 and I went through a terible spell in the beginning but finaly figured that there are several things which must all come together to feel good consistantly.

You have to get enough hours of sleep every night. I find that eight hours do it fo me I wake about eight hours after going to bed.

The leaks have to be taken care of and I use the strips too.

The mask may be leaking and bothering you during the night. I found this to be a major problem solved by using nasal pillows instead of a cushion mask.

I use the generic equal of Tylenoy PM each night to help me sleep.

I use Pur-sleep every night to help me go to sleep more quickly.

Occassionaly I don't get my eight hours and I am dragging the next morning.

I hope something above might click for you.

TerryB

[Country4ever]

Also make sure you don't have a sinus infection. They can really drain your energy. You can have an absess and it doesn't have many symptoms, other than maybe some headaches and fatigue.
Have you had a physical recently? Might be good to just check up on your other systems too........maybe get a CBC, Chem profile, and thyroid levels.