Sleeping WAY MORE since I started Bipap

[lcosborn]

I started BiPAP therapy about 2 weeks ago. I was on CPAP for a few months before that. I seem to be doing almost nothing but sleep! I slept almost three solid days and nights recently. I woke up at 10:30 am today, it's now about 6:30 and I'm ready to go to bed! I am having major brain fog and can't seem to function at all.

My stats from the Encore Pro show that my AHI has been dropping. It went to 15 for a few days, then down to 10, and is sometimes lower. (I've had three sleep studies, with AHIs of 29, 39 and 49 respectively.)

If I am having some kind of rebound from sleep deprivation and REM deprivation, how long is it supposed to last?!

Help!

Lara Osborne

[roster]

How about filling out your equipment profile (text not images).

Do you have the software for your machine?

[BanjoPaterson]

Hi Lara,

I've been on CPAP for over a year now and I still find there are day(s) where it feels like before CPAP and my mind's all foggy - so it's indeed possible to have good days and bad days (with, hopefully, the good days outweighing the bad). I have also found that my bad days have typically occurred because of something, for example this winter I needed to use the humidifier, but my wife likes the bedroom at arctic temperatures, so despite wrapping the hose and trailing under the sheets, I was still getting moisture in my mask which woke me up repeatedly. However, there have usually solutions (in this instance the 'Aussie' heated hose).

Also, as you say, maybe your brain's catching up on sleep. Hope things get closer to normal the longer you stay on treatment.

Cheers.

[-SWS]

I started BiPAP therapy about 2 weeks ago. I was on CPAP for a few months before that. I seem to be doing almost nothing but sleep!

I slept almost three solid days and nights recently. I woke up at 10:30 am today, it's now about 6:30 and I'm ready to go to bed! I am having major brain fog and can't seem to function at all.

Welcome aboard... Did your dramatically heightened pressure to sleep occur only AFTER your change to BiLevel? And did you change from CPAP to BiLevel because you had difficulty sleeping with CPAP? If yes to both of those questions, then I'm thinking you probably are paying back sleep debt....

My stats from the Encore Pro show that my AHI has been dropping. It went to 15 for a few days, then down to 10, and is sometimes lower. (I've had three sleep studies, with AHIs of 29, 39 and 49 respectively.)

Your residual AHI on BiLevel still sounds a little high. Was it better or worse on CPAP? What do your sleep professionals think of your 10'ish to 15'ish residual AHI?

If I am having some kind of rebound from sleep deprivation and REM deprivation, how long is it supposed to last?!

The time varies. Some people report taking weeks to pay back sleep debt. Others don't seem to have much sleep debt to pay back. Be sure to tell your sleep doctor about your intense drive to sleep. Also, do you have any Seasonal Affective Disorder (SAD) tendencies? Chicago skies are gray and the days are short right now. If SAD happens to be one facet of your sleep issues, then light therapy might be warranted.

Good luck and keep us posted.

[larry63]

I started BiPAP therapy about 2 weeks ago. I was on CPAP for a few months before that. I seem to be doing almost nothing but sleep! I slept almost three solid days and nights recently. I woke up at 10:30 am today, it's now about 6:30 and I'm ready to go to bed! I am having major brain fog and can't seem to function at all.

My stats from the Encore Pro show that my AHI has been dropping. It went to 15 for a few days, then down to 10, and is sometimes lower. (I've had three sleep studies, with AHIs of 29, 39 and 49 respectively.)

If I am having some kind of rebound from sleep deprivation and REM deprivation, how long is it supposed to last?!

Help!

Lara Osborne

I'm like you. 4 months on CPAP here and I'm a bout ready to throw in the towel.
I

[lcosborn]

That's extremely helpful to know. It is possible that I am paying back a huge sleep debt. I didn't see much change one way or another on CPAP (DeVilbiss Intellipap, Smartlink software). But on the BiPap the software (Encore Pro 2) says I have had a pretty dramatic decline in my AHI, but I am sleeping even more than I was, which is already a ton!

Most of my symptoms have been psychiatric--depression and ADD symptoms. I'm taking a high dosage--250 mg--of the SSRI Luvox (Fluvoxamine), and I was taking Adderall (for ADD). I am wondering if these meds have different side effects for a rested body than a sleep deprived body.

For example, in August I decided to stop taking the Adderall until I got the sleep apnea straightened out. The other day I took 20 mg of it because I particularly needed focus that day, and I was literally awake all night. I used to be able to take 20-40 mg of Adderall and then take a nap.

I'm now wondering if the Luvox is also having a different effect on me than it used to. It does list fatigue and sleep abnormalities as side effects.

I'd like to cycle down from the Luvox to the lowest dosage possible.

Is it possible that the SSRI is causing the sleepiness?

[cflame1]

yes it is possible

[M.D.Hosehead]

Is it possible you are in withdrawal from Adderal?

[lcosborn]

Adderall has a pretty fast clearance rate. It generally only works in the body for a short time and then gets flushed out, like caffeine. Since I stopped taking it in August, that's probably not the issue.

SSRIs tend to slowly build up in the body (at least from what I understand), and take a long time to leave the body. It is actually dangerous for that reason to just stop taking SSRIs quickly. You have to taper off slowly over weeks or even months, or you can have serious rebound effects which can be pretty nasty, even including things like psychosis and hallucinations.

[-SWS]

Well, depression and ADD symptoms are often secondary to sleep apnea. So quite a few of our posters have reported weaning off drugs for either condition with their doctors' help. And generally, sleep/wake problems can sometimes be compounded. On the off-chance that your current severity of daytime sleepiness or even depression are impacted by short days, you might find these search links useful:
http://www.google.com/search?q=%22light ... =firefox-a

Additionally, I'd start wondering about that 10'ish to 15'ish residual AHI. Is your AHI still high because your machine settings are not yet optimized? Or is your AHI still high because you happen to have a condition known as complex sleep apnea? That first scenario, suboptimal machine settings, seems to be the more commonly reported anecdote among our message board posters. That second scenario, complex sleep apnea, is not uncommon either.

Here are some links describing complex sleep apnea:
http://www.rtmagazine.com/issues/articl ... -11_03.asp
http://www.chestnet.org/accp/pccsu/comp ... a?page=0,3
http://www.sleepreviewmag.com/issues/ar ... -06_03.asp

In some cases complex sleep apnea goes away as patients gradually acclimate to PAP therapy. If your residual AHI has been slowly going down, your body might be going through such an adaptation phase. In other cases, special servo ventilation machines are prescribed. This person ended up faring better with supplemental O2 than a servo ventilation machine:
viewtopic.php?f=1&t=55279&st=0&sk=t&sd=a#p517197
viewtopic.php?f=1&t=56868&p=534393#p534393

Feel free to submit your detailed Encore graphs to this message board if you would like to hear potentially useful comments from your fellow patients!

[lcosborn]

I had another sleep study this Monday and my pressure settings were suboptimal. So, thanks to the message boards, I figured out how to get into my machine and change my own pressure last night. Today I have been way, way less depressed! I'm still tired, but the horrible obsessive thoughts that come with the depression have lifted somewhat. This is wonderful news.

I attached last night's Encore Pro report to see if anyone has any insights. There seem to be some hours where things are perfectly calm, and then the next hour I have a ton of "clear airway" apneas, which seem to be Respironics' way of saying central apnea. My doctor said that it is normal to have some variation in apnea frequency by stage of sleep. Compared to my first reports, these look so clean it is amazing! My first reports all seemed like confetti, there were so many little colored lines.

Thanks for any insights,
Lara Osborne

http://picasaweb.google.com/lara.osborn ... directlink

[-SWS]

Hello again, prof Lara! I'm glad you posted again. That's excellent news that your recent lab tweaks resulted in better sleep.

Your residual AHI is still up around 9'ish---with mainly central events outstanding. Some of our posters swear that keeping their leak line nice and flat helps with both their sleep and residual AHI. While I can find no white paper citations directly supporting that claim, it's an anecdote that's shared on the message boards again and again. So I'd recommend keeping an eye on how flat or jagged your leak line happens to be. You might be another person who finds that managing your leak line makes a difference.

Sensory-based arousability during sleep can be an issue for those with heightened tendencies IMO. So if you happen to be a "sensitive sleeper" then consider controlling your sleeping environment toward eliminating just as many sources of sensory disturbances as possible. That strategy might even extend toward managing bodily aches and pains, which are also potential sensory disturbances during sleep.

Sleep hygiene is important for poor and marginal sleepers as well:
http://www.google.com/search?q=sleep+hy ... ed3ee60de5

I'm not sure if your Respironics clock is skewed or if you are prone toward circadian rhythm skew as I am. If your internal sleep-clock is skewed, getting that back on track can help with depression as well. Good sleep hygiene practices help manage a tendency toward circadian skew. Melatonin helps me regulate my sleep onset times when my internal sleep-clock tries to skew later into the night than I want it to. Other patients rely on light therapy to treat or prevent circadian skew.
http://www.google.com/search?q=%22circa ... ed3ee60de5

I'd suggest that you continue to keep an eye on your data and residual AHI with us as your helpers. I'd also suggest asking and/or searching about literally anything that comes to mind relative to getting better sleep. People here are very helpful and very knowledgeable in my opinion. So feel free to post and even PM. We're glad to have you here!

Suggestions or thoughts from others?

[SleepingUgly]

For example, in August I decided to stop taking the Adderall until I got the sleep apnea straightened out. The other day I took 20 mg of it because I particularly needed focus that day, and I was literally awake all night. I used to be able to take 20-40 mg of Adderall and then take a nap.

I haven't read every word of this thread, but this part caught my eye. It's possible you were becoming tolerant to Adderall (i.e., needing higher doses to get the same effect or getting a reduced effect with the same doses). When you went off Adderall entirely from August until now, you essentially took a drug holiday, which may be why 20mg hit you harder. Oddly, I used to be able to take 400mg of Provigil and drink caffeine prior to my nose/throat surgery, and now I get very disrupted sleep and insomnia with much lower doses. I haven't yet figured out if that's due to the decongestant in my Allegra-D in combination with the other stimulants, or what.

I would have to read this thread more thoroughly to see what your issues are, but keep in mind that too much stimulants can also cause "obsessive" thoughts.

[lcosborn]

I hit the CPAP Wiki and starting learning about leak lines. I'll keep an eye on these stats and see if it seems to help.

The clock setting on my machine is way off, and Lincare said the only way to reset it is by sending the machine back to the factory. I find this extremely frustrating because I do want to track my sleep hours accurately. Getting on a regular sleep schedule is essential to me if I'm ever going to get out of this swamp and begin living like a normal human being. It is astounding to me that people actually get to jobs at on time, every day, at a regular hour. I have no idea when I am going to fall asleep and when I am going to wake up!

Sleeping Ugly, I hadn't thought about the issue of tolerance, but I think you are right. I had built up a pretty high tolerance for the Adderall, and after I took a break from it I probably did have a more intense effect. But your story of taking 400 mg of Provigil, wow! That is a whole lotta Provigil.

I do want to cycle down from the anti-depressants eventually, but I read the post the Golden Rule--only change one thing at a time--so I'll give my new settings a chance to work first.

As per SWS' suggestion, I uploaded some reports to Google docs, and I would be thrilled to receive some coaching!

https://docs.google.com/viewer?a=v&pid= ... y=CPvv9uQP

https://docs.google.com/viewer?a=v&pid= ... y=CNTVpZQB

Lara

[rested gal]

Welcome to the message board, Lara. A warm welcome from Laura (me! ) Sure needs to be warm 'cause it's cohhhhhhld down here in Tennessee... and I'll bet a lot colder up where you are!

You couldn't be in better hands, with -SWS helping you with his always-good suggestions.

He kindly helped me get my cpap therapy on the right track years ago.

Hope all goes well for you. Looks like you're working on your therapy very intelligently. And diligently.

Do please keep posting to let us know how it's going.