Sleepyhead data - please help

[stacyrings]

I thought I would put up the latest of my Sleepyhead data in hopes that one of you could help me to figure it out, recognize what I need to be aware of, and steps that I can take to get a better night's sleep. This night I was still using my old mask that was not a FF mask but I did tape up. If you click on the images, you can see them bigger.


Jan9Data_1 by stacyrings, on Flickr

Jan9Data_2 by stacyrings, on Flickr

Jan9Data_3 by stacyrings, on Flickr

Jan9Data_4 by stacyrings, on Flickr

[MaxDarkside]

Here's some things I see, I may be wrong...

=> You woke up about a dozen times, whether you were aware or not.
=> You are not getting much deep sleep (about 20 min., maybe)
=> You are not getting much REM either
=> Your "sleep architecture" is disturbed, it is not a clear process (light, deep, REM, light, REM, etc. on a regular basis or pattern).
(probably because you are waking up)

Just my judgment, but I'm a newbie at this (8 weeks or so)

[Pugsy]

AHI roughly 4...predominately full Obstructive apneas over Hyponeas. Technically the under 4 is acceptable. I see roughly 2 clusters of OAs which very likely could be either related to REM stage sleep or supine sleeping. It appears that you are using the machine in straight bilevel mode. Can't see which pressures exactly. Next time if you could include the information that is below the colored pie it would be helpful as it gives us all the numbers at a quick glance. Snores and leaks are minimal and obviously not an issue.

On paper this report is acceptable. The only slight bug to me (if this were my report) might be the 2 groupings of events. It is not a huge deal though unless for some reason you are sleeping poorly, waking up maybe during these times.... How are you feeling? Is your sleep fragmented?

If you feel well rested and don't find yourself waking often then I would sit back and watch the reports.
If you don't feel well rested and you find yourself waking a lot during the night and since we know that fragmented sleep is something we want to avoid, then I would try to isolate the cause of the fragmented sleep. Some people find that they feel more rested and sleep better if they break up those "clusters".
If the cause is supine sleeping sometimes staying off their back will help. If the cause is REM sleep then a teeny tiny bit more pressure might be enough to break up the clusters.

So your numbers are acceptable...How do you feel? Is this report pretty much the same as you have on other nights or is this was better or worse? Did you have a specific question about anything you see here on this report?

BTW these machines do not gather any sleep stage information. In fact they have no idea if you are awake or not and it is impossible to know which stage of sleep exactly. If based on past history with a sleep study that mentions either REM or Supine sleeping being "worse" then you might assume that those clusters are related to one of those or both but there is zero way to know for sure.

[stacyrings]

I don't feel rested but better than I did when my pressure was set at 14/8. This night was about the 4th night with the new pressures of 18/14. I didn't wake up this night that I remember or if I did, it was very very briefly to roll over. I don't sleep on my back, only my side or kind of my half side/ half stomach.

Is this about the best sleep I can expect to get?

[MaxDarkside]

Be sure you don't put too much weight on what I say, it's based on what I see in my data but we are all different, sometimes much different. Pugsy is the wise one! I ALWAYS listen to what Pugsy says!

[Pugsy]

I don't feel rested but better than I did when my pressure was set at 14/8. This night was about the 4th night with the new pressures of 18/14. I didn't wake up this night that I remember or if I did, it was very very briefly to roll over. I don't sleep on my back, only my side or kind of my half side/ half stomach.

Is this about the best sleep I can expect to get?

Ahh...that's the $64,000 question isn't it. Is this as good as it gets? Truthfully? We don't know at this point.
I haven't seen your prior reports at the lower pressure but based on this report I have no doubt that the pressures were woefully inadequate. So in essence you are 4 days into an effective pressure range and quite honestly too soon to gauge things.

If you can get your hands on your sleep study reports then you might see that REM sleep is a contributing factor. I know it sure was for me. If you aren't sleeping on your back then that eliminates supine sleeping. Knowing if it is REM or not isn't a hugely critical thing though. It doesn't really matter the cause except for sometimes for peace of mind and giving us a reason.

What would I do if this were my report? I would sit back and use the pressures as they are now and watch those "clusters". I recently made a change to BiPap after being on APAP for well over 2 years. I discovered that it took me 4 to 6 weeks for the "numbers" to settle down with no changes. At first they were sort of like yours...AHI in the 4 to 6 range...Now mostly around AHI of 1 with no changes in anything at all.
While sitting back watching these pressures I would sort of start a journal to keep track any possible variables in things which might affect how I feel. Example...I have discovered that 8 hours of sleep eliminates the need to nap during the late afternoon..7 hours doesn't...even if both night's reports point to near perfect numbers. I simply feel better with more hours of sleep.
I also would take a hard look at other possible mitigating factors which might impact how well rested I might feel that might be unrelated to sleep apnea and remember that the machine only fixes sleep apnea. It doesn't do a thing for my old arthritic back which feels like an elephant has danced on it all night. Do what you can to limit anything that might affect your sleep that is unrelated to OSA...bed comfort, pain, meds...you get the idea.

I would do this for a couple of weeks...watch the pattern...If you still see those clusters occurring pretty much every night and you simply cannot isolate any other reason for not feeling so great..then I would maybe try a wee bit more pressure just to see if breaking up the clusters made me feel any better.
I know that I for one had those clusters in REM and I did notice a difference when they were broken up.
Not a huge difference but a difference. Why not change the pressure now? Because we don't know for sure that these clusters are the problem nor do we know for sure that they are an every night thing.
Finally, sometimes there is a lot of truth to "give it time". Use the time to look for other possible factors that are perhaps a factor in feeling less than we want.

An AHI of 0.0 doesn't guarantee that we feel like a brand new person. There are just so many other factors involved with restorative sleep. I wish it were that simple but it simply is not.

One other question? What meds (even OTC) are you taking...if any? Sometimes meds mess with how we sleep and also how well rested we feel and we don't know that meds are impacting things.

[stacyrings]

Here is the data from a week before when I was still on my old pressures.


Jan3Data_1 by stacyrings, on Flickr

Jan3Data_2 by stacyrings, on Flickr

Jan3Data_3 by stacyrings, on Flickr

Jan3Data_4 by stacyrings, on Flickr

I'll also get the other data you mentioned tonight when I get home.

Meds, I'm on Effexor, Topamax, and Neurotin in the morning and Lithium, Topamaz, and Neurotin in the evening along with a every other day Singular (it so expensive and still works well for me so I stretch it out by taking it every other day) and 200 mcg of B12.

Max, I appreciate what you have to say too.

[Pugsy]

Yep, I was right. Prior pressure let a lot of events sneak past the defenses.

Meds, I'm on Effexor, Topamax, and Neurotin in the morning and Lithium, Topamaz, and Neurotin in the evening along with a every other day Singular (it so expensive and still works well for me so I stretch it out by taking it every other day) and 200 mcg of B12.

Give me a bit of time to research the meds side effects. I think one or two of them has a known side effect of "fatigue" or something like that. Might even mess with sleep architecture a bit also. I understand the need and likely can't be changed but it might help you understand and accept that feeling less rested might be partly a side effect to meds. It wouldn't be the first time. You know damned if you do and damned if you don't thing.

[stacyrings]

I know the Neurontin makes me sleepy. That's why I only take it twice a day and not 3 times like my doc would rather me take it. I think Effexor can make you sleepy but I've been on that for so long that if it does, I don't feel it. I did try switched it to night and didn't like how that made me feel.

[Pugsy]

I briefly looked up your meds. Known side effects below which might impact how you feel in general. I only noted the side effects that might impact how you might feel during the day regarding feeling well rested or not and might impact sleep architecture. How much do these meds really impact how you feel we really don't know but we do know that some symptoms that we normally associate with sleep apnea (fatigue, drowsiness, etc) can also be associated with these meds sometimes.

How much any drug impacts the body is going to be related to dosage and half life of the drug and how your own body responds.

I would suspect that meds play a part in how you feel but I wouldn't put the entire blame on them. You say you are feeling somewhat better than before...so obviously part of you problem is related to OSA.
It is entirely possible that with more time it will continue to improve. I would still watch those clusters if if were me and maybe try to "fix" them later if they still stuck around...just to see if they made any difference.

Effexor..
http://en.wikipedia.org/wiki/Venlafaxin ... de_effects
Insomnia is common side effect. Means it can mess with sleep architecture and anything that messes with sleep architecture messes with how well rested we feel.

Somnolence also listed common side effect and even more than insomnia...(or "drowsiness") is a state of near-sleep, a strong desire for sleep, or sleeping for unusually long periods (cf. hypersomnia). It has two distinct meanings, referring both to the usual state preceding falling asleep, and the chronic condition referring to being in that state independent of a circadian rhythm. Somnolence goes back to the Latin "somnus" meaning "sleep."

Topamax....http://en.wikipedia.org/wiki/Topiramate minor known side effect of drowsiness and fatigue.

Neurotin....http://en.wikipedia.org/wiki/Gabapentin drowsiness known side effect

Lithium...http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000531/ tiredness.

Singulair http://www.singulair.com/montelukast_so ... p?WT.svl=1 trouble sleeping, bad or vivid dreams, depression, and a couple of other side effects that point to something which could quite possibly upset sleep architecture.

[Pugsy]

If you can safely change dosage times it might help a bit if the known drowsy makers can be taken early enough in the day to lessen half life after effect. You know those better than I would.
But definitely your meds can sure impact how you feel during the day.

[stacyrings]

Ugh. Isn't sleep supposed to be easy???? LOL Thanks Pugsy!

[Pugsy]

Ugh. Isn't sleep supposed to be easy????

Yeah it is supposed to be easy and people take it for granted...
I have a similar issue.. I have bad arthritis..my pain med wires me up something fierce..can't sleep when I take it close to bedtime. It actually comes with a drowsiness caution sticker and most people that is the most common side effect but I have to be different and have the insomnia side effect that is much less common. Go figure.

If I don't take a pain pill...I don't sleep well due to pain...so I have to take a different medication at bedtime and a side effect to it is that it might make the OSA a bit "worse".. Well...I just let the machine do its job and not worry about it. I have to get some sleep. So damned if I do and damned if I don't.

[archangle]

Here's some things I see, I may be wrong...

=> You woke up about a dozen times, whether you were aware or not.
=> You are not getting much deep sleep (about 20 min., maybe)
=> You are not getting much REM either
=> Your "sleep architecture" is disturbed, it is not a clear process (light, deep, REM, light, REM, etc. on a regular basis or pattern).
(probably because you are waking up)

Just my judgment, but I'm a newbie at this (8 weeks or so)

I'm not familiar with judging REM, deep sleep, etc. from a CPAP graph. What do you see in the data that indicates REM, deep sleep, etc.