How long did it take before you knew cpap worked?

[Pugsy]

I guess I'm feeling like the whole thing is a shot in the dark with the .8 events in non-supine and all. It was almost like a "you don't have SA if you're on your side but we're going to make you sleep on your back (even though you don't do that at home) and tell you that you need cpap" ... huh?

Have you seen your sleep study reports to evaluate just how much of an impact the small number of events that you have when you sleep on your side might be impacting things? Like oxygen level drops?
Are you having any of the normal OSA symptoms? Frequent awakenings? Nocturia? Morning headaches? Daytime sleepiness? ETC.
Anything? The reason I ask is because if your OSA is not diagnostic when you sleep on your side and you say you never sleep on your back then if you are having any of the usual symptoms then maybe you aren't always on your side because something is causing the symptoms.

Did you discuss with the sleep doctor the fact that you feel you never sleep on your back? Like "Hey doc....I don't ever sleep on my back....if I promised to stay on my side all night do I really have to use the machine?"

[lorraineg57]

Here's my summary report from my diagnostic night. No mention of how much time was spent supine/non-supine. I also expecimted
documentation of what happened immediately prior to awakenings, which may be in the raw data but isn't here.

Oh yeah, I discussed the issue with my pcp at length. Her response was that the sleep lab recommended a second night. After getting the results from the titration study, and me once again explaining that I don't sleep on my back. Of course the second night showed improvement, they made me sleep on my back again! Her response was to try the cpap for a week and see how it goes basically.

As far as sx's. Waking 2-4x every night. Major sleepiness during the day (makes driving scary). Never feeling rested obviously.



DATE OF TEST: 09.04.12
PATIENT HISTORY: The patient is a 55 year old female who is 65 inches tall and weighs 128 pounds. The
A patient was referred to the Sleep Disorders Center for Obstructive Sleep Apnea and insomnia. The patient
has an Epworth Sleepiness Scale score of 14. _
NOCTURNAL POLYSOMNOGRAPHY: ‘ 1 . '
Full montage polysomnography was accomplished utilizing 4 channels of EEG, 2 channels of EOG, 1 channel
of submental EMG, ECG, right and left tibial EMG, thoracic and abdominal effort gauges, air flow
measurement using thermistors, snore sensor and pulse oximetry_ Apnea is deflned'a cessation of airflow or
an 80% reduction of airflow from baseline. Hypopnea is defined as a 30-80% reduction in airflow from
baseline. Hypopneas must be associated with a 4% desaturation to be counted as part of the apnea +
hypopnea index (AHI). . r .
INTEFIPRETATION: 1
Sleep architecture and efficiency: On the first or diagnostic night of testing, the patient slept 344-5 minutes
out of 401 .5 minutes in bed to yield a decreased sleep efficiency of 86%. The latency to persistent sleep was
increased at 38.5 minutes. The architecture of sleep stages was abnormal. Stage one was absent, stage two
was increased at 57.3% TST, delta sleep was increased at 29.3% of TST, and REM stage sleep was
decreased at 13.4% of TST. The latency to REM stage sleep was decreased at 76.5 minutes.
Sleep fragmentation: There was moderate sleep fragmentation with 126 arousals and 5 awakenings greater
than one minute to yield an arousal +awakening index of 22.8 events per hour.
Respiratory parameters: The oxygen saturation on room air was 98 %. There were 6 apneas and 30
hypopneas yielding an apnea + hypopnea index (AHI) of 6.3 events per hour. Of the 6 apneas counted, 1 of
these apneas was a central event. The AHI was 62.0 events per hour in the supine position and 0.8 events
per hour in non-supine positions- There was a significant positional component to the patient’s sleep
disordered breathing. During respiratory events, the oxygen saturation reached a nadir of 90%. There was
moderate, intermittent snoring noted during the diagnostic study. .
Electrocardiogram: The electrocardiogram was without evidence of arrhythmia.
IMPF-lESSlON:
1. Mild Obstructive Sleep Apnea associated with mild oxyhemoglobin desaturation.
2. Decreased sleep efficiency, increased sleep fragmentation, and abnormal sleep architecture.
3. There was a positional component to the patients sleep disordered breathing.
4. The electrocardiogram was without evidence of arrhythmia.
REOOMMENDATION: 1
The patient should return to the Sleep Lab for a PSG with PAP titration.
‘Given the positional nature of the patient’s sleep disordered breathing, you could consider positional therapy
should Positive pressure therapy not be effective or tolerated.

[lorraineg57]

Hi - welcome to the club. This is a great forum to get all your questions answered.

It can take months to get adjusted to the cpap and to start feeling better. I started feeling a little better after about one month. If you pay attention, then you'll notice the very subtle differences in the beginning. Waking up w/o a headache. Waking up w/o your muscles screaming (from lack of o2).

If you post your equipment in your profile that will give us more specific info to comment on. RE: sinuses on fire. Do you use a humidifier? What is the temp setting?

I know it's a really hard adjustment but to give it a fair shot you have to give it a couple months.

I've never had a.m. headaches or muscle pain. This all started with frequent awakenings that hit with menopause. When estrogen patches gave no relief, my pcp started pushing sleep study. Yes, I do use a humidifier, I think I have the temp set at 65 since I'm usually warm. I hope I see some improvement before then. I only have 60 days to decide I think (that's when the insurance actually buys the equipment instead of renting).

[Pugsy]

Your oxygen levels dropped to 90%. Not horribly low but they did drop.
When you wake up 2 to 4 times a night do you wake up with a full bladder and need to go urinate? Need as in full or nearly full bladder as opposed to "I am up already might as well go pee". Nocturia is a common symptom of sleep apnea. Before I started on cpap I was waking up about every hour with a full bladder...so full it hurt. That was the first symptom I saw go away. That alone was worth it to me.

It would have been nice if they had broken down the arousals into supine and side sleeping. We don't have to have a really bad desat or full grown apnea or hyponea to have an arousal.
So assuming that you do stay on your side all night...something still may be going on with your sleep architecture because you don't feel so great.
Often sleep disordered breathing is more involved than just apnea events of some kind. That's why many people complain of still feeling like crap and their AHI is less than 1.0 and they don't understand why they don't feel as good as the numbers appear to look.

I can see why you are wondering "why do I really need this thing if I sleep on my side all night". Doctor may be thinking that sometimes you turn over in bed and not know it. Also might be thinking that it is worth a try to see if your other not so great feelings can be fixed with the use of the cpap machine.

[lorraineg57]

Your oxygen levels dropped to 90%. Not horribly low but they did drop.
When you wake up 2 to 4 times a night do you wake up with a full bladder and need to go urinate? Need as in full or nearly full bladder as opposed to "I am up already might as well go pee". Nocturia is a common symptom of sleep apnea. Before I started on cpap I was waking up about every hour with a full bladder...so full it hurt. That was the first symptom I saw go away. That alone was worth it to me.

It would have been nice if they had broken down the arousals into supine and side sleeping. We don't have to have a really bad desat or full grown apnea or hyponea to have an arousal.
So assuming that you do stay on your side all night...something still may be going on with your sleep architecture because you don't feel so great.
Often sleep disordered breathing is more involved than just apnea events of some kind. That's why many people complain of still feeling like crap and their AHI is less than 1.0 and they don't understand why they don't feel as good as the numbers appear to look.

I can see why you are wondering "why do I really need this thing if I sleep on my side all night". Doctor may be thinking that sometimes you turn over in bed and not know it. Also might be thinking that it is worth a try to see if your other not so great feelings can be fixed with the use of the cpap machine.

No, I'd just wake up...I mean like wide awake...pee if I was up but I don't think that's what was waking me. I'd be up for 10-15 minutes, go back to bed and go right back to sleep , but an hour and a half later, I'd be back up. That's another thing that makes me think something is awry, I'm out (pre-cpap) within 5 minutes of hitting the pillow. Is that normal?

Agreed, that would have been wonderful. Perhaps there is more definitive info in the raw data, this summary really didn't answer my questions. Definitely frustrated with the doc's response. I thought she should have made an effort to find out the info that wasn't included since she was the one that pushed me to get the sleep study to start with.

[Pugsy]

No, I'd just wake up...I mean like wide awake...pee if I was up but I don't think that's what was waking me. I'd be up for 10-15 minutes, go back to bed and go right back to sleep , but an hour and a half later, I'd be back up. That's another thing that makes me think something is awry, I'm out (pre-cpap) within 5 minutes of hitting the pillow. Is that normal?

Normally the nocturia side effect from OSA is the production of excess urine. What happens is that the apnea events put the heart under duress and the response is the production of a stress hormone with a long name that I can't ever remember and it goes to the kidneys and sends the kidneys into over drive...so the kidney's produce more urine. So commonly the bladder has a lot of urine in it when we wake up from an OSA induced full bladder. Of course there are also other reasons for nocturia that are unrelated to OSA. If you wake up every hour to 90 minutes it may be that the kidneys just haven't had enough time to fill up the bladder. Since your OSA is worse on your back maybe since you don't spend any time on your back it just hasn't been bad enough to produce much of the stress hormone. Not sure though since it isn't clear cut...just tossing out ideas and stuff to think about.

Something is waking you up though. During your trial period if you can get to the point where you are sleeping through the night comfortably with the mask and machine you might have your wake up why question answered.
Of course there are also other things that wake us up during the night.
The fact that you have multiple wake ups being reported tells us that your sleep architecture is being messed with. Of course anything that messes with sleep architecture is unwanted because we just feel like crap the next day since we didn't get the normal cycles and normal amount of time in each cycle.

I think if it was me I would still try to get the cpap thing sorted out to see if by any chance the fragmented sleep improves.
Try to isolate what is causing the wake ups. Any meds that might have an insomnia side effect? I take a pain pill during the day that actually has a may cause drowsiness sticker on it but there are a few people who it causes insomnia. I am one of those people. If I take that pain pill after 6 PM I am wide awake at 2 AM after only a couple of hours of sleep.

Something is waking you up and something is messing with your sleep architecture and causing reductions in some sleep stages and increases in the other sleep stage. So something is going on. Sounds like your doctor is hoping that whatever is going on is related to sleep apnea and hoping it will improve with cpap. It might and it might not but I think it is worth investigating.

[billbolton]

1 night!

[Sheriff Buford]

My "ah-ah" morning was day 19. I have been "tweaking" my therapy ever since. I just recently found that I feel much better during the day by reducing my leak levels from less than 24 l/m to zero. Don't know why, but it worked.

Sheriff

[xenablue]

It took until I saw the results of my sleep study results. The split-study showed immediately that CPAP worked perfectly for my OSA.

Did I feel better? Not for many months, and I'm still waiting to bounce out of bed with unlimited energy. Apart from seeing from my nightly data that CPAP works, the other very noticable change is that since Night #1 I haven't had to get up several times for bathroom visits every night. In 2 years I've gotten up to go to the bathroom probably 3 times - not in the one night - and usually because I drank something less than an hour before bed.

Cheers,
xena

[msla]

For me, the last half of the night during my split night study.

[kteague]

My early CPAP experience was a nightmare. I was given a machine that didn't give me data, so I didn't know that my prescribed pressure of 10 needed to be increased to 12 to be most effective. I told my doc I was falling asleep immediately but waking back up in a very few minutes (often just 2 or 3 minutes), and repeating this all night long. I was instructed to just hit the ramp and go back to sleep. After several months of getting dramatically worse instead of better, I found this site. Right away it was suggested I shorten my ramp time since I fall asleep right away, and increase my ramp pressure, which was 4. My behavior of hitting the ramp every few minutes was condemning me to trying to treat my sleep apnea at a pressure of 4 nearly all night every night. Nearly killed me. So I really count my time to improvement from the time I joined this site, because what I was doing before was not therapeutic treatment, so it would be unfair to say it took so many months for CPAP to work when it didn't have a chance to work. I think that factor should be considered any time a person is thinking their treatment is slow to work. Maybe the time of getting adjusted, finding a mask, tweaking pressure, not keeping mask on all night, etc. should not carry an expectation of doing much to help symptoms. From the time my treatment was therapeutic, it took me a few weeks to completely stop taking the mask off in my sleep. I think if I was not not dealing also with limb movements during sleep, I would have seen a more marked improvement improvement in my symptoms at that point. Even so, the fog began to lift bit by bit.

When one is not seeing results, my first thoughts are #1 is their treatment optimized and proven by data?, and #2 are there any other contributors to their sleep disruption that need to be addressed? To the OP, your symptoms that sent you to a sleep study seem to say either you are sleeping on your back more than you know, your time in the lab is not fully representative of your sleep at home, or (and?) you have other contributors. As you tease those answers out you can expect to see things improve. Best wishes.

[lorraineg57]

I'm two months into it and i sleep worse and feel worse than i did before diagnosis

Unfortunately, that's where I'm at right now.

I'm trying to adjust to the nasal pillows at this point, which btw I like much better than the nasal mask. They mistakenly sent me the Swift LT instead of the Swift FX (which is now on it's way.)

For some reason though, last night there was a lot of condensation and water drops actually coming out of the pillows. Actually had water up my nose, not a lot, but enough to feel it and woke up in the middle of the night with heartburn. I never get heartburn...sigh....So, between the gas, heartburn and just generally acclimating,
I'm taking the thing off mid-night just to get a few hours of sleep. Even if I'm waking (sleep maintenance insomnia was what started this whole journey) a couple times a night, I'm still more comfortable/rested than with the cpap. For some reason, it takes me well over an HOUR (sometimes more) to drift off with the cpap, without it, I'm out in under 10 minutes. It seems like my sleep is sounder with cpap if I don't have the gas/heartburn/fussing with the thing going on, but that's so rare. It takes me so long to fall asleep with it that I can't tell if it's actually helping when I finally fall asleep or I'm just so exhausted after lying there for so long that I just zonk. I doubt downloading the data would help me decipher that since apparently I don't really have events when I'm side sleeping anyway.

I'm just really tired.

[Lizistired]

I knew the morning after my titration.

[Suddenly Worn Out]

One or two nights and I knew it was making me feel better. A week on it and I was much better. It did not take long to notice improvement.

Eric

[Suddenly Worn Out]

As far as getting maximum benefits from CPAP, that took oh about close to a year. For maximum benefits I had to discipline myself to exercise regular, diet and lose weight and decrease my klonopin dosage. All while being 100% compliant with CPAP. That did it. I felt pretty good doing all of that. Unfortunately, when I reverted to my old ways of gaining weight back, returning to the higher klonopin dosage and not exercising daily, I did not feel all that great despite use of CPAP. However I still felt WAY better than I did off CPAP, even with bad habits restored.

But I noticed the immediate things like night sweats, restless sleeping, waking up during the night, waking up with a dry mouth and sore throat...those things went away in days or about a week max. And they return if I stop using CPAP.

Eric