Frustrated.. But not giving up.. Sleep Study again

[traveling Utz]

I have been going through this for almost a year now..

I had an initial sleep study last year, severe, 39 an hour.. Was well informed when I went to the DME, made sure I got a data capable machine. The DME would not give me an auto set. I initially had a Quattro FX. I Had issues falling asleep..

I switched to the nasal pillows, still unable to fall asleep. I also obtained a Swift LT nasal mask, trying to find something that worked.

I also purchased a anti-leak strap from Pad-a-cheek, along with mask liners from Pad-A-Cheek.. Sadly, my head is to small for the anti leak strap, so it is of no use.

I have been able to adjust and am no longer having any issues falling asleep, but when I wake up in the 1-3 AM time frame, I cannot fall back asleep.

Currently, I am back to the pillows, with a chin strap for mouth breathing.

At my last check up with my DR, we discussed my issues. He is sending me back for another sleep study. I am going back to St. Agnes Hospital in Baltimore. They have revamped their sleep study area.. My last time was horrible dealing with construction etc.. Hoping for the best..

My issues with the Quattro FX and Activa LT were both leaking, no matter how I adjusted things.. And the Anti Leak strap not being the right size for me didn't help..

[Pugsy]

I quickly glance back at your prior posts. Didn't see any examples of software reports but you mentioned that apneas were prevented.
Could you please post a image of a typical night's detailed report?

Insomnia can't always be blamed on sleep apnea as much as we would like for it to bear the total blame.
CPAP therapy can't fix bad sleep if the bad sleep isn't totally related to sleep apnea.
Though it's always a good idea to look at the therapy to see if anything stands out that might be a mitigating factor and make bad sleep worse.

Do you take any meds even OTC?

Google "sleep maintenance insomnia"

Please check out these 2 books.
Sound Sleep, Sound Mind, by Dr. Barry Krakow
Sleep Interrupted, by Dr. Stephen Park

[traveling Utz]

I dont know how to post a image, I use both Sleepyhead and Res meds..

I have tried OTC sleep meds, they havent done a thing.. I still wake up in the 3-4hr range and cannot fall back asleep with the mask..

Will research the link and the books.. thank you!

Also, I have stopped drinking any caffeine after lunch.. This was a biggie for me, as I use to always drink iced tea till the evening..

[Pugsy]

By meds I mean what meds are you taking, if any? Meds that might be messing with sleep is the first thing to check out.
Looking for any possible med side effects that might mess with sleep
Example...I take Ultram for pain control during the day and despite it coming with a "may cause drowsiness" sticker...a few people get insomnia with it.. and I drew the short straw and it happens to me.
So I can't take my "may cause drowsiness" pain pill because it wires me up something fierce at bedtime. If I do manage to get to sleep it only lasts a couple of hours and I wake up and end up cleaning something at 2 AM
So no Ultram past 6 PM if I expect to sleep.

How to post images of reports discussed here
viewtopic.php?f=1&t=81072&p=737779#p737779

[Mary Z]

traveling Utz, I agree this is an imsomnia issue/sleep issue which may impact your machine use and success. As Pugsy said it's worthwhile to look at results from the software in any case. The books she recommended are fine books. Just visiting the section for sleep medicines in the drugstore you can see that in the US sleep is a precious commodity. You 've already reviewed sleep hygiene and are limiting caffeine. In addition to the sleep test perhaps you can hookup with someone who specializes in sleep- getting to sleep and maintaining sleep, someone in the mental health field perhaps.
Did you have the same sleep issues prior to CPAP therapy?
If all else fails there is a sleeping pill now marketed for middle of the night insomnia. It's a sublingual form of ambian. There is also a sustained release form- ambian cr. I know that sleeping pills are not an answer for the long term, but perhaps you can get some full nights sleep while you work on the problem.
Good luck. Please keep us up to speed on your progress. It will help the next person with these issues..

[traveling Utz]

Thanks.. I will look into posting the results when I get home later tonight...

As for Meds.. I am on Lipitor.. and Androgel, which I know has a sleep apnea side effect.. I was dealing with this, and both previous sleep studies were done prior to taking the Androgel..

My Dr. does not agree with prescribing the sleep meds.. We had that discussion. He did give me a 2 week supply of the Ambien CR. It did work, and I was able to sleep through the night. He feels I shouldn't use them..

And in case I fail to say so.. THANK YOU.. To everyone.. I have learned so much by reading these boards..

[Pugsy]

My Dr. does not agree with prescribing the sleep meds.. We had that discussion. He did give me a 2 week supply of the Ambien CR. It did work, and I was able to sleep through the night. He feels I shouldn't use them..

Understood. Some docs are like that and there's a good reason sometimes. It's always better to try to fix the cause than just to cover it up.

You might talk with him about something that I use and others on the forum use. See how he feels about using amitryptiline in very low dose as a "stay asleep aid". My sleep disturbing factor is pain...turn over in bed it hurts and wakes me up. Trying to go from supine sleeping to onto my side...it hurts and wakes me up.
I take amitryptiline 10 mg about 3 hours before bedtime...it helps me "sleep through the pain". I can sure tell a difference in my sleep quality when I forget to take it.
It's relatively benign at such small of a dose. Originally prescribed for depression in large doses...like 150 to 300 mg multiple times a day and pretty much guaranteed to make a person a walking zombie at those doses...it does a decent job in tiny doses for helping person get to sleep and stay asleep. Non narcotic and not habit forming and won't make your OSA "worse". Worth a discussion anyway. Might help you sleep just a little deeper and sleep through whatever it might be that is causing you to wake up.

You need good sleep though and taking something like that doesn't stop you from still trying to work through the cause of the insomnia though. It's always a good idea to fix the cause whenever possible instead of using a bandaid.
In my case...hey we know it's the pain and there is no magic fix for bad arthritis beyond make things as optimal as possible in terms of bed comfort and pain control. I could take a muscle relaxer but those are real no nos because they cause the soft tissues in the airway to relax too...they can make the OSA worse. Besides...one muscle relaxer and I am a zombie for 3 days...morning hangover after effect. I don't have much, if any, morning fog with the Amitryptiline as long as I don't take it at 11 PM right at bedtime..

Just a thought and worth about what you paid for it.

[Todzo]

The ventilatory instability and carbon dioxide maintenance issues associated with Positive Airway Pressure (PAP) therapy are often ignored either through ignorance or lack of perceived options. Therefor I suggest that you read the following and take them with you to discuss with your doctor. The papers:

Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721

[traveling Utz]

I am sorry, i wasnt able to get to the computer last night to attempt to post screen shots.. A byproduct of a teenager and middle schooler with homework needs..

Another very rough night.. I placed a call to my Drs office requesting some Ambien CR until I get this settled.. I am WORE out..

I see references to Sleep Doctors.. If I was to research them in this area, what is their specialty?

[traveling Utz]

Ok..

Last night, after not getting sleep for the past couple of nights.. I took a doxylamine succinate.. Normally it doesnt help.. But, because I was so wore out.. I got 7hrs of sleep. I used the Swift FX pillows w/ and chin strap. My leaks were the lowest I have had.. When I had the Quattro FX and Activa LT, leaks were skyrocketed.

I hope the screen shots worked.. THANKS Pugsy!!

[DoriC]

I have been going through this for almost a year now..



I also purchased a anti-leak strap from Pad-a-cheek, along with mask liners from Pad-A-Cheek.. Sadly, my head is to small for the anti leak strap, so it is of no use.


My issues with the Quattro FX and Activa LT were both leaking, no matter how I adjusted things.. And the Anti Leak strap not being the right size for me didn't help..

How about contacting Karen(Padacheek) directly and see if she can custom make a strap for you. She'll help in any way she can.

[jweeks]

Last night, after not getting sleep for the past couple of nights.. I took a doxylamine succinate..

Hi,

Thanks for posting the graphs. Despite the AHI being pretty close to the target of being under 5, the data appears to show a problem. You had a number of central events. I don't, however, know if they are all real centrals. It is hard to tell from the machine data. Further, the cause of the centrals cannot be seen. They might be something that happens to you anyway, or they could be pressure induced. That is, the pressure of the CPAP machine was high enough to trick your body into thinking that it didn't need to breathe. This could be a condition that is called mixed apnea or complex apnea. Generally, it takes a fairly skilled and experienced sleep doctor (or a specialist) to sort this out and come up with a treatment plan. It might also mean getting a different kind of machine, such as a BiPAP or ASV machine.

Best bet is to see if this reoccurs, and if so see your doctor about it. If you have already had your new sleep study, or if you are about to have another one, then hopefully this will get diagnosed correctly this time, and a better treatment plan will be developed.

-john-

[traveling Utz]

I looked back through the data this morning, to include last night.. It appears to be common to have the same amount of centrals.. What do I bring with me? or how do I explain this when I go for my sleep study? My sleep study is on 3/11..

I also made an appointment with the Neurologist that is attached to the sleep center. My Dr's office wasn't to pleased I made the appt without them. They did give me the referral I needed.. I also got a prescription for Ambien CR. I explained I need something, until I can get this figured out..

Last night, I took the ambien and went to bed at 9:30.. Was asleep around 10.. I woke up one time for the bathroom, put the mask back on.. and.. wait for it.. YES.. I fell back asleep!! That has been my problem forever!!

Woke up with the alarm and didn't need to drag it out for a half hour to finally get up..

[Dreamrobot]

Hi TravenlingUtz,
how about posting the graph from last night since you seemed to sleep more than usual?
And I'm curious to know what was the pressure needed (or determined) when you did you last sleep study ; did you have centrals then?
DR

[traveling Utz]

You know.. I thought about doing that when I checked the numbers this AM.. But, failed to do so..

I will do that first thim tomm AM, as my evenings are crammed when I get home..

Thank you!