New to Forum: 6 Months in and Sleep is Still Very Fragmented

[Pugsy]

Nothing on that report that is exciting at all.

Do you take any meds at all? Even OTC? If so, what, dosage and when?

Do you have trouble getting to sleep initially when you go to bed or is it mainly that you wake often? When you do wake often do you have trouble going back to sleep?

[kteague]

While others try to help you regarding data and settings, just in general about fragmented sleep...

Are you on any meds that can adversely affect sleep?
What about medical conditions? (thyroid dysfunction, etc)
Do you have any issues with limb movements? They can fragment sleep.

[M'ohms]

Do you take any meds at all? Even OTC? If so, what, dosage and when?

Do you have trouble getting to sleep initially when you go to bed or is it mainly that you wake often? When you do wake often do you have trouble going back to sleep?

Pugsy, I take Synthroid 137 mcg every morning after I get up due to thyroid removal 5 years ago, and use a HRT patch. That's it.

I try to go to sleep around 9:00 each night. It usually takes me around an hour to get to sleep, on average. On a few occasions I can fall asleep within 15 minutes. With most of my wakes, I usually go right back to sleep within 10 minutes-- a couple of times a night, it can take up to 2 hours. After 4:00, I wake off and on every 15 minutes or so.

[M'ohms]

Are you on any meds that can adversely affect sleep?
What about medical conditions? (thyroid dysfunction, etc)
Do you have any issues with limb movements? They can fragment sleep.

Thank you for your interest. My sleep study showed no limb movement. As to the thyroid, I had thyroid cancer 5 years ago which resulted in complete thyroid removal. I have been stable on 137 mcg synthroid ever since. My oncologist doesn't believe that my dose do synthroid is contributing to my sleep problem.

[Pugsy]

Do you have copies of your sleep studies that show the stages of sleep % and all that stuff? If not then it would be a good idea to get them.
I assume that you had severely fragmented sleep prior to the OSA diagnosis and everyone was hoping that once the OSA was effectively addressed that the fragmented sleep would go away? Is that what happened or has the fragmented sleep just started with the masks and machine use?

It's no wonder you don't feel so great during the day. Fragmented sleep for any reason will sure do it....problem is finding out what is causing the fragmented sleep and trying to fix it.

Do you have a different detailed report that is more exciting to look at?
One with some of those clusters you are talking about? Though bear in mind if you are spending much time awake with mask and machine on then we have to wonder if any clusters that are seen are awake/semi awake clusters or the real deal because we can't tell for sure when you were awake or not.

Do you have any other factors that might contribute to the fragmented sleep? Pain? Arthritis? Anything that you can lay your finger on that might be a possible culprit?

[M'ohms]

Pugsy,
I am going to my sleep doc on Sept. 5th and will ask him for my complete sleep study. I thought I had it, but I guess not.

Yes, my sleep was fragmented before OSA, and I have been a light sleeper as long as I can remember.

I don't have any other issues that I can put my finger on that would cause me to wake up. I guess I'm just a blah kinda person (but I will find you a better night's report)!

[Pugsy]

Often when we sleep poorly and feel tired when we stumble across the OSA diagnosis we have the "AHA" moment where we think "that's why my sleep is poor and I feel like crap" and we assume (and hope) that once we fix the OSA stuff that we will feel better and start sleeping better. Unfortunately there's so much more to getting good quality restorative sleep than just getting the OSA under control. The machine does a great job of fixing stuff related to OSA but not so good of a job at fixing stuff unrelated to OSA.
When you talk to your doctor next month you might want to talk about other things that can impact sleep and cause insomnia and fragmented sleep and not just the reports from the machine that may not be all that exciting to maybe put the blame on.
Having a nice 0.0 AHI doesn't guarantee that you will sleep great if the reason you weren't sleeping so great is unrelated to OSA.
People want to put all their problems in the OSA basket and expect the machine to fix all the problems. It's human nature to want to do that. Unfortunately it isn't always that easy and that simple.

[oak]

[quote="Pugsy"

Do you have a different detailed report that is more exciting to look at?


You crack me up!!!

[M'ohms]

Maybe this is a little more exciting (or maybe not...):

[Pugsy]

Well, at least there is some activity on these reports to look at.
My main question would be the obvious clusters mess in the middle of the night on both reports....what's the chance of all that being awake breathing getting flagged by mistake?
Remember the machine doesn't know if you are awake or not and it can and will flag awake breathing irregularities by mistake.
We don't breathe nice and regular while awake...we may not realize it but we don't. We do a lot of pausing and sighing and when in bed we also likely do a lot of tossing and turning in bed. It's very common to sort of hold our breath when we turn over in bed. Again we don't realize it but we do it.

If you told me you slept through the night and we saw these reports that might mean something but when you tell us that you routinely wake about every hour or so and often it can take 20 to 60 minutes to get back to sleep then we have to question if the cluster of exciting stuff is real in the sense that you were indeed asleep or if it was all related to awake breathing (sometimes called sleep/wake/junk).

Next time you wake up in the middle of the night turn the machine off and on again real quickly if you find that you aren't going back to to sleep readily. That way we will see a blip in the flow and pressure line that we can look at to see if any clusters seen are around the time where the marker blip happens to be.

[Sir NoddinOff]

Fragmented sleep can be a slugfest. It's not easy to beat because it combines the hardest challenges of CPAP therapy, with the worse parts of one's sleep hygiene, with the worse parts of sleep anxiety. That's not to mention ones meds (legal or otherwise), daytime stress, an unproductive or chaotic sleep environment, plus a crappy lifestyle (not that I'm suggesting you have succumbed to any of these things - just throwing it out for general consumption )

I've struggled with fragmented sleep for a year and a half and am only now starting to make real progress. I wish you luck and hope your quest for healthy sleep goes smoother than mine did.

A final little teaser note: In sleep labs when people are awakened from stage one or two sleep, they usually swear they weren't asleep, when in fact they were... those two first stages are a necessary prep process that leads to deep sleep... sadly it just doesn't usually feel like 'real sleep'.

[M'ohms]

Thanks to everyone for your comments. I will try to remember to turn the machine off and on like Pugsy suggested and perhaps take notes if I think of something meaningful during the night. Also, you make a great point about CPAP not curing all our sleep problems. Maybe that's something I just have to accept!

[Pugsy]

Also, you make a great point about CPAP not curing all our sleep problems. Maybe that's something I just have to accept!

Well, I am one of those that had to accept it myself but not before I gave it everything I had in the way of trying to figure things out just in case. So we can still keep trying to turn over rocks to see if we can figure out what might be going on with your situation.
In my case it didn't take too many rocks to turn over to figure out what my "extra" issues were but even once we figured it out it took a lot of trial and error to figure out the best way to address it the best way we could.

So we won't give up that's for sure but we just have to be realistic about things. This is where it helps if you have a good doctor to work with that is willing to think outside the box.

Maybe your sleep studies showing the sleep stages may be of some help...sure wouldn't hurt and maybe we can sweet talk mollete into helping us out here with some ideas. We have already exhausted my usual suspects that I look at first...meds, pain, other health issues that can impact sleep quality.
We can't really expect you to feel the good numbers you see on the reports when you have so much fragmented sleep. The body just doesn't get the right amount of each stage of sleep that is needed. You know the normal cycles we go through each night.
When you wake up enough to remember waking up every hour or so and know you don't go right back to sleep then we know that your sleep cycles are totally messed up and even if you didn't have OSA things would still be sub optimal in terms of sleep and how you feel.

It's not like you can quit using the machine though...we know that part is needed anyway so while you are having to use it there's no harm in starting to look for rocks to turn over to try to figure out what is going on.

[SleepWellCPAP]

M'ohms, you have more than capable folks posting on this threat for sure.

I'm just going to throw this out there for any value it may provide.

I have occasionally come across people who claim to not feel rested, and the exact cause was elusively inapparent. Since good rest has as much to do with brain waves as an open airway, I suggested they try to think of absolutely nothing when their sleep was disturbed. Literally, if you wake up, as best you can, try to think of nothing at all. I had one patient tell me he would visualize colors to do this. Starting with blue and ending with black if I remember right.

Once you're able to hit at least 6 hours of uninterrupted rest, my guess is that it will take about a week for cortisol and melatonin to resync. Diurnal hormones. Could that be a possibility?

Jim

[M'ohms]

That is certainly worth a try. I definitely have some things to work on. Thanks!