Tired after new machine?

[DoriC]

Play dumb IF they notice.
More than likely, they won't even care unless you are not getting in at least 4 hours per night.
Most of us need more anyway--but we don't need the stress from sleeping without the machine.

That's what happened in our case, I changed the settings after the first week and when they asked me to bring in the card after 30 days, all they checked was compliance, they didn't even look at the RX. Nobody cares more about your health than you do! Minimum is most important setting and 5 is really low, I'd go along with the others and try 7-10. Good luck and keep us posted.

[MitzyG]

Thanks for the continued support! My titration result was 11, but 11 all night was misery. Last night, I bumped it up to 7 min. But I'm tempted to move the upper to 11 and see. I'm topping out now at 9 and I'm unclear whether the machine would calculate me at 9.5, 10, 10.5 or somewhere in between. I notice that it goes up to nearly 9 while I'm having incidents and it continues. That would indicate to me that I'm topping out and the machine would think I need more.

Regarding the settings...maybe I give them too much credit... heaven forbid they actually try to manage the settings with me. I'll take the advice and fix it so that *I* can be comfortable.

[Wulfman...]

Thanks for the continued support! My titration result was 11, but 11 all night was misery. Last night, I bumped it up to 7 min. But I'm tempted to move the upper to 11 and see. I'm topping out now at 9 and I'm unclear whether the machine would calculate me at 9.5, 10, 10.5 or somewhere in between. I notice that it goes up to nearly 9 while I'm having incidents and it continues. That would indicate to me that I'm topping out and the machine would think I need more.

Regarding the settings...maybe I give them too much credit... heaven forbid they actually try to manage the settings with me. I'll take the advice and fix it so that *I* can be comfortable.

My "guess" is that you're tired because of all the pressure changes while you're trying to sleep. Some people can tolerate it and others cant.
When you're in a sleep stage (like REM or a deeper stage), your breathing changes and the machine interprets that as needing to increase pressure. When that happens, it may bump you out of that sleep stage. You need to cycle through the sleep stages during the night and disruptions to those cycles will leave you feeling unrested. If you find yourself waking up frequently during the night, that would be a clue.

Too many people get convinced that they "need" and APAP. The truth is that they can really screw up a person's sleep. I don't try to dissuade anyone from having one (I have four myself that are all set for fixed pressure), but try to explain their limitations, advantages and disadvantages.


Den

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[MitzyG]

See...my sleep study said that I didn't have many problems in non-rem sleep but I had severe issues during rem sleep. That's why the doctor claimed I needed an auto so that I could have less during non-rem but more during REM. But then, the guy sticks me with a brick at 11 and I was CONSTANTLY having issues with the machine forcing my mouth open, feeling uncomfortable, coughing up air etc. Once I went to the auto, I felt so much better. But I'm wondering if I have some 11 moments, but not the entire night. I don't think the switching itself is waking me up. Over time, I'm waking up in the middle of the night less and less. Of the times I wake up, I probably wake up equally as often on higher pressure and lower pressure.

[Wulfman...]

See...my sleep study said that I didn't have many problems in non-rem sleep but I had severe issues during rem sleep. That's why the doctor claimed I needed an auto so that I could have less during non-rem but more during REM. But then, the guy sticks me with a brick at 11 and I was CONSTANTLY having issues with the machine forcing my mouth open, feeling uncomfortable, coughing up air etc. Once I went to the auto, I felt so much better. But I'm wondering if I have some 11 moments, but not the entire night. I don't think the switching itself is waking me up. Over time, I'm waking up in the middle of the night less and less. Of the times I wake up, I probably wake up equally as often on higher pressure and lower pressure.

Are you using software to see what's going on during the night? With an APAP you really NEED to see the data.


Den

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[MitzyG]

Yup...I'm using sleepyhead and insisted on a machine that would collect the data for me. I changed the max to 11 and now I'm going up to nearly 9.5 (vs the former max of 9). I actually feel pretty awesome. Not "energizer bunny" but not "ready to crawl right back into bed". I'm pleased.

[Wulfman...]

Yup...I'm using sleepyhead and insisted on a machine that would collect the data for me. I changed the max to 11 and now I'm going up to nearly 9.5 (vs the former max of 9). I actually feel pretty awesome. Not "energizer bunny" but not "ready to crawl right back into bed". I'm pleased.

Glad to hear that. Maybe you need to move the minimum up a bit, too. What EPR setting are you using?
Be aware that EPR drops the therapy pressure by the number of centimeters of the setting. For example, if you used a fixed pressure of 10 and an EPR setting of 3, your "effective" therapy pressure at the point where you finish your exhale and begin to inhale is only 7. So, since you're using a range of pressures, at lower pressures it's going to be even less effective therapy pressure at that point.
AND, quite a few people experience their apneas at that point.....at the end of exhale and beginning of inhale.


Den

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[MitzyG]

Guys...here's an update. I changed the machine to a range of 7-12. Life got better for a day or two, then got worse again. Last night, I tried the small nose pillows and a Swift LT headgear. My leaks went down, my AHI went down, I still feel like a piece of crap. I did wake up in a puddle of sweat, which I don't understand since it's not menopause.

Would you suggest that I stick with the new mask awhile and see if it "gets better"???

One other piece of info...I had EPR set to 3. I have now changed it to 1 to see if that'll help.

[Rick007]

After 90 days on the machine I am more tired during the day than I have ever been in my life.

I know that my SleepyHead data shows that I have high Flow Limitations, which might be the cause , but my AHI number is almost always less than 1.

Mitzy, Just to rule out my theory that Flow Limitations are causing our common problem, how does your Flow Limitations graph look?. Does it look anything like this, or is it fairly flat?

[MitzyG]

Sorry...mine is fairly flat

http://www.flickr.com/photos/24521211@N04/11693859974/

1-1-2014 2-56-02 PM by MitzyDGoose, on Flickr


1-1-2014 3-03-29 PM by MitzyDGoose, on Flickr

[Jay Aitchsee]

Guys...here's an update. I changed the machine to a range of 7-12. Life got better for a day or two, then got worse again. Last night, I tried the small nose pillows and a Swift LT headgear. My leaks went down, my AHI went down, I still feel like a piece of crap. I did wake up in a puddle of sweat, which I don't understand since it's not menopause.

Would you suggest that I stick with the new mask awhile and see if it "gets better"???

One other piece of info...I had EPR set to 3. I have now changed it to 1 to see if that'll help.

Mitzy, I haven't followed your posts closely, but it appears you are making multiple significant changes in your therapy very quickly. I would advise you to slow down, make one change at a time and allow your body time to adjust to it for several days before making another. Otherwise, I'm afraid you'll have a very difficult time optimizing your therapy. Don't expect an overnight miracle with any change and if you change more than one thing at a time, you won't know what's causing the result, whatever it is.
Jay

[MitzyG]

Jay...I know you're right and normally, I would tell someone else the SAME thing. I feel desperate to get some rest! ARGH! I said it...I WANT THE NIGHTMARE TO BE OVER! And the ironic thing is...I now have significantly more dreams/nightmares than before, but I'm still tired AND have the emotional issues of having to remember the dreams. I'm on vacation, need to return to work on Monday and I was sure that 2 wks would be enough time to get this figured out.

(deep breath). Last change. I'll stick with these settings for awhile. I think I'm getting "closer" so I need to give the settings a good college try.

I've been trying to stay off of caffeine. I was feeling bad, so I drank a second can. I tried again to drink only one soda per day, but I'm tired. I was afraid to nap and wreck the night. I was really hoping to quit drinking soda altogether, but I'm too tired and didn't want to sleep too much.

Thanks for letting me vent...I will be stronger tomorrow.

[Rick007]

Sorry...mine is fairly flat

Thanks for that info Mitzy, I guess we can rule out that as a cause. All your numbers look really good. I don't think any amount of fiddling with pressure is going to improve those numbers. Here are another couple of my theories I have for feeling so tired, and with your input we might be able to confirm or eliminate them.

My original OSA diagnosis had an AHI=60 which is considered severe. Now my AHI is always less than 1. I have heard than when an apnea event occurs, the brain goes into fight or flight mode. In other words adrenalin is released into the bloodstream to help the body fight off the attack. The theory is that my brain is releasing only a fraction of the adrenalin it used to, and during the day I am just not used to living with the reduced levels of adrenalin. From what I have read, my body will eventually become accustomed to the new levels, and I will begin to feel normal again. So my question to you is how high was your untreated AHI?. Did you also go from severe to normal, or were you considered more moderate?

My second theory is that I may be suffering from depression. When I was diagnosed with OSA it affected me badly. I was about to turn 59 in a few months and the diagnosis made me suddenly feel very old. I was convinced that if I ever had another nap on the couch without my machine that I would suffocate and die. As I said in an earlier post my original brain fog and confusion has improved since PAP therapy. I actually wake up in the mornings feeling pretty good, but the tiredness hits me about an hour later. It is this delay that makes me consider depression as a cause.

I feel desperate to get some rest! ARGH! I said it...I WANT THE NIGHTMARE TO BE OVER! And the ironic thing is...I now have significantly more dreams/nightmares than before, but I'm still tired AND have the emotional issues of having to remember the dreams. I'm on vacation, need to return to work on Monday and I was sure that 2 wks would be enough time to get this figured out.

Now I certainly don't know you, but like me, I can see you expected a quicker recovery and seem disappointed that things didn't change overnight. Would you consider that maybe you are depressed over this whole thing? Do you find that you become more alert when you are having a good time with family and friends, and the tiredness returns when you are alone and begin to think about your future with PAP?

Rick

[MitzyG]

My untreated was 64 episodes per hour, pulse ox went down to 86%.

I thought that the sweating thing was the adrenaline. I had it OCCASIONALLY before CPAP (like 10x per year or less), but I thought that it was infection or something since it was like one time, then every other night was fine.

I wake up not wanting to get up at all. I eat, have my soda and I feel pretty decent. Then, it feels like the big crash. I had tried without the morning soda, but then I just wanted to crawl right back into bed and I really wanted to DO STUFF for vacation...wasn't interested in sleeping through it all.

I admit to struggling with depression. I also admit to struggling at work (unrelated to the sleep issues). Everything else in life is fine and I go through bouts when I feel very depressed but there's no reason for it! So when I read that the sleep apnea could cause it, I was thrilled. I have had my hormone levels and vitamin levels checked and corrected...I felt FAB afterwards, but then it "evened out" and I was tired/sad again. So I really think the sleep is the last thing.

I was prepared for a long battle and when I started feeling FAB, I thought "Life is good!" But then I started on the rollercoaster and that's where the frustration is! I think it also got worse with situations at work and I'm dreading returning next week. Slow progress forward - I could live with that. But up and down...EEK! I'm also REALLY frustrated with the doctor's office, which has contributed to the agony. In 20 years, I've never called the insurance company as often as I have in the past 2 mos!

One other bad bad thing I did? Last week, I went to a drive in that was offering a double feature. Now...I really only wanted to see the second movie and had they shown the second movie first, I would have chosen my sleep over Anchorman 2. So I ended up getting to bed at 1am and I'm slowly trying to move my body back to normal bedtime (9pm).

Not sure if you can relate to any of that.

[Julie]

Would both of you (Mitzi & Rick) be willing to forget - short term - what your machine says and try something new? Like a few days of mouth taping at night to see if you are in fact losing too much pap air that way? You're both using nasal masks and while you may not be aware of leaks, and/or your machines are not recording them, what's to lose? This is my bonnet's bee and while I know some people here think I'm a bit nuts, I believe in what I'm suggesting - as a trial, seeing as you seem to be at a loss anyhow.