Newbie and confused

Hi,

I got diagnosed with sleep apnea last month. During the polysomnography my AHI was 19.4. I am 42 years old now. I am not sure for how long I had this condition. I have hypertension and pre-diabetic. I have been struggling with sleep since my undergrad. Somehow I managed to get by. Due to poor sleep and anxiety, doctor suggested me to take Clonazepam .5 since 2018 and I am religiously taking it from that time. I didn't have snoring all these years. My wife has started complain about around 1 year. At first I shrugged it off then I recorded my whole night and found the loud snoring. I went a ENT specialist and he suggested me to use nasal decongestant since I do not look like overweight. My BMI is 25.1. Since the snoring persisted, he suggested me do a polysomnography. The doctor prescribed me to use a CPAP machine and told me to taper off clonazepam slowly. It has been 21st day use of Resmed airsense 10 autoset. Somedays I feel so refreshed but my expectations are getting high. Is there any suggestions for the beginners to the full benefit of CPAP machine? I have attached the most recent sleephq screenshot and the last 21 days trends.

https://sleephq.com/public/cbb94cf7-2f9 ... 6267611f7b
https://sleephq.com/public/db243f1e-a43 ... 72ea989990

Thanks,
hungry_sleepr

What model of which machine do you use? And which mask?

Once you get set up 'ideally' with help from experts here, you should start to feel better more consistently, but it's never perfect every night (who/what is?).

I am using resmed airsense 10 autoset. I am using mirage FX nasal mask.

hungry_sleeper wrote: ↑

Sat Nov 12, 2022 10:30 am

I got diagnosed with sleep apnea last month. During the polysomnography my AHI was 19.4.

That puts your untreated OSA in the moderate range, which is well worth treating with CPAP.

The doctor prescribed me to use a CPAP machine and told me to taper off clonazepam slowly. It has been 21st day use of Resmed airsense 10 autoset. Somedays I feel so refreshed but my expectations are getting high. Is there any suggestions for the beginners to the full benefit of CPAP machine? I have attached the most recent sleephq screenshot and the last 21 days trends.

First a big thank you for including the links to the data.

The fact that you sometimes "feel so refreshed" is a good indication that you are well on your way to feeling refreshed on almost every day. You have good reason to be getting high expectations.

But you need to remind yourself that there may be some bumps along the way. Just think of them as bumps instead of serious setbacks and I think you'll do just fine.

In terms of why you're not (yet) feeling "so refreshed" on every single day, here are some things to keep in mind:

• Healing the damage that OSA has created can take time. The fact that you are already experiencing good days is a sign that your body is healing nicely. The fact that you are only feeling good on some days is a sign that there's more healing to be done. So be patient---things should continue to get better as you continue to PAP.
• We don't actually sleep exactly the same every night. Even people with perfectly normal sleep have some bad nights; its just that they have far more good nights than bad ones. In time you should find that with CPAP you have many more good nights than bad ones. Don't sweat the occasional bad night. Only worry if you start to have a string of bad nights that lasts long enough to become troublesome.
• You say you've been on Clonazepam since 2018 and that it was prescribed as both a sleeping aid and an anti-anxiety medication. You also say the doc who prescribed the CPAP wants you to taper off the clonazepam. Have you started tapering? If so, is the tapering going slowly enough to not be causing any additional problems with your sleep and/or your anxiety? Tapering off too quickly could lead to problems. But on the other hand, with CPAP you ought to be able to successfully taper off since the bad sleep was probably caused by the OSA desats and arousals, and the untreated OSA may very well have increased your daytime anxiety.

In terms of your data, things are looking pretty good. Here are some additional more specific comments:

• Your leaks are technically under control, but is there any chance that they are causing you to wake up, particularly on the nights where you don't feel as refreshed in the morning? If the leaks aren't waking you up, they are small enough to ignore. But if they're waking you up, then fixing the leaks might lead to more "good" days.
• Flow limitations are what drives your biggest pressure increases. You can informally think of a flow limitation as an airway that is at high risk of collapsing, but it has not yet collapsed to the point where a hypopnea or apnea has occurred. If the pressure is not bothering you, a modest 1 or 2cm increase in your minimum pressure setting may help smooth out some of the flow limitations.

It's very encouraging that you're having days when you feel refreshed. With time, I bet you'll have more.

Your AHI is good. To head off a few more OAs, you could experiment with raising your minimum pressure by 1 to see what happens.

You have bouts of flow limitations. These may or may not affect the quality of your sleep. Do you have a stuffy nose or allergies?

It's good you've started tapering off of clonazepam, but be aware of the potential side-effects as you decrease usage. Some of them are related to sleep and daytime fatigue. More here: https://americanaddictioncenters.org/wi ... clonazepam
The good thing is that if you're having side-effects, they'll decrease and disappear over time.

One thing I notice is that you never have a night without an interruption to therapy. Are those bathroom breaks?

It also looks as though you sleep during the day. Is that correct?

Miss Emerita wrote: ↑

Sat Nov 12, 2022 11:43 am

It's very encouraging that you're having days when you feel refreshed. With time, I bet you'll have more.

Your AHI is good. To head off a few more OAs, you could experiment with raising your minimum pressure by 1 to see what happens.

You have bouts of flow limitations. These may or may not affect the quality of your sleep. Do you have a stuffy nose or allergies?

It's good you've started tapering off of clonazepam, but be aware of the potential side-effects as you decrease usage. Some of them are related to sleep and daytime fatigue. More here: https://americanaddictioncenters.org/wi ... clonazepam
The good thing is that if you're having side-effects, they'll decrease and disappear over time.

One thing I notice is that you never have a night without an interruption to therapy. Are those bathroom breaks?

It also looks as though you sleep during the day. Is that correct?

I think sometimes sleephq lists data based on the users time zone and makes it a bit tricky that way.

You pose a good question though about sleep quality. If you hover/tap on any segment of the session data it breaks down each session by time if you click on it.

I wonder what happened Thursday.

edited to correct myself

I notice you have some Central Apneas in your record. These MAY be (not certainly but may be) "treatment emergent" central apneas. When a person is first on CPAP, they breathe more efficiently and exhale more carbon dioxide, thus causing a person not to need to inhale as frequently. Not inhaling for more than 10 seconds is a central apnea. TECAs generally go away in the first few months of CPAP usage.

Your numbers look good. I see you are using EPR of 3, which is the primary tool for fighting flow limitations and hypopnea.

Stay the course. It often takes a while to see all the benefits of PAP therapy. Persevere. Don't get frustrated or disappointed. Time, patience and perseverance are the keys.

It's very encouraging that you're having days when you feel refreshed. With time, I bet you'll have more.

Your AHI is good. To head off a few more OAs, you could experiment with raising your minimum pressure by 1 to see what happens.

You have bouts of flow limitations. These may or may not affect the quality of your sleep. Do you have a stuffy nose or allergies?

It's good you've started tapering off of clonazepam, but be aware of the potential side-effects as you decrease usage. Some of them are related to sleep and daytime fatigue. More here: https://americanaddictioncenters.org/wi ... clonazepam
The good thing is that if you're having side-effects, they'll decrease and disappear over time.

Miss Emerita wrote: ↑

Sat Nov 12, 2022 11:43 am

One thing I notice is that you never have a night without an interruption to therapy. Are those bathroom breaks?

Yes, these are annoying bathroom breaks. I hope that someday it will disappear like magic.

Miss Emerita wrote: ↑

Sat Nov 12, 2022 11:43 am

It also looks as though you sleep during the day. Is that correct?

No, I don't sleep at the day time. Sleephq probably didn't apply timezone properly in their reporting.

hungry_sleeper wrote: ↑

Sat Nov 12, 2022 10:30 am

I got diagnosed with sleep apnea last month. During the polysomnography my AHI was 19.4.

That puts your untreated OSA in the moderate range, which is well worth treating with CPAP.

The doctor prescribed me to use a CPAP machine and told me to taper off clonazepam slowly. It has been 21st day use of Resmed airsense 10 autoset. Somedays I feel so refreshed but my expectations are getting high. Is there any suggestions for the beginners to the full benefit of CPAP machine? I have attached the most recent sleephq screenshot and the last 21 days trends.

First a big thank you for including the links to the data.

The fact that you sometimes "feel so refreshed" is a good indication that you are well on your way to feeling refreshed on almost every day. You have good reason to be getting high expectations.

But you need to remind yourself that there may be some bumps along the way. Just think of them as bumps instead of serious setbacks and I think you'll do just fine.

In terms of why you're not (yet) feeling "so refreshed" on every single day, here are some things to keep in mind:

• Healing the damage that OSA has created can take time. The fact that you are already experiencing good days is a sign that your body is healing nicely. The fact that you are only feeling good on some days is a sign that there's more healing to be done. So be patient---things should continue to get better as you continue to PAP.
• We don't actually sleep exactly the same every night. Even people with perfectly normal sleep have some bad nights; its just that they have far more good nights than bad ones. In time you should find that with CPAP you have many more good nights than bad ones. Don't sweat the occasional bad night. Only worry if you start to have a string of bad nights that lasts long enough to become troublesome.
• You say you've been on Clonazepam since 2018 and that it was prescribed as both a sleeping aid and an anti-anxiety medication. You also say the doc who prescribed the CPAP wants you to taper off the clonazepam. Have you started tapering? If so, is the tapering going slowly enough to not be causing any additional problems with your sleep and/or your anxiety? Tapering off too quickly could lead to problems. But on the other hand, with CPAP you ought to be able to successfully taper off since the bad sleep was probably caused by the OSA desats and arousals, and the untreated OSA may very well have increased your daytime anxiety.

robysue1 wrote: ↑

Sat Nov 12, 2022 11:38 am

In terms of your data, things are looking pretty good. Here are some additional more specific comments:

• Your leaks are technically under control, but is there any chance that they are causing you to wake up, particularly on the nights where you don't feel as refreshed in the morning? If the leaks aren't waking you up, they are small enough to ignore. But if they're waking you up, then fixing the leaks might lead to more "good" days.
• Flow limitations are what drives your biggest pressure increases. You can informally think of a flow limitation as an airway that is at high risk of collapsing, but it has not yet collapsed to the point where a hypopnea or apnea has occurred. If the pressure is not bothering you, a modest 1 or 2cm increase in your minimum pressure setting may help smooth out some of the flow limitations.

Thanks for the suggestion. I will definitely try with increasing the minimum pressure.

Agree with all of the above.
I want to add that some people find their sleep distrubed by pressure changes, and narrowing the range helps with that too.
Your flow limitation are accompanied by snores - another indication that higher minimum pressure could help.

Julie wrote: ↑

Sat Nov 12, 2022 11:09 am

What model of which machine do you use? And which mask?

Once you get set up 'ideally' with help from experts here, you should start to feel better more consistently, but it's never perfect every night (who/what is?).

@Julie: The machine info appears in the linked daily charts, though not the mask

@hungory_sleeper you can add the details of your machine and mask(s) to your profile - which will make it appear in all your posts automatically.
It would also help if you added your time zone and its offset from the UTC (Universal Time Clock), since we each see our own time zone in SleepHQ charts - and even discussing what happened when can become confusing.