Bilevel user- sleepy, tired, bad memory

Hello,
I have been on bilevel for about a year at this point. never felt refreshed. always very sleepy & tired, bad memory, difficulty concentrating. I have tried few different settings but nothing has worked so far.

I am sharing the recent graphs with different PS settings that I have tried.

PS-4
https://imgur.com/a/COatKTt

PS-5
https://imgur.com/a/4ILrFyx

PS-5.6
https://imgur.com/a/romkM1v

How much real sleep do you think you are getting? Are you sleeping soundly for the most part or are you waking often during the night?

Do you take any medications (even OTC) and if you do....name, dosage.

Do you have any other physical or mental health issues that can impact sleep or how you feel?

How much real sleep do you think you are getting? Are you sleeping soundly for the most part or are you waking often during the night?
---I dont have wake up more than once at night.
mild noise seems to wake me up. I tried to track sleep with samsung watch. it shows very little deep sleep like 10-20 min

Do you take any medications (even OTC) and if you do....name, dosage.
Do you have any other physical or mental health issues that can impact sleep or how you feel?
--- I have all year around allergies. time to time I take anti-allergy medications(Levocetirizine Dihydrochloride/Ebastine/Rupatadine Fumarate whichever dr prescribes) which are not sleep indcuing & also use spray(Fluticasone Furoate,27.5 mcg/spray). I dont have any other health/mental conditions.

Male or female?
Age?
When is the last time you had a complete work up including routine labs as well as some non routine labs like hormone levels, vitamin D levels, or iron levels?

Male or female?Age?
- Male, 40, 176cm height, 67kg weight.

When is the last time you had a complete work up including routine labs as well as some non routine labs like hormone levels, vitamin D levels, or iron levels?
-eco, ecg, ett, vit d, tsh, iron panel done within last 6 months. all are ok.

can anyone comment on my graphs? is there any adjustments I can try?

zzz7 wrote: ↑

Mon Apr 07, 2025 12:13 am

can anyone comment on my graphs? is there any adjustments I can try?

The problem is that your data shows excellent treatment at all three settings---if these nights are typical for you.

Heck, there's not even that much obvious evidence of the extra spikiness we associate with lots of restlessness and sleep-wake-junk breathing. (That might change if we could zoom in on the breathing to where we could see individual breaths. If you're willing, you could upload the data to SleepHQ and post links so we can do the zooming.)

So the upshot is this: Dial-winging is not likely to fix your problems if your data always looks like this: The AirCurve 10 is doing its job of preventing the vast majority of your obstructive events from occurring. Your unintentional leak rates are quite good. And your flow limitations are almost non-existent.

And then there's this: The most obvious thing that jumps out at me in the data you post is the "bedtimes".

On 3/28, you start therapy at 5:07 AM
On 4/2, you start therapy at 23:52 PM
On 4/4, you start therapy at 4:49 AM

Any reason why you're going to bed at dawn on two of these nights and at roughly midnight on the middle night of the three?

I ask because the highly inconsistent bedtimes may be part of your problem with getting a consistently good night's sleep and those inconsistent bedtimes may be part of why you're not feeling good during the part of the day you are actually awake.

Do you do shift work that requires you to stay up (most) of the night on many nights? And then do you try to have a more "normal" schedule on your days off? If so, it could be the shift work that is causing your on-going problems.

If you don't do shift work, then I'd say that you need to establish a more consistent sleep schedule than the one you currently have.

thanks for the review.
I am sharing the link to my sleephq data.
https://sleephq.com/public/teams/share_ ... ff8989c588

yes, sometimes need to work at night but not on a regular basis. I tried to maintain a consistant bed time but always fail measurably. sometimes I cant fall sleep on time even after trying for hours, and waking up has always been very challenging for me even after 10+ hrs sleep. it is a vicious cycle for me. I feel so bad during the day which most days makes me fall sleep during daytime and impact sleep at night and it goes on. some days I fall asleep early within very short time after hitting the bed then wake up after few hours, spend couple of hours try to fall back to sleep. last night was like this.

robysue1 wrote: ↑

Mon Apr 07, 2025 8:41 am

zzz7 wrote: ↑

Mon Apr 07, 2025 12:13 am

can anyone comment on my graphs? is there any adjustments I can try?

The problem is that your data shows excellent treatment at all three settings---if these nights are typical for you.

Heck, there's not even that much obvious evidence of the extra spikiness we associate with lots of restlessness and sleep-wake-junk breathing. (That might change if we could zoom in on the breathing to where we could see individual breaths. If you're willing, you could upload the data to SleepHQ and post links so we can do the zooming.)

So the upshot is this: Dial-winging is not likely to fix your problems if your data always looks like this: The AirCurve 10 is doing its job of preventing the vast majority of your obstructive events from occurring. Your unintentional leak rates are quite good. And your flow limitations are almost non-existent.

And then there's this: The most obvious thing that jumps out at me in the data you post is the "bedtimes".

On 3/28, you start therapy at 5:07 AM
On 4/2, you start therapy at 23:52 PM
On 4/4, you start therapy at 4:49 AM

Any reason why you're going to bed at dawn on two of these nights and at roughly midnight on the middle night of the three?

I ask because the highly inconsistent bedtimes may be part of your problem with getting a consistently good night's sleep and those inconsistent bedtimes may be part of why you're not feeling good during the part of the day you are actually awake.

Do you do shift work that requires you to stay up (most) of the night on many nights? And then do you try to have a more "normal" schedule on your days off? If so, it could be the shift work that is causing your on-going problems.

If you don't do shift work, then I'd say that you need to establish a more consistent sleep schedule than the one you currently have.

Hello robysue1,
I have shared my sleephq link.if possible pls have a look and let me know what you think.

Things are kind of busy at work right now.

If I get a chance, I'll try to scroll through the data on the link a bit later today.

But I still think the answer to your problem is not going to be dial winging: Your obstructive sleep apnea is well treated. And that means your on-going problems are likely caused by something else. The "something else" might just be bad sleep possibly caused by a combination of the irregular bed times and some intermittent insomnia:

zzz7 wrote: ↑

Mon Apr 07, 2025 10:35 am

yes, sometimes need to work at night but not on a regular basis. I tried to maintain a consistant bed time but always fail measurably. sometimes I cant fall sleep on time even after trying for hours, and waking up has always been very challenging for me even after 10+ hrs sleep. it is a vicious cycle for me. I feel so bad during the day which most days makes me fall sleep during daytime and impact sleep at night and it goes on. some days I fall asleep early within very short time after hitting the bed then wake up after few hours, spend couple of hours try to fall back to sleep. last night was like this.

zzz7,

I've spent quite a bit of time tonight looking at your data between March 24 and April 6. (This was available via the SleepyHQ link you posted.). But before getting to your data, I want to remind you of what you've written about the subjective quality of your sleep:

zzz7 wrote: ↑

Mon Apr 07, 2025 10:35 am

yes, sometimes need to work at night but not on a regular basis. I tried to maintain a consistant bed time but always fail measurably. sometimes I cant fall sleep on time even after trying for hours, and waking up has always been very challenging for me even after 10+ hrs sleep. it is a vicious cycle for me. I feel so bad during the day which most days makes me fall sleep during daytime and impact sleep at night and it goes on. some days I fall asleep early within very short time after hitting the bed then wake up after few hours, spend couple of hours try to fall back to sleep. last night was like this.

Even before starting to look at your data, what you've written indicates that you quite likely have a problem with insomnia and/or a circadian rhythm problem. Either (or both) can explain why you sometimes can't fall asleep "on time" and why you sometimes feel like you can't fall asleep even if you've been trying "for hours" to get to sleep. Your insomnia problem may involve both sleep onset insomnia (can't get to sleep when you first go to bed) and sleep maintenance insomnia (wake up and can't get back to sleep in a timely fashion).

The fact that you sometimes work at night quite likely aggravates things on the nights that you when go to bed at a more "normal" time: Your body may have (somewhat naturally) adjusted to a "sleep window" that simply starts much later than normal in part because of the need to stay awake later on the days when you are working.


Here are my impressions about your data.

1) Bedtimes are way too variable. This may indicate that you've got a problem with sleep onset insomnia since going to be "early" does not seem to improve your sleep on most of the nights where you go to bed any earlier than midnight.

2) You often sleep very, very late---often after noon. But it's not clear whether the quality of sleep during the last hour or two you are in bed is particularly good sleep. In other words, there is evidence of a lot of so-called sleep-wake-junk breathing during the hour or so before you turn the machine off when you finally get up.

3) There are often extended periods of time when your VAuto is not on in the middle of the time you are attempting to sleep. And that brings up an important pair of questions: Are you just taking the mask off and then going to sleep for 60-120 minutes without the machine? Or are you getting out of bed because you are so frustrated with the whole mess of not sleeping very well?

4) Even as frustrated as you are, there are times when you are getting what appears to be high quality sleep that is not interrupted by apneas. Here are some screen shots of snippets that show what appears to be decent quality sleep:

March 31:


April 2:


April 3:


April 4:


The problem is, however, that your periods of decent quality sleep don't make up the bulk of your nights: On almost every night there is a lot of evidence of some significant sleep-wake-junk breathing that most likely corresponds to periods when you are struggling to get to sleep or you are sleeping very lightly and bouncing back and forth between a light sleep and wake or you are just having a whole bunch of spontaneous arousals that are preventing you from moving from the lightest stage of sleep to a more deep stage of real, continuous sleep. Here are some examples of some periods of "bad sleep" because you are either not really asleep or you are so restless that you're more than likely trapped in a vicious circle of sleep wake junk:

March 25:


March 28:


March 29:



Because your data looks good when you are actually asleep, I don't think there's any dial winging that can be done to make you feel better. In other words, the fact that you are feeling bad during the daytime is most likely because your sleep is simply bad sleep. It's no longer bad because of sleep disordered breathing---the machine is preventing your apneas from occurring. Rather your sleep is bad for some other reason.

Given what you've said, I think you've got a significant problem with insomnia. Unfortunately, there's not a magic bullet for "fixing" insomnia when it's not being triggered by sleep disordered breathing. Essentially the goal is to reduce the amount of time you spend lying in bed trying unsuccessfully to get to sleep or to get back to sleep after a middle-of-the-night wake. This involves teaching your body to associate being in bed with being asleep instead of being awake. Self-treatment for insomnia starts with being much more aware of your sleep hygiene as well as learning about behavior patterns that make the insomnia worse and behavior patterns that help alleviate the insomnia. When self-help tools don't work, there are two basic approaches: Cognitive behavior therapy for insomnia (CBT-I) and prescription sleep medication. The two approaches can be combined.

The starting place is to start by doing the following things:

1) Establish a regular wake-up time that works for your lifestyle (including your job). Ideally you should have no problem sleeping until your desired wake up time. And your wake up time should be something that you can enforce seven days a week.

2) Work backwards from the desired wake up time to choose a bedtime. Since most people need 7-8 hours of good quality sleep, it's important for your time-in-bed window not be excessively long: Lying in bed not sleeping well can only be fixed by consolidating the sleep cycles and reducing the time you spend lying in bed awake. So if your desired wake up time is, say 10 AM, then a reasonable bedtime might be 2:00 or 3:00 AM.

3) Once you've decided on your mandatory wake up time and your desired bedtime, you need to work on enforcing them. For wake-up time, it's a matter of simply forcing yourself to get up even if you feel horrible and awful. For bedtime, it's easier: Don't go to bed any earlier than your desired bedtime and only go to bed if you actually feel sleepy. In other words, if your are not sleepy when bedtime comes around, just stay up until you do feel sleepy.

4) Give yourself a reasonable amount of time to fall asleep, but do NOT watch the clock if you find yourself unable to sleep. Most people with decent quality sleep fall asleep within 15-20 minutes of going to bed. If it feels like you've been lying in bed much longer than that without being able to get to sleep, it's worth getting up and going into a different room. Do something reasonably fun and relaxing until you do feel sleepy. Apply the same rule when you wake up in the middle of the night: If you can't get back to sleep in a reasonable amount of time, just get up and go into a different room and do something enjoyable until you do feel sleepy.

5) Do your best to eliminate napping: Napping unfortunately makes it harder for an insomniac to get to sleep and stay asleep.

6) Do your best to not worry about your sleep---particularly when you are lying in bed not sleeping. Worrying about your sleep is one of the quickest ways to destroy the quality of your sleep. This last thing is really, really hard for people---particularly people who have suffered from untreated sleep disordered breathing for many years and who then find that things don't improve much once they start on CPAP therapy. It's important to remember that your brain got extremely used to sleeping very lightly and repeatedly arousing yourself over and over all night long when your sleep apnea was still untreated. And it takes some people's brains a whole lot of time to unlearn the need to be super-vigilant at night. But until your brain figures out that it's ok to fall into a deep, continuous sleep with the CPAP on (because your breathing won't stop), your brain just might continue waking you up even though there are no apneas occurring because you are using the machine. Teaching the brain to "shut up and get some sleep" can be hard, but the problem is an insomnia problem, and unfortunately dial winging the machine's settings isn't going to fix the problem.

Thanks robysue1 for the comprehensive analysis and suggestions.