3 1/2 Months In & Could Use Some Help

KayakKid wrote:robysue,

Thank you for all the tips. I may try splitting the Ambien in half and only taking 5mg and see what happens. It is a matter of really not being cognizant of what I am doing when I wake up at night. I'm going to talk to the sleep doc about Belsomra and see if that may be a better alternative for me. I have thought over the past few months that my difficulties with keeping the mask on could be psychological. I even mentioned them to my DME, but he really didn't have any good recommendations for me. CBT may be the way to go. Do you have any suggestions on a particular type of therapist to see that specializes in sleep related issues?

My CBT for Insomnia was directed by a PA in my sleep doc's office. When I needed some (additional) CBT for some anger management issues concerning my difficult adjustment to CPAP, my sleep doc's PA simply referred me to a local psychologist who specialized in CBT therapy. It helped.

I think the important thing is to get someone who really knows CBT and is flexible enough to learn something about the specifics of what you are dealing with.

robysue wrote:

KayakKid wrote:robysue,

Thank you for all the tips. I may try splitting the Ambien in half and only taking 5mg and see what happens. It is a matter of really not being cognizant of what I am doing when I wake up at night. I'm going to talk to the sleep doc about Belsomra and see if that may be a better alternative for me. I have thought over the past few months that my difficulties with keeping the mask on could be psychological. I even mentioned them to my DME, but he really didn't have any good recommendations for me. CBT may be the way to go. Do you have any suggestions on a particular type of therapist to see that specializes in sleep related issues?

My CBT for Insomnia was directed by a PA in my sleep doc's office. When I needed some (additional) CBT for some anger management issues concerning my difficult adjustment to CPAP, my sleep doc's PA simply referred me to a local psychologist who specialized in CBT therapy. It helped.

I think the important thing is to get someone who really knows CBT and is flexible enough to learn something about the specifics of what you are dealing with.

Thank you.

KayakKid wrote:I'm going to talk to the sleep doc about Belsomra

http://www.consumerreports.org/cro/news ... /index.htm

ChicagoGranny wrote:

KayakKid wrote:I'm going to talk to the sleep doc about Belsomra

http://www.consumerreports.org/cro/news ... /index.htm

I know that Consumer Reports has panned Belsomra on a number of grounds. Consumer Reports is quite negative on all sleep medications, strongly suggesting that most insomnia problems can best be dealt with through self-help and CBT-I. And when prescription medication is clearly needed (because the insomnia has NOT responded to self-help and CBT-I) Consumer Reports' "favorite" prescription sleeping med has long been Ambien since it's cheap and it works for most people.

However, I want to say that for me Belsomra has been a godsend. I simply could not tolerate the Ambien side effects---I was on Ambien for over a year while waiting for Belsomra to clear the final hurdles in the FDA approval process.

Since starting CPAP my sleep problems have become intractable: I have spent most of the last five and a half years working with CBT-I, which I firmly believe in and which has helped tremendously. And I've done everything my docs have asked (and more) in terms of cleaning up and working hard on on my sleep hygiene. I've spent most of the last 3 years working hard on using CBT techniques to keep my delayed sleep phase problem under control---i.e.~keeping my natural sleep period from drifting too far off what my daytime job requires.

But even with all my hard work, the fact remains that I still have serious problems with both insomnia and delayed sleep phase problems. And I have finally had to admit to myself that my sleep doc is correct and that I do better taking sleeping medication more nights than not. But Ambien causes too many side effects and Lunesta and Sonata simply do not help me fall asleep. (Sonata is the worst for me: It weirds me out in a way that I literally can't fall asleep until it starts to wear off.) The Belsomra helps me keep my sleep schedule from getting too far out of control and it does not trigger a "hangover" the way Ambien did. Moreover, the Belsomra does not constipate me the way Ambien did when I was taking Ambien at least 5 nights a week.

So yes, Belsomra is expensive. And in clinical trials it's not really any more effective than Ambien. But if you cannot tolerate Ambien (or Sonata or Lunesta) or if Ambien (or Sonata or Lunesta) does not work for you, it is well worth considering a Belsomra trial.

So it's been five nights since I switched from CPAP to APAP. The first night (04/15/16) was the longest I have been able to keep the mask on. The one thing I did differently was I broke the Ambien in half and only took 5mg at bedtime. When I woke up during the night I was fairly alert and took the 2nd half and went back to sleep with the mask on. I have since tried the 5mg/5mg with the Ambien, but the problem is I have not been able to get to sleep initially on only the 5mg. The couple nights I took the full 10mg at the start of the night I woke up in an Ambien haze and subconsciously never put the mask back on. I am very much looking forward to meeting with the sleep doctor the day after tomorrow and hopefully getting some more answers. Here are a few Sleepyheads from the past few nights. If anyone has any input it would be greatly appreciated.

KayakKid wrote:If anyone has any input it would be greatly appreciated.

Your CPAP works.

Are you disciplined about sleep hygiene?

It would be helpful to see the rest of the graph...your machine seems to be working a bit too hard....

lilly747 wrote:It would be helpful to see the rest of the graph...your machine seems to be working a bit too hard....

I'm following the exact instructions on here regarding how to post screenshots. Not sure how I could get more of the graphs on here.

KayakKid wrote:

lilly747 wrote:It would be helpful to see the rest of the graph...your machine seems to be working a bit too hard....

I'm following the exact instructions on here regarding how to post screenshots. Not sure how I could get more of the graphs on here.

Sorry I just needed to click on the image you posted....it' OK what you posted

OK the graph on 4-15 gives the most data and it is cut off and clicking on it does not work....but.....

What I see is your machine going from 5/8 to almost 11/14. That is about a 6cm swing. Your AHI is not so bad, but the question you might want to ask is, is the swing pressure causing a problem with my ability to sleep?


EDIT: also FL seems to be a big problem....

lilly747 wrote:What I see is your machine going from 5/8 to almost 11/14. That is about a 6cm swing. Your AHI is not so bad, but the question you might want to ask is, is the swing pressure causing a problem with my ability to sleep?

I see nothing wrong with that - it's unlikely to be causing his problems because the pressure changes gradually over several minutes. If you want to talk about pressure swings, he is using EPR of 3, and the pressure changes 3 cm on every breath. Personally, I never liked to use EPR.

Chevie wrote:
I see nothing wrong with that - it's unlikely to be causing his problems because the pressure changes gradually over several minutes. If you want to talk about pressure swings, he is using EPR of 3, and the pressure changes 3 cm on every breath. Personally, I never liked to use EPR.

Chevie,

What could the benefits be of reducing or eliminating EPR?

KayakKid wrote:What could the benefits be of reducing or eliminating EPR?

I tried EPR a good many times at all three levels. The pressure cycling up and down with every breath was distracting to me.

EPR is exhale relief for those who feel like they have trouble exhaling against higher pressures. I never had a problem with high pressures. I quickly got so comfortable with high pressures that it doesn't seem like I am breathing against pressure.

You could cut EPR down in steps over a few nights. If you get to the point the exhale pressure bothers you, then turn the EPR setting back up a notch.

You need to figure out how to sleep more, and then work on the best machine settings to prevent apnea.

I may be different from many people. When I wake up in the morning, the machine may be running at 16 cm, and I don't even feel like there is any pressure. But, if I were using EPR, the pressure changes are distracting.

I have apneas on exhale and inhale according to the sleep doc. So, if I use EPR, then the lower pressure on exhale makes me more prone to have apneas.

A lot of getting the correct machine settings is experimenting, checking the data the next morning and making a mental note of how you think you slept and how you feel throughout the day. Some people keep a journal.

Good luck.

Chevie wrote:
Good luck.

Thank you for your input.