Last night's sleepy head data- # CA's okay?

Wonderbrah wrote: 1.) The best AHI I've had is with pressure set to 9-20

2.) To be honest, sleep quality feels the same to me between 9-20, 15-20 or anywhere in-between. I can't specifically peg a different between pressure settings. In terms of comfort 15 is no less comfortable than 9, starting out. I don't remember any awakening in regards to last night except the fourth one. I wouldn't say it's unusual for me to wake up in the middle of the night, regardless of pressure. When I take melatonin I think I'm more likely to sleep throughout the night but last night I did not. I'm trying to cut that habit because it makes me drowsy in the AM. I don't have a hard time getting back to sleep regardless of pressure either.

So subjective quality of sleep has not changed regardless of pressure but I think the objective sleep considering the data has.

Seems to me that the increased minimum pressure hasn't actually done anything for you:

• Increasing the min pressure has not improved the objective AHI data, and indeed the AHI seems to have gone up with the pressure increase.
• Increasing the minimum pressure has not improved the subjective quality of your sleep.

So that begs the question: Why use the higher pressure range if it's not helping and may be making things worse?

Here's what I would recommend:

1) Go back to using the 9-20 pressure range and stick with 9-20 for at least one to two weeks---regardless of the AHI data. It takes time for our bodies to adjust to CPAP and you may still be in that adjustment period. You can always reevaluate whether you need more pressure at the end of the 1-2 week period. And keep in mind that if your OAI + HI is well below 5.0 on almost every night, then increasing the pressure is not likely to do much in terms of making you feel a lot better.

2) Consider taking the melatonin earlier in the evening rather than right at bedtime. When my sleep doc had me experimenting with taking melatonin to try to stabilize my delayed sleep problem as well as help with my "too many spontaneous arousals" problem, he told me to take it 5-6 hours before my desired bedtime. Taking it earlier in the evening may help with the problem of melatonin leaving you too drowsy in the AM.

3) Consider taking less melatonin. Many people think that megadoses of melatonin are the best way to address sleep problems; they are wrong. If you are taking 3mg or more of melatonin, you need to cut the dose way back. Try to take no more than 1-1.5mg of melatonin each evening.

4) Try keeping a very simple journal with the following data:

• How well you feel immediately on waking. Keep it simple and use a 0-5 scale where 0=Awful and 5=Wonderful.
• How well you feel during the day. Keep it simple and use a 0-5 scale where 0=Awful and 5=Wonderful.
• How you feel at bedtime. Are you more physically exhausted and less sleepy? Or are you more sleepy and appropriately tired?

After a week or two of keeping the journal, try to correlate your best and worst days with what's going on in your CPAP data. You may find that as long as your AHI < 3ish, there's no correlation at all between a super low AHI and feeling particularly good during the day. If that's the case, then you know that in the long term you don't need to go chasing an extra low AHI.

robysue wrote:

Wonderbrah wrote: 1.) The best AHI I've had is with pressure set to 9-20

2.) To be honest, sleep quality feels the same to me between 9-20, 15-20 or anywhere in-between. I can't specifically peg a different between pressure settings. In terms of comfort 15 is no less comfortable than 9, starting out. I don't remember any awakening in regards to last night except the fourth one. I wouldn't say it's unusual for me to wake up in the middle of the night, regardless of pressure. When I take melatonin I think I'm more likely to sleep throughout the night but last night I did not. I'm trying to cut that habit because it makes me drowsy in the AM. I don't have a hard time getting back to sleep regardless of pressure either.

So subjective quality of sleep has not changed regardless of pressure but I think the objective sleep considering the data has.

Seems to me that the increased minimum pressure hasn't actually done anything for you:

• Increasing the min pressure has not improved the objective AHI data, and indeed the AHI seems to have gone up with the pressure increase.
• Increasing the minimum pressure has not improved the subjective quality of your sleep.

So that begs the question: Why use the higher pressure range if it's not helping and may be making things worse?

Here's what I would recommend:

1) Go back to using the 9-20 pressure range and stick with 9-20 for at least one to two weeks---regardless of the AHI data. It takes time for our bodies to adjust to CPAP and you may still be in that adjustment period. You can always reevaluate whether you need more pressure at the end of the 1-2 week period. And keep in mind that if your OAI + HI is well below 5.0 on almost every night, then increasing the pressure is not likely to do much in terms of making you feel a lot better.

2) Consider taking the melatonin earlier in the evening rather than right at bedtime. When my sleep doc had me experimenting with taking melatonin to try to stabilize my delayed sleep problem as well as help with my "too many spontaneous arousals" problem, he told me to take it 5-6 hours before my desired bedtime. Taking it earlier in the evening may help with the problem of melatonin leaving you too drowsy in the AM.

3) Consider taking less melatonin. Many people think that megadoses of melatonin are the best way to address sleep problems; they are wrong. If you are taking 3mg or more of melatonin, you need to cut the dose way back. Try to take no more than 1-1.5mg of melatonin each evening.

4) Try keeping a very simple journal with the following data:

• How well you feel immediately on waking. Keep it simple and use a 0-5 scale where 0=Awful and 5=Wonderful.
• How well you feel during the day. Keep it simple and use a 0-5 scale where 0=Awful and 5=Wonderful.
• How you feel at bedtime. Are you more physically exhausted and less sleepy? Or are you more sleepy and appropriately tired?

After a week or two of keeping the journal, try to correlate your best and worst days with what's going on in your CPAP data. You may find that as long as your AHI < 3ish, there's no correlation at all between a super low AHI and feeling particularly good during the day. If that's the case, then you know that in the long term you don't need to go chasing an extra low AHI.

I've been taking 300 mcg of 6 hour sustained release melatonin and it has been working great. I definitely agree, less is more with melatonin. I know this is an old thread but do you mind taking a look at my last night's graph data again? I have recently been sleeping a hell of an amount- 12-18 hours on a set pressure of 20.0 and it has been rough juggling sleep, school and work. So last night I wanted to experiment with a lower pressure range of 9.0-12.0 and my AHI actually was as low as it's ever been: a 0.74. That's incredible to me. Maybe the central apeas I was having with the higher pressure was making me feel more tired because last night I didn't have any and I feel much more refreshed than I have in quite some time. One area of concern though is my RERA's, which there were quite a lot of. The most I have ever seen actually. Do you think I may be better off with a lower pressure setting than a high one?

http://imgur.com/a/fDwRw

Wonderbrah wrote: I've been taking 300 mcg of 6 hour sustained release melatonin and it has been working great. I definitely agree, less is more with melatonin.

Good to know you found a melatonin dose that works well for you.

I know this is an old thread but do you mind taking a look at my last night's graph data again? I have recently been sleeping a hell of an amount- 12-18 hours on a set pressure of 20.0 and it has been rough juggling sleep, school and work. So last night I wanted to experiment with a lower pressure range of 9.0-12.0 and my AHI actually was as low as it's ever been: a 0.74. That's incredible to me.

While one night does not a trend make, the fact that your posted data looks good for the night with a pressure range of 9.0-12.0 suggests that it is well worth experimenting with the lower pressure for a week or so so see if your sleep genuinely improves at a lower pressure.

It also begs the question: When you were sleeping at CPAP @20cm, what were your AHIs like? And where you getting more CAs, but less RERAs and Hs scored?

Maybe the central apeas I was having with the higher pressure was making me feel more tired because last night I didn't have any and I feel much more refreshed than I have in quite some time. One area of concern though is my RERA's, which there were quite a lot of. The most I have ever seen actually. Do you think I may be better off with a lower pressure setting than a high one?

Your RERA Index is only 2.56 and your total respiratory disturbance index (RDI) is only 3.84, which is considered effectively treated.

The RDI = AHI + RERA Index, and most doctors would say that sleep disordered breathing is effectively treated when the RDI < 5.0. Some people don't feel their absolute best until the RDI is below 3.0 (or even below 2.0), but you have to judge how you feel for yourself.

And yes, I think you may be better off with the lower pressure setting than the higher one. Keep it at 9-12 for a week or so and see how you feel and see what the RDI and AHI are. If you're feeling fine at that pressure and the RDI stays below 5, then in my opinion, you've got high quality evidence that you don't need 20cm of pressure.

Final note: Some people will say that the fact that your pressure is hovering right at your max setting of 12cm is evidence that the max pressure is not yet high enough. If your RDI is a bit high and you're not feeling well and your pressure is maxed out for much of the night, then yes, it's true that a bit more pressure is needed. But if you're feeling fine and the RDI is low, it could just be that your max pressure is set at where a fixed pressure machine would likely be set and that's all you really need to treat your OSA.