ASV insomia freak out

Dear Pugsy,

Pugsy wrote:Do you take any medications, if so what?

Effexor (Venlafaxine) 150 mg/day, Lamictal (Lamotrigine) 100 mg/day, a glass of vinified Chassela once in a while.

What exactly is the complaint that you are having where you don't feel the good numbers...is it fatigue, excessive sleepiness during the day...whatever. Just saying "I don't feel good" isn't enough...be specific about what isn't feeling so great.

Actually it isn’t so much fatigue. Fatigue becomes a problem when stupid mistakes start to accumulate and I loose faith in myself. The effort to concentrate, to recheck every step and scaring myself with what would be the next mistake, is wearing me out until I fall asleep. The whole sleep apnea came up because I got send for a sleep study.

29 Feb 2016 : 1960 height 1.84 m weight 72 kg

Tot Sleep time 376 min 6h16 (6.27)
N1 after 17‘ 171 min 45 %
N2 after 20‘ 192 min 51 %
N3 after 94‘ (2x) 3.5 min 1 %
REM after 256‘ (1x) 26 min 7 %
Awake 19x if > 30” 17+24 min 5.8 %

Breathing events 353
AHI 252 39 /h (252/6.55 h= 38.5)
RDI 353/6.55h 54 /h
(Respiratory Disturbance Index: The total number of breathing events / total sleep time without therapy)

Micro-Arousal 288 44 /h (288/6.55 over whole night except for REM 26 min & 1x 23 min)
RAI (Respiratory Arousal Index) 22/h
Sleep efficiency 90 % (41/393=10%)

totTime in apnea 41 min (97 A * 25.2 s = (41 min) over 2.2h (132 min) = 1/3 of the time)
totTime in hypopnea 73 min (155 H * 28.4 = reduced respiration over whole night)

O2 desat 172 26 /h
Saturation > 90% 136 80% almost only when on the back
Saturation 80-90% 36 20% only when on the back
Saturation < 90% 3 min 0.7%
O2 Desat Suspine 171 40 /h
O2 Desat Non Suspine 5 2 /h

LM/RRLM leg movement 164 25 /h (Respiratory Related leg movements)
PLMS 18 2.7 /h (periodic jerk and kick of legs every 20-40 seconds in sleep)
RERA 0

Position :
Back 257min 65% AHI 51
Left Side 70min 18% AHI 24
Right Side 66min 17% AHI 5
Side tot 136min 35%
LM 164

How many hours of sleep are you averaging and are those hours of sleep fragmented with multiple wake ups...if so, how many and any idea why?

Lots of wake ups due to aerophagia, noise and just realizing that I am awake. Often related to stupid events for which I feel bad or responsible.

Have any other health issues going on? Pain?

Moody roller cost classified as Attention Deficit Disorder (not to call it bipolar). Join pain, mainly elbow and shoulder, chronic inflammation. Could be psoriasis arthritis, an autoimmune issue. Other ways I am healthy. Ride my bike, run after my kids (5 and 9), climb trees …

Remember these machines fix one problem and that problem is sleep apnea.

Yes, but if waking up is not prevented it does not really help. Is there a way to record micro arousal at home ?

Example...yesterday I messed my back up...worse than usual. … I am worn out before the day begins.

Well this I can relate to. I use my elbows not my back and yes it works perfectly.

By the way, some thing which could strengthen your back is lay on your belly and lift legs and arms just off the ground. Start with short periods. No need to overdo it. Swimming but only on your back or gently rowing are also really good for back issues. Running, bike riding, lifting weights however are very bad.

Here's the deal...I would feel this way even if I didn't have sleep apnea. I simply got crappy sleep that was totally unrelated to sleep apnea.

Yes got you. So, I am back to one of my first questions as to could crappy mood be a culpid of sleep apnea ? central sleep apnea ?

It's easily done...just set some of the parameters so the machine functions like a regular auto bilevel device.
I have the S9 Adapt which is the prior model to your AirCurve 10 ASV...and there's no real difference in the setting options...so I know it can be done.

Well I must be to stupid for that. Can one set an AirCurve 10 ASV with settings like EPAP min 5.6 IPAP max 9.4 PS 1-4 ? or EPAP 6 IPAP 9 ?

Thanks for help, really appreciate this familly

Look up both your meds and their side effects...and google multiple sources also google and read up on "SSRI and sleep stages".
For sure the Effexor messes with sleep architecture and insomnia is a well known side effect.
I realize why you are taking it and the other but they are very likely playing a part in the multiple wake ups and even inability to fall asleep at times.
Fragmented sleep for any reason will sure mess with how we feel during the day.
Meds may not be all of the problem but they are very likely to be a factor.

esel wrote:Well I must be to stupid for that. Can one set an AirCurve 10 ASV with settings like EPAP min 5.6 IPAP max 9.4 PS 1-4 ? or EPAP 6 IPAP 9 ?

Yes. It can be done but you have to limit PS which is needed for the centrals.

EPAP plus PS equals IPAP.

Minimum EPAP 6
PS min of 3 and max of 3
will give you IPAP of 9 and make it your max IPAP.

EPAP 5.6 and max IPAP of 9.4...you would need to limit PS max to 3.8 if it will do it or just say 4 and have IPAP max of 9.6.

You might need to switch over to ASV mode instead of Auto ASV mode though. I don't have my S9 Adapt (like your AirCurve 10 ASV) handy at the moment (it's in the closet while I am using something else) and I am really short on time but this evening I can dig it out and see what it will let you do.
Should be fairly simple if you change it over to ASV mode (which I think you should have available).
Otherwise you have to set minimum and max EPAP to the same thing to keep EPAP from moving.

Curious if the titration showed respiratory related limb movements improved with the machine and how the other limb movements were in comparison to the diagnostic study posted.

If the side effects of a needed medication are too disruptive, you can always ask your doctor if another drug could be tried.
Never be afraid to make your doctor work a little harder.
Besides, if drugs are changed, these meds will need supervision during withdrawal or a change-over.
Once again, do not be ashamed to make your doctor work, but be kind to him and his staff.

Pugsy wrote:Look up both your meds and their side effects...and google multiple sources also google and read up on "SSRI and sleep stages".
For sure the Effexor messes with sleep architecture and insomnia is a well known side effect.

Wauuu, thanks a lot, did not realize that the meds so much affect sleep! Odd is that over time my sleep is degrading.

Could the meds induce sleep apnea ???

Regarding my AirCurve 10 ASV, I cannot decrease the delta of PS set to minimum 5. Meaning if I set PS min to 1 PS max can only be set to 6 or higher.

I can use my machine in CPAP mode with fixed pressure set to 4. I use this setting to check on my sleep apnea.



In ASV mode (not auto) I can set EPAP fine but if IPAP min is set to 1 IPAP max can only be set to 6 or higher.

I have trained myself to sleep on the side. I am training hard on burping in my sleep. I have and still try to train my machine to get used to ME ! but ether it does not like me or just can't tolerate with my breath smell Where is Grace~~~ and her sens of smell ???

kteague wrote:Curious if the titration showed respiratory related limb movements improved with the machine and how the other limb movements were in comparison to the diagnostic study posted.

Never had a titration. Only a polysomnosographie without CPAP. Regarding the respiratory related limb movements the doc sad that my principal problem was Obstructive sleep apnea and it is not worth to check up the relation of respiratory related limb movements as to fastidious to check of the graphs. He did not like me questioning him. At my first appointment checking my throat he said that it is a waste of money I do not qualify for sleep apnea. And when he looked at my report he asked me 3 times why my wife did not tell me that I have sleep apnea and reinspected my throat.

chunkyfrog wrote:If the side effects of a needed medication are too disruptive, you can always ask your doctor if another drug could be tried.
Never be afraid to make your doctor work a little harder.
Besides, if drugs are changed, these meds will need supervision during withdrawal or a change-over.
Once again, do not be ashamed to make your doctor work, but be kind to him and his staff.

Thanks froggy. I really appreciate your kind words.
I tried to stop the Lamictal. Withdrawals are tough but much worth was my crash afterwards.

I will bring it up to my doc. Specially that I know now their impact on sleep. And she is a great doc.

esel wrote:Regarding my AirCurve 10 ASV, I cannot decrease the delta of PS set to minimum 5. Meaning if I set PS min to 1 PS max can only be set to 6 or higher

Hmm..I wonder if it is because of your IPAP or EPAP minimums and maximums limiting the PS settings.

If I have some time I will dig out my S9 Adapt and see what happens. It may be a while though....grandson is coming for a visit and will be here 10 days.
So I won't be having much extra time for experiments and playing on the internet.
I don't have the manual for the AirCurve 10 ASV...I have one for the ST but it doesn't do variable anything so it's not a good comparison....

Can meds cause sleep apnea?
Depends on which sleep apnea and which med......and even then you are going out on a long skinny limb with the conjecture.

Heavy duty opiates could maybe cause central apnea by affecting the respiration drive and causing the instability that ends up with centrals.
I can't think of anything that could actually cause obstructive apnea because that is airway soft tissues sagging and blocking the airway...now meds that cause muscle relaxation can make OSA worse but I don't know that it actually causes it. They seem to make the tissues even more floppy but if they weren't floppy/saggy to start with I don't know that they were create a situation with OSA where there wasn't a tendency to have the floppy airway tissues ahead of time. Meds that might make the airway tissues more floppy....muscle relaxants especially and some opitates maybe.

Can the meds you are taking cause sleep apnea? I doubt it. I can't think of any stretching of the physiology of sleep apnea that could be caused by the meds you are taking.

Pugsy wrote:....grandson is coming for a visit and will be here 10 days.

Can the meds you are taking cause sleep apnea? I doubt it. I can't think of any stretching of the physiology of sleep apnea that could be caused by the meds you are taking.

Thanks Pugsy, will do some more readings and ask my doc for advice.

Enjoy grandson that is far more important...