Just got AHI (24), waiting on CPAP

Billymadison420 · Post by **Billymadison420** » Sat Jul 16, 2022 5:55 am

ozij wrote: ↑
Fri Jul 15, 2022 10:04 pm
The machine can't really force air through a clogged nose.

People react to the air temperature and to the humidity differently: for some the clogged nose improves with less, for some with more. You'll have to find out which is better for you.

Billymadison420 wrote: ↑
Fri Jul 15, 2022 7:48 pm

1. My nose is always clogged. Should I try nasal steroids every night, or those snore aids that open my passage ways?
Do your mean when you're awake, or is the only a response to CPAP?
If the former, it's and issue for and ENT specialist, and you will probably do better with a Full Face Mask (i.e. FFM) that lets the CPAP do its job even when you mouth opens in response to a clogged nose.

CPAP is not a solution for chronically clogged nasal passages.

May have to go with the full face mask! My nose is always clogged. Maybe I’ll talk with my ent, like you and pugsy mentioned.

Ok. I fell asleep. I took my mirtazipine last night. I woke up once at 3:30 last night and then made it again to 7:20. Went to bed at 11.

It said i had 3.5 apneas per hour on the MyAir app. So that’s good I think. I got a 96 score. 7:30 sleep. Unfortunately I feel awful still. Can barely walk down a street a feel so exhausted. I know it is supposed to take time to feel better. But I don't know what to believe anymore, with the doctors.

1. Doctor one said that I have Narcolepsy and that he has had severe apnea patients that have no fatigue
2. Doctor two said she doesn't suspect Narcolepsy at this point, and that she expects me to feel better with CPAP treatment.

I understand it takes time to respond. I will try to be as patient as possible. I just am desperate for relief.

So anyway I think the nose mask may work out fine. Once the humidifier kicked in it was easier to breathe. When I woke up at 3:30 it was because the nasal mask was making a funny noise because it was over condensed. I turned the humidifier back to auto and that seemed to work. But I’ll consider the face mask.

Thx for helping me get through the first night! May try to steal some extra sleep.

Pugsy · Post by **Pugsy** » Sat Jul 16, 2022 6:56 am

How long have you been taking mirtazipine ?
Why were you given it in the first place?
How regularly or irregularly do you take it?
Bed time only? or during the day sometimes?
Meaning for the most part it is fairly regularly something you take or something that is taken on a prn basis and not very often?

Do you take any other medications at all? Even OTC? If so, what?

What category of events made up that AHI of 3.5?
How many centrals, OAs, hyponeas????

Billymadison420 · Post by **Billymadison420** » Sat Jul 16, 2022 7:02 am

Pugsy wrote: ↑
Sat Jul 16, 2022 6:56 am
How long have you been taking mirtazipine ?
Why were you given it in the first place?
How regularly or irregularly do you take it?
Bed time only? or during the day sometimes?
Meaning for the most part it is fairly regularly something you take or something that is taken on a prn basis and not very often?

Do you take any other medications at all? Even OTC? If so, what?

What category of events made up that AHI of 3.5?
How many centrals, OAs, hyponeas????

1. Been taking it since December. Only take at bedtime. (before CPAP treatment) I had experimented with not taking it (as you don't have to take it everyday) and didn't notice much difference in EDS.
2. From December to June I was taking it every day. Been spotty since then. But probably will continue taking it every night to try and get used to CPAP treatment.
3. No other medications other than the daytime stimulants (at least over the last few months): Sunosi, Provigil.

On the MyAir app, where would I see the category of events? Or is this only something that OSCAR (I don't even really know or understand what that is, yet, as a newbie) would report? If so do I need to do anything special for that, and do I need an SD card?

Side note: Oscar. I am on Mac. And can't seem to use the app. It won't allow me to even allow it access in security and privacy. I can't even open it. Won't even allow me to grant it permissions.
Thank you so much for your guidance and patience.

-B

Pugsy · Post by **Pugsy** » Sat Jul 16, 2022 7:15 am

I don't use MyAir but I have seen people report the number of centrals, OAs and hyponeas from somewhere on the MyAir app.
Maybe a different page.

Otherwise....it is also available (sort of by doing some backwards math) on the machine's LCD screen sleep report.
Explained in the provider manual.
I forget did you get the AirSense 11
https://media.resmed.com/sites/3/202106 ... ER-ENG.pdf

or AirSense 10
https://www.respshop.com/manuals/ResMed ... %20her.pdf

I can't scroll far enough back to see exactly which you got.

On the LCD screen it reports
AHI..
then sub categories of
AI....then it gives a central index in the AI
Apnea Index (is the total of central apnea index plus obstructive apnea index and it gives us central index so you can do the math and figure out obstructive index)

Then we take the AHI and AI numbers and figure out hyponea index....and come up with what OSCAR would show you .
Remember all that algebra math we had to learn and rolled our eyes about saying "I won't ever use this"....well we are using it.

AHI is a total of the AI or apnea index plus the hyponea index.
AI is compose of central and obstructive index.

See why we use OSCAR? No thinking involved and no need to use algebra.

I wouldn't be surprised if your AHI is mainly central in numbers. Probably mainly awake related false positive flagging.
So much so that I would be surprised if it wasn't mainly awake flagged stuff since you report the problems initially with congestion and falling asleep.

Please don't tell me that you really expected the overnight miracle???? I know people get them but they are actually very rare. Patience...you are going to need a lot of it at first.

Pugsy · Post by **Pugsy** » Sat Jul 16, 2022 7:19 am

I haven't had a chance to really research the mirtazipine and potential side effects in depth...maybe later.
Usually any of those kinds of meds have fatigue, drowsiness, etc kinds of side effects and may even affect sleep quality itself.
Like it might affect sleep stages....I don't know for sure because I haven't researched it but will try to get that done later.

ChicagoGranny · Post by **ChicagoGranny** » Sat Jul 16, 2022 7:25 am

Billymadison420 wrote: ↑
Sat Jul 16, 2022 5:55 am
My nose is always clogged. Maybe I’ll talk with my ent

Get rid of the "maybe". A clogged nose can sabotage your CPAP therapy. There is no use to suffer from that when good solutions are available.

If your nose is clogged when applying the nasal steroid spray, the steroid may be lost in mucus and not get to your nasal membranes. My ENT recommends using the steroid spray in the morning after a saline nasal rinse to clear the mucus. Steroid nasal sprays work systemically. It's not like you use it now and your passages open up. It may take four or five days before the full effects kick in. In the meantime, I would agree with using Afrin medicated spray at bedtime. If you later discontinue it, we can advise you on how to deal with any rebound congestion.

Here are some good instructions on using nasal steroid sprays - https://familydoctor.org/nasal-sprays-h ... correctly/

Pugsy · Post by **Pugsy** » Sat Jul 16, 2022 7:33 am

Afrin used only at night and teeny amounts isn't likely to cause the physical dependence nearly as quickly which can lead to Afrin rebound problems. Short term and teeny amounts is quite safe.
And even if someone does end up with a bit of rebound...there are ways to lessen the annoying problems.
Been there...done that myself. More than once.

Steroid sprays aren't immediate relief drugs...they are meds that have to be used consistently to work their magic.
They aren't quick relief like the Afrin is.

Billymadison420 · Post by **Billymadison420** » Sat Jul 16, 2022 7:46 am

Pugsy wrote: ↑
Sat Jul 16, 2022 7:15 am
I don't use MyAir but I have seen people report the number of centrals, OAs and hyponeas from somewhere on the MyAir app.
Maybe a different page.

Otherwise....it is also available (sort of by doing some backwards math) on the machine's LCD screen sleep report.
Explained in the provider manual.
I forget did you get the AirSense 11
https://media.resmed.com/sites/3/202106 ... ER-ENG.pdf

or AirSense 10
https://www.respshop.com/manuals/ResMed ... %20her.pdf

I can't scroll far enough back to see exactly which you got.

On the LCD screen it reports
AHI..
then sub categories of
AI....then it gives a central index in the AI
Apnea Index (is the total of central apnea index plus obstructive apnea index and it gives us central index so you can do the math and figure out obstructive index)

Then we take the AHI and AI numbers and figure out hyponea index....and come up with what OSCAR would show you .
Remember all that algebra math we had to learn and rolled our eyes about saying "I won't ever use this"....well we are using it.

AHI is a total of the AI or apnea index plus the hyponea index.
AI is compose of central and obstructive index.

See why we use OSCAR? No thinking involved and no need to use algebra.

I wouldn't be surprised if your AHI is mainly central in numbers. Probably mainly awake related false positive flagging.
So much so that I would be surprised if it wasn't mainly awake flagged stuff since you report the problems initially with congestion and falling asleep.

Please don't tell me that you really expected the overnight miracle???? I know people get them but they are actually very rare. Patience...you are going to need a lot of it at first.

Perhaps this was a regional commercial. But in the words of the great JG Wentworth, it’s my money and I want it now! Lol! Upon further review maybe I actually do feel a little bit better. Maybe it’s just placebo. Maybe not. I seem to feel a little bit more chipper. And I only had a few sips of coffee. And no stimulant. Hmmm.

Intellectually was I expecting a miracle, no of course not. Was I hoping for one. Yes. Unrealistic thinking

. Of course I’m going to keep at it. If nothing else for the other health benefits.

I gotta figure how to get OSCAR working on my Mac. And I will go grab an SD Card! Thank you so much for the advice!

ChicagoGranny · Post by **ChicagoGranny** » Sat Jul 16, 2022 7:51 am

Billymadison420 wrote: ↑
Sat Jul 16, 2022 7:46 am
Upon further review maybe I actually do feel a little bit better.

Standard advice says not to try to judge how well you slept by how you feel in the morning. Wait until the end of the day and evaluate how you felt during the whole day. Energetic? Excess sleepiness? Etc.

Pugsy · Post by **Pugsy** » Sat Jul 16, 2022 8:02 am

You know one of my greatest "disappointments" about cpap was I really thought it would make me into a "morning person"...bounce out of bed rearing to go with tons of energy. It didn't do that then I realized that I was expecting cpap to make me into something I never was in the first place.
BUT I noticed a gradual improvement in some things and a more marked improvement immediately...
The morning killer headaches from lack of enough oxygen essentially quit straight away.
The nocturia also quit straight away. I was getting up to pee about every hour with a painfully full bladder each time.
Those 2 symptoms going away....worth using cpap all by themselves.

What was more slow to come was the overall energy level improvements and overall sleep quality improvements along with a reduction in the need to take a nap during the day.
Pre cpap...I would get up at 7 AM and be desperately needing a nap by 9 AM.
Post cpap...no need for morning naps at all and the need for an afternoon nap depended on hours of sleep...and that still is true today.
Been on cpap 13 plus years now.

Patience pills....you are going to need a lot of them. They are big and hard to swallow and taste horrible...but you need them.

Billymadison420 · Post by **Billymadison420** » Sat Jul 16, 2022 9:26 am

Pugsy wrote: ↑
Sat Jul 16, 2022 7:19 am
I haven't had a chance to really research the mirtazipine and potential side effects in depth...maybe later.
Usually any of those kinds of meds have fatigue, drowsiness, etc kinds of side effects and may even affect sleep quality itself.
Like it might affect sleep stages....I don't know for sure because I haven't researched it but will try to get that done later.

Ironically it’s been quoted as lowering the AHI. The sleep specialist from University Hospital didn’t seem to feel oanything for or against it.

It definitely is mildly sedating. Unfortunately it just helps with getting to sleep so much, and helps my anxiety.

Billymadison420 · Post by **Billymadison420** » Sat Jul 16, 2022 9:29 am

Pugsy wrote: ↑
Sat Jul 16, 2022 8:02 am
You know one of my greatest "disappointments" about cpap was I really thought it would make me into a "morning person"...bounce out of bed rearing to go with tons of energy. It didn't do that then I realized that I was expecting cpap to make me into something I never was in the first place.
BUT I noticed a gradual improvement in some things and a more marked improvement immediately...
The morning killer headaches from lack of enough oxygen essentially quit straight away.
The nocturia also quit straight away. I was getting up to pee about every hour with a painfully full bladder each time.
Those 2 symptoms going away....worth using cpap all by themselves.

What was more slow to come was the overall energy level improvements and overall sleep quality improvements along with a reduction in the need to take a nap during the day.
Pre cpap...I would get up at 7 AM and be desperately needing a nap by 9 AM.
Post cpap...no need for morning naps at all and the need for an afternoon nap depended on hours of sleep...and that still is true today.
Been on cpap 13 plus years now.

Patience pills....you are going to need a lot of them. They are big and hard to swallow and taste horrible...but you need them.

Yes it seems like it’s going to take a tremendous amount of patience on my part. I’ve been up for about five hours now and I can honestly say I do think I feel a little bit better even today. I had a really great burst of energy this morning and actually wanted to go driving around and exploring new places. One of my favorite things that I liked to do that I mostly stopped because I felt so tired.

I’m crashing now a bit. But I’ll take that for one day. I will also follow up with the ENT and see if we can do some thing about this nasal congestion but for the CPAP therapy and just in general. I’ve been dealing with that a long time I guess.

Very grateful to be under the tutelage of the Jedi council of sleep apnea! Thank you again for your time and thoughts.

I just picked up a SD card from Staples. I will take it further look into Oscar on my Mac.

Pugsy · Post by **Pugsy** » Sat Jul 16, 2022 9:47 am

That med may or may not do anything much for sleep quality. I dunno. Not familiar with it.
I just know that most mood meds have the ability to maybe impact either sleep itself or how we feel during the day.
That particular medication is in a little different class of mood meds so it may not be as common.

But if you need it to help you fall asleep right now....we have to remember that sleep is our primary goal right now so we do whatever it takes to get the sleep.
Deal with any potential side effects later if we need to.

I have a similar issue in my life. Sometimes I need some help sleeping and I know that the "help" sometimes gives me a morning hangover kind of thing where I don't feel quite as good as I would like but it doesn't last all that long.
I have 2 choices...feel yucky for a short while from the medication hangover like side effects....or feel like crap the entire day from not getting enough sleep. I choose short term yucky over long term yucky.

Almost all medications will have some sort of side effect that might be a cause for "yucky" for someone.
Sometimes we don't have a choice because we have to take the medication and deal with the side effects because the reason we are taking the medication is pretty darned important. ...like my BP meds...I would be in much bigger trouble if I didn't take my BP meds.
We learn to accept it and move on or if the side effects are horrible...change meds.

Billymadison420 · Post by **Billymadison420** » Sat Jul 16, 2022 9:53 am

Pugsy wrote: ↑
Sat Jul 16, 2022 9:47 am
That med may or may not do anything much for sleep quality. I dunno. Not familiar with it.
I just know that most mood meds have the ability to maybe impact either sleep itself or how we feel during the day.
That particular medication is in a little different class of mood meds so it may not be as common.

But if you need it to help you fall asleep right now....we have to remember that sleep is our primary goal right now so we do whatever it takes to get the sleep.
Deal with any potential side effects later if we need to.

I have a similar issue in my life. Sometimes I need some help sleeping and I know that the "help" sometimes gives me a morning hangover kind of thing where I don't feel quite as good as I would like but it doesn't last all that long.
I have 2 choices...feel yucky for a short while from the medication hangover like side effects....or feel like crap the entire day from not getting enough sleep. I choose short term yucky over long term yucky.

Almost all medications will have some sort of side effect that might be a cause for "yucky" for someone.
Sometimes we don't have a choice because we have to take the medication and deal with the side effects because the reason we are taking the medication is pretty darned important. ...like my BP meds...I would be in much bigger trouble if I didn't take my BP meds.
We learn to accept it and move on or if the side effects are horrible...change meds.

Yep! It's all a cost benefit analysis.

We do the best that we can.

Pugsy · Post by **Pugsy** » Sat Jul 16, 2022 9:55 am

Do see what you can get done about the chronic nasal congestion issues.
You know even without OSA being involved the fact that someone might have chronic congestion especially at night can potentially mess with sleep quality and anything that messes with sleep quality can mess with how we feel during the day.
I know if I can't breathe through my nose I just don't sleep well at all. LOTS and lots of wake ups for sure.
When I get some sort of upper respiratory infection with a lot of congestion or drainage or whatever...I know I won't sleep well. I just do the best I can to deal with it (hence the Afrin in my medicine cabinet for emergencies) and hope the illness is short lived.

And if nothing else...clearing up the congestion will make cpap therapy easier. The machine might try to blow past that congestion with more pressure but it won't help at all though the higher pressures can be a problem causing increased leaks or even aerophagia...so treating the congestion ahead of time will in the long run potentially help avoid other cpap use issues.

Just got AHI (24), waiting on CPAP

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