So you are going to have to work (hard) at teaching your body to learn what quality sleep actually is.sleepyzzzz wrote: ↑Fri Feb 03, 2023 6:22 pmI appreciate all the advice, and many of the things you said my brain is convinced of .
the problem is my body does not understand, although it's "normal" to wake up through the night, when it happens to me, i wake up zombie.
And that means you are also going to have to work (hard) on teaching your brain to not overthink about the wakes. I still think that you are making the problem worse than it should be by focusing so much attention on the wakes.
In other words, you've got sleep anxiety: You are anxious about the quality of your sleep and that anxiety makes it even harder for you to get the kind of restful sleep that you want to have.
How did you wind up on so many prescription medications at the same time? As I said before, most docs are reluctant to prescribe more than one thing at a time for insomnia, and it appears that several of these medications may have been prescribed with the idea that they might improve your sleep.i know the meds are too much, without them i'm more zombie
But the fact is, they are not improving your sleep if you still feel like you need to be in bed 11-14 hours each day just to function. And you need to let the prescribing doctor(s) know these medications are not improving your sleep.
So let's get back to basics: Why was each medication prescribed? What dose are you taking for each of the medications? When are you taking each medication? And have you talked with the prescribing doctor(s) about the fact that your sleep is still rotten in spite of all of these medications?
More detail is actually needed here.I would like to tell you that this is a 5 years struggle, so believe me when i tell you, i did not end up with this post suddenly, i have tried everything there is about sleep from sleep hygiene, to surgeries.
You say you've tried sleep hygiene techniques. What exactly does that mean to you? Do you get up at the same time each day? Do you go to bed only when you are sleepy, instead of when you are exhausted? Do you understand the difference between feeling sleepy and feeling exhausted? What about caffeine and alcohol consumption? Do you force yourself to get some physical activity every day, even if it's not much? Do you make sure you get outside during the daytime every day for more than just a few minutes? Do you read or watch TV while lying in bed? What about spending time on your cell phone or laptop when you are in bed? Do you have a bedtime routine? If so, what does it consist of? When you wake up in the middle of the night, what's the first thing you do? Look at a clock or your cell phone in order to calculate how little you slept since the last time you woke up?
You say you've resorted to "surgeries" to fix your sleep problems. What surgeries? Surgery is not something that is used for sleep maintenance insomnia, which is what your problem currently is---your data shows any OSA you might have is well under control.
Have you actually tried Cognitive Behavior Therapy for Insomnia (CBT-I)? If so, what specific behavior modifications were suggested? Which ones did you actually try? And how long did you stick with them? The thing about CBT-I is that it does not not work overnight, and to make it work, you really do need to stick with it for several months, not a few days.
And because they're not on your list of current medications, it's also worth asking: Have you ever been prescribed medication that is actually prescribed on-label as a sleep medication rather than medication that is frequently prescribed off label as a sleep medication? In particular, have you ever been prescribed Ambien, Lunesta, Sonata, or Belsomra? If so, what's the result? Note: These medications are not designed to be taken together or together with other medication that may cause drowsiness.
My points:at the end, i'm handicapped, i am not able to have a fixed schedule and go to work, and the only thing i could feel makes a difference in my night apart from all the added meds ( i did not use meds for 3.5 years of this "situation" ),
1) All those added meds may be contributing to your problem rather than helping right now.
2) Establishing a regular wake up time (regardless of how zombie like you feel) may be the first step in teaching your body how to get back to a "fixed" schedule that would allow you to go to work.
You need to hold on (firmly) to the idea that your body can wake up feeling fine with as little as 6 hours of sleep when things go well. That means your body does not actually need (or probably want) 11-14 hours of tossing and turning in bed fighting to get just a little more sleep.i think is the Bilevel machine, there are some magic nights where i sleep 6 hrs straight with the PAP and wake up rested,
I think you want a magic solution. And there is not one. We don't sleep the same every night.but using the same numbers in other nights does not work, my body keeps "shifting" adapting, mutating, i don't know how to explain it, but i tried cpap, S mode, Vauto and all kinds of paramters, i'm still struggling to keep the arousals mute each night.
Here's what I think is going on: You have one or two good nights with a particular set of settings. Then you have a bad night and you improperly conclude that something in the machine's settings is what caused the bad night when in reality the bad night was caused by something related to the old-fashioned insomnia. In other words, you expect the PAP machine's settings to solve a problem (spontaneous arousals) that cannot be solved by PAP. Spontaneous arousals are caused by whatever is driving the old-fashioned insomnia that is NOT related at all to sleep apnea.
In other words, you need to not look at the machine's settings expecting to find an explanation of why some days you wake up feeling fine after only 6 hours using the machine and some days you wake up feeling like a zombie after using the machine for 11-14 hours. It's much more likely that there are other insomnia related reasons for why you sometimes (often?) don't wake up feeling rested after spending 11-14 hours in bed.
And to feel better on a consistent basis, you need to tackle finding ways to fix the sleep maintenance insomnia itself and quit expecting to find a magic bullet solution in dial-winging the PAP machine's settings.
Start by doing some self reflection about your attitudes towards your sleep and your expectations that your sleep is likely to be bad---so bad that you need to just spend a few more hours in bed trying to get some sleep. It could be that your frequent expectations that you are going to sleep lousy becomes a self-fulfilling prophecy on many nights.
It sounds to me like your obstructive apnea is likely well controlled with a reasonably low EPAP and hence higher EPAP doesn't make you feel any better or worse. It also sounds like you personally find a higher PS more comfortable to breathe with. (So do I: In my case PS = 4 allows me to exhale fully and completely and naturally, but PS = 3 does not.)from my notes/experience, PS > 3 helps
sometimes i feel a steady pressure is better like the Smode and sometimes i return to vauto, my body responds to low pressure high PS almost same as high epap high PS.
It's not uncommon for OSA to be much worse in REM. Pugsy is quite experienced with that: Her untreated REM AHI was sky high, but her untreated non-REM AHI was very low. It took her a while to sort out a VAuto range that allows the machine to go where it needs to go to control her REM-based apnea, but also is much lower when she's not in REM.MY first ever sleep study before surgeries had 14AHI and 42 REM AHI,
When we wake up right after a REM cycle, we're likely to remember our dreams. When you wake up right after each REM cycle and you not only remember your dreams but start working on making sure that you continue to remember them when morning comes, you are prolonging the wakes (either consciously or unconsciously) to the point where the length of the wakes becomes problematic in terms of your overall sleep quality.i know each time i wake up i feel i just woke up from a dream, i have 6, 7 dreams at night that i remember most each night,
In other words, your overall sleep quality might improve if you simply told yourself "Yeah, I just had a dream. Let's roll over and go back to sleep" instead of focusing on what the dream was about and why you were dreaming and why you just woke up.
It's also worth noting: If a person gets roughly 8-9 hours of good quality sleep, they will have gone through about 6 complete sleep cycles, and that means they will likely have had 6 REM episodes. And it's quite likely that the person might even have woken up very briefly after each of those REM cycles. But they realize they just woke up for no real reason, and (unless the dream was really spectacular) there's no real reason to focus on the dream. So they go right back asleep in a minute or two. And in the morning? They don't remember any of those wakes or any of the dreams. And they feel rested and refreshed.
You're taking 11-14 hours to get through 6 or 7 full sleep cycles, possibly because you're making yourself remember each dream by prolonging the wake to the point where it may be difficult to get back to sleep. And so the total WASO goes up and overall the lengths of the wakes go up and the wakes become problematic in terms of your sleep quality. And when you finally do get out of bed, you feel like a zombie.
Restricting your time in bed (through getting up at the same hour, even if you don't want to get up) will help teach your body and brain to consolidate those sleep cycles---meaning your body and brain will both learn to keep the wakes very short and not attempt to remember every dream every night.
Three big comments here:i also "SEE" flow limitations on my airflow, sometimes it is at the expiratory cycle, sometimes is narrow or double peaks at inhale, and although i'm not able to fix these, they show that there is something wrong in my respiration mechanism when sleeping.
1) Overall, your flow limit graphs are not that busy. In other words, your flow limitations seem to be pretty minimal and at the scale of the data you've already posted, they don't seem to be responsible for a large number of arousals/wakes. If you are really concerned, post some specific examples where you've zoomed in enough to see the individual breaths---we need about 10 breaths before the flow limitation and about 10 after it.
2) If you are genuinely concerned about small amount of residual flow limitations, they might respond to an modest increase in pressure. Whether to increase the min EPAP setting or the PS setting (so that IPAP is increased) is a good question. But it's also important to understand that not everybody's flow limitations even out with increased pressure. Sometimes too much pressure (either EPAP or IPAP) can lead to further breathing instability instead of more stability. For some people, there's a sweet spot of getting the residual flow limitations down to "good enough" instead of "eliminated". And the activity in your posted data shows that your residual flow limitations are definitely down to "good enough" for most people.
3) You may be overanalyzing the data looking for something that's not there. In other words, if a few flow limitations are occurring during a period of clear sleep breathing and there's no visible signs of them leading to a clear arousal, not worrying too much about them may lead to better quality sleep overall. Again, you could post a few zoomed in examples if you want to.
