One Good Night and then a Bad. Why????

I have been on therapy for just a little over 2 months now and overall, I think I am doing fairly well. My biggest issue is that I seem to have one really good night sleeping and then the following one will be a disaster. I have adapted to my Swift LT and leaks do not seem to be an issue. I have software and I download my data each day. The AHI doesn't change much and is stable at <3. On my good nights, I fall asleep easily, I transition between position changes quickly and easily, have little to no rain out and breathe comfortably on my CPAP.

On my bad nights, the exact opposite happens. I have chest pain and shortness of breath, I really notice the noise of my breathing, every position change wakes me up completely and I have to reposition the nasal pillows and the hose behind my head, I have rain out that drowns me when I turn from side to side, I get a tickle in my throat that makes me cough, and the list goes on and on.

I just don't know what I am doing wrong. I am going to bed at the same time each night. I am sleeping 7-8 hours each night as advised by my physician. I keep the same sleep hygiene pattern each night. I am perplexed. Any thoughts or ideas to help me sort this out would be greatly appreciated. I am still very new to all of this.

Thanks a bunch.

How is your machine configured?
Your profile shows that you have the M Series Auto w/C-Flex.

Den

I have the M Series Auto APAP with A-Flex. The first month, it was used in APAP mode with a range of 4cm for the low pressure and 10 cm for the high pressure. The ramp feature was set for 40 minutes at 4cm if activated. A-flex was set at 1. One month later, my doctor set my machine at straight CPAP of 6cm with C-flex of 2 to see if I would tolerate this better. There was some improvement and there was far less rain out. My AHI has stayed less than 3 except for when I used it in the hospital and I was on narcotics (AHI was 8-18). My titration study has indicated that I needed a pressure of 10 cm and that an APAP machine neccessary as my AHI is terrible when in REM sleep and much worse when on my back vs. my sides. Hope this helps.

Some random thoughts......

You're still pretty early into your therapy.
Turning down your humidity might help your rainout issue.
If you're taking blood pressure medicines like Lisinopril, that could be exacerbating/causing your coughing.
The range of pressure 4 - 10.....the setting of "4" may have been too low to start
Your present setting of "6" may not be high enough.
I have no experience with that mask, but some of the Swift masks (especially the earlier ones) were noisy.
If you're napping in the evening before going to bed, that extra sleep may mess up your regular sleep time.

One more.....sleeping on one's back is normally the worst for apneas. If you're normally a back-sleeper, you may need to explore sleeping in a different position......like your side.

Den

I used to do that, I'd get a good night of 8 hours of sleep then I couldn't sleep for 2 days because I wasn't tired. Then from being awake so long I become so tired I finally get another good night. Repeat over and over, think they call it idiopathic hypersomnia.

I ended up taking 3 mg of Melatonin 30 minutes before sleep, works like a charm. Been taking it now
since 1991-1992 nearly every night and a 3rd arm hasn't grown out of my forehead yet.

The Kirkland brand 96-tablet SLEEP-AID also works pretty good, it is the same ingredient found in Unisom or Tylenol "PM" but without the Tylenol, pretty cheap too. It is 25mg Doxylamine Succinate Tablets, single dose. Costco also has Melatonin Plus by Schiff which works pretty good. Both claim they are not habit forming.

PLEASE be careful with Melatonin. I take meds to regulate my heartbeat and even after checking with a pharmacist, who said "NO PROBLEM", ended up in the emergency room where they clocked my rate at 212 bpm.

Hi Wulfman: You are right on several points. I am very new to therapy so I may just need to be more patient and give it more time. You were absolutely right about 4 cm of pressure being way too low when I was on APAP. I was really suffocating on 4 cm. I too have thought about maybe going up to 7 cm on my straight CPAP but my AHI's look so good.

As far a BP meds, I have been able to come off of them since starting XPAP. My blood pressures have become low normal now so that is a great thing. I wasn't taking lisinopril through. I have not been napping recently but I was several weeks ago when I was recovering from an illness. I sleep side to back to side all night long. I love the Swift LT for the fact that if allows me to sleep on wither side so readily.

Hi Snoredog: Good point about the hypersomnia. I will maybe try the melatonin but with care.

Hi lktnky: Thanks for the warning about melatonin. At least if it happens to me, I will know what to blame but I figure that it is worth a try.

I guess the bottom line is to be patient and keep working at it and things should hopefully get better. Right??

I still have bad nights too but less and less. We have similar set ups. I found that playing around with the aflex helped. I settled on 2. I also tested out the cflex but it drove me nuts. I also find that I do better with my range of pressures on the apap to be less dramatic than they gave me originally. When there is a large increase in pressure change, I would wake up. So keeping my low at 10.5 and my high at 15 (I was titrated at 11) seems to be working well for me. You may want to play around with some of this a bit to see what works for you. I found it helpful to keep track of the adjustments I made and noted my sleep quality.

Also, I got a heated hose and have no more rain out in spite of keeping a very cool bedroom and using my humidifier on 4 or 5 on occasion (usually around 2 though).

Anyway, just hang in there. If your like me, you will gradually get used to it and sleep better and better and more consistantly. I find that even on my bad nights, I sleep better than I did pre-APAP.