Out of the Frying Pan and Into the Fire! Then, Deep Sleep.

I am not 100% certain I don't have mouth leaks, but given that I wake-up from them within minutes

Does smartcode show you how long you've been leaking?
What does your Intellipap report for "exhale puffs" ?
What do you have it set at?
Have you made any pressure changes in an attempt to lower your AHI? The magic "number" 5 for AHI is arbitrary and like others, you may need an AHI lower than 4 to really feel better. Actually, you did feel better at 2.5

Hate to hear you are still having so much trouble. While I am a big proponent of newbies getting extra sleep for a while, I've also experienced first hand having other causes of feeling bad besides sleep debt, as in ineffective treatment and limb movements. Everyone's degree of recovery is different, seems to me that sleep debt is expected to be prolonged if one has not optimized their treatment or is still having trouble getting to sleep or staying asleep. But aside from that, one should look outside of sleep debt for an explanation for feeling bad. Did you get a chance to look at your report about your limb movements? Does your wife say if your legs or feet move much while you sleep?

ozij wrote:

I am not 100% certain I don't have mouth leaks, but given that I wake-up from them within minutes

Does smartcode show you how long you've been leaking?
What does your Intellipap report for "exhale puffs" ?
What do you have it set at?
Have you made any pressure changes in an attempt to lower your AHI? The magic "number" 5 for AHI is arbitrary and like others, you may need an AHI lower than 4 to really feel better. Actually, you did feel better at 2.5

Good questions. According to my machine, I haven't been leaking and very rarely have exhale puffs. For instance, here is from two nights ago:


AHI results from the last two weeks (avg. sleep of about 8 hours):
2.0
2.5
4.0
3.0
7.0
2.5
4.0
3.5
4.5
4.0
4.0
6.0
7.5
3.0
3.0
4.0

Notice the 2.0 and 2.5 at the beginning. Was still tired.

kteague wrote:Hate to hear you are still having so much trouble. While I am a big proponent of newbies getting extra sleep for a while, I've also experienced first hand having other causes of feeling bad besides sleep debt, as in ineffective treatment and limb movements. Everyone's degree of recovery is different, seems to me that sleep debt is expected to be prolonged if one has not optimized their treatment or is still having trouble getting to sleep or staying asleep. But aside from that, one should look outside of sleep debt for an explanation for feeling bad. Did you get a chance to look at your report about your limb movements? Does your wife say if your legs or feet move much while you sleep?

My wife has said I move around a lot in my sleep. I have PLM data from two sleep studies - one was the diagnostic, the other was a titration.

Diagnostic Test:
PLM Index with Arousal: 1.5 events/hour during non-REM sleep
PLM Index without Arousal: 1.7 events/hour during non-REM sleep

Titration Study (more recent):
PLM Index with Arousal: 3.7 events/hour
PLM Index without Arousal: 19.6 events/hour during non-REM sleep

So say I am at 3 events/hour causing arousal - if you add that to an AHI of 4 I could still be having as many as 7 arousals per hour, more than enough to fragment sleep and prevent Deep Sleep from setting in.

Apparently so far i am still working the frying pan.

Can your wife observe and describe what your moving around a lot looks like? If movements are random, they can be respiratory related if they correlate with events. They can also be pain related, or even RLS. If she describes a rythmic stereotypical pattern and appearance to many of your movements, that would sound more like PLMD. PLMD is sometimes known to manifest more with cpap treatment. That's why sometimes you can see none in the diagnostic study but some in the titration. Problem is, once a person gets used to using cpap and has everything tweaked to where OSA is no longer an issues, PLMD movements can increase even more than could be observed in a titration where good sleep is hard to achieve just due to the environment. My current sleep doc did another study on me after being pretty sure the cpap treatment was doing its job, using my usual pressure and mask, just to see the status of my limb movement treatment. While home videotaping won't identify arousals, it could give you a better idea if your limb movements are random or not.

I've had to loosen my chinstrap to stop my front teeth from hurting all morning. Maybe I am in fact mouth breathing, but not enough to trigger the Intellipap's leak monitor. I just bought the software package for my cpap so now I can get detailed leak rate data instead of just the percentage of time when the leak was over some preset threshold. Hopefully by next week I'll know if I am mouth leaking. If only there was an affordable, at-home system to monitor sleep stages to see what is associated with arousal.

I am sorry to hear that you continue to have problems with your sleep. More than you can imagine, I understand. I wish I had great words of wisdom. Unfortunately, though you already addressed one of the contributors (poor sleep due to apnea), it appears you have other complicating factors. Restless Legs, PLM, who knows! What I do know is that it is probably time to head back to your sleep doctor and explore other issues.

From someone who struggles daily with sleep, I wish you well in this continued phase of your journey!

JohnBFisher wrote:I am sorry to hear that you continue to have problems with your sleep. More than you can imagine, I understand. I wish I had great words of wisdom. Unfortunately, though you already addressed one of the contributors (poor sleep due to apnea), it appears you have other complicating factors. Restless Legs, PLM, who knows! What I do know is that it is probably time to head back to your sleep doctor and explore other issues.

From someone who struggles daily with sleep, I wish you well in this continued phase of your journey!

Thanks JohnBFisher! I am giving this one more month, then I go back to the sleep doc. Ironically, I hate doctors - they are almost always so burned out from seeing so many patients and having so little time for each patient that they can barely feign compassion and are rarely as thorough as proper modern medicine requires.