Doctor Visit Today - Looking for input

I am about three weeks into my CPAP therapy. I am feeling better but I am still having a few issues. I still have a horrible time falling asleep despite taking my home brew cocktail of 10mg melatonin and 2 benadryl. I take this about an hour before bedtime and still lie in bed for an hour to an hour to fall asleep. Once I do get to sleep I am getting about 6 hours sleep with one to two arousal's that I remember which is much improved that the 5-10 that I would have before CPAP and I feel more rested during the day.

Thanks to this group I now can see my data from my machine. I am having wild swings in my AHI number ranging from 7.0 to 20. I find this interesting since at my first sleep study they recorded my AHI as .6 and my RDI as 29.5. That night was the absolute worst night of sleep that I have had in years as the sleep tech commented that I only slept for about 3 total hours and never hit rem sleep. The second night on CPAP I felt great when I got up and walked out with a shiny new System One with an initial pressure setting of 6.0. I was sleeping OK. but when the DME pulled the data over the internal modem, they found that my AHI was ranging from 20 to 40 and got an order to move the machine in an AUTO IQ trial for three days that resulted in a new pressure setting of 10.5. I am feeling even better since then, but I still am having a few arousal's. I have posted the summary data below and sample of a bad night and a good night. What do I need to be concerned about, what questions do I need to ask as I am so new to this.

The only reason I had a sleep study is that I went in to my GP for something to help me sleep, before he would give me a script he wanted me to have a study. I went along with this to be the supportive Husband as my wife had just gotten out of the hospital after a bout of CHF related to her ASD (atrial septum defect) repair that was done about 10 years ago. They had recommended that she have a study to check for OSA as she has hypertension, CHF, a bit over weight and struggles with depression. The long and the short, we now have his and hers CPAP machines.

Here is my data
Note - on 11/21 I was still using a Swift LT that I pulled off in the middle of the night. That day I got fitted for a Quattro FX


Summary Data




Good Night


Bad Night did not feel as rested in the morning but better than before CPAP - I did also take a nap on this day as I had been driving back from a Thanksgiving trip.


Thanks for the input in advance. If I don't need to be concerned please tell me, as my wife always tells me I over analyze everything.

Dave

Here is the link to my flicker page if anyone wants bigger images to view

http://www.flickr.com/photos/24572605@N00/

Dave

Well, I will take a stab at commenting on your information.

You do not say what the findings were from the original sleep study. I would be interested, since it appears your current system is not fully addressing your problems.

I recommend that you request a referral to a specialist. Just from the information that you posted, it appears you might have complex sleep apnea. That is, as the pressure increases you start to experience central sleep apneas instead of obstructive.

The "CA" is a Clear Airway apnea. That is, it appears your airway is open. However, without all the other input, it is difficult to tell if you are having a central apnea or not. What is fairly clear is that per the example you provided on your bad nights your AHI is higher than it should be.

This type of problem is beyond the realm of a GP. It's time to see a specialist. It might be time for another sleep study. And it might be time for a BiLevel machine. If the problem continues, your medical team might head you toward an ASV machine to address the CA events. But let's not get ahead of ourselves. If a BiLevel machine works, then it's cheaper and easier (hence, better).

Hope that helps.

I wonder if the two Benadryl might be contributing to the 'centrals'.
Perhaps your doc could suggest/prescribe a sleep aid that is not a CNS depressant.
I know Benadryl is ubiquitous and cheap; but maybe there are better choices, given your situation.

As a former paramedic - I understand the mechanism of action of benadryl, I was doing this as a quick fix as my GP would not give me anything for sleep and my Sleep Doc was on vacation. Today was the earliest I could get in.

Hopefully she can get me something at least for the short term so I can get my sleep cycle regulated. I have tried Trazadone and Ambien with mixed results, trazadone did nothing and Ambien turned me into a zombie.

Dave

Don't put too much faith in the "CA" numbers reported by the machine. Or even the OA numbers.

Without an EEG, it can't tell if you're awake or not. If you're awake breathing pauses don't count as apneas.

Without an oximeter or EEG, it can't tell if it's a "real" apnea. "Real" apneas require an O2 desat or an EEG arousal.

Without a chest effort belt, it may score a central apnea as obstructive.

Get SleepyHead if you haven't already done so and look at your actual waveforms. How long are your apneas? Do you stop breathing completely for the whole time the machine scores an event?

The machine scored numbers ARE useful. However, the waveform data has a lot more info if you look at it. A 120 second total apnea is a lot worse than an 11 second partial apnea.