Not Sleeping Well and Not Sure Why

First post here but I have been lurking for a while. I was diagnosed with OSA around 2004 and had a Remstar CPAP machine until October 2012. I think I was originally prescribed 12cm and then that changed to 18cm after a second study. I was dropped back down to 12cm after a third study and that was working ok. I lost 70 lbs from 2011-2012 and by late 2012 I was back to not sleeping well again. I went to the local clinic and the person I saw (not a dr but had special sleep apnea certifications) said all my problems would be solved with a new APAP machine. She recommended a range of 8-20cm. I started on the APAP in October 2012 and felt ok for a bit, but as time went on, I was feeling worse and worse. I downloaded SleepyHead and imported my data and saw that my pressure was flatlining at 8. Taking this into consideration, I adjusted the range to 4-12cm and now my pressure runs around 6-7cm each night and my AHI is well under 1. From what I've been reading, I should be feeling pretty good at this point, but that is not the case. I feel worse than ever now and am tired all the time to the point where I struggle to stay awake at work sometimes. I thought that between the weight loss and the low pressure, perhaps I no longer needed therapy, but after going without it for a week I felt worse than I do now. I did get an appointment to see an actual sleep dr, but the earliest I could get in was mid-April. I am at a loss and was hoping the fine folks here could maybe offer some suggestions. I don't usually have trouble falling asleep or staying asleep, but the quality of sleep is poor to non-existant. I do work rotating shifts, but I don't think this is a factor. Anyways, I've included some of the info from SleepyHead below.









Any ideas/suggestions?

Thanks!

Do you take any meds...OTC or RX? If so what?
Do you wake up often during the night for any reason? Have trouble going to sleep or staying asleep?
Exactly what do you mean when you say you are feeling worse and worse? What symptoms?

I am on a low dose (20 mg) of Lisinopril (blood pressure) and have been on this for about as long as I've had a CPAP. As for OTC, I take fiber supplements and vitamins everyday. I rarely take tylenol or aleve, sometimes the PM variety as well.

I don't usually wake up at night. I do once in a while if I am congested or if I end up laying on my hose. I don't usually have trouble going to sleep or staying asleep. The only time that really happens is when trying to transition off overnight shifts. I have a little trouble going to sleep or staying asleep when I am with my fiancee, but that should be better now that she has a new bed.

When I wake up, I don't really feel as if I have slept at all. I have a headache all day, my eyes feel fatigued, my mind is all foggy, I yawn a lot, I am starting to fall asleep at work when trying to read documents. It feels like how I felt before I was diagnosed and began treatment. I am just tired all over and just have minimal energy to the point where I can't work out as much as I used to at the gym.

Your rotating shifts might be an issue. Many struggle with issues related to non-routine schedules, since many people cannot tolerate having a sleep schedule that varies, rather than being the same everyday.

Robysue has published several threads with links to sleep hygiene issues; you could search her posts to see if anything jumps out at you.

If meds are not an issue, you might want to look at diet. For example, sugar and caffeine consumption and food sensitivities. Also, you might want to have a blood test for your Vitamin D level and inflammation (CRP, uric acid, etc indicate levels of inflammation in the body). Inflammation and low vitamin D are often culprits for fatigue and can mimic symptoms of poor sleep.

If you have access to a recording pulse oximeter, you could wear one for a night to make sure that your O2 doesn't dip during the night. Even if apneas are not an issue, you would at least have the confirmation that your O2 levels are good while sleeping. Do you smoke, for example? Smokers have lower O2 levels, usually. At least you could exclude oxygen deprivation as a reason for that morning headache.

Is your blood pressure well-controlled on your blood pressure med? The only way to check this is to check your blood pressure everyday, a few times a day, at the same time, for at least a week.

As you said, your sleep data seems good, so you have to look elsewhere.

Good luck.

tubaman21 wrote:Lisinopril

http://en.wikipedia.org/wiki/Lisinopril#Adverse_effects
From the list of possible side effects (which is rather long) this stands out like a sore thumb.

Drowsiness, headache, tiredness

Meds often have side effects that get blamed on sleep apnea and we expect the machine to fix those side effects but it can't if the cause is maybe something else. Your reports look good on paper. So that means we start looking elsewhere for possible culprits for not feeling so great. Meds is the first thing I always look at...then sleep patterns, hours of sleep, fragmented sleep, pain, comfort, etc. That's why I asked the questions that I asked.

You might talk to your doctor about the Lisinopril...see if there is something else you could take or maybe with effective sleep apnea therapy the need for the blood pressure med may even be eliminated...some people are lucky enough to find that their hypertension goes away with effective OSA therapy.

My sister takes blood pressure medicine (no OSA though) and was complaining for the longest time of feeling crappy like you are and she got online and found out that her med was a known culprit for that crappy feeling. She talked to her doctor about it and they changed meds and she said the difference in how she felt was remarkable.

Hi. I am no doctor, but something in your SH stats jumped out at me. Your machine scores RERAs and the index looks low, but you are still seeing quite a bit of Flow Limitation. It may be possible that you have UARS (Upper Airway Resistance Syndrome) in addition to your OSA. If you tend to react to these FLs with an arousal (only way to really know is with a PSG in a lab that can detect esophageal pressure along with the EEG) it can lead to sleep fragmentation and a skewed sleep architecture. So, although you have the apneas under control you may still feel fatigued due to lack of Deep and/or REM sleep. It may be something to discuss with your doctor.

NotLazyJustTired wrote:Hi. I am no doctor, but something in your SH stats jumped out at me. Your machine scores RERAs and the index looks low, but you are still seeing quite a bit of Flow Limitation. It may be possible that you have UARS (Upper Airway Resistance Syndrome) in addition to your OSA.

Hi,

Dittos. I suffer with mild UARS right now, but it was really severe while I was losing weight. My data looked just as perfect as your data, but I felt the same way you describe...like a zombie.

The one thing that helped me for UARS was very high pressure. Since my machine didn't detect RERA or react to it, it didn't know to raise the pressure. I was running at 21 and 22 for a while. That is a difficult pressure level to deal with, but it worked.

I don't know if there is a pattern here, but I have heard of a few people who have experienced this same thing after losing a ton of weight. The OSA gets better, but UARS pops up, and that can be even harder to diagnose and treat. In fact, some sleep centers still don't measure UARS or even recognize it as a disease.

-john-

I am having a similar problem. Been on CPAP for 17 months, worked OK for the first 14 or so but recently I have been feeling like crap. Looked at my sleepyhead and noticed strange breathing patterns with breathing rate "spikes" periodically throughout the night. Looks like may be "stacking breaths" - inhalation is longer than exhalation - and periodically respond by sighing with a big breath in and big breath out. My rate of respiration also fluctuates wildly throughout the night. My guess is that my breathing pattern is so screwed up that I am never dropping into the deeper stages of sleep and don't feel rested, even though my AHI is under control now. I too am on the doctor appointment waiting list. Let us know what you found out from your visit.

_macgyver wrote:I am having a similar problem. Been on CPAP for 17 months, worked OK for the first 14 or so but recently I have been feeling like crap. Looked at my sleepyhead and noticed strange breathing patterns with breathing rate "spikes" periodically throughout the night. Looks like may be "stacking breaths" - inhalation is longer than exhalation - and periodically respond by sighing with a big breath in and big breath out. My rate of respiration also fluctuates wildly throughout the night. My guess is that my breathing pattern is so screwed up that I am never dropping into the deeper stages of sleep and don't feel rested, even though my AHI is under control now. I too am on the doctor appointment waiting list. Let us know what you found out from your visit.

Are you using an APAP in a range of pressures? If you are, then that would explain your not getting into the deeper sleep stages. In fact, your whole description sounds like that scenario.
It would help if you would provide some information regarding your equipment and pressure settings.

Den

.

Hello tubaman21,

I would have to agree with RandyJ on this one for sure. Of all the people I have worked with using pressure therapy, shiftworkers have the hardest time feeling benefit from their equipment. Timing is so important when it comes to a recuperative sleep episode, it might be worth looking into changing your schedule so that you can turn in at the same time everyday for at least a month.

Hope that helps, please keep posting progress. It will be interesting to see what happens. The download you posted, in my opinion, looks completely unremarkable. You should be sleeping great and feeling rested.

Jim