CPAP Trouble: Take one-bajillion

Hello,

Before I get into my issues, Ill give you a brief overview of my history. I am 27 years old, weigh 150 even and was diagnosed with OSA in December of 2010. I had unknown symptoms since I was 19-20, but I finally made a diagnosis, which was confirmed with a sleep study of OSA. I opted to attempt to have my tonsils out and a UPPP (whoops) to correct the problem, but to no avail. I was placed on Apap, over the CPAP as my request to monitor the data (resmed S9 with HH and FFM), even though I tried EVERY option of mask on the planet, I could never repeat the sleep quality I got during the titration study (I felt AMAZING when I woke of, like I just bench pressed the world 20 times amazing). After about 8-9 months with no real improve, and after consulting with several doctors, we decided I would be a good candidate for MMA. I had my MMA surgery Jan 20, 2012 (I will never forget that day......uhg) and proceeded to begin the long recovery phase. At around June I had my first post-op sleep study to find a reading of 1.5 AHI. I was thrilled at the numbers, but I still didn't fell better, or like I did after the first titration study. I began to do some research and stumbled upon UARS. I read Dr Li's article on UARS and it was like he just read every symptom I had. I recently began self titration again, while I wait for an appointment with my new sleep doctor; and here is where the issues arise.

I stared progressively worse towards the end of 2012 Nov-Dec., like having trouble functioning levels of feeling bad. I busted out Ol' Cpappy to try and find so form of relief from this misery. I have been testing various levels of pressures, and find it set in Auto mode 6-7 has given me the best numbers. As I analyse the (I use the word "analyse" loosely) Data I can see events where I pause breathing up to 40 seconds. I still feel awful even though my numbers are good (sometimes I even have readings of 0.0). What gives? As far as my activity level, I exercise daily (cardio and calisthenics) eat 3-5 servings of raw fruit and vegetables daily, have had my thyroid checked, CBC done, blood preassure....ect. I am really at my whits end here, I am not sure what else a doctor could do, but I am willing to try anything. This has held me back for so many important years of my life, it kills me to feel like this. I would literally do anything to feel better and get back to where I can function and start SMASHING life again.

Ill post some Sleepyhead Data
and feel free to ask any other questions, Ill take all the help I can get.

Thanks

Average Nights data
http://i1339.photobucket.com/albums/o71 ... dd8579.png

Best night Data
http://i1339.photobucket.com/albums/o71 ... cd0494.png

I am too ignorant to be any help answering your questions. I am just replying to give this a bump. There are people here that are tremendously helpful and very knowledgeable. I am sure one of them will get you some answers very soon.

I feel so bad that you didn't get any replies sooner except for an air head. I promise help is coming.

Thanks for the bump. I figure someone will reply at some point.

They will for sure. I guess Pugsy isn't one line. She is great on helping. Many others here are too. Someone will answer with some real help.

Do you take any medications, even OTC?
Do you remember waking up during the night very many times for any reason?
Any trouble falling asleep, staying asleep or if you do wake up during the night do you have trouble going back to sleep.

Nothing on the reports is screaming "fix me and you will feel smashing again".
Only maybe might be the Flow limitations on the not as good nights but even that is not horribly horrible.

No Medicines for sleep (just take Multi/fish olis).
As for waking up yes, about 2/3 of my nights go like this: Sleep for 3-4 hours, fully wake up, get a sip of water then go back to sleep for 2-3 hours.
I really don't have much trouble with insomnia, I tend to fall asleep when I am ready.
That is why I am posting, I am really running out of ideas as to why I feel so awful and tired throughout the day. I try to isolate one possible issue at a time so I can fully rule it out as a factor/non factor.

There is clearly something fragmenting my sleep architecture, I just have run out of ideas.

Also thanks for the responses.

SS,
Have you had your testosterone levels checked?
A T

No, that was actually one of the first things I was going to bring up on my visit, although other than fatigue and restless sleep, I don't really have any signs of low testosterone.

This is why a clinical titration is useful... we "see" what is going on while the pressure is being adjusted to your breathing and sleeping patterns. We "see" how your heart, oxygen, arousals, brain waves, depth of breath, volume of breath and overall sleep quality are.

I recently watched a Dr.OZ show with a sleep segment on in...the Sleep Disorder DR. did a clinical study on ppl the sleep 0-5; 5-6; 7-8 and 9+ hours of sleep (this is from memory) and found an interesting correlation to diet and sleep. I am telling my pts to check this out too for quality sleep. This is in addition to "sleep hygiene".

No, I mean any meds...not just sleep meds.
It's the first thing we ask because people some times take something that has some side effects that either mess with sleep or sleep architecture or how we feel during the day in general.

Fragmented sleep for any reason is going to mess with how we feel.
Often the causes of wake ups and fragment sleep aren't always related to sleep apnea and/or sleep disordered breathing.
Makes it hard for the machine to fix something that it isn't designed to fix.

So when we still feel like crap and nothing screams out on the reports to be fixed sometimes we have to take a long hard look at other possible factors.

Now I have no idea if your flow limitations are significant or not. I have no idea if this is maybe UARS.
But it would not be out of the realm of possibilities for the FLs to maybe be a factor. Especially if they are causing low level arousals (where you may not remember them) but enough of an arousal to maybe wake you up and you have to start the sleep cycles all over again....and again...and again. So you don't get enough of the deeper stages of sleep and/or REM sleep.
Were talking maybes here...maybe it is and maybe it isn't.

Here's an example of my Flow limitations from my S9 machine.
Compare yours even on your good night to mine and you will see what I mean.

No I take no medicines in general.

What would they usually do to adjust to lower the FL if they are in fact an issue. I have suspected that may be one area that could be causing a low level arousals, I just have no idea how its dealt with, and really not much data other than mine for comparison so thanks for the chart. (I have experimented with higher and lower pressures and 6-7 is where I have found they are the lowest; they tend to go more erratic when I go above 10).

I don't know what the pros would do. If you have already tried more pressure and you say it seemed to be worse.
Have all the experiments been in APAP mode?
If so I wonder if the variations in pressure were also an additional disturbing factor for overall sleep quality.
Some people are sensitive to the least little change.
Your pressure ranges aren't real wild though.
Using EPR of 2? Have you tried lower or higher to see if that helps?
Maybe try cpap mode?

Flow limitation stuff is really hard to wrap around one's head.
You might find some educational stuff in another thread where Flow limitations may be a problem..even there we don't know for sure. Not sure which page the FL discussion becomes detailed but maybe 3rd or 4th.

viewtopic.php?f=1&t=88204&st=0&sk=t&sd=a

Ill try it in CPAP mode, yea, I have read that pressure fluctuations can mess with REM sleep, so I always kept the pressure range very narrow.
Ill try CPAP mode tonight and adjust the EPR settings and see if that helps.

Thanks for the link Ill read through it tonight, and thanks for the replies I really REALLY appreciate the input.

If you don't get anywhere with Pugsy's idea, could it be possible you have mild Fibromyalgia? Fibro will cause muscle pain (which you haven't said you have, so I assume you aren't in pain), but Fibro also messes with sleep. Its just a thought. Fibro can show its onset after some type of trauma, car accident, the flu, pneumonia, etc. Now this is just me guessing, I'd put a lot more confidence in Pugsy's Flow Limit theory, but I just mentioned this because you are young enough you may not notice any physical pain, but the Fibro is manifesting itself in the feeling crappy.

This is JUST ME GUESSING, I've have had Fibro for around 30 yrs. There is something when you have Fibro call Fibro Fog - you just feel foggy, cannot concentrate, cannot focus & just feel bad. Your description has SOME of the components of Fibro, but you aren't having the muscle pain that so often is how Fibro is diagnosed. An actual Fibro diagnosis means you feel pain when pressure is applied to 18 points on the body. If you don't get anywhere with the Flow Limit (and I hope you do), you might ask your Dr about Fibro & have him test the 18 points, along with running some more bloodwork. You are too young to feel this bad all the time.

I would still bet Pugsy is closer to the ball park than I am, but I just thought I'd throw my theory out there just in case.

Let us know how all this goes.
Jen

My Mom has Fibro, but I haven't had any chronic pain in the 18 areas. I was thinking of going to her doctor just to rule it out though thanks.