APAP or CPAP? Very confused

Luthie, it sounds like you have an excellent sleep therapist handling your case. You should really count your blessings, and thank her. Also let your doctor know. I think it's rare to get one that good.

You might want to let things settle out for a while. Sometimes, you have to let things settle out a bit and adjust to it.

I wouldn't start tinkering with pressure on my own yet. Give her a chance to get it right.

As for a sleep study, if you have a smart therapist and an S9 AutoSet, you probably don't need another sleep study unless you have problems. The machine sort of gives you a mini sleep study every night.

Thank you Pugsy and archangel: I guess I will leave the machine alone. I already think I messed something up because I came home, looked at the machine and my Sleep Quality from last night is all "0" where this morning it had numbers on it. Does it disappear after a day and go into the settings? I hope I did not erase the figures from last night?

I am fortunate that I do have a wonderful sleep clinician educator and a great sleep doctor who is the head of Critical Care Medicine and a pulmonologist. I really would like to ramp up a little bit to 7 or 8 but am afraid that I will erase something if I go into the clinical setting.
Pugsy, I also wrote my Primary and asked him once again if I can wean off the Cymbalta. last week he did not want me to because I am at a high dose, 60 mg for the back pain. And I understand that there is a horrific wean-down process, so I think he wants me to get the CPAP stuff right first. Please let me know if I erased last night's sleep quality as it now says 0 but looks like it has averaged in to my 4 days. Thank you so much.

Luthie2006 wrote:Please let me know if I erased last night's sleep quality as it now says 0 but looks like it has averaged in to my 4 days.

You didn't mess up anything. The daily session numbers on the LCD screen start at new day at 12:00 PM ...Noon per the machine clock...and automatically those numbers get reset to 0.0 at 12 PM starting a new "day" in terms of what the machine reports in a 24 hour period.
It's a normal function of the machine. You didn't harm a thing.
And yes, what you see now is just the 4 day average. Tomorrow morning the daily numbers will be there for tonight's session but they will also disappear tomorrow at 12 PM.

Pugsy wrote: The daily session numbers on the LCD screen start at new day at 12:00 PM ...Noon per the machine clock...and automatically those numbers get reset to 0.0 at 12 PM starting a new "day" in terms of what the machine reports in a 24 hour period.

How do the machines know what time it is? I unplug mine every day, and it doesn't say the time on the LCD screen anywhere, but the charts are always correct in Sleepyhead and Sleep Mapper

Cell phone system? Satellite? Internal battery?

Thanks Pugsy for the explanation. I thought I erased last night's report. My sleep clinician told me that she set the time on it for Central Standard Time. Thank you very much.

sc0ttt wrote:How do the machines know what time it is? I unplug mine every day, and it doesn't say the time on the LCD screen anywhere, but the charts are always correct in Sleepyhead and Sleep Mapper

Cell phone system? Satellite? Internal battery?

ResMed machines have an internal clock to set as well as an internal battery to keep the time when power is off.

You have a Respironics machine. There is no clock that we can set but there is an internal clock (and internal battery to power it) set at the factory to GMT time.....SleepyHead and your computer comes up with the correct time by using the time zone setting in Sleepyhead and SleepMapper draws from the machine and your computer clock.
The internal battery keeps time when the power is off.

Pugsy wrote:Weird that a med can cause both insomnia and somnolence (sleepiness) but it happens all the time. One person gets knocked on their butt and can't stay awake and the other is up cleaning house at 2 AM. Just the different way people react to the same medicine.

I used to take a Benadryl for allergies and lie awake all night. Everyone talks about it knocking them out, but for me it did just the opposite.

Pugsy wrote: You have a Respironics machine. There is no clock that we can set but there is an internal clock (and internal battery to power it) set at the factory to GMT time.....SleepyHead and your computer comes up with the correct time by using the time zone setting in Sleepyhead and SleepMapper draws from the machine and your computer clock.
The internal battery keeps time when the power is off.

OK that all makes sense except that my machine itself somehow knows when the "day" changes at noon because it shows up on the LCD screen as a new day... must be a time zone setting in there somewhere, somehow, even if it doesn't affect the data logging on the SD card.

I'll bet it's a firmware update thing that only DMEs and the factory can do. Maybe no big deal for occasional travel, but if I moved to a different time zone I'd want to get that done.

Thanks Pugsy - you are the greatest.

sc0ttt wrote:OK that all makes sense except that my machine itself somehow knows when the "day" changes at noon because it shows up on the LCD screen as a new day... must be a time zone setting in there somewhere, somehow, even if it doesn't affect the data logging on the SD card.

Yep. The LCD updating is also tied to GMT time but to Noon GMT time. It won't update and show last night's data until the "new" noon has passed per GMT time and a new "session" time frame has started. Then it will show last night's results. If you got up early enough and checked the LCD screen you might still see the daily data that was on the screen yesterday and when Noon GMT time has passed the daily data will change.

sc0ttt wrote:

Pugsy wrote: The daily session numbers on the LCD screen start at new day at 12:00 PM ...Noon per the machine clock...and automatically those numbers get reset to 0.0 at 12 PM starting a new "day" in terms of what the machine reports in a 24 hour period.

How do the machines know what time it is? I unplug mine every day, and it doesn't say the time on the LCD screen anywhere, but the charts are always correct in Sleepyhead and Sleep Mapper

Cell phone system? Satellite? Internal battery?

Why do you unplug your machine everyday? Just curious.


Stevoreno_55
MS Gulf Coast
06/04/14

Since I get up so early for work every morning (5:30 am) but am up before that anyways, I can click on the button and see my sleep quality for the past evening. But that is the least of my problems!
Sleeping is the first. I am getting used to the sleep mask and machine, and even figured out how to "up the ramp" from 6 that I thought would be good for me to 7.4. (just a random number). I may even bump it up to 8. Still waking up a ton of times at night, bathroom, and for "no apparent reasons" and lots of dreams. I wrote to my Primary (who is kind of an idiot), and I asked him if Cymbalta can cause insomnia and he said he hasn't heard of that. I know, too, Pugsy, that I have also read that Cymbalta can cause insomnia and other anti-depressants as well. I think, that once he saw how bad my back was on the MRI that my Spine Doctor ordered (not my Primary, he refused to because he said it was arthritis), then he decided, ok, she needs the Cymbalta and Celebrex for her back. I think he is apprehensive to take me off the Cymbalta because I may have the back pain again or he has stock with the pharmaceutical company in Cymbalta. I don't know. He knows that my back pain went from a 10 on the scale down to a 0-2 with every day Celebrex and Cymbalta and maybe doesn't want to "rock the boat." When I asked him a few weeks ago if I can get off the Cymbalta and see which med is working, he said he would rather be get off the Celebrex which I am not doing. I am going to a brand new Primary on July 21st, so I guess I will have to stick it out to till then and get another opinion. Cymbalta/Celebrex and no back pain but insomnia, or no Cymbalta, back pain,and no sleeping at all. Can't win for losing. Something will work eventually.

There are other meds besides Cymbalta that can help with the pain that don't cause as much trouble with sleep.
I take Amitryptiline 10 mg just before bedtime only. Look it up. While in larger doses used for depression like Cymbalta....in low doses used successfully for chronic pain issues. That was my compromise when I didn't want to go down the Cymbalta road. It works surprisingly well. I have significant arthritis issues..metal plate in my cervical spine and bad arthritis in my pelvis and lower back due to multiple fractures (MVA) years ago. It at least allows me to sleep without waking up 40 times a night every time I move and have pain.

Celebrex did nothing for me and I can't tolerate the typical NSAIDs due to bad GI distress from them.

Finally...some of your wake ups could also just be habit or the sensory overload from having the mask strapped to your face. Maybe they will reduce in time on their own as the body gets used to having the alien stuck on your face.
I think it took me 2 months to get past the sensory thing and I adjusted in general to the mask very well initially but the brain kept waking me up wanting to warn me about the alien stuck on my face.

Also...you mention need to pee during the night. Is this common for you? Is it large amounts like painfully full bladder or just wake up and think might as well go pee? Any other medical conditions that might be a factor there?

Pugsy, thank you again! I have spondylothesis, spondylosis, facet joint swelling, so not to compare. I am going to see a new Primary on 7-21, and I will ask him about the Amitryptiline. But I would be in pain with my back all day long (and I was non-functioning at a pain scale of "10") if I didn't take Celebrex and/or Cymbalta. So I need something for the day to get me by too. Celebrex is the least causing GI NSAID, but I do take prescription Dexilant every morning (60 mg) proton pump inhibitor. I will definitely ask the new doctor about Amitryptiline and if he would recommend that at night. Daytime I need something too. Why are you so against taking Cymbalta, 60 mg for low-back pain? I was just curious why? What do you take in the daytime for pain?
I am getting used to the mask and air. I even upped the "ramp" (and figured it out actually on the clinical setting) to 7.4 from 6. I know my sleep clinician would not mind at all. Her hospital is a very far drive (1 hour each way from my hospital to thers) It feels better at 7.4 now. Why the awkenings, I don't know. Going to the bathroom just once now and I try not to drink liquids after 7:30 pm.
Can you tell me why you prefer Amitrytoline (isn't that a very old drug?) over Cymbalta, and what do you do for the pain in the daytime?
Luthie2006 Thanks Pugsy

I take Ultram (tramadol) during the day for pain. On a rare occasion when I have done something stupid I have hydrocodone opiate available for extreme pain times where fast and immediate relief is needed.

Why don't I want Cymbalta...I read up on the side effects. My sleep is too fragile anyway and the last thing I want is to add something else that causes insomnia (plus all the other side effects)....Plus it's habit forming and the withdrawal from any of those meds is horrible plus when I took something similar in the past (for depression due to divorce) it made my skin feel like bugs were all under the skin. I just don't want to take that particular class of medication.
Doc said "let's see if amitryptiline will help enough" so I did and it does. You can take it during the day for pain but it makes me too drowsy so I don't want that.

The tramadol (been on it since 1990 and the MVA) helps me a lot for 99% of my daytime pain control if I would take it fairly regularly. It just causes insomnia for me if I take it in the evening.
So all I need is something to help at night. Otherwise I have awakenings every time I move and I have to move around a lot or it makes the pain worse. Amitryptiline does the trick for me...YMMV of course but in such a small dose it is rather benign and forgetting a dose doesn't cause horrible withdrawal issues and if I forget to get the RX filled and go without it I don't climb the walls.

I do know about the spondylosis things...that's why the plate in my neck. The cervical vertebrae were unstable and slipping into the spinal cord. Horrible pain...like a burning hot poker in my neck and no amount of opiate ever touched it. Had 2 vertebrae removed and replaced with donor bone. Doc said I had 2 others that needed work but 2 was all he wanted to try to do. With the plate at least they don't slide into the spinal cord trying to cut it off anymore. Still some encroachment on the nerve ending facets and all that...neck still isn't totally pain free but the burning hot poker pain is gone thankfully. My neck is a mess. When I was 35 the radiologist said my neck looked like a 65 year old neck...and it was a beautiful neck compared to what it is now at 62.

All this was pre cpap though. Only been on the machine for 5 years now. My sleep is still fragile though due to pain if I don't take care of myself. With the amitryptiline I might wake briefly 3 to 5 times during the night due to discomfort (usually when I am on my back) but I normally go right back to sleep. Without it...20 to 30 times. I did that not long ago by accident. Forgot to take it until way late and elected not to because if I take it late it makes me a bit groggy in the AM and I needed to be alert early the next morning. Might as well have taken it and been groggy because my sleep was so fractured from pain I felt like crap anyway.
Been taking it for about 4 years now. Tried other things for a while and settled on this as it is the lessor of the evils available. There's a risk vs rewards thing with any drug out there..even plain old aspirin.
NSAIDs....the GI problem is beyond fixing so zero reward...no sense in me going there but with other meds I always research thoroughly before I ever start.

There's a time and place for all these meds. My time and place may be different than yours though.
Sometimes we are damned if we do and damned if we don't.
Like which is worse? Insomnia from the meds or insomnia from pain? Tough call.

Stevoreno_55 wrote:Why do you unplug your machine everyday? Just curious.

I completely pack it up every day and put it away. I'm thinking of getting a special nightstand though, like this:


Sorry to take this thread so far off topic. I didn't see any other threads about CPAP specific nightstands.