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Need Help - Centrals? + I just can't stay asleep!
#1
Need Help - Centrals? + I just can't stay asleep!
Hi everyone.

I posted here about a month or so ago, but I'm back again for help. I need to figure out if feeling unrested is due to my APAP not providing a functional level of therapy (and thereby not allowing my brain to stay asleep) or due to unrelated behavioral insomnia.

Basically, my issues are:

* I can fall asleep within a minute or so of going to sleep, but I can not stay asleep. I wake up every single night multiple times per night. I have a very hard time falling back asleep, and it can sometimes be hours before I do. I've ALWAYS had this problem - like from childhood. Like I said above, I can't tell if this is now all some sort of brain-behavior stuff or if that the CPAP therapy isn't working as well as it should, and therefore I'm still waking up because I'm not fully treated.
* Even if I get 7-8 total hours of rest (or more), I'm not feeling rested throughout the day. From 3:00 pm on is haaaaaaaard. Major brain fog - yesterday I couldn't remember the last name of my boyfriend of eight years. (Wha?!?) Right now it's very hard for me to pay attention to work or anything that takes focus like reading. If I engage in any sort of exercise, I'm basically a vegetable the next day.
* My machine is clocking "clear airways" mainly, but lately I've been having a few other things going on as well.
* I live in Colorado, so high altitude.

Here's the "good news":

* I'm very compliant with my APAP, have no issue keeping my mask on or anything like that.
* My AHI is generally under 2.
* I do feel better than I did before any sort of therapy, but I've gotta figure out a way to feel more refreshed.
* My pulse oximeter just came today, and I will try that out tonight.

Okay, so here's a little more info:

* Thinking that CBT-i would help me, I joined a National Institute of Health study for people on CPAP who are still experiencing insomnia. It's being run through Stanford and National Jewish. They're testing whether Sleepio (an online protocol) is as effective as in-person therapy. I got put into the control group, so now I can't get any official CBT-i therapy (either online or in-person) from the hospital for A YEAR (until the study is over). This doesn't preclude me from getting it elsewhere or doing sleep restriction, etc. myself. I've done a ton of research on CBT-i and I know what needs to happen. My issue is that if I force myself to get up at a specific time every day, I feel so drunk-tired during the day that I'm afraid to drive, etc. I understand that it's kinda the point of the sleep restriction, but I'm having a very hard time doing the whole CBT-i think myself. I did look around in my city for a different therapist. The one person who has availability and isn't associated with the hospital told me that she's not really a "sleep" expert (she's a general psychologist) and may not be able to help since I have Apnea as well.

* Starting point for therapy was:
AHI of 19.4 (side) - 26.3 (supine)
All apneas were Centrals
Hypopnea index: 15.6 (side) - h 18.1 (supine)
I'm mid-40's, thin and female. Had sleep problems and insomnia my whole life, so it's not peri-menopause or anything like that.


I've attached my original sleep study and a couple of night's worth of Oscar data. Any help would be very, very much appreciated. Please note: on last night's data, you'll see a weird thing about 2:34 am. I was so frustrated, that I turned on the EPR to see what it would feel like. It felt sh**ty and "unsupported", so I turned it back off.

Thanks again in advance folks. I really value this resource!!!!


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#2
RE: Need Help - Centrals? + I just can't stay asleep!
I used to fall asleep in seconds only to wake up in minutes, wait a while before feeling like I could go back to sleep, fall asleep in seconds, rinse & repeat all night long. serious cognitive & physical deficencies. after trying a different machine that treats ca, I finally got my ahi way down but sleep was still fragmented. there are many things besides apnea that contribute to unrefreshing sleep. in my case it turned out to be periodic limb movement. something to watch for. I didn't see it mentioned in your sleep study report. also, considering you had zero obstructive apnea in that summary, and plenty of centrals, you may need a machine that treats centrals (your machine does not). you aren't likely to be helped by insurance though since your ahi is low.
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#3
RE: Need Help - Centrals? + I just can't stay asleep!
I've had an in-lab study that showed no periodic limb movement. As far as the insurance is concerned, my deductible is high so I'll be paying out of pocket for whatever anyway. I don't really care about the money, I'll figure that out. I just need to feel well.
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#4
RE: Need Help - Centrals? + I just can't stay asleep!
EPR should help your therapy. Set EPR=1 with the expectation to increase it.
This is to treat your flow limitations. We will keep a watch on your Central Apneas.


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#5
RE: Need Help - Centrals? + I just can't stay asleep!
Going off the high central to 0 obstructive, you are in the market for the ResMed AirCurve 10 ASV, the central apnea tool to best squash these. What you have now is giving satisfactory number results, but it may not be able to bring effective therapy. My best suggestion for use with the current machine is to reduce pressure swings as much as you can; that includes no Ramp and probably no to that EPR you experimented with as well.

Forget all these numbers for a minute and answer "How do you feel" after a night's therapy?
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Need Help - Centrals? + I just can't stay asleep!
I feel tired. Really tired. If I didn’t have to get up to care for others I would sleep more.

Can you all explain how the EPR would be a good idea or a bad idea? Confused about the conflicting advice.
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#7
RE: Need Help - Centrals? + I just can't stay asleep!
Bonjour and I cross posted. I defer to his advice on the EPR suggestion. We would want to follow up with OSCAR results to see how good or bad its use affects you. He said EPR of 1, try it and if you feel it's wrong for you switch it back off.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Need Help - Centrals? + I just can't stay asleep!
Thank you! I'll try the EPR at 1 and we'll see how that works. I didn't know anything about flow limitations, so thank you!
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#9
RE: Need Help - Centrals? + I just can't stay asleep!
EPR is a two-edged sword. Swing it one way (Up) it treats Flow Limits, RERAs, UARS, Hypopneas, and Snores. Swing it the other way (down) and it lessens the amount of CO2 washout from your blood and reduces Central Apnea.
That is why I said to watch the central apnea. What I didn't do was go into a long discussion on ho Treatment-Emergent Central Apnea works. One of the things I hope to learn by raising your EPR is to see if your central apneas are in fact Treatment-Emergent. Yes, I am acutely aware of both of these factors.
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#10
RE: Need Help - Centrals? + I just can't stay asleep!
So...night one, my centrals were worse (AHI over 3 instead of around .05-1.5) and the flow limit didn't really look different. Thoughts?
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