New Rx effects on overall sleep

[PaulaO2]

Other than the number of them, has anything else in the pattern of them changed? Have they always been in big clumps like that?

It looks as though you are rolling onto your back. The machine immediately tries to compensate but can't because it can't go high enough. After a while, you start having events until you wake up and, most likely, roll off your back.

Nudge the pressure up again to 13 then leave it for a while. Let everything continue to settle. Unless your AHI continues its climb non-stop, just leave it alone for now. You are introducing too many variables.

[eseedhouse]

This is what I get, also happily without any pain.
https://en.wikipedia.org/wiki/Scotoma#/m...cotoma.gif

I get those too, and the gif captures the effect pretty well. Never any pain, at least so far. My doctor knows about it but doesn't think it is a significant problem.

[Beej]

...My doctor knows about it but doesn't think it is a significant problem.

Actually, migraine is a risk factor for stroke. If you have migraines, learn the stroke risk factors, plus the signs of a stroke.

[Beej]

Other than the number of them, has anything else in the pattern of them changed? Have they always been in big clumps like that?...

Yes, the events typically clump when I having lots of them.
I do sleep on my back most of the time as it is the most comfortable position for my connective tissue disease. Sleeping on my side can be painful.

The 3 things I changed on the CPAP for last night was to increase the
Starting pressure to 8 cm from 7.6 cm
Minimum to 10 cm from 8.6 cm
Maximum to 12 cm from 11.6 cm
And that was after 8 days at the same levels.

And I've been at the same dose of the lamotrigine for about 10 days. With the more than 24 hour half life, it is continuing to build up in the blood stream until it gets close to a steady state.
How it builds:
day dose cumulative level
1 50 50.0
2 50 75.0
3 50 87.5
4 50 93.8
5 50 96.9
6 50 98.4
7 50 99.2
8 50 99.6
9 50 99.8
10 50 99.9 <-- Where I am now
11 50 100.0
12 50 100.0
13 50 100.0
14 50 100.0

The next step up is supposed to be to a 100 mg dose.

[Beej]

Slowly beating the AHI back down.

I'm moving the Rx time early a couple hours at a time, so it may have less impact on the AHI. I'm supposed to increase the dose in 3 days; not sure that is a good idea, though, since it screwed up the AHI.

The pressure settings are now:
10.0 cm minimum (I could probably raise this up to 11.0 cm, since I never stay much lower)
13.0 cm maximum (I'll give it a few more days, then possibly increase it to 14.0 cm)

Week overview here

Last night here

[eseedhouse]

The drug you are on is known to increase REM sleep. If you have more OA's while dreaming (common) this would be a likely cause of increased AHI.

[eseedhouse]

...My doctor knows about it but doesn't think it is a significant problem.

Actually, migraine is a risk factor for stroke. If you have migraines, learn the stroke risk factors, plus the signs of a stroke.

Well I don't get migraines, I just get scintillating scotomas (love that phrase). When I first reported these to my previous GP he did have me in for a scan of my brain and the arteries leading to it. He has since retired.

I have plenty of risk factors for everything, being old, fat, diabetic and, oh yeah, ugly. So far I've made 72 without any strokes or heart attacks, but no doubt they will arrive eventually. Maybe the ugly is keeping them at bay...

[Beej]

...Well I don't get migraines, I just get scintillating scotomas (love that phrase). ...

Um ... I believe those are migraines. Migraine does not equal headache, although many people with headache brought on by migraine have linked the two. Migraine is believed to be cortical spreading depression in the brain - an electro-chemical issue.

[Beej]

The drug you are on is known to increase REM sleep. If you have more OA's while dreaming (common) this would be a likely cause of increased AHI.

Thank you. That is helpful. I've been reading so much on it, that one slipped by. Another drug I am on, protriptyline, tends to reduce REM sleep, which keeps the sleep less deep and was initially prescribed for a mixed central apnea. Maybe the two will balance out!

Last night's AHI was down to 1.2 on ResScan, so I am making progress. Moving it earlier in the day seems to have been helpful, along with increasing the maximum pressure.