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Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
What the hell is wrong with me. How does someone suddenly develop severe worsening of their OSA despite losing weight. The only variable was taking and withdrawing from finasteride which causes wild hormonal swings as evidenced by lab results and f*ckery/silencing of androgen receptors in people afflicted with post-finasteride syndrome.

It gave me severe persistent insomnia and doubled my required minimum pressure. This is utterly unbelievable.

My supplier is sending data from this bilevel that I've been using for the past 3 weeks to my sleep doctor who recommended DROPPING my minimum pressure to 4 when I need AT LEAST 15, so he's off by 11. Is this severe OSA now? It must be. I can't tolerate these high pressures. I am going to lose this fight.

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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
you should read Spy Car http://www.apneaboard.com/forums/Thread-...-Adventure
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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
I don't see why you need 15 cmw?  I see much lower values from your charts, maybe try 8-13 PS=3.
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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
(11-13-2018, 10:55 PM)bonjour Wrote: I don't see why you need 15 cmw?  I see much lower values from your charts, maybe try 8-13 PS=3.

What are you basing that on? I'm getting clusters of 50s OSAs at 13cm and had another 50s OSA at 14cm.
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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
(06-10-2018, 02:32 PM)yrnkrn Wrote: Cpap/bilevel titration in a competent sleep lab you will get quite reliable answers you can't get from the cpap/bilevel flow data only. Such as if you're waking up due to respiratory effort (RERA) or due to PLMS or unrelated, if you have real CA etc.


+ if the above obstructive events are really obstructive
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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
(11-19-2018, 03:32 AM)yrnkrn Wrote:
(06-10-2018, 02:32 PM)yrnkrn Wrote: Cpap/bilevel titration in a competent sleep lab you will get quite reliable answers you can't get from the cpap/bilevel flow data only. Such as if you're waking up due to respiratory effort (RERA) or due to PLMS or unrelated, if you have real CA etc.


+ if the above obstructive events are really obstructive

I understand. For now it'll be extremely difficult for me to do a proper titration study since I can't fall asleep until morning. But these obstructives are being recorded on two different machines, plus they disappear when I wear a cervical collar which is something I can't really do consistently as it gets way too hot for me.

Last night I was wearing the collar but took it off at a bit over half way, at 14 min EPAP:

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However I get aerophagia and these irregular, rapid breathing clusters that lasted two hours near the end of therapy and some throughout the night:

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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
You had seen inconsistent results for a long time which does not appear to be resolved using CPAP, APAP or BiLevel over large range of parameters.
Maybe ASV would solve the breathing issues and if you can trial ASV - go for it.

However, it's also possible something else happening in your sleep which is confounding the results. You could have SDB comorbid with something else. 
From the air flow signal alone it is not possible to understand what is going on. A sleep lab is best equiped to diagnose more complicated situations such as this. I am sure some sleep labs would be willing to diagnose in the morning as well. Failing this, home sleep test would provide you with lots more information than the flow signal. I think some HST also do EEG which would be preferable.
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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Hang in there.

A fair number of us have been where you are.

Personally, I also had continuing insomnia even after CPAP and had to repeatedly push for help. Fortunately, there was a psychologist in the area who specializes in sleep restriction. It’s helped a great deal.

Basically the idea is this...
  • Keep a sleep log for x nights, time to bed, wakeups, etc.
  • Estimate the average number of hours you actually slept over the period.
  • Compress your sleep interval down to that number of hours (but never less than 4.5 hours), sleep that number only for at least 2 to 3 nights.
  • Increase the amount of sleep slowly over remaining nights, like a quarter hour a night until you get to  what seems like the optimal 7 to 8 hours.
  • Repeat as necessary.
Here’s a more exhaustive explanation, the actual therapy is referred to now as Cognitive Based Therapy for Insomnia, or CBTI. I’d encourage you to seek professional help if this seems too overwhelming, or there are other factors at play beyond what you’ve discussed.

https://adaa.org/sites/default/files/Runko_177.pdf
Geoffrey Rush as Philip Henslowe, (Shakespeare in Love) "I don't know. It's a mystery."
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RE: Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Interesting breathing pattern that I'm not familiar with, and have no clue how to mitigate. Could you include charts for pressure and resp rate to show this?
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