[Pressure] Tired of feeling tired but more tired

[PeaceLoveAndPizza]

Apnoeic events are internal, but can be affected by things external to your body. Sleeping position, room temperature, hours between eating and drinking before bed, room lighting, all impact sleep quality. Changing position can result in breath holds which cause CA events. Eating too close to bedtime may result in reflux which will cause more swallowing of air and trigger different events. It is an endless list of frustration if not carefully managed.

Sleeping on your back requires different management than side or stomach sleeping. Fetal and supine positions are preferred to prone and provocative positions, but some folks just have to sleep in those positions for personal reasons. In a supine position your airway will naturally want to close form gravity, so it may require more pressure support to keep things open. Every one is different.

A soft cervical collar accomplishes two things. First, it helps keep the neck aligned which helps keep the airway from kinking causing flow limitations or other apnoea events. Second, it helps keep the jaw from dropping so can help reduce leaks.

Pillow height and support helps with neck alignment vertically (how high) and also with sufficient support can help horizontally (less chin tucking). Some of us use a SCC and CPAP pillow to maximize the effect of keeping things open.

Increasing things in 0.2 increments is a good idea to give time to adjust.

[quietlyamuck]

UARSBAL, my point was that the testosterone supplement may well be doing more harm than good because it is costing you money that can be spent on things that have been specifically demonstrated to help with your primary problem of sleep that is unrestful and the reduced sleep efficiency. If there was evidence that nuclear waste —or gamma rays, whatever, LOL!— increased testosterone production, even just for the anti inflammatory effects of testosterone —even if it turned me green!— I would be consuming my share! Thankfully, testosterone has other effects, regrettably, one of the problems of a deficiency is all manner of sleep problems.  Often, physicians are reluctant to prescribe replacement out of an unwarranted concern that the replacement itself will result in sleep disordered breathing.  (AFAIK) that assertion is not supported by the evidence; the potential to or the ability to does not ipso facto imply causation.  I suspect that pre existing sleep disordered breathing that contributed to the deficiency in testosterone production is found because they are looking for it after the treatment began; a kind of cart before the horse thing.  It may well be the case that UARS may be analogous to prediabetes in terms of sleep disordered breathing.  Regardless, I suspect that you are likely to encounter considerably less difficulty in obtaining help in this area (hormone replacement) if you are not consuming tribulus terrestris or horny goat weed, for example.  As supplements go, besides what I mentioned previously, zinc magnesium aspartate (ZMA) has some evidence behind it concerning sleep initiation and sleep quality as well as helping build muscle mass.

You mentioned that NHS would not cover a sleep study, this seems like a gross oversight on their part as the serious sequela of sleep disordered breathing are well documented.  In any case, I gave your situation some further thought and it occurred to me that a reduced ejection fraction would potentially produced interrupted sleep as well as reducing sleep efficiency and making sleep initiation more difficult.  Would the NHS cover an echocardiogram?  The potential causes of a reduced ejection fraction make for a long list, however, it is something that is worthy of consideration, particularly, since a sleep study will not be an option.  Reduced kidney function can also result in sleep disordered breathing, however, an estimated glomerular filtration rate can be calculated from information presented in a complete metabolic panel and some basic metabolic panels —depends on the lab.  If the lab does not provide an eGFR, there are reliable calculators at various sites related to chronic kidney disease. I find it curious that daytime sleepiness, a hallmark of sleep disordered breathing, when chronic kidney disease is known to result in central sleep apnea, when found in relation to high blood urea nitrogen, appears to be dismissed offhandedly when presumably it would be a reason to investigate further.

The authors of the following paper state the limitations of their work honestly and they do, later in the paper note that the ingredients for which they found some evidence of benefit, the authors also found evidence negating the observation.  The authors did not seem to evaluate the quality of the research as one would do for a meta-analysis, however, I do believe the work provides a succinct and accessible source of relevant information.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6920068/

I am not a physician, I am differently educated, either not enough or too much, I don’t know which LOL! I do spend time in the gym and, like most other gym goers, I have an interest in anything that would make my effort more productive.  I wish I had payed attention to sleep and sleep disordered breathing sooner, I would have bought a BiPAP —based on what I know now— merely on principle LOL! In spite of the amount, I hope I have been helpful.

[quietlyamuck]

PeaceLove and Pizza, thank you for your reply. I am definitely going to try the soft c-collar since the reason I gave up on the CPAP specific pillow was that any position other than perfectly supine resulted in more leaks with the inevitable wakeup.  I even tried a full facemask (I do not recall what it was called but it looked like the faceplate of the helmets I’ve seen U-2 pilots wear in old photos) under the premise that the face mask that covers nose and mouth caused leaks when the mouth relaxed and the mask wedged against the side of the pillow whereas the full mask would push against my face harder.  Turns out that the pressure would exceed the forehead seal.  So far, the F-20 has worked the best but it wedges against the pillow and slides unless it is either new or very old.  Since I had to be turning my head just right for the mask to wedge on the pillow, I wish someone would have suggested a soft c-collar sooner.   

I have never been a big fan of pillows because, when I was a kid, I would experience these horrid cramps which, somehow, were not a valid reason to stay home. Honestly, when I started therapy, I fully expected that the first thing I would be told was to get rid of the pillows until I saw the bed. I have to sleep on my back because I had shoulder surgery on the left side (the cure may well have been worse than the disease) and I will have surgery on the right side here in a few days that will keep me off that side for at least 6 weeks.  It is entirely possible that I will be able to roll on that side again after that.  However, before everything began, I was one of those people that looked dead when sleeping…would that someone would have noticed the hypopnea events, everyone was just happy that that “my guy doesn’t snore”… and I would love to go back to that now that the BiPAP keeps the airway open.  

I think I am going to try  the c-collar first (I do not know what I will do in the summer, people might not believe it but it does get hot in Wyoming even if it is just for a few nights a year) and if it works, go without the pillow to let my neck stretch out from a computer lean —I am open to suggestions concerning this as well.  I hope that I might be able to make the straps less tight since the collar will keep my mouth closed and it has got to be better than the chin cup straps.  That was such a mess that tightening the mask worked and felt better.  Having said all of that: 0.2? It sounds like what you are saying is that there is a certain height and width of pillows that, for a given person, will produce better outcomes? 

In terms of the digestive tract, my problem was the gassy mornings (it took about 6 hours every day) for about a month or a little more after every pressure increase —it was MUCH, much worse in the beginning.  I kept on with the treatment because, even with the wakeups, the sleep was ridiculously better, even when interrupted, compared to what I would have sworn was better and uninterrupted sleep before the sleep study.  

I am asking all these questions but it is not my intention to hijack the thread.  I have just found my sleep interrupted pretty much since I began treatment but, since I didn’t need to get up, I was told that it is ok to wake up occasionally.  I probably won’t be happy until I sleep for 10 hours and my AHIs are zero regardless of how many hours I sleep.