[Treatment] Decline in sleep quality & pain in dreams; CPAP data showing nothing abnormal

[rahidz2003]

Hello! I've been on CPAP therapy since the start of 2018, after I dealt with several years of complaints regarding my awful snoring, as well as vivid and physically painful dreams* and overall lethargy.

It's been going alright but lately I've had some backsliding in my sleep quality (namely, I wake up more, my dreams are more and more vivid/painful/frightening, and I'm not feeling quite as refreshed as I used to). I haven't made any significant changes to my equipment or to my sleep/lifestyle habits that would explain this.

So I was wondering if y'all could look at my sleep data and suggest possible improvements to my machine settings (in particular I'm a bit confused about how to determine the optimal pressure minimum and maximum), as well as possible causes.

Thank you all very much in advance for ANY information y'all can offer

*This is by far the most annoying symptom to me, simply because it seems so rare. My sleep doctor was quite surprised by it, and most scientific literature I've read on the matter treats the experience of physical pain as a curiosity more than anything. It ain't that curious to me when I dream about animals tearing me apart from limb to limb. I do not have any chronic pain while awake, nor does the pain persist after I wake up (though there is sometimes a very temporary numb/sore feeling). And my mental health is quite good too; I'm a pretty laid back person with few day-to-day stresses.

[Crimson Nape]

Hi rahidz2003 -

While your AHI doesn't look bad, I'm seeing elevated flow limitations and slightly low tidal volume.  I think I would try the following:

• Turn off any ramp.
  
• Set the EPR to 3 and on Full Time.
  
•  Increase your pressure range to 9 - 18.  With the EPR set at 3 this will keep your exhale pressure at 6 to 15.
  

The EPR set at 3 should reduce the flow limitations and, with the ihigher inhale pressure range, increase your tidal volume.

Good luck!

[Hydrangea]

I don't know if this helps you at all, but I figured I'd throw it out there...

The times when I have pain in my dreams are times when my body is at an angle that is causing pain (ie: my arm is pinned under my body and has fallen asleep... in my dream, I'll have a bad dream that includes shoulder pain).

I wonder if that could be a small factor for you.

[Dormeo]

One footnote to Crimson Nape’s advice. You might want to increase the pressure in stages, perhaps going up 1 at first, letting that settle in, then maybe .6, and so on, going more gradually as you get higher. Of course, if it all feels fine, then zoom on up there!

[Sleeprider]

Actually i think the red-neck's advise is pretty good. Existing median pressure is at 9.0 already, and with EPR at 3, the effective pressure will drop. The ERP should help with the flow limitations, so I anticipate less pressure fluctuation and much more comfort. Good advise!

[Dormeo]

Crimson Nape = redneck! Would have taken me forever to get it—good one, CN!

[ardenum]

Hello! I've been on CPAP therapy since the start of 2018, after I dealt with several years of complaints regarding my awful snoring, as well as vivid and physically painful dreams* and overall lethargy.

It's been going alright but lately I've had some backsliding in my sleep quality (namely, I wake up more, my dreams are more and more vivid/painful/frightening, and I'm not feeling quite as refreshed as I used to). I haven't made any significant changes to my equipment or to my sleep/lifestyle habits that would explain this.

So I was wondering if y'all could look at my sleep data and suggest possible improvements to my machine settings (in particular I'm a bit confused about how to determine the optimal pressure minimum and maximum), as well as possible causes.

Thank you all very much in advance for ANY information y'all can offer  

*This is by far the most annoying symptom to me, simply because it seems so rare. My sleep doctor was quite surprised by it, and most scientific literature I've read on the matter treats the experience of physical pain as a curiosity more than anything. It ain't that curious to me when I dream about animals tearing me apart from limb to limb. I do not have any chronic pain while awake, nor does the pain persist after I wake up (though there is sometimes a very temporary numb/sore feeling). And my mental health is quite good too; I'm a pretty laid back person with few day-to-day stresses.

Seems pretty straightforward to me, you experience pain for some reason, and your brain interprets it in a way that creates your 'animals tearing you apart' dream. I'm sure the pain comes first then the dream. 
Two things I can think of, vascular or neuropathy. You might be having some blood flow issues, do you experience 'burning veins' sensations? If it's really bothering you I can think of 2 things to do, 

1. nerve conductive studies to determine if theres any nerve damage, 
2 MR-angiography of limbs, I suppose arms and legs are where the pain is at? To see if you have any changes to your blood vessels

[rahidz2003]

While your AHI doesn't look bad, I'm seeing elevated flow limitations and slightly low tidal volume.  I think I would try the following:

• Turn off any ramp.
  
• Set the EPR to 3 and on Full Time.
  
•  Increase your pressure range to 9 - 18.  With the EPR set at 3 this will keep your exhale pressure at 6 to 15.
  

The EPR set at 3 should reduce the flow limitations and, with the ihigher inhale pressure range, increase your tidal volume.

Good luck!

Thank you very much, will do this and report back. Tomorrow if the settings are unbearable (which seems unlikely), otherwise in a few days after I've collected more data :)

The times when I have pain in my dreams are times when my body is at an angle that is causing pain (ie: my arm is pinned under my body and has fallen asleep... in my dream, I'll have a bad dream that includes shoulder pain).

This may very well be the case, I do toss and turn quite a bit in my sleep, I can go to bed a nice straight line and awaken looking like I've been playing Twister (though I can't say I've ever sleepwalked or such).

If this is the issue, not quite sure how to resolve it. Unfortunately I can't really tell my body to stop squirming while I'm not conscious of my movements.

Seems pretty straightforward to me, you experience pain for some reason, and your brain interprets it in a way that creates your 'animals tearing you apart' dream. I'm sure the pain comes first then the dream. 
Two things I can think of, vascular or neuropathy. You might be having some blood flow issues, do you experience 'burning veins' sensations? If it's really bothering you I can think of 2 things to do, 

1. nerve conductive studies to determine if theres any nerve damage, 
2 MR-angiography of limbs, I suppose arms and legs are where the pain is at? To see if you have any changes to your blood vessels

Perhaps, but I've never awoken in pain nor do I experience it anywhere outside of my dreams, do you know if such issues can restrict themselves to solely the REM stage?

Also sadly as much as I'd love to run my body through dozens of studies and tests (and I would!), I'm not even close to being able to afford it. I will definitely bring them up at my next appointment though, and see if the financial issue can be bypassed somehow.

[rahidz2003]

Ok, brief update...

So my AHI is a little higher on average (1.89 vs. around 1 previously), but so far significantly fewer painful dreams and fewer awakenings. Is this good or do y'all recommend further adjustments?

Also is it fine to turn the ramp back on? I find inhaling uncomfortable when I start the machine, like the CPAP wants me to breathe longer than I naturally want to. But afterwards everything is comfortable.

[Dormeo]

It sounds like you're resting better, which is great. You're seeing an uptick in CAs, which may settle back down as you get used to your new settings, but you're also seeing improvement in flow limitations, which is very good. I'm not an expert, but if I were you, I'd let all this settle in further, and I'd use the ramp in whatever way felt best. But let's wait for an expert to weigh in!