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[Treatment] Please Help me get it Right this Time
#1
Please Help me get it Right this Time
Hello ApneaBoard!  My name is Colton, I am 27 years old, and I have been diagnosed with moderate sleep apnea for about 2 years.  I have a normal BMI—probably a bit over 23.0 right now.  To be frank, I’ve had daytime sleepiness problems for a long time.  Some of that was because I didn’t get enough sleep in high school and college, but at this point, I’m starting to wonder if I’ve had this problem for a while.

So around 2 years ago, I did an in-lab sleep study and was diagnosed with Moderate Sleep Apnea with an AHI (and RDI) of about 19—all of which were hypopneas.  There were some other strange things about the study—particularly, my REM latency being over 5 hours, but the doctors weren’t really concerned about that.  I’ve attached the image of my report (sorry for the bad quality—If you want me to double check something, you can ask me) in case that’s of interest to anyone.

Following the study, it was decided that I’d start on an APAP—I was taken to a different room where I met with a local DME and received a ResMed Airsense 10 with AutoSet and Humidifier.  I unfortunately do not remember what the pressure settings were, but I didn’t have a separate titration study for them.  I started with nasal pillows and set up a few follow-up appointments for the following months.

Things didn’t go well from there.  Sometimes, the issue was forgetting to wear the CPAP, but there were probably even more times where I would wake up to find that I had taken off the mask in the middle of the night.  I tried I think 4 different masks—one was the nasal pillows, one was a full face mask, and the other two were somewhere in between.  I also had my pressure adjusted once, but I don’t remember what was done—just that I wasn’t supposed to mess with it myself.

None of that really helped though.  Some of the issue may have been that I felt like the CPAP was trying to breathe for me.  I know that’s not accurate because that’s not how the machines work, but that’s how it felt.  That being said, who knows if that’s why I was taking it off while I was asleep?

Needless to say, three months later, I was deemed CPAP noncompliant and my machine was taken away.  My doctor then gave me the choice to try another machine or an oral appliance.  In hindsight, I should have gone with another machine, but I ended up going with the appliance.

It took a few more months, but I received my appliance and began using it.  I definitely thought it was helping at first, but as time passes, I get less and less sure.  I wanted to do a study to test how much the appliance helped at the time, but COVID happened and I did my best to avoid the hospital during the worst of it.

About 2 months ago, as things started to improve, I decided to reach out to the lab again for another test.  This time, they ordered an in-home study.  I did the test, and found that my AHI with the appliance was closer to 8 which I think is a pretty big improvement, but my general sleepiness doesn’t necessarily think so. (Attached the results from this study as well)

My doctor said that it was about what she expected from the MAD and that there wasn’t much more that could be done to lower it in the same way.  I was hoping that the lower AHI would mean I’d have more energy, but that hasn’t been true.

Out of desperation, I reached out to an ENT, but he said my throat has plenty of room and I shouldn’t be having issues (which I have heard is sort of a useless response if they look at your throat while awake.).  He mentioned a deviated septum and while I may correct that later, I don’t think correcting it would help my sleep much at all.

And that brings me to now.  Really, I’m sort of clueless at this point.  Do I need a second opinion?  Would getting another in-lab study help?  How much of my sleepiness is from Sleep Apnea?  How much is from depression?  How much is from Hashinoto’s Thyroiditis (which I can’t find a doctor who will treat it because my TSH is normal)?

I’m also on 40 mg Fluoxetine and 20 mg Vyvanse.  Could those be making it worse?

At this point, my weekday life is:
  - wake up late
  - spend several hours forcing myself out of bed
  - drive an hour to work
  - work for 9 hours + however long meals are
  - drive an hour home
  - spend an hour trying to do something for myself before inevitably failing
  - fall back asleep

And then repeat.  The real kicker is, it’s very often that I’m not leaving for work until 2 PM because I just have so much trouble getting out of bed.  And I don’t know how much of that is sleep and how much of it is depression.

For one, I hate my job, but finding companies that will be accommodating for flexible hours like that isn’t easy.  So I’d like to get my sleep under control to at least give me a chance.  And I figure the first step to that is figuring out my sleep issues.

And that’s what brings me here.  I just don’t know what to do next.  So if any of you have advice, it would absolutely be welcome.

Thanks so much,
Colton

Looks like my at-home study attachment got lost, so I’m adding it again here.


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#2
RE: Please Help me get it Right this Time
Welcome to the forum.
I'll suggest a 2fold approach.
1. Sleep hygiene . Resear h this and change your sleep habits to promote good sleep
2. Restart using a PAP machine. You failed APAP with an AutoSet so request a BiLevel, specifically the ResMed VAuto. This machine because it is intended for nonco.pliant CPAP users.

I'm sure we could have generated better numbers with your AutoSet.
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#3
RE: Please Help me get it Right this Time
Thanks for the advice!

I’ve done a quick look on sleep hygiene.  Easiest things for me to do so far will be:
- Move my phone charger away from my bed
- No screens for an hour before bed
- Make sure computer monitors are off
- Stop eating things before bed
- Go to bed at a consistent time (although this will be a little weird since I’m getting home so late.  But I should hopefully be able to shift that forward as I correct things.)

The ones that are going to be more difficult are:
- regular exercise
- waking up at a consistent time
- not going back to sleep after waking up

I’m hoping the ones in that second list will get easier with time though.

As for the BiPAP, I’ll try reaching out to my doctor again to schedule something.  I’m slightly worried that I’ll have issues with it feeling like it’s breathing for me, but if I can adjust the machine, maybe I don’t need to be worried about that.

Also, would you recommend avoiding a DME entirely?  I didn’t have a choice last time, but now that I know more, I’m wondering if paying for the machine myself would be better.
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