If the data looks good---your AHI is consistently below 5 and your leaks are under control---and if you are NOT having any identifiable comfort issues such as aerophagia, nose sores, claustrophobia, etc., then chances are the fragmented sleep is being caused by something other than PAP issues and/or ineffectively treated OSA.
And PAP does not fix bad sleep
; PAP only fixes sleep disordered breathing, regardless of whether it's CPAP, APAP, bi-level (VPAP-S) or auto bi-level So if there are any other causes for the bad sleep
, those other causes have to be addressed before the overall quality of the sleep improves.
So fixing the fragmented sleep requires identifying and dealing with the cause of the fragmented sleep rather than simply tweaking the PAP settings.
So the first thing you need to do is to try to identify what other things
might be causing the fragmented sleep. Questions to ponder:
1) What does your overall sleep hygiene look like?
2) How fragmented is the sleep? How many wakes do you typically have during the night? How long are you typically awake during the night? How much total sleep would you say you get on a typical night?
3) Do you have any medical conditions other than OSA
that have fatigue or trouble sleeping as major symptoms? Thyroid problems often manifest themselves with daytime fatigue as the main symptom; anxiety and depression both can cause fragmented sleep; heart disease can affect the quality of sleep; and chronic pain (from any source) can lead to both daytime fatigue and fragmented sleep.
4) What medications do you take on a regular basis? Many medicines have "fatigue" and "problems sleeping" on the list of side affects.
5) What kinds of things are you willing to do in order to try to reduce the fragmentation in your current sleep patterns? In other words, would you prefer an approach that is largely non-drug based, but may require some significant, long term changes in your behavior (cognitive behavior therapy for insomnia) or would you prefer taking sleeping medication (such as Ambien) to see if that reduces the fragmentation or would you prefer a mixed approach? There is NO "correct" answer to this question that universally applies to all people. But you need to figure out what you are most comfortable with because the most effective way for you
to try to deal with your
fragmented sleep strongly depends on the answer to this question.
6) What are your expectations? In other words, what are you trying to achieve? Unrealistic expectations about what "decent" or "good enough" sleep is can lead to additional stress caused by worrying about the bad sleep, which can make the sleep get even worse. As hard as it sounds, sometimes it helps to simply not worry about the sleep for a few weeks.
You also write:
Quote:Does the change in pressure from IPAP to EPAP and back bother you in any way?
NOT AS FAR AS I KNOW UNLESS THAT IS WHAT IS WAKING ME UP BUT BY LOOKING AT THE DATA, I DON'T THINK THAT IS THE PROBLEM
1) Can you post some data from a very restless night? Post the flow rate (wave flow), the pressure line, and the leak line. Point out when you think the wakes occurred. It would also help to zoom in on one of the wakeful periods so that we can see about 5-10 minutes before the wake occurred, the wake itself, and (if possible) 5-10 minutes after you think you finally got back to sleep.
2) Have you ever tried fixed pressure(s)? You might do better on fixed pressure and experimenting with a fixed pressure setting is worthwhile if you have nothing else to try.
Quote:And while I'm sure you've said in some previous thread, could you recap why the doc has switched you from the AutoSet to the VPAP? What specific problems was the doctor hoping would resolve with the switch in machine?
BECAUSE I WAS STILL HAVING FRAGMENTED SLEEP, TIRED DURING THE DAY, NO ENERGY SO I HAD A SLEEP STUDY ON A BILEVEL AND THEN I WAS GIVEN A BILEVEL. I DIDN'T SEE THE SLEEP DOC AFTER THE SLEEP STUDY (I CANCELLED MY APPOINTMENT)
So "failure to resolve daytime symptoms" was what was used to justify the switch from APAP to bi-level?
How severe is the untreated OSA? And how long would you say you had OSA before it was diagnosed? The unfortunate and sad fact is that there are a small number of OSA patients for whom residual daytime sleepiness and fatigue remain issues even with effective PAP therapy and (seemingly) sound sleep. One theory is that the damage from the OSA is just too extensive in those patients to fully heal. Some docs are willing to prescribe an anti-narcolepsy drug like Provigil or Nuvigil to these patients---as long as the patient continues to use the PAP every night and the data from the PAP looks good. In other words, the Provigil/Nuvigil does not do anything to treat the OSA, but it can alleviate the remaining unresolved daytime symptoms. The downsides to using Provigil or Nuvigil include both cost (insurance may not pay for it) and the fact that these are pretty powerful drugs with a bunch of potentially serious side effects, so not everybody tolerates them very well.