I'm going to split my response up into several shorter posts.
(02-05-2014 08:25 PM)me50 Wrote: [quote='robysue' pid='58083' dateline='1391611251']
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.
UNLESS THE FRAGMENTED SLEEP IS CAUSED BY NOT TOLERATING THE PRESSURE, LEAKS, ETC.
In that case, the VPAP is clearly not fixing
the bad sleep
; the VPAP is causing
the bad sleep
Or more technically, PAP is contributing to the bad sleep
in spite of fixing the sleep disordered breathing.
For what it's worth, I understand all too well how PAP can cause bad sleep
by triggering an excessive number of wakes or severe bedtime insomnia or both. I've dealt with some serious CPAP-induced insomnia off and on for the last three and a half years. And it's not fun, to say the least, to be sleeping with a machine that is supposed to fix your sleep by fixing the sleep disordered breathing part of the problem, only to have your sleep remain bad sleep
because of an excessive number of wakes tied to problems tolerating the pressure, dealing with leaks, and other sensory stimuli that either wake you up or keep you from getting to sleep in the first place.
Since you have good reason to believe that the VPAP itself is leading to fragmented sleep, you need to do some sleuthing to figure out how
the VPAP is contributing to the fragmented sleep. Because the only way to fix bad sleep caused by VPAP intolerance
is to figure out how to make the VPAP more tolerable.
Questions for you to ponder:
1) If the AHI is not consistently below 5.0, then the question to ask is: Is the pressure setting sufficient to fix the sleep disordered breathing?
Because if the VPAP is NOT fixing the sleep disordered breathing, then the VPAP is NOT fixing the fragmented sleep that is being caused by too many sleep disordered breathing arousals and wakes. The therapy itself must be effective in terms of reducing the AHI (or RDI for UARS patients) before there's any hope for getting high quality, non-fragmented sleep. So what does the data say about the efficacy of your therapy?
2) If you think the fragmented sleep is due to pressure intolerance, what's going on that's leading you to that conclusion? How uncomfortable are you when you're trying to get to sleep? How uncomfortable are you when you first wake up in the middle of the night? And exactly what is "uncomfortable"? Is there air in your stomach? Is your nose and throat dried out? Do your sinuses hurt? Do you ears hurt? Is there air getting into your eyes from inside the tear ducts? Or is the problem that you feel suffocated because there's not enough air coming through the mask to inhale comfortably, and that leads to a wee bit of panic, which leads to fragmented sleep?
3) If you think leaks are contributing to the fragmented sleep, are the leaks large unintentional leaks that show up in the data? Or are they small annoying, but persistent leaks that don't show up in the data? Is the intentional exhaust flow
from the mask disturbing you? Are you willing to consider other masks? (and why or why not?) And what have you done to try to solve the leak problem and how successful was it?
4) Are other mask issues contributing to the fragmented sleep? Do you have to adjust the headgear so tight that it hurts by the end of the night? Does part of the frame or part of the headgear lie right on top of a sensitive place in your face or head? (Straps going directly over a painful TMJ, for example, can lead to additional TMJ pain and that can lead to fragmented sleep.) Does the mask prevent you from sleeping in your favorite pre-CPAP sleeping position? Are you willing to consider other masks? (and why or why not?)
5) Are other VPAP-related comfort issues contributing to the fragmented sleep? Is the air coming through the tube too cold? too hot? too dry? too humid? Are there noise issues that tend to wake you up or keep you awake? Does the hose get in the way of moving around in bed with a minimal amount of effort?
If you can identify some of the ways the VPAP therapy is contributing to or causing your fragmented sleep, then you've got a target to start working on. But it's up to you to figure out how
the VPAP therapy is leading to the fragmented sleep in the first place.