Pokey49 - Therapy Thread

[Pokey49]

EJ:
I wear a fit bit and it gives me a sleep profile each morning. I do question its accuracy because it has no electrodes on my head to record REM & deep sleep. But what it routinely shows is most nights Ihave numerous awakenings. A lot of nights I do good to get an hour of REM or deep for the night. I got 1hr 20 minutes of deep ladt night and only 52minutes of REM.  It often swings back n forth between the two day to day. I shared with Super Pilot I was on a benzodiazepine for 20 years and I currently take an antidepressant.  ADs are supposed to help fractured sleep but I have my doubts that’s true. Throw cpap into the mix now ? I’m not convinced yet that it helps ones sleep stages. Time will tell I guess, hopefully the sooner the better. 

Question. If you switch an APAP to CPAP mode can you still have EPR?? If so that might be the way to go given how you described my last nights report.

[jdougc]

If you switch from APAP to CPAP mode you can still have EPR.

My sleep tracker can't consistently/accurately differentiate between deep and REM sleep. Without an EEG, just tough to do. My tracker gets my awakenings fairly well.

[ejbpesca]

EJ:
I wear a fit bit and it gives me a sleep profile each morning. I do question its accuracy because it has no electrodes on my head to record REM & deep sleep. But what it routinely shows is most nights Ihave numerous awakenings. A lot of nights I do good to get an hour of REM or deep for the night. I got 1hr 20 minutes of deep ladt night and only 52minutes of REM.  It often swings back n forth between the two day to day. I shared with Super Pilot I was on a benzodiazepine for 20 years and I currently take an antidepressant.  ADs are supposed to help fractured sleep but I have my doubts that’s true. Throw cpap into the mix now ? I’m not convinced yet that it helps ones sleep stages. Time will tell I guess, hopefully the sooner the better. 

The possibilities for not getting quality sleep are many.  PAP therapy can be a cause of sleep disruption.  After over 17 years of it, I never lost fatigue and severe daytime sleepiness. One reason for that is on my 4th in lab sleep study the technicians asked if I would stay past the usual up and gone time of 8:00 a.m. and participate in a "nap," study.  I complied. 

From the nap study, I was diagnosed with narcolepsy which I think is a mysterious and rare condition.  I think my severe apnea, which has never been addressed properly till recently, is part of the narcolepsy.  I have other health issues that also rob me of quality sleep including chronic pain due to permanent spinal injuries.  I've been doing a bit better lately but every night is unsure.  It was found that one hour after the sleep study and eating breakfast the tech could turn out the light and I would be in REM sleep in a few minutes, repeatedly for four sessions of one-hour naps.  I never realized I had fallen asleep.  I wonder how many here have had a "nap," study.

From experience, I feel that many medications can disturb sleep at times and may help someone sleep at other times.  Benzos, antidepressants, nerve pain meds, antihistamines, meds for hypertension, melatonin, and who knows what else can affect sleep differently not only for individuals but also affect an individual differently at different times.  My neurologists over the past 30 years have agreed with that notion. (3)

It was just in the last year I started getting better results from PAP therapy by advice here and elsewhere on how to adjust PAP pressures.  It has finally given me the ability to not have to fight off sleep during the day more than just once in a while.  I got a load of advice that did not work for me but finally hit upon some key issues that did.  Yet for me, hopefully not you, I cannot expect good sleep nightly due to my ailments. At least I have dialed in some pressure numbers on my machine, got a mask that is more comfortable and doesn't leak so much.  This has given me the benefits of more energetic days in a row than I've had in decades.   

Without "feeling better," one may ask, "So why continue with PAP?" For me, it is the issue of very high blood pressure and fear of what may happen if I stop therapy.  And, finally, I am getting more days the truck missed running me over than in years.  I just wish I would quit dreaming such weird vivid dreams, but they come and go.  That's a mental thing also not well understood.  I relive past trauma in them, not good. 

Here's hoping you get a good night's sleep, wake feeling okay, and maybe discover how to repeat that.  I never have, but of late I've at least had hope due to a few better days.

[Pokey49]

Last nights OSCAR reports are attached below

It seems like my AHI keeps getting worse for whatever reason. Or is that the way it goes, great AHI some days, not so great other?? I see the following if I am interpreting correctly: 
CA's and inhalation ?? pressures (red curve) are up at the beginning and end of the therapy session
Respiration rate zigs and zags
Snores are up beginning and end
AHI varied if I am reading correctly from 3-22 ?????? But my summary says my AHI was 4.57. How does that calculate.
Leaks dont look at that bad to me

I may be getting some leaks because my chin strap is not keeping my mouth closed, especially when the pressure bumps up over 9

Whether I am on or off cpap Ive been waking up feeling pretty rotten. I think its related to a medication that my doc put me on, then decided I should get off of it after 2 months, but its not a medication you can just stop. I have to slowly taper it. SO who knows if cpap is helping or hindering or making things worse under such circumstances. So far not feeling any better.......

[SarcasticDave94]

We're not after exact same results from night to night, so yes expect it to vary a bit. However yours is a bit much.

The slightly increased pressures near the beginning shouldn't be an issue. You're transitioning to sleep, throat relaxing, then CPAP needs to boost a bit.

Not sure on your leaks, but it shouldn't go up dramatically after a modest pressure of 9.

It's possible there's other things you'll need medical tests on as well, as Apnea aren't the only thing that can affect sleep.

[jdougc]

You had 1 obstructive apnea event.
The extremely high pressure maximum let your relatively low flow limits drive your pressure up. That seemed to contribute to your CAs.
A tight pressure range would prevent that.
Consider 9.0 to 9.4 for a few nights.

[ejbpesca]

Yes, AHI can be up and down nightly.  Some manage to get consistently low AHIs, but I'm not one of them. 

Pokey wrote:
"AHI varied if I am reading correctly from 3-22 ?????? But my summary says my AHI was 4.57. How does that calculate."

If it were not for that rapid succession of CAs you show during the last hour of sleep the AHI 4.57 would have been very low.

The summary AHI is the average number of events per hour over the entire sleep session. You can have many hours of good looking OSCAR graphs then have your AHI wrecked by a cluster of events over one hour or less 

I have clusters of events like what you got in the last hour but they are Hs and/or OAs. My clusters run up to AHI 70, lasting around an hour, and will run my AHI summary up to over 10.00.

I find it very interesting you had so many CAs so quickly.  You can zoom in on that area to look at breaths to see the events close up.  You can research the cause of Central Apneas which is the same as Clear Airway apneas.  I have found their cause is not well understood.  A few here and there is common.  So many in a row is not.  I see the CAs started, then a break in therapy, therapy starts again, and here comes one CA after another. ??

Can you recollect anything of what you may have been experiencing that last hour? 

 

[Pokey49]

I can’t recall what I was experiencing in my last hour of sleep only what I recall upon awakening after that last hour with all the CAs. 
Whole body pain, stiffness, thick headed feeling with mild headche, needed to take some deep breath’s. Took some time for sxs to resolve. Went back to sleep without cpap. Awoke with same symptoms. Not sure what’s going on? I may be wrong but I think one of my meds is the villain.

[ejbpesca]

I'm 75 and a greenhorn to this CPAP stuff. I have tested as having low moderate OSA with an AHI of 16.5. I am getting fitted next week for the first time for CPAP. Ive been advised here to go with a ResMed Airsense 10 or 11 which is is an autopap machine if I understand correctly. I have some questions. 
1) does the cpap machine determine the needed inhalation/exhalation pressures based on my respiratory physiology or does it require a tech or me experimenting with pressure settings?
2) I don't think I can tolerate a full face mask, but I am a mouth breather, especially at night. Can I use a chin strap to effectively accommodate a nasal pillow or partial face mask?
3) I am almost a 100% side sleeper. Is this of benefit or hinderance one way or another? or it doesnt matter? 
4) how long does it take to acclimate  to and or benefit from cpap. It seems a fair number of people here have their share of intolerance to it??
5) Will cpap help alleviate the whole body pain I wake up with most mornings?
Thanks
Pokey

ResMed AirSense 10 is my preference, many do well with the AirSense 11 Both are APAP machines that adjust pressures within settings of minimum and maximum.  Both are popular machines.

1. Some techs do a common setting of 8 min. 20 max (20 is the top limit) pressures for an auto adjusting machine and make no other adjustments due to expecting the machine to make auto adjustments based on respiratory physiology.  I, like many others, do not have access to a tech for further adjustments so I view OSCAR reports and make adjustments as needed. Each is an experiment. Advice for those adjustments is found on this forum.  I feel it requires experimentation with adjustments to get the best therapy.  If a tech will/can to it then good, but often it is up to the user to do it.  The difference between "set it and forget it" and making custom adjustments to better suit an individual can result in dramatically better therapy, but that is just part of it so on to question 2.

2. You can use a chin strap but whether or not it will effectively accommodate a nasal pillow will not be known until you try it. By "partial face mask," I think you are referring to a hybrid mask.   A hybrid nasal/mouth mask is an option for mouth breathers.  I think you have tried the F40, which is my preference.  Nothing I've tried to keep me from mouth breathing (4 types of tape, 3 collars, 2 chin straps) works so full face either hybrid or jet pilot it must be...for me. 

3. Side sleeping is not necessarily a benefit or hindrance.  Side sleeping for me results in fewer apneas. Some lower their head downward during side sleep causing apneas that the PAP machine cannot correct.  A cervical collar is often recommended to prevent the head from downward movement during sleep (chin tucking). Chin tucking can happen in any sleep position.  For you, it doesn't matter (side sleep) if you do not lower your head which will pinch off airways like putting a crease in a garden hose to shut off the flow.

4. How long it takes to acclimate to PAP therapy is based on the individual.   Some do it in days, others weeks or months and some never do and give up.  It took me about 3 months.

5. PAP (APAP, CPAP, BPAP) therapy does not alleviate whole-body pain.  It gives therapy for apnea which untreated could be a source of waking with whole-body aches.  In my case, even with a great night of therapy (as per OSCAR report) I wake with whole-body pain due to ailments like arthritis.  Within about an hour that pain reduces to a tolerable level.  PAP therapy will not alleviate that pain nor address any of my chronic pain sources.  What I hope to get from good PAP therapy is a more energetic day.

At 73 and with permanent spinal injuries, waking up for me is rough. PAP will not fix that.  Each morning or afternoon when I wake up I feel as though I have been in a car wreck.  That feeling eases up over the first hour,  but then my chronic pain from injuries comes on.  A night of good PAP therapy helps me cope with it.  With good PAP therapy I feel better, tolerate my chronic pain better, and do not start to pass out from exhaustion by noon.  No nap is needed which is great.  My blood pressure goes to normal levels (with help from meds).

PAP therapy for me is different each night...good, average, and terrible. OSCAR is my monitor of PAP therapy.  It is through OSCAR and advice here, not a tech or doctor, that I managed to get adjustments to my machine doing much better than the standard 8 - 20 Autoset pressures.  Some dial in good settings and get much more consistent good PAP therapy.  We all are so different in how we react it takes experimentation to find what settings are best and what are settings best changes.

I have no access to a tech so I must do it and since the setting changes need fine-tuning so much by experimenting, I don't know how a tech doing it would be practical.  Lanky Lefty offers an online service to analyze OSCAR reports then he tells you what adjustments to make.  His service is too expensive for me. 

It was also finding a mask that is more comfortable and does not Large Leak at higher pressures that has made a BIG difference for me.  That happened just a year ago. I went 17 years with leaky, uncomfortable, jet pilot full face masks and a very poor level of therapy.

[Pokey49]

I think my sleep is being messed up by a medication one of my docs put me on. It’s doxepin which is an antidepressant which was supposed to help me sleep. Well a drug of any kind does not always elicit the intended response. Sometimes quite the opposite. Sometimes they cause more problems than they solve. Unfortunately I’ve been on it for  2 months now and it’s not something I can just stop. So I have to slowly taper off of it. Throw in trying to adapt  to pap May add some fuel to the fire creating an idiosyncratic affect on my sleep. But then I might be wrong. Maybe it’s just the med boogering up my sleep or maybe it’s just the cpap. Hard to know. 

EJ I can certainly empathize with you in that it sounds like we both really struggle with sleep. In different ways it sounds like but still a struggle. 
I’ll try again tonight and see what happens. I think will take JDougs advice and drop the max pressure down a few licks.