0.0 AHI - Fragmented Sleep and Waking Fatigued

[Korgunaard]

Been on PAP therapy for over six months now.  Every single night since I have had fragmented sleep and still wake up fatigued.  I am no expert on analyzing OSCAR data but from what I do know I can't see anything glaringly wrong with my charts.  Would anyone be so kind as to let me know if they see something weird or have some advice?  If you need more screenshots let me know.  Thanks.

[OpalRose]

Did you have a sleep study done?  If you have a copy, post it here.

There isn't anything on the chart you posted that jumps out as a problem.  Is this a typical night for you?

There is very minimal flow limitation, no leaks, no apnea.  Respiration may be a tad high, but not bad.  

The only thing you may want to consider for better sleep comfort is to move your minimum pressure to 7cm. This will allow full use of EPR 3.

Also, consider that poor Sleep Hygiene can cause fragmented sleep.  [Sleep Tips]

[Korgunaard]

Thanks for responding.  I do have a sleep study, I will share that.  This is an extremely typical night for me.  I have tried APAP 5.0 to 12.00 with 3 EPR, that was my initial prescription.  Pressure always stayed at almost 5.0 the whole time.  I have tried CPAP 6.0, CPAP 4.0, CPAP 8.0 with EPR 3, CPAP 7.0 with EPR 3, and now CPAP 10.0 with EPR 3 and it actually just keeps getting worse as I go up.  I tried CPAP 8.0 with no EPR, suggested by someone who has spent a lot of time trying to help me, and my aerorphagia was so bad I couldn't keep going.  Even the aerophagia from the 7.0 and 10.0 with EPR 3 was very uncomfortable.  I have no idea what to do and I want to cry at this point.  Sharing the study as well as the experiement with new pressures from last night.

Edit: I can't post the sleep study PDF and I don't know how to convert it to another format.  Any suggestions?

Edit: Converted it to PDF and then it wouldn't allow me to upload more than 3 images.  Combined them all together and now the image is too large.  I am confused.

[Sleepster]

There was never any indication that you needed a higher pressure. I would lower it back somewhere near where it was. That should make you more comfortable.

Did you have fragmented sleep before you started CPAP? I did. And it continued for a long time after I started CPAP. I finally saw a sleep doctor and she prescribed trazodone. It helped some. I hardly ever have to take it now, but I still wake too early sometimes. But now I usually manage to stay in bed and fall back asleep.

What I used to do, and still do on the rare occasion that I wake in the middle of the night, is get out of bed and read, using the lowest light level possible.

You need to practice good sleep hygiene, following the info given in OpalRose's post.

It just takes time, everyone progresses at a different rate. We all probably spent decades with untreated sleep apnea, creating some very poor sleep habits. It will take some time to reverse that.

Doctors tell us that everybody wakes up throughout the night, but often we have no memory of it so we think we slept through the night without waking.

[OpalRose]

I either missed the Aerophagia, or you didn't mention it prior.

That changes things a bit.  The best way to hopefully eliminate  Aerophagia is to start with a lower pressure in Cpap mode.  Then raise the pressure a little after a couple days of no symptoms.  Then, if no Aerophagia, keep raising pressure slowly.  If you start to have Aerophagia symptoms again, then lower the pressure.  

This is trial and error to find the pressure that will stop Aerophagia and at the same time   give good therapy results. It's unlikely you'll need high pressures.

I suggest Cpap mode at 6cm. EPR 2
Try Soft response instead of Standard.

After a couple days, if no discomfort, raise pressure to 6.4cm.

Let us know how you do and repost.

[hejohoo]

Do you have any device that measures sleep quality (especially deep sleep)? Like the Oura ring etc.

I have found out from my own experimenting that some medication can suppress deep sleep. I have recorded my sleep with Oura for years and when I am on my ssri my deep sleep tanks to about 0-10 minutes a night.

[Korgunaard]

I have tried so many sleep medications I have lost count (I also tried all last month without medications and fell asleep fine but woke up just as frequently.  Meds or no meds I just can't stay asleep).  I have seen a therapist for years and have learned and practiced pretty good sleep hygeine.  I was told CPAP would help improve my sleep but frankly, it feels more segmented than it did before.  I do appreciate all of the help, sincerely, but this is all very depressing.  If what you are saying is true, that this might just be the best my sleep is ever going to get, it makes me just want to give up.  Feels like a wasted pursuit right now and a lot of wasted money.  I have even started video recording myself at night to see if there are any odd physical things I am doing that would keep waking me up, but nothing.  My last ditch effort is to see a specialist at Rush Medical Center in Chicago that deals with more complex sleep disordered breathing and another appointment with a sleep neurologist.  At this point, though, I'm very skeptical, and I am tired (pun intended) of trying.

Sincerely,

Thank you all for your concern.

[Sleepster]

If what you are saying is true, that this might just be the best my sleep is ever going to get, it makes me just want to give up. 

Actually, I told you the opposite of that. It will improve, but it does take time.

At this point, though, I'm very skeptical, and I am tired (pun intended) of trying.

Raising the pressure is likely the cause of your aerophagia. It was never necessary. I recommend you set the EPR to 3, and then put the machine in APAP mode and set the pressure range to 7 - 10. Leave the settings like that for at least a week and post your charts every 2 or 3 days. After a couple weeks you'll have your settings optimized. Then all you have to do is use the CPAP machine every time you sleep and occasionally check your data. That will definitely improve the quality of your life. The alternative is living a miserable sleep deprived life with a greatly increased chance of a stroke or heart attack and an early death.

[Korgunaard]

Unfortunately, I discovered today one possibility all of this is going poorly for me, even with seemingly postive data. I have bipolar disorder and there are some research articles indicating that CPAP is a poor choice of therapy for people like me. It can possibly cause manic events, new sleep disorders, and it really messes up our sleep architecture causing severly fragmented sleep. None of the research is conclusive, but it is clearly a point of consideration for people with bipolar disorder and the professionals diagnosing and treating them. Hopefully I can find something that works with the help of the sleep ENT and/or neurological sleep specialist in the next month. No matter what though, it is looking like there is no immediate, easy solution for me. Bipolar disorder has been a real burden in my life and it continues to be so.

"Psychiatrists, clinicians, especially laboratory physicians who record electrophysiological signals; It should be kept in mind that CPAP therapy, which is initiated in patients with BD, will worsen manic symptoms, shorten sleep duration, and cause REM behavior disorder while treating sleep apnea."

[FooMan]

Do you have any device that measures sleep quality (especially deep sleep)? Like the Oura ring etc.

I have found out from my own experimenting that some medication can suppress deep sleep. I have recorded my sleep with Oura for years and when I am on my ssri my deep sleep tanks to about 0-10 minutes a night.

I just started using a CPAP ~2m ago and I have noticed the same thing with my deep sleep. Also wake up with head aches now. First I thought it was the head gear, but I've loosened the straps and made it comfortable while not compromising the seals. Part of my suspicion is the deep sleep.  I have contacted Oura and they've asked me to send my charts which I will. If you find an answer please let me know.