4 years, still feel like garbage

[Sleepster]

No, I am never awakened by anything once I am asleep.....

We can be awakened during the night and have no memory of it.

If you're taking ambien every night, waking after a few hours and unable to get back to sleep, I believe this is a documented issue with that drug. They developed a time release version designed to address this issue, but I'm not sure how successful it is at treating the problem.

I had this problem with ambien and stopped taking it. For me, it was a very effective drug, but it quickly lost its effectiveness after I used it for a few nights. Strangely, I've since gone years without taking it and then tried it again, but it has never had the effect it had the first time I took it. I fell asleep watching TV and my wife had to drag me to bed. I had no memory of it happening.

[Route67]

To answer the last few questions, yes.....I have had multiple physicals, check-ups blood work and more these past 12 months; remember, I was in the Obesity weight-loss program and their work on us is extensive and very thorough. In fact, I just had my 6-month check up which included blood work on many different levels.

My testosterone level was fine last I had that checked by a Urologist 2 years ago.

I appreciate everyone's comments here, but I am not familiar with a lot of the terms and acronyms; and not sure what the EPR level is, but I can surely try it at 3.0. And tomorrow I will go to my medical supply company and get a full face-mask and try that, or at the very least a chin strap.

Can anyone tell me what settings changes may help me? I know how to change the settings myself based on tutorials here, and despite what the Docs and the medical supply company tell me about not messing with them I have no trouble changing the settings as needed.

[justMongo]

EPR = Exhalation Pressure Relief is a CPAP feature that lowers the pressure on a CPAP machine when the patient exhales in an effort to make breathing more comfortable. CPAP machines provide continuous positive airway pressure, making it easier for the patient to inhale, but harder to exhale. Exhalation pressure relief generally offers three possible settings: 1, 2 or 3, with each number signifying the degree of pressure reduction. (A setting of 1 provides the least pressure relief; a setting of 3 provides the greatest relief).

FYI, we have a list of acronyms in the WIKI
http://www.apneaboard.com/wiki/index.php?title=Acronyms

[Sleeprider]

A quick review of the List of Acronyms will help http://www.apneaboard.com/wiki/index.php?title=Acronyms

EPR is exhale pressure relief, available on Resmed machines. It offers lower pressure between 0 and 3 cmH2O during exhale, then the machine returns to pressure for inhale. Your machine is currently set at 2.0. You could change that setting to 3 and it would give you a slightly lower exhale pressure. Based on the lack of any obstructive events, it looks like it wouldn't hurt, yet it might benefit RERA (respiratory event related arousal).

[PaytonA]

By the way, the arousal portion of RERA does not mean that you became totally awake but can be simply "arousal" to a lighter sleep stage. That could explain why no dreaming.

Best regards,

PaytonA

[green wings]

Thanks for the feedback. I personally would ask for another sleep study with you using your APAP machine and have them check your sleep architecture (percent of time spent in each sleep stage). If this isn't normal, you won't wake up feeling rested.

They would also check for arousals due to periodic limb movement or respiratory effort (RERA) or other things that I probably don't know about.

Regarding Ambien, if you're going to take it, I would go with the CR (continuous release) type. The regular type does tend to wear off after about six hours or so, so it's not good for people who are prone to early waking.

I am basing that on what I've read. The regular Ambien works fine for me, since I am prone to having delayed-onset type insomnia. (I've been taking mirtazapine for sleep for the past year. I started tapering it down a couple of weeks ago. I'd like to find out if I can fall asleep without a sedating medication, plus it increases appetite. I've gained 20 pounds while I've been taking it, & I'm tired of the way it makes my brain perceive food.)

Do you feel any more rested on the mornings after you've taken Ambien? I ask because I have read and been told that Ambien "fixes", or at least improves, sleep architecture. (I have also been told that Ambien is evil and addictive.)

I'm guessing that you don't feel any better with the Ambien or you would have said so. Trying the CR type would be something to ask your doctor about.

There's a new-ish medication for insomnia called Belsomra that has a different mechanism of action that you could possibly try as well.

I'd still be in favor of another sleep study if you can get one, preferably without a sleeping pill if you can manage that. It would be good to find out what's going on with arousals and sleep stages.

P.S. I mainly asked about your meds and supplements to be sure you weren't doing something like taking a B complex vitamin at bedtime. I've known people to start doing that and develop a sudden case of severe insomnia.

To answer the last few questions, yes.....I have had multiple physicals, check-ups blood work and more these past 12 months; remember, I was in the Obesity weight-loss program and their work on us is extensive and very thorough. In fact, I just had my 6-month check up which included blood work on many different levels.

My testosterone level was fine last I had that checked by a Urologist 2 years ago.

I appreciate everyone's comments here, but I am not familiar with a lot of the terms and acronyms; and not sure what the EPR level is, but I can surely try it at 3.0. And tomorrow I will go to my medical supply company and get a full face-mask and try that, or at the very least a chin strap.

Can anyone tell me what settings changes may help me? I know how to change the settings myself based on tutorials here, and despite what the Docs and the medical supply company tell me about not messing with them I have no trouble changing the settings as needed.

[Sleepster]

Can anyone tell me what settings changes may help me?

Without the chin strap or full face mask to take care of the leaks, making adjustments won't be productive.

[green wings]

If I had experienced such a big change as losing 130 lbs, I think I'd be wanting to drop my APAP pressure until I started seeing some apnea events. You might only need a pressure of 8.0 or 10.0 now, but I don't see how you'd know that without experimenting. What do the rest of you following this thread think of that idea?

It would possibly fix your leak problem, too.

(This is a separate issue from your still being tired.)

As far as what you can do immediately, I would keep an eye on your daily leak numbers. There is something going on there. If you look at the % of Time above Leak Rate Threshold value, it was okay until around a month ago. http://imgur.com/0zn6psp

If you go to the "Overview" tab in SleepyHead, you can look at a bar graph for "Large Leak" and see if it's happening every night or exactly what's going on.

[Sleepster]

You might only need a pressure of 8.0 or 10.0 now, but I don't see how you'd know that without experimenting.

You can see by looking at the graphs (Post #25) that it's likely the pressures you stated are indeed all that's needed.

The problem, though, is the leaks. The easiest attempt at a fix is a chin strap or full face mask.

[monikah123]

How long did you sleep per night when you were younger? When did the change occur? I know 5 hours can be enough for some people, but I think not for most. Do you have a lot of stress in your life - financial, personal, etc? I'm in awe in what you are able to do on a daily basis, given how little sleep you are getting.