Can Mild OSA (AHI of 9) + Severe PLMD be Responsible for severe symptoms?

[gohoos1998]

Thanks for the rec. I actually was taping early on, but the tape itself was quite uncomfortable. I think cloth tape would be better.

[gainerfull]

How'd last night go?

[gohoos1998]

Appreciate you checking in. It was mixed.

Turning off ramp made it much easier to breathe and thus fall asleep. I also kept the mask on for the whole night which was good.

Bad news is that I actually feel much worse. My anxiety is probably the worst it has been in 10 years. 

I don’t think it’s necessarily the new settings, but the CPAP in general because this also happened one time a few weeks ago when I wore the mask for 6 hours that night.

I have no idea what is happening. Very perplexed. Makes me want to give up but also know that I may just have to troubleshoot. Literally feels like I’m on a drug.

 I’m probably going to take a night off tonight and then use again with the new setting we talked about as an experiment.

[gainerfull]

Sorry to hear you're having trouble. I don't have any advice to offer on anxiety like you're experiencing as I don't have any experience with it but I'd urge you to try to sleep with your CPAP for as many hours as you can per night even if it's 1 hour. The risk of sleeping untreated is massive sp02 desaturations that over time will lead to cognitive decline and stress on your cardiac system. You'll also have extremely fragmented sleep architecture and miss out on vital deep & REM sleep.

One thing that can cause stress / fight or flight / anxiety upon waking up is some people are very sensitive to breathing out against higher pressures. Also, if your sleep apnea is not well treated your body can release a lot of cortisol as you experience sleep disordered breathing so you can wake up stressed out.

Potentially if you can overcome this speed bump there are two paths that might help you:

1. Constant pressure mode - find the minimum pressure that will control your sleep disordered breathing then add EPR to help w/ hypopneas. I'd probably start you at 8cmH20 on constant pressure mode w/ no EPR. This will eliminate the pretty wild swings in pressure you see on APAP and our bodies respond better to constant pressure from my experience.

2. Bilevel - you'd need a new machine for this but you could potentially set yourself up with a low EPAP so it's easy to breathe out but enough to control obstructive events and use IPAP to take care of hypopneas, RERAs and snoring. You'd probably be pretty comfortable at 10/6 to start out.

If you can find the time I'm curious what your sleep looked like at the new minimum pressure - looking back at your chart with the 2+ AHI I am a bit suspcious that you might also have some light positional apnea considering the cpap raised the pressure and couldn't resolve some events for a pretty long time overnight.

[gohoos1998]

            Wow, this is super helpful. It's a major conundrum. I know OSA is no joke. I feel like I have to at least continue to give it a go because of the consequences. I also assume it will only get worse as I get older. 

Your comment on spO2 desaturations made me think about something I saw in my original sleep study. I was at 88 percent or below for about 4.7 minutes, but only slept for about 4.5-5 hours. I usually sleep about 8, so if you extrapolate, you'd assume I'd be under 88 percent for about 8 minutes or so. I know the supplemental oxygen threshold is over 5 minutes, but my doctor did not even bring this up. Perhaps something to think about, although I know CPAP can help with desats.

I'm going to provide my oscar data from last night. 

Again, really appreciate your help here. More than my doc would ever do.