Help me out here please

[iceman2k]

I'm about 1 year into CPAP and still struggle every day with daytime sleepiness and waking up in the morning. Also, restless at night and typically not able to go to bed at a "normal" time and fall asleep. Not supposed to take any sleep meds either and I don't other than melatonin supplements sometimes. Currently on 2 meds for possible narcolepsy and they do help some with "lifting the fog" my sleep still sucks, I'm still tired in the afternoons, and it gets harder and harder to wake up to my alarm every day for work. AHI is generally low, 2.44 average over the last 6 months per Sleepyhead. I had a tonsillectomy, septoplasty, and UPPP done in late Feb '17 which lowered my unassisted AHI from 38 to 8.5. Currently on a set pressure of 8 based on my last sleep study 2-3 months ago. Also recently switched masks due to rising leak rate and it seems to be better. 

I was told to look into RHI and RERA events but don't know how to interpret them. Can you point me in the right direction, please?

   

   

Phillips Dreamstation APAP 500X110

[Melman]

You had 0.63 RERA events per hour. That's not bad. The main issue I see from your data is that your not sleeping long enough to be rested. If 6 hours and 20 min is typical you may just need to get to sleep earlier if possible.  your fixed pressure appears to be working pretty well. Have you considered trying auto-pressure mode ? It may help eliminate some of the hypopneas and OAs.

[iceman2k]

I had been on auto for a few months after my surgery but it wasn't keeping up and my AHI was all over the place from 3-15 events per hour so they set me on a steady 8 and that "improved" things a lot. As far as getting more sleep, I just can't do it. Sometimes it is a function of family or work stuff, other times it is just a racing mind and sitting in a silently living room until 4am sometimes waiting to feel tired enough to go to sleep. Of course I could could easily go sleep at 10am or 1pm or any time that isn't feasible.

[DavePaulson]

Often times auto doesn't work well for people if the pressure setting is wide open like 4-20 as they are typically set. You are still experiencing both obstructive and hypopnea events, so 8 isn't doing it for you could try raising it to 9 or using auto at 9-12.

[trish6hundred]

Hi iceman2k,
WELCOME! to the forum.!
You might have to make adjustments to your settings to improve your CPAP therapy.
Hang in there for more suggestions and answers to your questions and goodD luck as you continue on your CPAP journey.

[Sleeprider]

Your events remain obstructive in nature suggesting you will probably benefit from an increase in pressure. I would suggest a pressure of either 9.0 fixed, or 9.0-12 in auto. Since you don't have any snores or flow limitations, auto pressure will be of limited effectiveness as the machine will tend to stay at the minimum pressure. It is not uncommon that people do not have the apnea/hypopnea precursors the machine relies on to increase pressure ahead of events, particularly following UPPP surgery. No doubt the procedures helped your apnea and flow limitations, but it removed the signals that make an APAP work.

I agree with the comment that you need to find time for at least 7-hours of sleep. Time on the machine is not all sleep time, and your current 6-hours is going to leave you short-changed on rest.

[iceman2k]

Thank you for the suggestions. I will move my pressure up to 9 and give it a week and pull a new report from SH to see what the numbers say. 

As far as the hours of sleep goes, as I said, it's not something I can really control outside of taking sedatives. If I go to bed before I just feel exhausted I just toss and turn which wakes up my wife, and that is a whole other set of problems to deal with then. I just need my CPAP to make the sleep I do get as restful as possible and right now it isn't doing it for me. Hopefully, the pressure change makes a positive impact for me and thank you all again. I follow up in a week or so with new data but please let me know if you have any other suggestions between now and then.

[robysue]

As far as getting more sleep, I just can't do it. Sometimes it is a function of family or work stuff, other times it is just a racing mind and sitting in a silently living room until 4am sometimes waiting to feel tired enough to go to sleep. Of course I could could easily go sleep at 10am or 1pm or any time that isn't feasible.

and

As far as the hours of sleep goes, as I said, it's not something I can really control outside of taking sedatives. If I go to bed before I just feel exhausted I just toss and turn which wakes up my wife, and that is a whole other set of problems to deal with then.

You are describing an insomnia problem in addition to the CPAP problems you are dealing with.

The "mind racing" thing is not going to magically disappear once you have the AHIs consistently below 5. And you're not likely to start feeling fully rested in the morning as long as you're not sleeping enough.

I understand your reluctance to take sleeping medication.  But there are nonpharmaceutical ways of trying to rein in the insomnia.  How is your sleep hygiene?  Do you wake up at the same time every day---even when you have a bad night?

On a "normal night" how long does it take you to get to sleep when you do go to bed?  And what do you typically do before you go to bed on a "normal night"?

How much caffeine do you consume? How late in the day do you drink caffeinated beverages?

And when your mind is racing until 4AM you may want to try other strategies instead of just sitting quietly in a dark living room. You might want to consider turning the light on and reading. Or putting a CD on and listening to some soft music. Or doing a crossword. Or making yourself a cup of sleepytime tea.  In other words, you might want to do something fun to get your mind OFF of whatever it is that  is racing through it and preventing you from getting sleeping. Once you manage to get your mind distracted, it may quite the racing. And once it quits racing, you may find that you will start getting sleepy enough to go to bed and fall asleep in a timely fashion.

[iceman2k]

No, no, no. There is no reluctance to medication. It's that I was specifically told by my sleep doc that I'm not supposed to take any sedatives. I'm not a heavy caffeine consumer, mostly because it has no noticeable effect on me anymore. Most days I just drink water and others I may have a Coke with breakfast or lunch. 

On a "normal" night I stay up until I am exhausted and can fall asleep relatively quickly, maybe 3-5 minutes sometimes faster. To wind down I vary between TV, reading, video games, boring work research, sitting in the quiet, you name it. Reading will put me to sleep on the couch but then I wake up with a sore neck and back and have trouble getting back to sleep when I get in the bed. Reading in bed doesn't work because I nod off fairly quickly and then drop the book, phone, tablet on my face waking me up.

[stanleydean]

Hi iceman2K, welcome to the forum, you will find help here so stick with it. It seems that many of us experience some of the same issues that you are struggling with tn terms of lack of enough sleep and quality of sleep. I think soft music and/or easy reading can be helpful when it is difficult to get to sleep. I also think that TV and video games micht be counter productive. Different things work for different people. For most of us it is important to get enough sleep so don't give up on finding that right formula for you. Eating after dinnertime can make it difficult to drop off as can drinking certain beverages. When I have trouble dropping off I sometimes can get to sleep by trying to solve some hypothetical problem in my mind Being too warm or too cold could keep you awake as will being angry or upset when you try to fall asleep. Keep plugging away and you will most likely make some improvement.

Hoping for much improvement for you,

Stan