7 months on, daily headaches/zombie-feel

[bosskyroyale]

Hello! Looking for any assistance (thank you so much in advance!!!) -- been having daily morning headaches painfully throbbing since late November 20 when I bumped up to 7.0-12.8.  The headaches fade away by 4:00pm or so (with Excedrin when they get really bad).  

I work ER shift-work, so my sleep schedule is very erratic; bedtime around 4-5am, awake around 11am-1pm.  I continue to feel like a zombie when I wake up.  I've tried to increase my pressure, but I really haven't a clue. Sleep doc programmed me at 4-20cm of course for a home sleep study of 30 AHI, & just says since my AHIs look to be under 5 each morning that I'm fine.  

Yeah, I don't feel fine; feel worse these 7 months since before beginning therapy.  I used to be able to sleep 8-9 hours.  Now, super lucky if I can get 6-7 broken hours.  

I wear a custom dental sleep mouthpiece.  FFM f30s mask & automatic humidity nightly.  I tried a cervical collar back in October but it didn't work out; too constrictive and couldn't breathe.

[hegel]

Sometimes headaches are caused by low oxygen during the night. You have a low minimum setting. Your chart looks excellent; you don't seem to need more pressure to address apnea But maybe you need more minimum pressure to provide more oxygen? this is a just a guess on my part. Hopefully others with more experience will chime in. If not, raising your minimum pressure to 8 would seem to be a risk free experiement.

[Gideon]

Your numbers are excellent, but the headaches continue. The below is just to tackle your comfort.
Increase your min pressure by 2 cm and give it a couple of days. If that works we can titrate down if you need it, if not increase by 1 cm and re-evaluate than by another 1cm if needed.

[bosskyroyale]

Thank you both so much for the review, I'll try going up by 2 and report back Thursday!

[bosskyroyale]

So I went up to 8 for the past 2 nights (9 all at once just felt crazy!). Wednesday morning awoke with the worst headache ever; had to get a doc to shoot me up with steroid shot & toradol just to function at work.

Last night... well, I did sleep. No headache today, that's great!  But I have never seen my numbers this high!  Still feel like a zombie, lots of brain fog today. Fitbit says my avg sp02 was 92% these past two nights, down from my usual average of 94%.

I can keep attempting to titrate slowly up to 9cm if needed... any thoughts?

[Melman]

The chart from 2/10 shows you had a short period of positional apnea as indicated by the cluster of events. You may have tucked your chin to our chest which compromises the airway. If this happens frequently we recommend a soft cervical collar but from your charts this appears to be a one time event. It can also be caused by using a pillow that is too thick. I wouldn't be concerned unless it happens more frequently.

[quiescence at last]

Looking at your charts from 2/9 and 2/10, the automated feature of adjusting pressure never reached 8 minimum, and rarely got just below 9 before the machine was boosting your pressures in response to flow limitations. I would be adjusting my min pressure to 9 at this point. Your upper limit of 13 cm does not seem to be a restraint except for a short period about 08:00 to 09:20 on 2/10. I would leave the upper limit alone for now.

QAL

[bosskyroyale]

Thank you so much Melman and QAL, I'll toughen up & go up to 9 and see how it goes over these next few days.  If I have more than a single run of the hypopneas/reas, I'll break back-out the Caldera.  

[bosskyroyale]

Ugh, I've been at 9/13.2 for 5 days and I feel the exact same... awful!  I've been giving a 1-10 self-rating scale each day, and today's the first day I looked at Oscar.  

Each day I'm between a 1-3 awfulness rating, foggy head, continuing headaches each and every morning.  Feels like there's leaks all night, but by all accounts on the charts, I'm fine & no big leaks at all.  Just don't feel like I'm sleeping any, exhausted all day.  Fitbit Charge 4 chart attached also.

Would any of you mind taking a quick look, seeing if there's anything I could adjust?  Or, just take my chances with making a Neuro appt (oh, please no --that guy insists I should use 4-20cm and 1 EPR)

[quiescence at last]

I like that you got 2 cycles of REM sleep, and about the right percentage, but generally a first deep sleep should occur before a REM period. And, 6% is no enough. I would be reading thru materials about enabling or increasing deep sleep.

Otherwise, your apnea score is really good. So, breathing disturbance may not be causing sleep phase issue.

QAL