Newbie: Numbers great, no REM

[jaybeem]

I have been on CPAP for almost three weeks. I did a lot of reading on the board to solve the problems I was having with CPAP: got a hose hanger, changed pillows, used Lansinoh, am learning to sleep on my side instead of my stomach, etc. My AHI is never above 2 and my leaks are minimal. But I don't think I am getting any REM sleep. I have two problems:
1) Severe dry eyes, probably from cataract surgery, and possibly exacerbated by CPAP. I am seeing an ophthalmologist and am using GenTeal night gel and Systane Balance during the day. I may have to resort to duct plugs. I rip an eye mask off in the night; I just don't seem to be able to tolerate it.
2) I am always awakening about two hours into sleep and often at two hours intervals after that...right when I should be going into REM.

I have tried Tylenol PM, my sleep aid of choice, but it didn't make any difference. I used 1 mg. time-release melatonin for four nights. I left the land of the walking dead, but was still very tired. My sleep doctor is out of town for three weeks, so I saw my primary care physician last week. She prescribed Ambien, which I was reluctant to use. But I tried it last night. I slept four hours, was awake for three hours, then slept thee more. But I awoke with facial and throat edema. Not good!

I almost think my body has been trained by apnea to not go into REM sleep. I can't figure any way out of this. Any suggestions?

[trish6hundred]

Hi jaybeem,
WELCOME! to the forum.!
The mask is the hardest part of CPAP therapy. There are several different types of masks, have you only tried pillows? If that is the case, you might want to consider trying a different type of mask.
I notice you mention in your profile that you are using EPR. Some people say that feature gets in their way and is more of an anoyance, others have no problems with it. EPR is a comfort feature.
You could try turning off EPR and see if that helps.
Best of luck and hang in there for more suggestions.

[jaybeem]

Hi jaybeem,
WELCOME! to the forum.!
The mask is the hardest part of CPAP therapy. There are several different types of masks, have you only tried pillows? If that is the case, you might want to consider trying a different type of mask.
I notice you mention in your profile that you are using EPR. Some people say that feature gets in their way and is more of an anoyance, others have no problems with it. EPR is a comfort feature.
You could try turning off EPR and see if that helps.
Best of luck and hang in there for more suggestions.

I have Swift FX nasal pillows. I don't think I am having big issues with the mask except keeping it sealed.

I have presumed that having a pressure drop on exhale was a good thing...as opposed to exhaling against the pressure. Am I not understanding what EPR is?

[vsheline]

I have presumed that having a pressure drop on exhale was a good thing...as opposed to exhaling against the pressure. Am I not understanding what EPR is?

Hi jaybeem, welcome to the forum!

Since your AHI is low, I suggest you continue to use EPR, if using it feels more comfortable.

At the same time, I suggest you take a look in your SleepyHead or ResScan data to see if it is hypopneas/apneas which are awakening you up. I would zoom in closely on the waveform plots of the Flow and the High Rate Pressure, to try to see if it is hypopnea/apnea "events" which are waking you up.

If obstructive events are occurring and waking you up, you might want to call your doctor to see if he/she wants to try slowly increasing the CPAP pressure setting (like 1 cmH2O per week or two). Quite often we get reports from members that the titration pressure obtained from a sleep study was too low (or too high), and their CPAP pressure needed adjustment.

And, since you are using a CPAP machine (in contrast to an auto-adjusting APAP machine), I think turning EPR down or off may reduce the number of obstructive apneas or hypopneas; but to prevent obstructive events, I would think it would be better to continue using EPR (if EPR makes breathing more comfortable for you) and to simply raise the CPAP pressure.

If central events are waking you up, it may be helpful to lower or turn off EPR, since (for a few people, at least) using EPR can make centrals more likely.

Take care,
--- Vaughn

[Sleepster]

I almost think my body has been trained by apnea to not go into REM sleep. I can't figure any way out of this. Any suggestions?

I think you're right. All you have to do is wait and let your body adjust to the CPAP therapy.

I also have fragmented sleep, but it has gradually gotten better as the months go by.

I wouldn't presume you're not getting any REM sleep, though. You're just waking up every couple of hours. Give it some time and it'll pass.

Remember that your body has spent a lot of time adapting to sleep apnea and now it has to reverse itself. That's a process, not an event.

[jaybeem]

There does not seem to be any relationship between events and awakening. I just looked back over my SleepHead data, and events have never, ever preceded waking up. My AHI since I started is 1.09, a number that most people would love to have. I am basing the no REM on how exhausted I am. I am averaging almost 9 hours of sleep a night, but I feel like I haven't slept in a long time...even when I first get up.

I do consider it possible that my eyes are waking me up. Although I have not been able to tolerate a mask, I am going to try it again tonight after giving myself a stern talking-to.

I was really down today because it feels like I am never going to get out of this exhausted rut. But at least my body isn't being subjected to apnea.

Thanks for the advice and the "process, not an event." It wasn't until I started reading posts that I realized that CPAP is not an overnight magic wand.

[Tez62]

Thanks for the advice and the "process, not an event." It wasn't until I started reading posts that I realized that CPAP is not an overnight magic wand.
[/quote]

Jaybeem, welcome, you are looking at around 3 - 6 months before you start to feel the full effects and everyone is different. It comes down to a number of factors, how long you have had sleep apnea for, how servere it is, your diet, whether you exercise, etc. Your body has to heal similar to if you broke a bone. I was diagnosed about two years ago after living with it for 48 years, I started feeling less tired after about 3 months. After two years I can still get tired during the day and occassionally have a 15 minute snooze but I am 200% better than I was two years ago

[vsheline]

Severe dry eyes, probably from cataract surgery, and possibly exacerbated by CPAP. I am seeing an ophthalmologist and am using GenTeal night gel and Systane Balance during the day. I may have to resort to duct plugs. I rip an eye mask off in the night; I just don't seem to be able to tolerate it.

Have you tried increasing the amount of CPAP humidity?

If you are using heated hose in Auto Humidity mode (highly recommended) the highest hose temperature (86 degF) will put highest moisture content in the air.

If using non-heated hose, I suggest trying a humidifier setting of 5 and going higher if no rainout (condensation in hose or mask) problems.

Take care,
--- Vaughn

[Shastzi]

Hi jaybeem!
#1.
Unless you can get your hands on a ZEO (simple brain wave monitor) you never really know if you are getting REM sleep unless you wake up and remember a fragment of a dream.
...Unfortunately ZEO is going bankrupt. I hope someone will pick up that business because it is a useful device for troubleshooting.

#2. if your eyes are getting that irritated from the pressure, you might be having problems with pressure behind your eyes. In this case try a total face mask. (looks like what firemen wear) Getting it to seal is a bit more problematic but having pressure on front of your eyes may get you some relief with that irritation.
I was using the Quattro FX mask for a while and it was great except my eyes would be super irritated for hours the next day. I think the pressure in my nasal cavity was pushing all kinds of crap up into my eyes through the tear ducts. (back flow) Using the FitLife mask has solved that problem since there can be no back flow because the pressure is equal outside the eye vs inside the nasal/sinus cavities.

[jaybeem]

I slept with post-cataract silicone eye protectors taped over my eyes last night (with the perforation holes taped over, also.) Not much difference. I am not producing enough tears, a not-uncommon side-effect of cataract surgery. So while CPAP may be making matters worse, I don't think it is causing my dry eyes.

I am using a heated hose in Auto Humidity mode, set to 80, which is about as high as I can tolerate it.

I had not thought about back flow, just leaks (which aren't too bad) and the awful blow back from the Swift FX exhaust (which I got rid of with a hose hanger). As much as I have struggled getting used to the pillows--since I sleep part of the night on my stomach--I have been reluctant to change masks. But trying another mask may be worth it, if for no other reason than to eliminate back flow as a cause.

Thanks for all your suggestions. It helps enormously to know there are people out there with more experience and new ideas.