Two months in... some concerns

[Paptillian]

Friends,

I've hit my two month mark on therapy and am a little perplexed because of how I'm feeling lately. First, an update.

My machine data looks, at least to me, very very good. According to the data my average AHI is less than 1, leaks are well controlled, and my average usage is at least 8 hours/night. I couldn't ask for better results. Since I "hose up" every night and sleep with the mask all night long without taking it off, I couldn't ask for better compliance either.

Another plus: my frequency of "central" or clear-airway events has gone down. I now only have one or two a night compared to the 10-20 I used to have when I first started in June.

All indication is that my treatment is working effectively, thanks in large part to the support and information from my peers on this forum.

Lately though I feel as if I've come down from the initial "high" I got on CPAP, for lack of a better word. I'm feeling tired. Last night I went to bed early and got 10 hours of sleep. I had trouble getting up today (wife pulled me out of bed) and when I got up I had bags under the eyes... something I hadn't seen since before CPAP.

The flow charts for last night are posted below along with the summary data. I've compared them to ResScan and can confirm their accuracy, but I'm posting the SleepyHead data because it presents better.

Any thoughts on why I would feel like crap after a long night of good sleep? It's been a trend lately and I want to nip it... get back to feeling rested again.

A couple things:

* I did have a couple nights in the last week where I got less than full sleep (4-5 hours). I believe in sleep debt personally, but some doctors say that one good night's rest should be sufficient. Anyway even after a great night, I've been feeling sluggish & foggy.

* There were a couple nights recently where I experienced some night time blood pressure spikes (that warm / tingly / panicky feeling that we apneacs are all too familiar with). I slept through it. The CPAP data looked normal and AHI was below 1.

I have a pulse oximeter on order and am anxious to start comparing those results with my CPAP data.

I appreciate your thoughts on this and thanks for the continued support! It's been ups and downs, but I feel like I've come a long way already.

[jgjones1972]

Looks real good!



Don't get discouraged.

I think it's normal. I hit a slump at about 3 months in. I've been at it for almost a year now and I still have periods in which I go a while sleeping a lot with great numbers, but not feeling as good as when I go through periods having trouble getting to/staying asleep and averaging a lot less sleep, but feeling great. Things are leveling off though; but very slowly.

There is so much that isn't yet fully understood or known about sleep that offering any answer other than "we are still adjusting" would just be a wild guess.

Hopefully you will be spared the "absent minded" phase I went through at about 5 months in. I would spend a large part of my day looking for things I had set down, that I was just using a few minutes before, but had completely forgotten where I left them. That phase lasted a couple months. I never had that problem before or since; but I chalk it up to therapy because it was happening at the exact same time as a phase I went through in which I was only averaging 6 hours of sleep a night, but springing out of bed every morning and feeling like a champ all day.

It seems like most of the standard indicators of good therapy (blood pressure reduction, acid reflux resolving etc.) happen fairly rapidly, but many others can take a very long time. Many say a year or more, and that is probably assuming optimum therapy. I'm of the opinion that the major stuff probably takes a year or so, but there are probably many things having to do with sleep quality that the body could take several years or more to adjust to.

You are doing great, your therapy looks to be tuned in near perfectly. Hang in there and don't get discouraged. It is probably just a phase.

It never hurts to mention it to your doc, but when I did during my first slump he told me that we could do a full blood work up but it would be a waste of time because he figured everything would still be all monkeyed up because I was still in an adjustment phase.

[Paptillian]

Things are leveling off though; but very slowly.

That's encouraging to hear; thanks! I hope not to be forgetting where I put things, though that already happens from time to time.

My follow-up with the sleep doc is set for next month and I'll be sure to bring it up.

[Sleepster]

I agree that slumps are a normal part of the process. Last month my wife was out of town for a week, my job arrangements had temporarily gotten stressful, and to top it off I pinched a nerve in my lower back. I slept terribly for a few nights, waking up drenched in sweat during the night, and feeling like crap. My AHI went up.

It's taken a few weeks to get back to normal.

[Mark Risley]

I have had exactly what you are describing. Wake up, good night, 9.6 hours, no leakage etc., only to get up, come back to bead after brushing my teeth and lay there in bed feeling exhausted. Like I'd been in a heavy weight prize fight. For me, my body was still struggling for more air! So give it more air! I suggest moving the air pressure up little by little until you feel better.

[jgjones1972]

I have to very firmly disagree with the recommendation to increase pressure. (WOW! I think this is the very first time I've ever ever said that! )

The numbers look great...the chart looks good. CAs are going away...pressure looks to be tuned in near perfect. Looks like a perfect time to just leave it alone for a while.

The machine is doing its job!

In the long run, when CAs are very few, you may find increasing the minimum by 1 to 2 centimeters (at most) may give slightly (very, very slightly) better numbers. But that's hardly a concern at this point.

Many would be very, very happy to get their therapy tuned in this well.

If I were to suggest any change at all, it would be to start thinking about gradually eliminating EPR.

Just my two cents.

[Paptillian]

I've been debating whether or not to raise the min. pressure to 5 instead of 4, and is something I wanted to discuss with the doc. Breathing at 5 feels a little more comfortable than breathing at 4, but more pressure is more pressure.

jgjones is right, the data looks too good to mess with. What I'm wondering is if going from 4 to 5 would have any real value to me besides a comfort tweak. One of the goals of the auto algorithm is it tries to administer the minimum pressure necessary which is something I can appreciate. Raising it needlessly would defeat that goal.

Regarding EPR, is the concern that EPR affects treatment, or that it increases central apneas?

[zonk]

Any thoughts on why I would feel like crap after a long night of good sleep? It's been a trend lately and I want to nip it... get back to feeling rested again.

Numbers are useless if you,re not getting a restful sleep, first get decent sleep and then look at the data. Leak numbers might be within the acceptable range but those spikes (also correspond with spikes in pressure) might indicate some mouth leaks, escape air thru the mouth can compromise the therapy. Chinstrap or full face mask may help (full face mask allows to breathe thru your nose or mouth without any compromise)
You've asked for any thoughts ... my thoughts are:
1- Do nothing ... wait for the oximeter to arrive so you can check oxygen desat during the nights
2- Increase the minimum pressure by couple of cmh20 together reducing EPR or even turn it off completely. EPR does not drop pressure below 4 so if the minimum pressure at 4, both inhale and exhale at 4 too

Others things might also help, try to sleep on your side and keep sinuses clear

[archangle]

Even in my pre-apnea days, if I got a really long night's sleep, for instance, sleeping in on Saturday, I'd often feel tired and worn out the rest of the day. I'd even find that if I got 10 or more hours of sleep, I'd need a nap in the afternoon.

Personally, I find I feel better if I raise my minimum pressure a bit above where my AHI goes basically to zero.

[Sleepster]

I don't believe that raising the pressure to give yourself a greater flow of air is advisable. The pressure is used to provide a splint to keep the airway from collapsing, not to force air into your lungs to help you breathe. Even at the lowest possible pressure of 4 cm you're getting a greater flow of air than you do when you're awake and not wearing your mask.