What does all of this mean?

[mcsheltie]

Here are my first two nights. Thursday night I spent most of the time fighting with the mask. But I figured out how to cohabitate with it by morning. Last night was a typical night for me. I went to sleep quickly and woke up frequently throughout the night. None of it was equipment related. Now I see the reason for it. What do I about it?

[robysue]

mcsheltie,

There's nothing in your first two night's of data that screams "FIX ME NOW". Your overall AHI is quite satisfactory for someone just starting out on this journal. Your leaks are not perfect, but they are quite acceptable in terms of therapy.

It takes time to get used to CPAP therapy and learn how how to sleep well with a six foot hose attached to your nose at night. But you've already made some progress: You didn't fight as many battles with the mask last night as on your first night.

You write:

Last night was a typical night for me. I went to sleep quickly and woke up frequently throughout the night. None of it was equipment related.

What do you think is waking you up? And how many times do you remember waking up?

And before CPAP, how many wakes would you typically remember in the morning? And what (if anything) did you remember about those wakes?

If your body is very accustomed to waking up fully (in response to apneas or anything else), it can take time for the body to learn that with CPAP it is *safe* to sleep soundly and not wake up at night. Some people's brains and bodies figure this out quickly---in the first couple of weeks. Most people take a month or two before they are sleeping soundly with the CPAP. A few of us, including me, take a lot longer.

Finally, how bad is your untreated OSA? In other words, what was your diagnostic AHI?

[AlanE]

Just two nights on therapy?

Go with the flow. Two nights on therapy is not enough time for your bod to get used to it. Given that your AHI is less than 5 I'd say you're doing a fine job so far. I've been on CPAP since March 2015 and I still get up during the night.

[mcsheltie]

mcsheltie,

There's nothing in your first two night's of data that screams "FIX ME NOW". Your overall AHI is quite satisfactory for someone just starting out on this journal. Your leaks are not perfect, but they are quite acceptable in terms of therapy.

It takes time to get used to CPAP therapy and learn how how to sleep well with a six foot hose attached to your nose at night. But you've already made some progress: You didn't fight as many battles with the mask last night as on your first night.

You write:

Last night was a typical night for me. I went to sleep quickly and woke up frequently throughout the night. None of it was equipment related.

What do you think is waking you up? And how many times do you remember waking up?

And before CPAP, how many wakes would you typically remember in the morning? And what (if anything) did you remember about those wakes?

If your body is very accustomed to waking up fully (in response to apneas or anything else), it can take time for the body to learn that with CPAP it is *safe* to sleep soundly and not wake up at night. Some people's brains and bodies figure this out quickly---in the first couple of weeks. Most people take a month or two before they are sleeping soundly with the CPAP. A few of us, including me, take a lot longer.

Finally, how bad is your untreated OSA? In other words, what was your diagnostic AHI?

I have been dealing with what I thought was insomnia most of my adult life (I am 60) My PCP put me on two Benzodiazepines for sleep. The last year or so I have been battling depression, brain fog and a SCARY lack of memory. I talked to my PCP about it and he wanted to put me on antidepressants. No thank you, I want to get to the bottom of it, not put a band-aid on it and make it worse. So I started seeing a functional practitioner. He suggested the sleep study. In the meantime, he has done thyroid, blood chem, hormone testing etc... I started researching and found out that the Benzos can cause all the problems I've been having. They are supposed to be a short term thing. I've been on them for 12 years! So I titrated off of them. Finally got in to the sleep study, which I thought was going to be a waste of time because I was sure I didn't have sleep apnea and was dx with... guess what! The tech said she wouldn't say I had any form of insomnia. Apparently Apnea was the reason I was constantly waking up. The two nights at the sleep center I never got out of stage 1 sleep. So here I am...

My normal sleep pattern is I fall asleep quickly (I actually did the same at the sleep center) I sleep for about 90 minutes and then I wake up. After that I doze/sleep for an hour, wake up, repeat. When I wake up I stay in bed and listen to a YouTube vid on my phone (screen off) and I usually go right back to sleep. If it is quiet I start thinking about things and then I don't go back to sleep. More and more I have to use the bathroom. But I think that is mental rather than physical. Lately I have been having problems with restless legs, which is a common Benzo withdrawal problem. But that too shall pass.

AHI at the sleep center was 30

[robysue]

My normal sleep pattern is I fall asleep quickly (I actually did the same at the sleep center) I sleep for about 90 minutes and then I wake up. After that I doze/sleep for an hour, wake up, repeat.

While you didn't get out of Stage 1 sleep in your sleep studies, wakes that are roughly 90 minutes apart are typically post REM wakes. So it could be that everytime your body tries to get into REM, you've been waking up from the OSA.

But since your body has been doing this for decades, you are going to need to realize that it's going to take some time for the body to learn that it's "ok" to actually stay asleep and go through a whole REM cycle.

When I wake up I stay in bed and listen to a YouTube vid on my phone (screen off) and I usually go right back to sleep. If it is quiet I start thinking about things and then I don't go back to sleep. More and more I have to use the bathroom. But I think that is mental rather than physical.

If the bathroom problem started before you started CPAP, then that might just be a symptom that your apnea was growing worse. Noturia---waking up needing to go to the bathroom---is a very common symptom of untreated OSA. It's often one of the first symptoms to disappear.

Lately I have been having problems with restless legs, which is a common Benzo withdrawal problem. But that too shall pass.

Good luck with the restless legs. I hope that as your body adjusts to no more Benzos, the restless legs abates. I wound up starting gabepentin this past summer on the suggestion of my sleep doc since since there's a family history of restless legs and I have continued to have far too many spontaneous arousals mixed in with several other official sleep diagnoses in addition to my OSA.

AHI at the sleep center was 30

That's border-line severe. Hopefully you'll have a smooth transition.

A book that may be useful for you to read is Sound Sleep, Sound Mind by Dr. Barry Krakow. It's technically a "self-help" book for insomnia, but it has some very high quality chapters on the mechanisms of sleep and how fractured sleep affects the body and brain. The second half of the book includes a discussion of the the role of untreated OSA in causing insomnia in many people. The book also includes a wealth of information about things to try when you just can't seem to sleep at night.

[Beej]

...The last year or so I have been battling depression, brain fog and a SCARY lack of memory. I talked to my PCP about it and he wanted to put me on antidepressants. No thank you, I want to get to the bottom of it, not put a band-aid on it and make it worse. ...

As someone who has the clinical diagnosis of depression, I want to note that an antidepressant is assuredly NOT a band-aid, when dispensed correctly. The antidepressant is supporting disordered brain chemistry that cannot fix itself. It is a medical/neurological problem.

I spent more than 20+ years coping with depression, without meds. Made it through college and grad school, too. About all I can say of that period is I survived it. Life had no joy, no fun. It was plodding uphill, through molasses, in January, every single day. When I finally got on an antidepressant that worked (and it took food not tasting good any more and then trying about 4 different ones), it made it possible to have a life besides trudging.

Short version: you might want to re-consider an antidepressant. Some of them, by the way, help with sleep disorders, despite their classification as an antidepressant, such as protryptiline and trazadone.

[mcsheltie]

...The last year or so I have been battling depression, brain fog and a SCARY lack of memory. I talked to my PCP about it and he wanted to put me on antidepressants. No thank you, I want to get to the bottom of it, not put a band-aid on it and make it worse. ...

As someone who has the clinical diagnosis of depression, I want to note that an antidepressant is assuredly NOT a band-aid, when dispensed correctly. The antidepressant is supporting disordered brain chemistry that cannot fix itself. It is a medical/neurological problem.

I spent more than 20+ years coping with depression, without meds. Made it through college and grad school, too. About all I can say of that period is I survived it. Life had no joy, no fun. It was plodding uphill, through molasses, in January, every single day. When I finally got on an antidepressant that worked (and it took food not tasting good any more and then trying about 4 different ones), it made it possible to have a life besides trudging.

Short version: you might want to re-consider an antidepressant. Some of them, by the way, help with sleep disorders, despite their classification as an antidepressant, such as protryptiline and trazadone.

Thank you! My depression was caused by the the drugs they gave me and sleep apnea. I have no desire for the side effects of antidepressants and what they can do to your brain. Getting my health back will take care of it.

[Sleeprider]

McSheltie, I am going to agree with the others, it is too early to start adjusting the machine to mitigate the hypopnea and RERA that is being recorded. That said, the RERA can be quite disruptive to sleep. You are on the right path to taking care of this by watching the data. As you know, you are on a single pressure and using an auto CPAP machine. So it is very likely that in auto mode, with a minimum pressure of 7, and maximum pressure of 10, you would continue to see a low occurrence of events, but variable higher pressure could probably clean up the hypopnea that are still getting through. You may want to discuss that possibility with your doctor later in the week. The sleep lab titration is only a snapshot of your sleep architecture, and it seeks the single pressure at which obstructive apnea is eliminated, and hypopnea is reduced to acceptable levels. That seems to be true in your case, but there is room for improvement if it doesn't clear up on its own.

[PsychoMike]

mcsheltie, a couple of things: 1) You mentioned fighting with your mask...it shows in the leak rate. Hopefully as you and the mask get better acquainted, it'll get a bit more under control.

2) Even with a nasal mask, starting off at a pressure of 4 seems dang low....and you're running far higher most (almost all) of the time that you are using your mask. In fact, it seems you're maxing out your pressure most of the time. I know you're just starting off, but I'd have a chat with your DME and let them have a look at what you've gleaned over the first few days to a week.

[rant] I don't want to be cynical, but a pressure range of 4-7 feels like a ploy to get an extra visit or two charged to your insurance. Too many folks come here complaining of the CPAP not working or feeling like they can't breathe and ripping the mask off their face every night (eventually followed by quitting therapy and throwing the machine in a closet). More often than not, the DME has set the starting pressure at 4 when these folks share their details. My personal view (and no, I'm not a Dr or RT, this is just personal opinion) is that initial set up should have a base pressure of 6 for a nasal mask and 7 for a full face....it's a little harder to adjust to (but EPR can help with that on ResMed machines), but you eliminate the "I can't breathe" feeling and give folks a better chance of being able to adjust to a mask and the pressure, meaning a better chance for therapy to work. [/rant]

[mcsheltie]

McSheltie, I am going to agree with the others, it is too early to start adjusting the machine to mitigate the hypopnea and RERA that is being recorded. That said, the RERA can be quite disruptive to sleep. You are on the right path to taking care of this by watching the data. As you know, you are on a single pressure and using an auto CPAP machine. So it is very likely that in auto mode, with a minimum pressure of 7, and maximum pressure of 10, you would continue to see a low occurrence of events, but variable higher pressure could probably clean up the hypopnea that are still getting through. You may want to discuss that possibility with your doctor later in the week. The sleep lab titration is only a snapshot of your sleep architecture, and it seeks the single pressure at which obstructive apnea is eliminated, and hypopnea is reduced to acceptable levels. That seems to be true in your case, but there is room for improvement if it doesn't clear up on its own.

Thank you! When I asked what does this mean, I was referring to all the data. Even tho I read over the pinned posts I still don't understand what a lot of means and how it corresponds to my sleep patterns. It's a foreign language to a newbie!