OSA and Sleep Aids...Lunesta, Ambien, etc.

[MellifluousBlues]

Hello all,
I am a noob to this forum but an OSA patient for over six years now. I have a few questions for whomever cares to share or is experiencing the same issues I have or has any idea/information that might be of help. But first the history...at least as completely as I can present at the moment.
When I was first diagnosed with OSA my first poloysomnogram showed an AHI of 50/hour and an RDI of 63/hour. I was miserable to say the least. I was put onto CPAP @ 11cmH2O and never really had any major compliance issues. Within a couple of days the chronic headaches that I would get, had been reduced and I started to feel a spring in my step again. Things were starting to look up.
Within a few months though, things started going backwards in terms of excessive daytime sleepiness. I brought this issue up with my doctor and was put on Provigil for EDS...starting @ 200mgs and working up to 400mgs before I stopped taking it all together. Even @ 400mg of Provigil I was still dealing with chronic EDS. At this point I had been taking Provigil for around a year or more and never found that it really did what it was suposed to and was only making profit for yet another drug company.
Another thing that I tried was using sleep aids to see if the "quality" of my sleep would be improved. I started with Ambien...before it went through it's negative publicity event...with ho-hum results. Then switched to Lunesta @ 3mg per night right before bed. Lunesta has given the best results and truly does seem to give a better "quality" of sleep, with some improvement in regard to EDS...for awhile. I started out taking Lunesta nightly but over time it had lost it's efficacy. At this point I only take it on nights when my mind is reeling and I know there is no way to fall asleep for a full nights sleep without some sort of help.
My first CPAP machine was a GoodKnight 420G with a heated humidifier and an F&P Zest. Never had any problems with this machine and mask combo of any kind. It served me very well for over 6 years. However at my last appointment I brought up the fact that I am still dealing with chronic EDS. So I was sent in for a CPAP titration to check for efficacy of therapy @ the pressure that I started out at 6 years ago with minimal PLM. The titration study showed a 94% sleep efficiency @ 11cmH2O and pulse/O2 never dropped below mid 90's. So the pressure I started out at hasn't changed. But I am still suffering from EDS. It is nothing for me to sleep an 8 to 10 hour night, and then nap another 4 to 6 hours out of any given day. I constantly deal with lithargy, moodiness, muscle fatigue, depression and headaches.
I passed all of this information onto my doctor and he set me up with a new machine with compliance tracking. Initially I wasn't sure why he wanted to track compliance as I sleep every night, all night with my mask on...as a matter of fact most nights I crave the peace of mind I get from knowing I can go to bed and have soothing humidified air going down my throat. If I'm in bed, I'm hosed. Then I started doing some digging online to see what machines were out there before I contacted my DME provider for the new equipment. It became clear after a couple days of research that CPAP therapy has come along way in the last six years. I was pretty much drawn to the S9 AutoSet with the H5i and have since made the purchase. I became a member here and have since been lurking and reading...allot. I got ResScan 3.14 installed on my laptop and it is now clear why the doctor wanted me to have a more current machine. There is allot more information available to a patient/careprovider via compliance tracking now than there was even a couple of years ago. It is like having a mini sleep study every night you turn your machine on and hook into it. A sleep study only allows for a "snapshot" in time of what is going on while we are sleeping. Now with the S9 and similar machines, we are able to capture a "film" if you will on a nightly basis. I am hoping that being able to monitor AHI and all other aspects that the S9 tracks will help to explain why I am still dealing with EDS.
I have been using the S9 for the last three nights and it seems to work well. I switched from the F&P Zest to the Swift FX as I have been getting pretty bad acne on my neck from having the headgear on my skin all night long. There is some leak with the Swift compared with the Zest but I'm sure some of that is finding the perfect strap adjustment. Last night I took an Ambien before bed as it was one of those nights and this morning loaded the SD card onto my laptop to find out I had an AHI of 1.4 last night. As I understand 1.4 is a pretty damn good night of sleep...anything under 5 being accpetable. However, as I look at my detailed information in ResScan, I can clearly see that there were multiple events in my flow chart that fell under that magical 10 second threshold that ResMed has set up on the S9.

So I guess the point of this thread is...
-Are there any others out there that are in the same boat and deal with some of the same symptoms of EDS and lithargy even though their xPAP compliance record is text book?
-Is anyone else using sleeping pills to improve the quality of their sleep? And has anyone found that these prescriptions make any difference how they feel the next morning...barring of course the "hangover".
-Is it possible that these "sub-apneas" are the root cause or are contributing to the EDS?

I am trying to get to the bottom of this as my doctor also ordered an MSLT within the next six months. I don't have a problem submitting to the MSLT...but am concerned about the can of worms that this might lead to...for example being diagnosed with Narcolepsy post MSLT. I have done some research on Narcolepsy and some of my symptoms match up, but then some don't. For instance, I do not and never have suffered from Cataplexy. I understand that Cataplexy doesn't present itself in every Narcoleptic...however, Narcolepsy is not a diagnosis I am willing to take on simply because my doctor hasn't come up with anything else. My wife and children are effected by my EDS on a daily basis and it is taking an effect on the entire family.
I'm at the end of my rope...have tied a knot in it...my hand is still slipping...someone, anyone...please help.

Also...
I can see a period of around 30 minutes at about 2AM this morning that my I had a series of these "mini" events. My "flow" graph became restricted...my "leak" graph shot up to over 30 LPM...my "flow limitation" graph spiked and the pressure went up from around 9 or 10cmH2O to over 13. Anyone have any idea what this might be about without looking at the actual charts?
I was wondering if perhaps my mask got off kilter and wasn't sealing properly maybe from moving in bed or something?

[Pugsy]

I can see a period of around 30 minutes at about 2AM this morning that my I had a series of these "mini" events. My "flow" graph became restricted...my "leak" graph shot up to over 30 LPM...my "flow limitation" graph spiked and the pressure went up from around 9 or 10cmH2O to over 13. Anyone have any idea what this might be about without looking at the actual charts?
I was wondering if perhaps my mask got off kilter and wasn't sealing properly maybe from moving in bed or something?

I cannot comment on the mini events as I don't know all that much about miniscule wave form data. You would need to post that data to get someone who knows the flow patterns input.

But I will tell you that the machines in APAP mode may try to fix a leak with an increase in pressure which in turn can feed the leak even more. At leaks above 24 L/min ResMed says that we can't rely on effective therapy or accurate event scoring. It is entirely possible that the mask became dislodged during movement in bed and subsequent leak made the pressure rise and possibly mess with event sensors. So anything reported during a leak near 24 L/min or above is usually suspect and I wouldn't spend a whole lot of time trying to sort through it. I would concentrate on what was showing at the other times when leak wasn't messing things up. We just can't accept what shows on the reports during a large leak as being accurate.

[MellifluousBlues]

I can see a period of around 30 minutes at about 2AM this morning that my I had a series of these "mini" events. My "flow" graph became restricted...my "leak" graph shot up to over 30 LPM...my "flow limitation" graph spiked and the pressure went up from around 9 or 10cmH2O to over 13. Anyone have any idea what this might be about without looking at the actual charts?
I was wondering if perhaps my mask got off kilter and wasn't sealing properly maybe from moving in bed or something?

I cannot comment on the mini events as I don't know all that much about miniscule wave form data. You would need to post that data to get someone who knows the flow patterns input.

But I will tell you that the machines in APAP mode may try to fix a leak with an increase in pressure which in turn can feed the leak even more. At leaks above 24 L/min ResMed says that we can't rely on effective therapy or accurate event scoring. It is entirely possible that the mask became dislodged during movement in bed and subsequent leak made the pressure rise and possibly mess with event sensors. So anything reported during a leak near 24 L/min or above is usually suspect and I wouldn't spend a whole lot of time trying to sort through it. I would concentrate on what was showing at the other times when leak wasn't messing things up. We just can't accept what shows on the reports during a large leak as being accurate.

That makes complete sense as all graphs correlate and "add up" to this exact thing taking place. It seems reasonable to assume that this was a leak that took place over about half an hour due to a change in sleep position and that it rectified itself after awhile. Thanks.

[Pugsy]

That makes complete sense as all graphs correlate and "add up" to this exact thing taking place. It seems reasonable to assume that this was a leak that took place over about half an hour due to a change in sleep position and that it rectified itself after awhile. Thanks.

I use APAP also. I have seen these leaks and spikes myself from time to time. I just mentally toss that time frame out the window. I figure I can't do much about the past and I can't trust the data so it is not much use to me. Now if it happened often I would maybe wonder a little more about how to limit it but it doesn't so I don't. One time I woke up with one of the pillows blowing air in my ear. It happens. I sometimes toss and turn a lot.

[Jay Aitchsee]

Hi Melli,
I think you got your answer on the leaks. The machine just can't compensate for the big ones, although it tries.
I've tried Ambien, Lunesta, and Provigil. I find a "little" ambien to be helpful. I split pills and take about 5 mg nightly. Tried Lunesta, didn't work for me. I've taken Provigil off and on for some time. I find it to be marginally beneficial with few (non for me) side effects.
I too, suffer from EDS, although my apnea is very well controlled with the use of APAP and ResScan. I have been diagnosed with severe PLMD and believe it may be the cause of my fractured sleep which results in very little deep or slow wave sleep.
To help me with this, I've added video recording with infra red camera, a recording pulse oximeter (CMS50E) and most recently a Zeo. I've only had the ZEO a couple of weeks, but I think it will prove to be very valuable in providing a subjective analysis of my nightly sleep. With this equipment, I can do most things a sleep lab can do at home every night. My doctor and I are now exploring gaba drugs for possible relief from the PLMD.
I guess the point of this, if there is one, is that I think the more you can discover about your personal sleep - what you are actually doing every night, the better chance you have of getting that "good night's sleep" we're all looking for.
Hope you get yours,
Jay