PotatoEater wrote: ↑Wed Sep 04, 2024 9:40 am
I've been on CPAP for a while, and although I've gotten excellent data results I've never slept well. I was diagnosed with very mild sleep apnea, started with APAP 4-20 with EPR 3,
then later switched to a bilevel to see if I could reduce flow limits. Despite a very low event count I was still waking up early and un-rested. For this reason I suspect I have UARS of some kind.
The data you posted does not show any flow limitations of significance. In other words, on the nights you posted data for, the pressure settings were plenty for smoothing out any kind of UARS-related flow limitation problems as well as preventing almost all obstructive events.
But your
flow rate curve seems a bit "spiky" when looked at in the given (full night) scale. Which begs the question: Are you having a lot of
spontaneous arousals that you don't remember and that are
not caused by sleep disordered breathing? And if you are, what can you do to try to minimize the number of spontaneous arousals?
Please keep in mind that minimizing spontaneous arousals can be devilishly hard---specifically because they're not caused by something that is easy to fix.
The main culprit I can identify is my nasal breathing, sometimes I wake up with it being difficult to breathe through the nose since I have narrow nasal passages and chronic allergies. I've been able to minimize my congestion with nasal spray and allergy shots, but it still persists. As for my PAP machine, I've tried a whole lot of guessing as to what settings I should be using, but it seems that nothing works.
First, nighttime nasal congestion might be part of what's causing some of the spontaneous arousals. When dealing with nighttime nasal congestion, the settings to look at are
not the pressure settings. Rather, you need to think about the settings you are using on the humidifier and heated hose (if you are using a heated hose).
So more questions:
1) What humidifier setting are you using?
2) Are you using a heated hose? If so, what is the hose temp set for?
3) When you are dealing with
daytime nasal congestion, does taking a hot steamy shower help clear your congestion or does it make it worse?
4) What kind of nasal spray have you been using? Something like Flonase (i.e. a nasal steroid)? Or something like Afrin (a nasal decongestant)? Or just a plain, simply saline spray?
5) Have you ever tried a neti pot or nasal rinse?
As a side note, I'm wondering if my nasal breathing is something I should be concerned about. I can just open my mouth if I have trouble breathing right?
If you use a full face mask you can open your mouth and breathe through it without causing large leaks that can lead to ineffective therapy.
If you use a nasal mask or a nasal pillows mask, opening your mouth up and breathing through it is likely to cause some significant large leaks that will adversely affect the efficacy of your xPAP therapy as well as lead to some significant dry mouth problems.
Also worth pointing out: Both small, pesky leaks and official large leaks can cause spontaneous arousals where you wake up just enough to try to fiddle with the mask to fix the leak.
Later you write:
PotatoEater wrote: ↑Wed Sep 04, 2024 11:17 am
When I say I don't sleep well usually it means that I wake up too early - at like 4 or 5 am. I'm not sure if I actually fall asleep again when I stay in bed for an hour or two longer after that. I don't feel very rested during the day, I'm quite drowsy but it's masked with anxiety. I assume that anxiety stems from poor sleep.
As hard and as unwelcome as it sounds, you may be aggravating the problem by lying in bed for an hour or two after you wake up
worrying about your inability to get back to sleep. I bet you also do a bit of "clock watching"---as in calculating how much time you have to try to get some sleep before your alarm goes off and it's time to get up anyway.
In all seriousness, you may be better off just getting out of bed when you wake up and you can't get back to sleep within about 15 minutes. Do something relaxing and
fun, but quiet. Allow yourself to
enjoy the peace and stillness of the house and the early morning. And if you find yourself starting to yawn in an hour or so, go back to bed and sleep some more until it is time for you to get up.
As for the anxiety: I think you've gotten yourself into what's called a
positive feedback loop: The worse you sleep, the more anxious you are about a lot of things, including the "bad sleep", and the more anxious you are, the worse your sleep is. In other words, the bad sleep and the anxiety feed off each other and your trapped in an escalating cycle:
.... bad sleep causes anxiety which causes more bad sleep which causes more anxiety which causes more bad sleep which causes more anxiety ....
And it doesn't matter which came first, the bad sleep or the anxiety at this point.
Breaking out of nasty positive feedback loops is difficult. In your case, I think it is important to do your best to not get over anxious about the sleep quality, even though that's a very, very hard thing to do when it feels like it's been months since you have slept well enough to feel genuinely good during the daytime.
You also write:
PotatoEater wrote: ↑Wed Sep 04, 2024 11:40 am
I'm trying to adhere to CBT principles (avoiding going to bed when not tired + having a consistent bedtime), so I try to go to bed at 11:30 pm.
Of course, sometimes I get too fatigued and go to bed early, which usually doesn't work.
More questions: What happens when you get so fatigued that you go to bed early? How does this
not work for you? Do you mean you can't get to sleep even though you are very, very
tired and exhausted and physically fatigued? Or do you mean going to be early increases the chance that you will wake up at 4:00 AM and not be able to get back to sleep? It's important for us to understand what goes wrong when you just go to bed early.
And some more questions:
1) What is your desired sleep schedule? In other words, when would you prefer to get up each day? And when would you prefer to go to bed each night?
2) Any chance that you more of a morning lark than a night owl? By that I mean: Is it possible that your body would prefer to be on an earlier sleep schedule than your brain thinks is appropriate? As an example, there are plenty of people out there whose body prefers to sleep from 9:00 PM to 5:00 AM instead of from 11:30 PM to 8:30 AM. And if a 9:00 PM to 5:00 AM sleep schedule works for their lifestyle, then they're happiest just going to bed rather early and getting up at the proverbial "crack of dawn".
It's important to answer
both of these sets of questions before trying to set up a consistent sleep schedule for yourself. If your body wants to be a morning lark, you need to set both a bedtime and wake up time that is consistent with when the body wants to be asleep, even if the brain has the knee-jerk reaction that nobody in their right mind wants to get up at 4:30 AM every day.
Best of luck in sorting out a sleep schedule that works for both your body and your brain. And I say that as a night owl who has had to accept that for the most part my body would prefer to sleep from about 2:00 AM to about 9:30 AM most of the time.
Finally you write:
PotatoEater wrote: ↑Wed Sep 04, 2024 11:41 am
One of the things I'm worried about is that I feel like maybe CPAP therapy is or has worked just fine for me and I'm stressing over the settings for no good reason. While I have seen marginal improvement ever since I started (I don't wake up every 2-3 hours, and I don't get heart pounding when I wake up anymore),
I feel like I still have many sleep apnea symptoms - trouble sleeping enough, anxiety, heart palpitations, fatigue. I've been on CPAP therapy for around 5 months now.
First, it's worth noting that CPAP is a process. It does take some people many months to start feeling genuinely better. And when "feeling better" finally starts, the difference can be subtle and easy to miss. In my case the first signs that CPAP was doing something positive for me was when I noticed the phrase "woke up with no hand or foot pain" in the insomnia log that I was keeping during my first War on Insomnia. I'd been waking up feeling like my hands and feet had been tightly clenched into fists all night long for several years before my OSA diagnosis. I think it was a flight or fight response that was happening every time I had a hypopnea or apnea before my diagnoses.
Second, not everything is related to OSA and CPAP. CPAP fixes one thing----sleep disordered breathing. It does not fix
bad sleep caused by anything other than sleep disordered breathing. If there are multiple causes the sleep is bad, then fixing the sleep disordered breathing by using CPAP can still leave the person with
bad sleep caused by other things. In your case, those "other things" might be as simple as getting a better handle on the nighttime congestion and whether its causing microarousals at night. Or it might be as complex as dealing with the "wake too early and can't get back to sleep" type of insomnia that you've described. Or it might be a combination of both of them. Or it could be something else.
Third, daytime fatigue and heart palpitations are symptoms that can be caused by a whole lot of things other than
bad sleep and (untreated) OSA. It's worth talking to your primary care physician and specifically asking them: What other than sleep disordered breathing and my current bad sleep might be causing these symptoms that ought to be investigated? Should I have a referral to a cardiologist to find out whether the heart palpitations are a new health problem that needs to be treated as a heart condition?
Joined as robysue on 9/18/10. Forgot my password & the email I used was on a machine that has long since died & gone to computer heaven.
Correct number of posts is 7250 as robysue + what I have as robysue1
Profile pic: Frozen Niagara Falls
