I was diagnosed with moderate OSA last December and began CPAP treatment in January of this year.  I was experiencing low energy levels and depression for a few years prior to my diagnosis which in turn affected my marriage and made me a generally unproductive person.  

On top of the OSA, I had poor sleep hygiene and would stay up later than I should.  I had no sleep pattern and would go to bed anywhere from 9PM to 2AM.  The times that I would go to bed at a reasonable hour, I would have difficulty falling asleep.  I would also have one or two drinks at least 2 times at night during the week and play on the computer before bed.

I have also been practicing a martial art since I was 24 (I am 40 now). The classes that I attend are once or twice during the week and can go quite late.  I often come home around 11 and generally have difficulty getting to sleep after class.  Most of the time I would be dragging myself through these classes and the only way I seem to make it through them was by having some sort of caffeinated beverage.   Obviously this would not help with my sleeping.

My loud snoring would keep my wife awake at night and would drive her out of the bedroom most nights.  She had suggested that I had Apnea for years because she would notice my breathing stop while I was asleep.   She had made me an appointment with a sleep Dr and I had a sleep study done.   At the same time a friend of mine was diagnosed with Apnea and had a very positive experience with the CPAP.

I was very encouraged that I had found something that could fix my fatigue/depression.

I had 2 sleep studies done.   I have a hard time falling asleep anyway and sleeping with wires all over me in a strange room was a difficult experience for me.  The first sleep study found that I have moderate OSA.  During the second sleep study, they had me on CPAP.  I almost gave up during the second study because I could not tolerate 2 masks that they tried on me.  The third mask I tried was a nasal type and I finally fell asleep with that.  

I was determined to have the CPAP work for me.  I had difficulty sleeping with the mask and had a hard time with adjusting to some lifestyle changes…like not staying up and drinking til 2AM.    I also noticed that I was constantly having nasal congestion which made wearing the nasal mask more difficult.  

I got a prescription for Ambien to help with my sleep onset and to help me with adjusting to the mask.  I started using nasal sprays and saline rinses for my congestion which seemed to help.  

I gradually started being able to wear the mask more but could only use it 4- 5 hours during the night.  At the same time I was improving my sleep schedule and stopped drinking during the week. For the first 2 months, I did notice some improvement during my waking hours.  I was no longer depressed and did seem to have more energy on occasion but was not feeling the improvement I was looking for.

At this point I was even more determined to get this thing to work.  I purchased the Res-Med software and data reader to look closer at my AHI and compliance.  I was immediately able to get more hours on the CPAP.  I was consistently getting 5-6 hours and sometimes 7.  My AHI was somewhere around 5-6 (AI around 1-2, HI 4-5)

I was excited that was getting that much time on the thing but I was feeling more tired than usual particularly on nights that I used it more.  I was feeling sleepier during parts of the day. I was having a hard time keeping my eyes open during meetings and when I came home, I would fall asleep on the couch for a few minutes.

One night I was able to get almost 8 hours on it and was enthusiastic upon awakening.  I started to go through my morning routine and started to feel real sluggish and fatigued.  I looked at my data and noticed that my AHI was 9.  My AI was low around 1-2 but my HI was close to 8.  I also noticed that my breathing seemed shallower during the day….not sure if that was real or not.

I made an appointment with the Sleep Dr to discuss my data and my sleepiness as it related to my use of the CPAP.  I didn’t get to see the Dr. but was able to talk to the Practitioner.  She concurred that my data looked pretty good, leaks low, ect…I asked about my high hypopnea and was told that the CPAP was too aggressive at recording the HI and that it didn’t mean anything.  I said OK but that it seemed to correspond to my fatigue. This was dismissed.  She then told me that what I was experiencing was due to my Ambien use and that what I was feeling was an “Ambien hangover”.  I mentioned that that couldn’t be since I took the medication the previous night and had only 4 hours with the CPAP and feel fine.  That was dismissed.  

I was basically told to stop taking the Ambien and the HI reading means nothing.

I feel that the Ambien has made a huge difference in my ability to fall asleep at a reasonable hour and feel that it has been very beneficial to me.  I have since tapered off it’s use but still use it.

I went to my family Dr. who quickly prescribed me Provigil to use in conjunction with the CPAP.  I found that with the use of this medication that my sleep has even further improved and that I am more alert during the day and a more functioning person….just ask my wife.

For the month that followed I did not use my CPAP very often to the point that I would not use it at all some nights.  I would just fall asleep and sleep soundly through the night.  I also noticed that my wife would not wake up from me snoring.  I told her that if she does hear me snoring that she should wake me up to put my CPAP on…and she occasionally does.

I had a follow up appointment with the my Sleep Dr. I wasn’t sure if I was going to go because I knew that I would catch an earful for not using my CPAP.  I decided to go so that I could discuss what I was experiencing…more use, more tired…I wanted to find out about an Oral appliance option and had questions regarding snoring and nasal congestion.  I decided that I would not tell them about being on Provigil.  I did not bring my data card because I did not have much data on there anyway.  

The Dr began to lecture me immediately about how she could not possibly work with me because I have never brought her any data….I said I brought in at least 3 months worth of data the month before…..well she found that.  She said it looked good and that I was doing well.. She asked why I had not been using the CPAP and I explained that I was feeling more tired with it the more I used it.  She explained that I was more tired because “My sleep bank is empty”.  Sorry, I don’t have a sleep bank.  I was really hoping for a more technical answer.  

I asked about what to do about my nasal congestion.  She told me I should “take a shower” to clear my nose and that saline, Nasonex…ect are not good.  I was hoping she would recommend me to an ENT

I asked about an Oral Appliacnce….she gave me a number and told me that it was a “!@#! shoot”.

She said she wouldn’t even consider something like Provigil (I didn’t even ask) until I had averaged 7.5 hours in a month with CPAP an that the insurance company wouldn’t cover it with my measly 5.8 hours avg of compliance the previous month…

She said that I should wear the mask no matter what and that any time I sleep without the CPAP does not count as sleep.  She said that as long as I had the CPAP on that that counted whether or not I was awake.

I used he CPAP 3 times this week to give it another try and again I have experienced the same… 6 hours on Monday…tired….3 hours Tuesday….not so bad…1 hour if that last night and I feel pretty good today.

I don’t feel so good about CPAP right now and I don’t want to go through life with untreated OSA.   I don’t want lose my job or die in a car accident either.  I have an appointment with a Dentist next week who does Oral Appliance fittings.

Not sure what to do from here

I have had the c-pap for almost 1 & 1/2 months and still getting adjusted.  Some nights are good and some are not but I continue to try and wil not give up becasue I have felt the effects and it has been good; more energy to do chores, excercise, etc.  This week not so good becasue I have been sick.  I have to take Ambien to sleep because I have tried so many times without it and simply cannot and I need the mask.  I am glad you cut down on your alcohol consumption becasue it is not good with medication.  I am a recovered alcoholic 22 & 1/2 yrs sober so I do not have to worry about that. I have depression and it has effected my marriage in the past also and I take medication for it. I hope you can find a dental device.  I am going to stick with the c-pap for now.  Everyone on this forum has said it takes time to get used to the mask and to feel better so I am being patient.  Good luck to you.

tuna; I am not sure why she had a problem with Nasonex, but whe was right about oral devices being a “!@#! shoot”.  Oral devices with mild apnea are probably a coin toss, but with moderate apnea they are a !@#! shoot.

You may or may not have a sleep "bank" but you quite likely have a sleep deficit.

Bearded One wrote:

tuna; I am not sure why she had a problem with Nasonex, but whe was right about oral devices being a “!@#! shoot”.  Oral devices with mild apnea are probably a coin toss, but with moderate apnea they are a !@#! shoot.

You may or may not have a sleep "bank" but you quite likely have a sleep deficit.

Thanks for the response.

I guess I wold have preferred some less "simplistic" responses from my Dr.  Do you have any objective information on success rates with CPAP as compared to an Oral Device?  

C_R_A_Ps is a game i don't understand. maybe if you speak in terms of poker i could relate better.  "CPAP is like having Aces in the hole (with an 80% chance of winning heads up)"  maybe an oral applice is like going for a flush draw?

She seemed to have a problem with everything that wasn't a CPAP.

What is the current thinking as far as the sleep deficit?  is this thought to build over time?  can you make up for lost sleep? I understood this differently in the past that you couldn't make up for sleep that is lost.

Hi Tuna,

I think that it’s worthwhile for people to explore other treatment options. My suggestion would be to get an initial consultation with a dentist who is certified through the American Academy of Dental Sleep Medicine. Also, if you have not seen it, there’s a Oral Appliance Forum on this site.

At the same time, keep learning about possible adjustments that might improve your ability to use the CPAP. CPAP is considered to be the “gold” standard of treatment for lots of reasons. It seems to me that the biggest problem is the number of hours that you are able to use it. Can you describe what you think is the biggest problems with it that might be limiting the number of hours that you can use it? Either here or in new future threads.

Regarding Nasal congestion:
Are you using a humidifier? Is it possible for you to experiment with changing the settings? Most people report that increasing the humidity will help with congestion, but there are some people who prefer less or no humidity.

See the thread Sinus Irrigation How-To Update located towards the top of the Help Forum. It is a permanent “sticky” thread that was started by, Vicki, one of the great moderators of this site. It’s worthwhile to try sinus irrigation to help with congestion. It has helped many people, and it is recommended by ENTs.

Good luck to you.

The sleep deficit is a figurative term.  Sleep apnea causes damage to various organs in your body, including your brain and heart (the sleep deficit).  Proper sleep allows your body to heal itself and correct the damage caused by the lack of proper sleep and by the oxygen deprivation.  This damage can take weeks or even months to heal.  When people first start using CPAP they tend not to be 100% compliant, which causes the healing to be even slower than it would be with 100% compliance.

The use of Provigil (speed) and Ambien (sleeping pills), (and alcohol?), isn't really helping your body heal itself; and it is hard to say what it is doing to your sleep architecture.  You also have a long history of horrible sleeping habits.  

There is also the fact that you were hiding your use of sleep modifying drugs from your sleep doctor and you were being deliberate deceitful when you didn't provide her your recent CPAP data card.  

With all these drugs and the fact that you were hiding important information from your sleep specialist, it really isn't proper to blame your CPAP for your sleeping troubles.

One thing that many people just do not get is that regardless if they feel less tired or not with the xPAP...their body is healing...and without using the xPAP they are only adding more stress on their vital organs.  CPAP is a full time thing...not a few hours a night or only at night but not with naps...everytime one does nto use the PAP they are basically starting over from the beiginning.  The best way i can describe in layman's term as to what SA does to you without CPAP:  Put a plastic bag over your head and pull it tight...hold it there for up to a minute...do this several times an hurs and see how you will feel...that is SA while you are sleeping and you do not realize it.

Surgery and oral appliances are only 50% effective in people with mild SA.  It is not reccomended for anyone with moderate or severe SA...And this is ony people with Obstructive SA.  No way will it work for those with mixed or central SA.  OP: do you even know which type of SA you have?

You can deal with the xPAP...you are both physically and mentally strong enough to handle it.  It is not all about the fatigue.  That is only a side effect of untreated SA.  It takes time to go away...and...the longer one goes without treating it the more damage becomes irreversable.  Lack of O2 kills brain cells...dead brain cells equal fatigue.  And yes, sleep debt is a real thing.

Hope you can work it out and come to terms with this....not the same as walking around with a tennis elbow.

My limited use of the CPAP seems to be due to me waking up with the mask being very uncofortable.  the feeling of "Pressure" on my face. When I take it off, I tend to fall asleep immediately with the feeling of extreme relief.  I was able to fight that feeling to some degree and fall back to sleep with it again on occasion.

The nasal cogestion is more a problem when I first get the mask on.  I played with humidifier settings to get the maximun humidity without pooling.  that seems to work.  My question is how much is my nasal cogestion contributing to my apnea?  There seems to be some correlation.  My snoring seems to have decreased now that I'm addressing the cogestion.

I have tried the sinus irrigation with some mixed results.  So I'm wondering if I have something structual going on.

Is there CAT scans of damaged organs before CPAP and of healed organs after CPAP?  

Yes, I have a long history of horrible sleep habits and drug use beyond what I have described here.  My caffiene had been way out of control and has since been reduced considerably. I Don't drink at all during the week.  i may have simply replaced these habits with others.  Provigil is hardly "speed" and I seem to have positive results from it.  The Ambien has helped considerbly as well and i'm sure it is a better alternative to drinking.  Overall I feel much healthier now than i did 6 months ago.  My relationships have improved as well as my productivity.

I felt that I was pretty open and honest with my sleep specialist.  There wasn't anything on my data card to hide.  Provigil was prescibed to me After my experience with the CPAP. I wanted answers to specific questions regarding that time.  I chose to not dislose my Provigil use.

tuna wrote:

I gradually started being able to wear the mask more but could only use it 4- 5 hours during the night.  At the same time I was improving my sleep schedule and stopped drinking during the week. For the first 2 months, I did notice some improvement during my waking hours.  I was no longer depressed and did seem to have more energy on occasion but was not feeling the improvement I was looking for.

One night I was able to get almost 8 hours on it and was enthusiastic upon awakening.  I started to go through my morning routine and started to feel real sluggish and fatigued.  I looked at my data and noticed that my AHI was 9.  My AI was low around 1-2 but my HI was close to 8.  I also noticed that my breathing seemed shallower during the day….not sure if that was real or not.

For adults, AHI < 5 is considered to be normal. So it's worthwhile to try to determine if it is possible to get a lower AHI than 9 during your CPAP treatment. For that purpose, some questions:

Is the diagnosis purely Obstructive sleep apnea? meaning few/no mixed or central type apneas?

What is the prescribed pressure setting? What was your AHI determined to be (specifically at that pressure setting) from the titration study?

The Obstructive condition is often worse when one is sleeping on their back (supine) or during REM stage sleep. Is either of these characteristics involved in your case? You should be able to find out from either the full sleep study report or the sleep doc.

tuna wrote:

My limited use of the CPAP seems to be due to me waking up with the mask being very uncofortable.  the feeling of "Pressure" on my face. When I take it off, I tend to fall asleep immediately with the feeling of extreme relief.  I was able to fight that feeling to some degree and fall back to sleep with it again on occasion.

When you say "Pressure" do you mean that the mask itself feels like it is on too tight? or does it feel like air-pressure against your face?

Or does it feel like you have difficulty exhaling? or that you are not getting enough air to breath?

There are three basic types of masks: Nasal, Full face, and Nasal pillows. Which one are you using?

Is it possible that you are breathing through your mouth? This is common in sleep apnea patients. Indications of this would be noticing it, feeling dry mouth. It can worsen nasal congestion. This is very important because breathing through the mouth can reduce the effectiveness of treatment.

tuna wrote:

Yes, I have a long history of horrible sleep habits and drug use beyond what I have described here. .

Has it occured to you that this history may have been strongly affected by the sleep apnea.

The poor quality of sleep from having sleep apnea may make it difficult for people to develop regular normal sleeping schedule. The drug use may have been an effort to self-medicate feelings of sleep deprivation. Sleep deprivation is a very difficult state to describle, but people want/need something to help them feel better.

There's probably research out there on before and after CPAP.  Many testimonials on here regarding diabetes beign easier to control...less diabetic meds needed, BP levels down to normal..arythmias(sp under control, less bladder infections, better cognitive issues, increased libido, weight loss, less need to self medicate with substances, depression goes away and so on.  Problem with SA is that the longer left untreated the more damage is done and usually irreversable.

If you are prone to depression then SA may not be causing the depression, might be making it worse but not the core cause...you may have to treat that indvidually.  Many substance abusers have underlying, minor psychiatric issues that can be easily regulated.

Let's get you through the mask issues...thee are several reasons as to why you are havign problems with it anywhere from anxiety to fit and mouth opening.  There are tried and true tricks for all situations.  Communicate them and we will see what we can come up with...as long as you are willing to try a few things.
.

here it goes...

from my sleep study:

AHI: 21  (this was all supline. felt restricted with all the gear)
REM AHI: 38
Oxyhemoglobin desaturation nadir: 87%
Arousal Index: 24

Total Apneas: 131 (in 7 hours)
2 Central
101 Obstructive
28 Mixed

My pressure setting is 8
I use an Autoset Vantage s8 w/ an Opti Life nasal pillow mask.
I do have a dry mouth when using the CPAP and do catch myself with my mouth open.
The data I have suggests that the leaking is in an acceptable range. (95th percentile 10.8)
On 7 occasions within a months worth of data my AHI was above 5 and sometimes as high as 10-12 with most the events being Hypopneas.

I have a hard time keeping the mask on for more than 4-5 hours at a time.  It seems like the times I exceeded >6 hours resulted in a sluggish feeling the following day.  I also found myself falling asleep at work and napping more than usual.

I wake up at least once or twice a night with desire to remove the mask.  I do feel like I am not able to take full breaths when wearing the mask.  The "pressure" I feel is a combination of the feeling of the mask on my face and the feeling of the actual air pressure in my nasal area.  The removal of the mask results in a feeling of relief.

i also prefer to sleep on my side and stomach which is combersome with the mask and tends to cause leaks.

tuna wrote:

Total Apneas: 131 (in 7 hours)
2 Central
101 Obstructive
28 Mixed

It is my understanding that you would qualify for a diagnosis of Obstructive sleep apnea. But about 20% of the respiratory events are not Obstructive, instead they are Mixed/Central. CPAP may not be the best type of PAP device to treat those types of events.

What did the results of your titration study look like? Were there Mixed / Central / hypopneas occuring during the titration study?

Quote:

I use an Autoset Vantage s8 w/ an Opti Life nasal pillow mask.
I do have a dry mouth when using the CPAP and do catch myself with my mouth open.

This indicates mouth breathing, and your machine reports an AHI of 5 with an occasional 10, which in on the high end, although it is not that high.   Your mouth breathing may be minimal and your machine may be able to compensate for it most of the time; this would explain the occasional 10 AHIs.  You may benefit from a full face mask, which should at least keep you from having a dry mouth and may eliminate the 10 AHIs.