Confused with APAP results!

[roster]

Looks like you are taking good care of the numbers and 7.5 hours of sleep is reasonable. If your lifestyle allows it, I suggest gradually stepping up the duration and intensity of your exercise routine. Varying the routine may also help. We do best with a combination of aerobic and resistance exercise but be careful of your shoulder.

[grumpygirl]

Well, I should have know that the "bliss" would be short-lived!! Last night was HORRIBLE to say the least. I woke up so many times it was pitiful! I went to bed at 10:30 and woke up at 12:30 stayed awake til 3:00 or 3:30 finally dozed off til about 5:00 and then took the darn mask off and slept til 6:00.
I am so FRUSTRATED I cannot begin to tell you. I woke up with a horrible headache which I cannot get rid of. My neck is killing me and I couldn't for the life of me find a comfortable position as I was struggling to get back to sleep. This whole ordeal is beginning to really be a problem-I just cannot get a good nights' sleep more than once in a while. I feel like crying this morning. My results look like this: pressure: 9.6, Leak: .08, AHI: 1.9, AI: 0.4 (high for me), HI: 1.5. Why are my hyponeas always the things that raise my results?? Is it because my pressure is set too low? The APAP range I'm still using is 8.6-10.4.
I tried changing my pillows (not nasal but bed pillows) last night to the buckwheat hull pillow in hopes that it would finally give my neck enough support that I could go to sleep. That did NOT happen-so I went back to the contour pillow and just spent the whole night shifting it and arranging it to try to give me enought support without giving me so much that it made my neck hurt-hence the headache.
I know I sound like the worst complainer in the whole world but I am just so frustrated and tired that I am completely spent!!
Any suggestions or thoughts?? I so appreciate all of the comments you guys give-and I don't know what I would have done over the last 2 yrs. without you. I am just about ready to go back to straight cpap at the 10.2 setting to see if I can get a night or two of sleep. It seems like my senario is that when I change the machine from apap to cpap or cpap to apap I'll get a night or two of sleep and then it all falls apart again. What's with that?? Thanks-GG

[KatieW]

I had the S8 AutoSet II for 5 months, and could not tolerate even a narrow range in apap. On cpap, I did just fine. I think the changes in pressure disturbed my sleep.

I switched to cpap, at a pressure high enough to take care of most of the events, but without causing aerophagia. I started at cpap 10 with EPR of 2, then nudged it up .2 cm at a time.

Now that I'm using the S9, I am using apap, and doing fine. So it may be that with your particular xpap, you do better on cpap than apap. So why not just stick with that?

Hope it gets better for you soon.

[roster]

I had the S8 AutoSet II for 5 months, and could not tolerate even a narrow range in apap. On cpap, I did just fine. I think the changes in pressure disturbed my sleep.

I was at the sleep doc a couple of weeks ago and she said some of her patients report this same problem with ResMed machines in auto mode.

Will that machine detect resistance below the hypopnea level? GG, I am wondering if you have an unresolved UARS component.

[Hope1952]

Well, I should have know that the "bliss" would be short-lived!! Last night was HORRIBLE to say the least. I woke up so many times it was pitiful! I went to bed at 10:30 and woke up at 12:30 stayed awake til 3:00 or 3:30 finally dozed off til about 5:00 and then took the darn mask off and slept til 6:00.
I am so FRUSTRATED I cannot begin to tell you. I woke up with a horrible headache which I cannot get rid of. My neck is killing me and I couldn't for the life of me find a comfortable position as I was struggling to get back to sleep. This whole ordeal is beginning to really be a problem-I just cannot get a good nights' sleep more than once in a while. I feel like crying this morning... I know I sound like the worst complainer in the whole world but I am just so frustrated and tired that I am completely spent!! Thanks-GG

I'm so sorry for the difficult time you're having but I want to thank you for having the courage to post about it. Your comments and the responses give me some hope. I'm having a horrible day and really struggling, too.

[Wulfman]

Well, I should have know that the "bliss" would be short-lived!! Last night was HORRIBLE to say the least. I woke up so many times it was pitiful! I went to bed at 10:30 and woke up at 12:30 stayed awake til 3:00 or 3:30 finally dozed off til about 5:00 and then took the darn mask off and slept til 6:00.
I am so FRUSTRATED I cannot begin to tell you. I woke up with a horrible headache which I cannot get rid of. My neck is killing me and I couldn't for the life of me find a comfortable position as I was struggling to get back to sleep. This whole ordeal is beginning to really be a problem-I just cannot get a good nights' sleep more than once in a while. I feel like crying this morning. My results look like this: pressure: 9.6, Leak: .08, AHI: 1.9, AI: 0.4 (high for me), HI: 1.5. Why are my hyponeas always the things that raise my results?? Is it because my pressure is set too low? The APAP range I'm still using is 8.6-10.4.
I tried changing my pillows (not nasal but bed pillows) last night to the buckwheat hull pillow in hopes that it would finally give my neck enough support that I could go to sleep. That did NOT happen-so I went back to the contour pillow and just spent the whole night shifting it and arranging it to try to give me enought support without giving me so much that it made my neck hurt-hence the headache.
I know I sound like the worst complainer in the whole world but I am just so frustrated and tired that I am completely spent!!
Any suggestions or thoughts?? I so appreciate all of the comments you guys give-and I don't know what I would have done over the last 2 yrs. without you. I am just about ready to go back to straight cpap at the 10.2 setting to see if I can get a night or two of sleep. It seems like my senario is that when I change the machine from apap to cpap or cpap to apap I'll get a night or two of sleep and then it all falls apart again. What's with that?? Thanks-GG

You might want to look into the Chiroflow (or Mediflow) water-based pillow. I was using one for a number of years before I started this therapy, and it's worked extremely well for me with this therapy. If you Google either word, you'll find lots of links to sources.

The S8 machines don't necessarily differentiate between a Flow Limitation (a partial hypopnea) and an Hypopnea. And, Flow Limitations are one of the things that triggers a pressure rise in the machines. So, if you're using a lower minimum pressure than what you "need", the pressure is going to be bouncing around during the night. If your subconscious is susceptible to those pressure changes, it can leave you not feeling well rested or can keep waking you up. If you're also doing alot of tossing and turning, that could be triggering pressure changes, too.

I would advise against switching back and forth (APAP - CPAP modes) so often. In fact, I would recommend setting it to CPAP mode and leaving it there for a week or two and see if that helps.

The mask may be another issue, but if you've adapted to yours, that may not be a problem.


Den

[echo]

I agree, you're probably better off with CPAP... but then we have the problem that the low pressures (10) aren't getting rid of your hypopnea's (or more likely the UARS component? **), but the higher pressures (12) are giving you aerophagia.
** While it's only one example, in my case a pressure of 7.5cm is enough to keep my AHI < 2, but I didn't feel better until I got up to 10.5cm (that's where my flow limitations are the lowest). Is that UARS, I have no idea? But a higher pressure works for me even though the AHI is exactly the same as the lower pressure!

As per KatieW's experience and what Den and others have said, I also second going back to whatever CPAP setting gives you the highest pressure without the aerophagia, maybe that's 10 or 10.2 or 10.4cm. And then after you should tweak some of your setup to try to reduce the aerophagia (as others have already suggested above), and see if you can work your way up to your titrated (or higher) setting.

Some suggestions and/or observations for the aerophagia (try things in this order, in my opinion):
- talk to your sleep doc and tell them that you need the higher pressure, but APAP does not work for you, and that the aerophagia on CPAP is keeping you from being compliant!
- try forcing yourself to sleep on your side (see Rooster's post and tips!) ... wedge may be preventing this sleeping position
- use chinstrap in addition to mouth taping to reduce the chipmunk cheeks and reduce likelihood of air filling in mouth
- use the highest EPR setting
- neck pain (i.e. head position) and aerophagia may be related: head tilted forward due to wedge is causing neck pain? and may increase likelihood of aerophagia?
- wedge pillow making things worse? raise head of mattress instead of wedge pillow.
- try hybrid FFM (would try it with chinstrap as well)
- bipap may help? need to talk to sleep doc.
- while you're doing all this, stay on CPAP mode. keep this consistent so you're not changing a million things at once. your sleeping brain will also thank you.

Below are some articles that may faciliate more ideas, and on which I based some of the comments above (thanks Google and cpaptalk posters):
http://www.cpap-supply.com/Articles.asp?ID=170
http://www.talkaboutsleep.com/message-b ... php?t=2784
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576330/
our-collective-cpap-wisdom/CPAP-hose-aerophagia.html

Here are some additional things to consider with your doctor:
- Get thyroid levels checked and even if you're on the edge of the "normal" threshold consider treatment (after 2+ yrs of CPAP this was what really helped me to overcome my tiredness)
- Get check for diabetes
- Get iron levels and quality/quantity of red blood cells checked
- night-time GERD is perhaps not well treated? This could be causing unstable breathing and/or throat conditions at night
- Make a complete list of ALL your symptoms (and medications) from the past two years to see what other health issues may be at play --- OSA can cause all sorts of complications, some acknowledged and known (and in my opinion, some not yet acknowledged).

[twasbrillig]

I would suggest getting more information about Upper Airway Resistance Syndrome (UARS). For UARS patients, the AHI and HI are not a good measure of whether CPAP is helping your sleep.

Tell us about the results of your diagnostic study and titration study. However, one issue that noted frequently is that UARS is usually diagnosed based on respiratory effort-related arousals (RERAs), and not all sleep labs measure this. This can make your treatment a huge puzzle. (sure has with mine...)

For UARS sufferers, insomnia is usually a bigger part of the picture (both pre-CPAP and with CPAP) After you have adjusted to the mask (and you said you have used CPAP for a long time, I believe), the insomnia is probably due to inadequate therapy. Your nervous system is being over-stimulated if there are many sleep disruptions and this causes release of stress hormones, and other physiological factors that have a longer term effect . You have to figure out whether there is still undetected sleep disruption, and this is much more difficult with UARS. With UARS, the AI and HI prove almost nothing about the effectiveness of your treatment. (which makes UARS different than OSA) However, CPAP is still the recommended first line treatment for UARS.

Also, to learn more about UARS, you can google Dr. Stephen Park. I think he captures the dimensions of the problem very well.

Twas

[grumpygirl]

So, what can be done about UARS?? If, as I understand it, it can be related to several different problems with restricted
breathing, how can one solve the problem?? No matter what setting I use on either the cpap or apap I am always tired and my morning stats are usually very good. Somehow I think it must be that I am having some kind of events(that often wake me up and I cannot go back to sleep)that my machine will not register. I am experiencing anxiety again(but no rapid heart beat at the time I wake up at night) much like I did before cpap therapy. So, I think as I said that I am waking up following some kind of event.
Short of having another sleep study-which I cannot afford at this time-how can find some relief??? GG