Sleep getting worse

[Pulpracer]

I've been using my CPAP - Phillips Respironics, for about six months. It feels like there was a sweet spot where I got used to it after about 1.5-2 months where I slept great. Now, over the last month, it feels as if I'm backsliding. I frequently have days where I'm more and more tired and feel kind of wiped out. Is this common - should I be doing something different?

Thanks!

RJ

[BlackSpinner]

Hopefully you have a machine that records real data. Post which machine exactly that you have (number is on the bottom, empty humidifier first) and which mask you are using.

[Sir NoddinOff]

This is not an uncommon problem among new CPAP users, so don't feel all alone. We need two things from you: As Blackspinner mentioned, we need data and that generally means installing Sleepyhead, which most of us are familiar with. Also we need you to fill out your equipment profile so we understand what your machine and mask setup consists of... sometimes the problem is just mechanical or fitting issues. It's a little more work for you, however you can then get solutions focused on such areas as leaks, AHI, central apneas and so forth. Otherwise we are just shooting in the dark. Look in Pugsy's signature line for tutorials and download links plus instructions to Sleepyhead.

[Pulpracer]

Hi Guys,

Thanks for the responses - here's my equipment (at least what it says on the bottom of the machine)

Phillips
- REMstar Auto DOM REF 560p
- System One Humid - Heated tube
- Mask - ResMed Quattro FX

It also has a little wireless box on the back to get info out. I tried to set up Sleepyhead once, but couldn't figure out how to get info from the machine into the software since there's no SD card.

Thanks for your help.

RJ

[BlackSpinner]

You can get an SD card at Walmart for under $10, a reader with a usb connection (if your computer doesn't have one)for under $20.

[palerider]

It also has a little wireless box on the back to get info out. I tried to set up Sleepyhead once, but couldn't figure out how to get info from the machine into the software since there's no SD card.

there's usually a sd card in the slot, which is hidden by the cellular modem stuck on the back.

[Pulpracer]

Hi guys - so I have Sleepyhead up and running - found the SD card behind the cellular device and have the data. I went through Pugsy's post on how to look at the data and although I now understand the data in terms of what it all means, I'm not sure I understand what it means for my quality of sleep or how to use it to help. It does look like my AHI is kind of high (average is about 8 - though with some pretty high peaks up to 14 a couple of times per month). But I'm not sure what to do about it. (should I post the data? is there a way to do that?)

Can anyone guide me to the right places to look? Also - I saw on Pugsy's post that any leak that wakes you up is not good - and I get woken up quite a bit by leaks when the pressure gets high. Am I looking at the wrong mask fit?

Thanks!

RJ

[Pugsy]

How to post images of what you see so that we can see too...explained here
Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779

Your AHI is sounding a bit high but we need to know the event category breakdown before offering any ideas.
Also need to know if those leaks that are waking you up are big leaks or just little leaks.

Sounds like you are likely running in APAP mode and maybe the starting pressure is not quite optimal and when it goes higher it causes leaks. It's hard to fit a mask when you start the night at say 7 cm....and you end up using 15 (just picked the numbers as example). What works at 7 won't work so great at 15.

There's a mask fit feature available on the 560 model machine so that you can use it and it will put out the higher pressure at the beginning of the sleep session so that you can maybe anticipate those pressures with better leak control.
You may also simply need a different mask....assuming that you don't simply need a new cushion for this one. The cushions do get tired.

Let's start by looking at a typical night's daily detailed report and go from there.

[Pulpracer]

Here are a few images. Let me know if you need more. I'm looking forward to your thoughts.

Best, RJ

[Pugsy]

You have the graphs...insp, Exp, and AHI ...don't need those.
Need Flow rate, pressure and leak graphs along with the Events graph on top.

But I see your problem...it's the minimum pressure. It's too low to get to where it needs to get in a timely fashion so many apnea events are happening before the machine can get to the pressure that is needed to hold the airway open.

Without seeing the pressure graphs...I am thinking that 7 cm would be a better starting point than 4 cm and with a more optimal minimum pressure then the machine won't have to go so high to try to fix something after the fact.
It works better by preventing in the first place. Often when the minimum is more optimal then the higher pressures don't even happen as much any more.

The pressure changes could also be a factor is disturbing your sleep and the wake ups and you might do better with a tight range but I would start with more minimum if it was me and work from there after I see what happens when the machine is doing a better job. Right now it's working extra hard trying to fix something and it's a whole lot better if the machine prevents in the first place what it is now trying to fix after the fact.

I only see one large leak flag that doesn't last very long at around 5:50.
Now the leaks even though small, could be waking you up but so could all those hyponeas and OAs and FLs and RERA that need to be reduced...then see if you are still having issues waking up.
So I suggest fix what is obviously needing fixing to start with and then see what's left that needs fixing.

The CAs or centrals are likely related to the wake ups as the machine often will mistake awake breathing irregularities for some sort of apnea event and usually will call it CA. Would keep an eye on them just in case but I don't think they are the issue here.
Up to you if you want to change that minimum yourself or have your DME do it but they will require a RX from the doctor.
No such requirement if you do it.
There's a link at this page that points you to instructions on how to change the pressure on your machine.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual
I would also suggest that you request the provider/clinical manual for your machine (make sure you get the right manual) because there's additional information it it that will help you understand your machine.

Right now you are showing the PR System One Auto CPAP in your profile...that would be model 550 (it's on a sticker on the bottom of the blower unit) and that machine has been replaced by the model 560 and it's called
PR System One 60 Series Auto CPAP ...2 different manuals...so if you have the model 560 you need to change your profile
I am betting you have the 560 because that's your choice with humidifier....it won't work with a 550 machine.
So confirm exactly which model you have before ordering so you get the correct one.

[Pulpracer]

Thanks! Requested graphs are below. The info on the bottom of the machine reads "REMstar Auto DOM Ref 560P. Is that the machine you're talking about?

Also - I'll give the pressure change a shot.

Thanks!

[Wulfman...]

Did you have a full-blown sleep study and did they come up with a specific therapy pressure setting?


Den

.

[Pulpracer]

Actually, no - I did not have a full-blown sleep study. The machine was prescribed by my GP. We did a sleep study where I wore a little box on my head with tubes under my nose for two nights at home. The pressure was set by the tech who dropped off the machine who said it would be a good place to start and fitted me for a mask (which actually turned out to be the wrong size and I had to replace it.)

[Wulfman...]

Actually, no - I did not have a full-blown sleep study. The machine was prescribed by my GP. We did a sleep study where I wore a little box on my head with tubes under my nose for two nights at home. The pressure was set by the tech who dropped off the machine who said it would be a good place to start and fitted me for a mask (which actually turned out to be the wrong size and I had to replace it.)

You may have started with those settings, but now you need a little bit more (minimum) pressure.


Den

.

[Pugsy]

Yes...if the model number says 560 then you have the PR System One 60 Series Auto CPAP machine and not the PR System One Auto CPAP machine....the 60 series makes a difference..
I think that the apneaboard sneaks in the word Remstar in some of their model names but just ignore it as all Repironics machines seem to get stuck with Remstar in the name somewhere...it doesn't really mean anything.

And yes...after seeing that pressure graph line.....7 cm would likely be a much better starting minimum pressure.
It should get you real close. Might need a little more but I would want to see what happens at 7 minimum first.
Often when the minimum is set higher/better...then the pressure stabilizes and doesn't even need to climb so high.
I have seen it happen often....bring the minimum up and the maximum will go down and sometimes significantly.