Help to adjust

[Dogjudge]

Sorry if this is a repeat, but I've gone through things and can't find an answer that fits.

I'm fairly new at this, so I realize that I have a lot to learn.

Got my CPAP machine about 6 weeks ago. After about a week, things were getting better and then after another few days everything went south. I'm waking up about every hour. I'll go back to sleep some times in 15 minutes, but some times it will take an hour and a half. When I go back to sleep, I sleep for maybe an hour.

Earlier in the week I went to the doc and he was telling me how great things were. AHI on my machine says six, but he said it was under 4. Don't know what there was a difference.

When I complained about waking every hour, he said that the pressure might have been adjusted too high and that when I'd go into REM sleep the pressure goes up and that what was waking me up. Don't know how to read pressures on a REMstar Auto A-Flex.

With the new setting for a couple of days, I'm still waking up about every hour, some times it might extend to an hour.

For anxiety issues, I've taken klonopin when needed for anxiety issues. Well aware of the health issues associated with it. Both my GP and the psych doc said that I could use the klonopin to help me sleep. I have totally stayed away from klonopin since I was diagnosed with sleep apnea maybe 4 months ago because I didn't want to screw up the sleep studies and I didn't want to screw up any numbers that I would have for the evaluation of where my machine was set.

At this point, I'm truly frustrated about not getting much sleep.

Whew. Now the question.

I was thinking about using the klonopin for a couple of days with the hope that it would assist me with getting adjusted to the machine more quickly. At the same time, from playing sports, I know that some pains you simply have to play through because pain relievers will mask a problem that you do NOT want to mask. Some pains you can use pain relievers and the play with little downside.

So from your experiences do I want to play through the pain, or can I use klonopin with the hope of adjusting quicker?

[Sheriff Buford]

I cannot comment on the pain relievers, but if you think the changing pressure is awaking you, you may want to consider straight cpap. Straight cpap therapy will pump air into the mask at a set pressure and not change during the night. Sometimes the change in pressure (in the autoset mode) will disrupt peoples sleep.

Also, please enter your equipment in the control panel. That way folks will know what equipment and mask you are using. It helps during dialog.

Sheriff

[kteague]

I don't have any experience with that med so I'll leave that discussion to those in the know. In general, I suggest since you are already off the med to try to get a clear picture of what you're dealing with before muddying the water. Have you tried a very low dose of melatonin? Are you on any other meds - like maybe one known to cause trouble with sleep? It may be that of those 5 events per hour, some of those are causing you to wake up. Examining in detail the data your machine collects could give you the answers you seek. BTW, possibly your doctor's mention of 4 vs 5 was them honing in on apneas only, not the combined AHI including hypopneas. At any rate, a 5 makes me feel your settings are not yet optimized. Once your treatment is optimally therapeutic, if your sleep hasn't settled down you may have to investigate a little further for other contributors. Was there any mention in your sleep study report of limb movements?

[Pugsy]

Get the software so you can confirm that there's nothing on the reports that might explain the unwanted wake ups..like leaks or clusters of apnea events or even if maybe the pressure is ranging wildly as that can bother some people.
Unless you have some off brand machine Sleepyhead will work with it...see links in my signature.

You have to make the decision about the meds. If you have taken it off and on for other issues and you know the risks...I would take it if it were me to help get over the rough patch BUT do learn to evaluate your own data because if there's something in the reports that is causing the problem you want to fix it and not cover it up.

Unsure about what you see in those detailed reports? Just post a typical night here and the forum members can offer their thoughts. Maybe something in it will be screaming "fix me and you will sleep better".

How to post images of reports explained here along with some examples.
Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779

[sleepy1235]

Pugsy's advice is the major thing to do.

I can only offer something of minor value here.

Sometimes when I am tired I will nap with the CPAP on and I have a tendency to wake up about every 45 minutes. I think of something pleasant to focus on and I fall back to sleep within minutes. They may very well not work for you. It has to be something nice that engages you thinking about it.

It is my mental exercise to fall asleep.

This doesn't solve the primary problem, but perhaps helps a little until the primary problem is solved. I think I probably wake up several times during the night but don't remember it in the morning.

[Nick Danger]

Klonopin can make your apnea worse, but it seems that your major problem right now isn't the apnea - it is your inability to sleep through the night. Given the advice from your docs, I'd use the Klonopin until you feel more comfortable with using CPAP and are sleeping better. Then you can try to wean yourself off it.

As you seem well aware, you don't really want to use that over the very long term if you can possibly get by without it - benzodiazepines do have significant addictive potential. But the problem right now isn't apnea and it isn't benzo addiction - it is sleeping through the night so you can function.

[Wulfman...]

I cannot comment on the pain relievers, but if you think the changing pressure is awaking you, you may want to consider straight cpap. Straight cpap therapy will pump air into the mask at a set pressure and not change during the night. Sometimes the change in pressure (in the autoset mode) will disrupt peoples sleep.

Also, please enter your equipment in the control panel. That way folks will know what equipment and mask you are using. It helps during dialog.

Sheriff

What he said! All of it.


Den

.

[Finnc]

My sleep doctor won't let me take Klonopin since going on Cpap saying it makes apnea worse. But since going off it I have not gotten more than 4-5 hours of sleep a night.

[Julie]

Have you tried Melatonin in very small amounts (.5 to 1 mg before bed)?

[Dogjudge]

Thanks for all of the comments.

I've only used Klonopin from time to time for anxiety issues. Probably 0.5 mg every other month.

When I last saw my psych doc (bi-polar depression issues) one of the things they always ask is "How is your depression." At that point, which was just at the initial consultation stages about sleep apnea, I said I had no true idea since I was only getting 4-6 hours of sleep per night and knew that the lack of sleep was probably contributing to my down moods. It was at that point he mentioned using klonopin as a sleep aid.

I have no intention of using it for even as much as a week. My thought process was that it some times takes our bodies time to acclimate to changes. So let's say, that things would be controlled in another month. I was thinking that if the klonopin got me into sleep cycles quicker, that my body would then be able to think that things were correct and I'd be able to cut the adjustment time shorter. If, from the experience of others, it wasn't going to change that adjustment time, then why bother? Or even worse case scenario that doing this would actually make the adjustment time longer because you'd essentially get your body thinking it was regressing and had to continually go back to step one every time you stopped the klonopin.
------------
Okay. Other information.

Machine - REMstar Auto A-Flex
Humidifier - System One Htd. DOM
Leakage - Zero
AHI 6.4. This is down from the start of 7.8
Periodic breathing - 2
90% - 9.1
5.0 cmH20 (That has to be the amount of water out of the humidifier, I'm assuming.)
I can't seem to find where the pressure setting is, and what it's at.

Thankfully, I started this discussion. My appt. was last Thursday. The doc's office left the card out. After my wife brought it home, apparently one of us threw the card out. I've got a call in to get another one.
---------------
Thanks for all the comments and help.

[Pugsy]

Go here and request the clinical manual for your machine...it will explain the data you are seeing on the LCD screen.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

The Remstar part of the model name is useless...all Respironics machines seem to use it.
If you have AFlex available then you have the APAP capable machine because only the APAP capable machine offers AFlex exhale relief.

So...look on the bottom of the blower unit for a 3 digit model number..may have DS or REF in front or behind the 3 digits.

If you have the model 550 (50 series)..that's the PR System One Auto CPAP xxxx
but that machine was replaced by the model 560 machine a couple of years ago so most likely you have the 560 (60 Series)
and the correct machine choice would be the PR System One 60 Series Auto CPAPxxx
make sure you request the correct manual.
The manual will explain all this plus a lot more and also tell you to how to get to the clinical setup menu so you can see the pressure settings.

5.0 cmH20

That's the starting pressure...has nothing to do with humidifier setting or water usage

AHI 6.4. This is down from the start of 7.8

That's a little high...need to see what it is made up of...use the software for seeing more details

90% - 9.1

That's a 90% number which just means for 90% of the night you were at OR below that number. People tend to forget the "or below" part of the definition. It sometimes is a useful number and sometimes not particular useful.

Periodic breathing - 2

Periodic breathing is a type of air flow pattern where the breathing sort of waxes and wans for at least 2 minutes. In small % numbers it's normal and no cause for alarm. In large % numbers with a lot of centrals (clear airway) it could mean a potential problem.
It's a % of time in periodic breathing...might or might not be Cheyne Stokes Respiraton...need to see the software reports
It's possible that some awake breathing can be mistaken for PB.

[Dogjudge]

I'll be back. On the top, it says System One. The only numbers (letters on the bottom) are DOM, and 560P. So, it's apparently a 560 model.

Thanks for the other link. I was able to find the pressure.

From my initial paperwork the machine was set to 5 - 12. It's now 5 - 9.

[palerider]

I'll be back. On the top, it says System One. The only numbers (letters on the bottom) are DOM, and 560P. So, it's apparently a 560 model.

Thanks for the other link. I was able to find the pressure.

From my initial paperwork the machine was set to 5 - 12. It's now 5 - 9.

pick
PR System One REMStar 60 Series Auto CPAP Machine
for your equipment in your profile.

[Dogjudge]

FYI with follow ups.

The Klonopin was a bust. Two nights at 1 mg. didn't help at all. On the third night I could tell I was starting to have the beginnings of an anxiety attack. My guess is that was caused by the Klonopin. Stopped that. AHI was 6.5 both nights.

When I met with the sleep doctor, he had dropped the maximum pressure from 12 to 9. So I decided last night to slightly increase the maximum pressure to 9.5. (Thanks to whomever gave the link that eventually led to how to adjust my machine.

Although I was moving all over the place, I can't remember waking up.

Checked my AHI this morning and it was 3.7.

From other things that I do, i.e. training dogs, I know to never judge behavior on one result. I want to see patterns over a week, or longer.

I'm going to leave the maximum at 9.5 and hope that the AHI stays the same, or maybe even drops further.

Fingers crossed.

Thanks to everyone.

Don't know why the machine isn't showing up. REMStar System One, Model 560

[Pugsy]

Don't know why the machine isn't showing up. REMStar System One, Model 560

You are still selecting the wrong machine...or if you are choosing the correct machine.... you aren't clicking on the submit button.
Whatever you are selecting has a broken link and that's why no machine is showing.
Plus the humidifier you have chosen is the wrong one as it won't work with a 560 machine.

Correct machine choice for the model 560 needs to include the words "60 Series" in it...and along with "60 Series" in the humidifier selection.

So here are the correct choices...note the 60 series included in the model name.

Machine....PR System One 60 Series Auto CPAP machine
Humidifier...PR System One 60 Series heated tube humidifier with heated tube (you choose this one even if you don't have a heated hose)

Don't forget to click on the "submit" button for the changes to stick.