Frequent Awakenings

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
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Re: Frequent Awakenings

Post by Pugsy » Thu Jan 29, 2015 4:53 pm

Den...auto bilevel in this situation has never been really given much of a trial because of the crap PS setting that was being used. PS of 0 to 15 is pretty much a recipe for immediate failure.

But I have no objection to fixed bilevel settings of 12/15 with PS of 3 or 4 as first experiment.
The settings I suggested in auto mode are really rather limited despite the appearance of the big numbers in this situation.

If she can't stand 12 EPAP though....and really needs a lower starting point due to comfort then the need for higher pressures might be more urgent later in the night when from the one report above it appears like more pressures are needed.

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Re: Frequent Awakenings

Post by Sleeprider » Thu Jan 29, 2015 5:24 pm

Java, you said earlier you didn't understand what PS means. PS means pressure support. It is the amount of pressure support that is added to EPAP. Your current EPAP setting is 12 cm. So the minimum PS of 3.0 means your inhalation pressure will be at least 15 cm (12+3). Your Max PS is set to 5.0, so your maximum inhalation pressure is 17 cm (12+5).

I think these settings are worth a try and should not be as disruptive as the other night where the pressure support was wide open. There is also merit to the ideal of CPAP pressure of 12.0. It kind of comes down to whether you find the "push" of air during inhalation comfortable or disruptive. What we have seen in your data is that you remove the mask when IPAP pressure goes above 14. So Pugsy is right. You might need to lower EPAP a little bit to tolerate the PS needed to sup port your respiratory tract and prevent apnea.

Be patient, try to get your optimum therapy, and the members here will try to help as best they can. Just for information, here is the Respironics titration guide for the 760 machine: http://sleepdx.respironics.com/PDF/Titr ... otocol.pdf Page 12 of 20 suggests starting ranges and pressure support PS for patients moving from CPAP.

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Re: Frequent Awakenings

Post by palerider » Thu Jan 29, 2015 5:35 pm

Pugsy wrote:It's odd but SleepyHead says in one area your PS was 3 but in another area 0...and your pressure graph doesn't look like PS was even on.
OP is using 093 SH, which I don't think properly supports the 760, thus leading to inadequate numbers on the summary. OP had been playing cuttypastyscrapbooky and cutting off the version numbers until this last one, where I can see the bottom half of the version number.

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Re: Frequent Awakenings

Post by Java » Thu Jan 29, 2015 5:51 pm

palerider wrote:
OP is using 093 SH, which I don't think properly supports the 760, thus leading to inadequate numbers on the summary. OP had been playing cuttypastyscrapbooky and cutting off the version numbers until this last one, where I can see the bottom half of the version number.
I'm sorry. What is, "cuttypastyscrapbooky"?
I didn't mean to cut anything relevant out. I was just getting rid of garbage like the task bar and background.
Do I have the wrong version of Sleeyhead?
I'm here for help, not to deceive anyone with "cuttypastyscrapbooky"

I really thought I was helping. I'm sorry


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Sleeprider
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Re: Frequent Awakenings

Post by Sleeprider » Thu Jan 29, 2015 6:04 pm

This is a unique situation, and I think Den interpreted it correctly on the first page of this thread. The auto BiPAP and APAP are endlessly chasing snores and flow limitations and increasing pressure. Java ends up removing the mask, resetting and starting the cycle all over again. This is a person that is not having high AHI and needs a constant CPAP pressure that is tolerable. Set the machine to run in CPAP mode at 12. Let's see what happens. There will be snores and flow limitations, but at least the patient might keep her mask on.

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Re: Frequent Awakenings

Post by Pugsy » Thu Jan 29, 2015 6:06 pm

Your version of SleepyHead isn't playing nice with the 760...that likely explains a lot as to why the graphs and statistics are whacko.
When you have time can you get the latest SleepyHead up and running or use Encore?
If you have a Windows computer and want EncoreBasic just send me a private message.

Oh..for future screen shots...turn off the AHI graph on the right side. It is useless in your situation (and most people's).

I am sorry...I totally missed the SleepyHead version you were using and it simply isn't compatible with the 760.

For others talking about using cpap and apap and all that.....those options have been tried in the past. This isn't my first time trying to help Java.
She was given bilevel to try in hopes she could get some sleep and help with the insomnia. We have already tried numerous other settings on her other machine without any success.
So cpap and apap at various settings have all been attempted in the past. We got good AHI and no snores and some nice looking reports but sleep quality was still in the toilet.
Sleep quality and the insomnia has always been the primary issue and not effective xpap therapy no matter which mode we tried or what settings.
Once we get the 760 dialed in....I don't know if it will help the insomnia or not but there are various setting options to try in an effort to fix things but remember...the best settings in the world can't fix problem if the problem isn't related to what we are fixing.

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Re: Frequent Awakenings

Post by Java » Thu Jan 29, 2015 6:22 pm

Sleeprider wrote:This is a unique situation, and I think Den interpreted it correctly on the first page of this thread. The auto BiPAP and APAP are endlessly chasing snores and flow limitations and increasing pressure. Java ends up removing the mask, resetting and starting the cycle all over again. This is a person that is not having high AHI and needs a constant CPAP pressure that is tolerable. Set the machine to run in CPAP mode at 12. Let's see what happens. There will be snores and flow limitations, but at least the patient might keep her mask on.

Just to be clear, I am not taking off the mask because of the machine. I wake up. 100% wide awake. So I get up out of bed and use the restroom and get a tiny sip of water to wet my mouth because the machine dries me up even with the humidifier. So I take the mask off because I woke up and I am getting up out of bed, not because the machine. I have never ripped my mask off in my sleep. I am 100% compliant. I don't mind using the machine at all. When I wake up, I am too alert to just fall back to sleep. My mind starts to play tricks with me and tells me I have to use the bathroom. If I don't get up and use the bathroom I will lay there for 20 minutes wondering if I should use the bathroom then I finally will get up and that's just wasted time. Does that make sense? So when I wake up, it is 100% up out of bed or else I will lay there debating whether to get up or not. When I get back in bed I fall right back to sleep within 30 seconds.
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Re: Frequent Awakenings

Post by palerider » Thu Jan 29, 2015 6:30 pm

Java wrote:'m sorry. What is, "cuttypastyscrapbooky"?
I didn't mean to cut anything relevant out. I was just getting rid of garbage like the task bar and background.
Do I have the wrong version of Sleeyhead?
I'm here for help, not to deceive anyone with "cuttypastyscrapbooky"
it's a problem that happens... not by intent, but just because you don't know what information is important.

instead of doing a full screen screenshot, you (and others) cut and paste bits of the screen, but that very often leaves out very useful detail that you didn't know was important.

as others said, your version of sleepyhead came out before the 760 did, so it's not well supported.

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Re: Frequent Awakenings

Post by Sleeprider » Thu Jan 29, 2015 8:40 pm

Pugsy wrote: For others talking about using cpap and apap and all that.....those options have been tried in the past. This isn't my first time trying to help Java.
She was given bilevel to try in hopes she could get some sleep and help with the insomnia. We have already tried numerous other settings on her other machine without any success.
So cpap and apap at various settings have all been attempted in the past. We got good AHI and no snores and some nice looking reports but sleep quality was still in the toilet.
Sleep quality and the insomnia has always been the primary issue and not effective xpap therapy no matter which mode we tried or what settings.
Once we get the 760 dialed in....I don't know if it will help the insomnia or not but there are various setting options to try in an effort to fix things but remember...the best settings in the world can't fix problem if the problem isn't related to what we are fixing.
Thanks for the history. You've been missed.

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Re: Frequent Awakenings

Post by palerider » Thu Jan 29, 2015 10:14 pm

Sleeprider wrote:
Pugsy wrote: For others talking about using cpap and apap and all that.....those options have been tried in the past. This isn't my first time trying to help Java.
...Thanks for the history. You've been missed.
I swear pugsy has a big fat notebook with all our names in it, and every notable thing we've ever said recorded in there.

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Re: Frequent Awakenings

Post by palerider » Thu Jan 29, 2015 10:19 pm

Java wrote:
palerider wrote:
OP is using 093 SH, which I don't think properly supports the 760, thus leading to inadequate numbers on the summary. OP had been playing cuttypastyscrapbooky and cutting off the version numbers until this last one, where I can see the bottom half of the version number.
I'm sorry. What is, "cuttypastyscrapbooky"?
here's an extreme example: viewtopic.php?f=1&t=103478

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Re: Frequent Awakenings

Post by Java » Fri Jan 30, 2015 3:47 pm

Here is last night, with the software update.

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Re: Frequent Awakenings

Post by Pugsy » Fri Jan 30, 2015 4:09 pm

I know you woke up a lot last night but how was the night in general in terms of comfort and ease getting used to the pressures?
Do you ever sleep on your back? I am wondering about those times where we see the snore clusters?
The machine is definitely responding to the clusters of snores but while snores are an indication of the airway trying to collapse they don't always end up with a full blown collapse and perhaps a compromise might be in order if you think the pressure changes are part of the problem.

They can be addressed in 2 ways...limit the pressure but allow the snores...the risk there is maybe further collapse and/or arousals from simply the snores even if they don't grow up to be a full blown OA.
or try to increase the base pressure again to limit the chance of the snores ever happening in the first place and the risk there is the chance of the generally higher pressure overall affecting comfort and maybe thus being a factor in sleep quality.
Damned if you do and damned if you don't.

You did max out the pressure briefly but at this point I don't think it was enough to worry about.
My own personal opinion about snores is that I don't like to see them in clusters because I know they can wake people up and there's a reason that auto adjusting pressure machines try to kill them....

Were you finally okay with the 12/15 that you started with?
The first break in therapy at around 3:40....did you ever go to sleep before you turned the machine off?

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Re: Frequent Awakenings

Post by Wulfman... » Fri Jan 30, 2015 4:29 pm

Well, after the first few awakenings/interruptions, it seemed that you had longer periods without having to get up and start over. Your snores were fewer and consequently not driving the pressure increases, so it appears that while you were able to stay at lower pressures, there were fewer distruptions.

Still not ideal, but I believe it demonstrates what I've been theorizing.


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Re: Frequent Awakenings

Post by Java » Fri Jan 30, 2015 4:45 pm

Pugsy wrote:I know you woke up a lot last night but how was the night in general in terms of comfort and ease getting used to the pressures?
Do you ever sleep on your back? I am wondering about those times where we see the snore clusters?
The machine is definitely responding to the clusters of snores but while snores are an indication of the airway trying to collapse they don't always end up with a full blown collapse and perhaps a compromise might be in order if you think the pressure changes are part of the problem.

They can be addressed in 2 ways...limit the pressure but allow the snores...the risk there is maybe further collapse and/or arousals from simply the snores even if they don't grow up to be a full blown OA.
or try to increase the base pressure again to limit the chance of the snores ever happening in the first place and the risk there is the chance of the generally higher pressure overall affecting comfort and maybe thus being a factor in sleep quality.
Damned if you do and damned if you don't.

You did max out the pressure briefly but at this point I don't think it was enough to worry about.
My own personal opinion about snores is that I don't like to see them in clusters because I know they can wake people up and there's a reason that auto adjusting pressure machines try to kill them....

Were you finally okay with the 12/15 that you started with?
The first break in therapy at around 3:40....did you ever go to sleep before you turned the machine off?
I had a rough start. Even though 12 isn't a high pressure, and I am used to pressures even higher, for some reason starting at 12 was a bit of an adjustment. It felt like my head was filling with air and my ears clogged up. Which I don't understand because I've had pressures up in the high teens. But after a few awakenings I did seem to get used to it. I still woke up a lot but I did have a couple good chunks of sleep in there.

I never sleep on my back. I am strictly a side sleeper.

I don't know if I am ready to start at anything higher than 12 right now... Maybe give it a day or two and I will go to 12.5

I did not really fall asleep till about 3:50am. I had the mask on trying to sleep but I was mostly awake. So maybe that is a factor too. Every time I would start to fall asleep I felt like I was suddenly falling and It would jerk me awake.

The craziest part was for some reason my mask seemed to fit better at 12. Like maybe at 10 there is not enough air to fill the mask pillows? I really don't know. Maybe I am just crazy. But the mask felt better at 12. It felt inflated.
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