I have my machine, ready for my 1st night == sort of

[EveOett]

I'm on night eight and still struggling. I try every night to settle in and after a couple of hours give up. I can't really afford to go to work not having slept. I can't seem to relax enough to shift into a sleep state-- though tired. Appreciate the encouragement on this board. Good luck!!!

[archangle]

I'm on night eight and still struggling. I try every night to settle in and after a couple of hours give up. I can't really afford to go to work not having slept. I can't seem to relax enough to shift into a sleep state-- though tired. Appreciate the encouragement on this board. Good luck!!!

Try wearing it during the day while watching TV, reading, etc. Take the water tank out before moving the machine.

What machine do you have? It should say something like REMstar blahblah near the display.

[FrayedTrain]

[quote="FrayedTrain"]Thanks for the tips, here I go for my 2nd night.

I started out better this time, but woke up and hour or so later with anxiety about the increased pressure. I needed a quick break, so took my mask off and intended to put it back on. Then my wife woke me, ask where my mask was and said I was snoring. I said "I just wanted to take it off for a few minutes." Well, it turns out I fell asleep and had it off for a couple of hours. Still had it in my hands though; I was going to put it back on, honest!

For the final two hours, thought I did 'okay'.

Something I did notice after reviewing the 1st and 2nd night in SleepyHead, I am seeing quite a few CA's (Clear Airways), especially after I've settled down and appear to be sleeping.I also see obstructions and hypopneas, but not as many as the CA's. When I first started treatment, I had a hard time exhaling, so I turned the EPR on. That has enabled me to use less force to exhale. Yet I still feel like I'm 'swimming upstream' with my exhales. I even feel like I am trying to exhale 'with intent' during the day. I'm not sure if it's the brain thinking it needs to 'keep up' with the pressure, or what.

So, am I really getting many centrals, or can they be misidentified obstructions? Duration of each is somewhere between 10 and 25 seconds. In the sleep lab without any CPAP I didn't have any obstructions, only hypopneas.

[Pugsy]

Are you still starting out the night at 5 cm? If so then turning EPR on isn't going to help much even if you have it set to maximum of 3 because the machine can't go lower than 4 cm.

The machine shouldn't be increasing the pressure above the minimum settings (5 at this time unless you have changed the setting) and even if you are using the ramp..the ramp starts at 4 cm and you get zero EPR at 4 cm.

If you are having trouble getting to sleep with the machine on don't go worrying about the centrals right now. There's a real good chance the centrals are simply awake/semi awake breathing irregularities getting flagged. Let's worry about them once you have better success keeping the mask on and sleeping for sure with the machine on if the centrals still seem too numerous to suit you.

Can you post an image of your last night's detailed report? This thread will show examples of what we normally like to see...don't need all those graphs on the right at all at this time. Don't need AHI graph on the right...don't need mask pressure on the right.
viewtopic/t103468/Need-help-with-screen-shots.html
How to post images using imgur.com to host the images is explained here
https://sleep.tnet.com/reference/tips/imgur

[BlackSpinner]

If you are tossing and turning you will get centrals. When you transition from one sleep stage to another you can also get them, especially going from drowsing to sleep, and if you are waking frequently you will go through that stage frequently.

Think of part of your exhale problem as weight training. The first times you lift that weighed it seems to weigh a lot more then it does 2 weeks down the road. Your muscles also feel sore for a few days. Because you are thinking about breathing during the night, you will be more aware of it during the day, especially since your muscle are bitching at you for making them work harder at night.

Another point is that my sleep doctor said it can take up to a month for your mind to adjust to sleeping with that thing on your face and that it is "SAFE to sleep and now you won't die while doing that and it doesn't need to mount a guard at night"

[FrayedTrain]

Here is my SH screen shot from last night.

[FrayedTrain]

If you are tossing and turning you will get centrals. When you transition from one sleep stage to another you can also get them, especially going from drowsing to sleep, and if you are waking frequently you will go through that stage frequently.

Think of part of your exhale problem as weight training. The first times you lift that weighed it seems to weigh a lot more then it does 2 weeks down the road. Your muscles also feel sore for a few days. Because you are thinking about breathing during the night, you will be more aware of it during the day, especially since your muscle are bitching at you for making them work harder at night.

Another point is that my sleep doctor said it can take up to a month for your mind to adjust to sleeping with that thing on your face and that it is "SAFE to sleep and now you won't die while doing that and it doesn't need to mount a guard at night"

Very good info here. Thanks for posting this. I think this kind of explanation should go into a 'sticky post' somewhere.

I posted last nights SH data. I'll keep at it. I'm pretty patient, but 'detail oriented' at the same time. It's probably why I became a software developer.

[Pugsy]

Are you comfortable changing the minimum pressure yourself?
If so I would suggest turning ramp off (if you are using it) and set the minimum pressure at 7 cm and increase EPR to 3 and see if that is more comfortable for you.

Starting out at 5 cm doesn't let you get the full benefit of EPR and you are only using EPR of 1 at this time.

Your leak line looks weird...it really doesn't go down (and stay down) to 0 and it should at least at the very beginning of the night.
It appears that the baseline is off and I am not sure why....almost like there is a leak somewhere in the circuit itself and not just at the mask.

[BlackSpinner]

Very good info here. Thanks for posting this. I think this kind of explanation should go into a 'sticky post' somewhere.

I posted last nights SH data. I'll keep at it. I'm pretty patient, but 'detail oriented' at the same time. It's probably why I became a software developer.

As a former software developer it is the kind of info that I find useful also. It is much easier to design a system if you know all the information and all the hidden little steps people don't usually think about when they do them.

[Pugsy]

Don't worry about the centrals right now. I suspect that they are related to either tossing and turning like Black Spinner said or simply awake/semi awake breathing confusing the machine. The machine doesn't know if you are awake or not. All it does is record and respond to breathing irregularities. Our awake breathing is much more irregular than our asleep breathing and it can often fool the machine.

Right now the important thing is get you more comfortable breathing with the machine and getting you to get some solid hours of sleep.

If I remember correctly you didn't have an in lab sleep titration so these settings (essentially wide open) are an attempt to self/auto titrate to optimal pressures.
Without more solid (and longer) blocks of sleep it is hard to figure out just where your pressure needs to be.
It is also possible that the changing pressures in auto mode are disrupting your sleep so you might do better with a really tight range of pressures or maybe cpap mode.

[Sleeprider]

Pugsy, You're in my brain. Before I ever saw your post I thought, this guy needs to increase minimum pressure a couple cm. The changing pressure is not allowing leaks to get under control when the machine just zooms up to 11. Obviously not much therapy taking place at 5.0, and it will be easier to sleep to just accept some additional pressure.

It's tough to get used to the pressure but after a while you will wonder if the machine is even on.

[Pugsy]

Pugsy, You're in my brain. Before I ever saw your post I thought, this guy needs to increase minimum pressure a couple cm.

Funny how I end up in people's heads.

I think that most likely even more minimum pressure will be needed if this person continues to need or want to use EPR but I figured that we could cross that bridge if we come to it.
He's having problems adjusting to exhaling against the pressure so he can't sleep and things sort of snowball downhill from there.

My first thought is simply make his breathing with the machine easier and using 7 with EPR of 3 is going to be a lot easier than 5 with just 1 EPR. He probably thinks I am nuts suggesting it but it's true for 99% of the people.
Once he is more comfortable in terms of breathing and not fighting the machine then we worry about optimal pressures but he has gotta get to sleep and stay there before we can do that accurately.

[archangle]

Never take your mask off without getting out of bed first. Burn that into your mind, or you'll keep taking it off "for just a minute" and going back to sleep without it. You may wake up later and not remember taking it off.

If you must take your mask off, get out of bed first. Mask up before you get back into bed.

You can punch the stop button and immediately turn it back on and get the pressure back to the starting pressure.

Zoom in on your central events and look at how long and how complete your centrals are. Long ones matter a lot longer than short ones. You can click on the events tab, then click on the clear airway events, then click on individual events.

[FrayedTrain]

The leak rate in my first night did go lower, last night it didn't. Good catch. I'll take a good look at everything, make sure the mask fits well too.

I have no problems changing the pressure, so I'll change the min pressure to 7, and bump the EPR to 3. The ramp is already off, that was suggested by my DME, the nurse (RN) said the diff between 4 and 5 wasn't much and I'd be better off just starting at 5 at the least.

I'll heed the warning about not removing the mask until I get up. Sounds like a good practice. I was reading some of the sleep routine steps in another post this evening. They gave me some ideas. This is all new, I'm not on any routine yet.

At work I don't have any major deadlines yet, but expect things to start up soon, so I better get a hang of this so I can function at work. It's early yet, and I know I've lost some sleep over the last two nights, but I have a sense that even though I feel pretty tired I am able to think better than before. Before I could only get one step at a time, trying to track several things was just too much for me. Now I am able to accomplish some multifaceted tasks. They aren't real heavy but a bit more than I've done recently. I hope this is a sign of things to come.

I'm ready for night #3. I think my next post will be a new one with a new title.

Thanks again and G'nite folk.