New here with questions of course

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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OkyDoky
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Re: New here with questions of course

Post by OkyDoky » Sun Mar 08, 2015 5:33 pm

Chris,
The air in the cheeks is normal until you learn to breath with your tongue at the roof of your mouth with the tip at the back of your top teeth. This helps tip seal off your mouth. Practice it during the day and after awhile it will become habit and the chipmunk cheeks will be controlled.
You may not want to decrease your pressure that much because the EPR at 3 already reduces your pressure. Do you have Sleepyhead running where you can monitor your data? This will be needed if you are trying to self titrate.
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Chris333
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Re: New here with questions of course

Post by Chris333 » Mon Mar 09, 2015 12:29 am

I have Sleepyhead, but no use pulling the card to look at the data as I've only been able to keep the mask on for about a hour before I pull it so I can sleep. 2 nights worth totaled 2.3 hours on the machine I'll see what happens today .

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Re: New here with questions of course

Post by robysue » Mon Mar 09, 2015 8:09 am

Chris333 wrote:I have Sleepyhead, but no use pulling the card to look at the data as I've only been able to keep the mask on for about a hour before I pull it so I can sleep.
This is a bad habit to slip into. You are training your body to fight the mask until you get fed up enough to take the mask off and go to sleep without it. You need to address this problem so that you stand a chance of becoming a long term PAPer. In other words, you need to find a way to teach your body that Time to Sleep = Time to Mask Up.

There are several ways to fight the problem of "I keep the mask on for an hour before I pull it off so I can sleep." Two common ways to address the problem are:

1) You can do the mask acclimation in the daytime when there's no pressure to fall asleep. Seriously, if the feel of the mask is bugging you or creating anxiety, using the mask for an increasing amount of time while watching tv or reading can help get over the "this feels so unnatural" sensations. By the time you can wear the mask for a couple of hours in the daytime without constantly watching the clock for "freedom from mask time", it may be easier to actually go to sleep with the mask on your nose.

2) What is your natural latency to sleep when you don't even try to put the mask on your nose? 10 minutes? 20 minutes? 30 minutes? When you do go to bed with the mask on your nose, you need to not allow yourself to get too frustrated. If you've not fallen asleep in your normal time frame, it's time to get OUT of the bed and go do something for a few minutes until you settle down. Once you start to feel sleepy, it's time to go back to bed and try again. For most people, this approach will lead to falling asleep with the mask on within a week or so.

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Chris333
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Re: New here with questions of course

Post by Chris333 » Mon Mar 09, 2015 12:46 pm

Well last night was a little bit better. I used the mask for 3 hours! With the low at 5 and high at 10 I got an average pressure of 6.7. AHI was 6.41. I set the ramp for 45 min and all of the AHI's came after the pressure ramped up. I still did a ton of swallowing and woke up with a sore throat, but at least I got something.

Wearing the mask itself doesn't bother me, its the air. It's like hanging your head out a car window on the freeway and trying to breath. But it was much better with the pressure down.

Also I have a nasel pillow mask coming so that may work better.

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Pugsy
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Re: New here with questions of course

Post by Pugsy » Mon Mar 09, 2015 1:03 pm

Are you using EPR? If so at what setting? I can't read the numbers on the report you posted and I can't enlarge it.

Your starting pressure may be too low for comfort along with if you are using EPR it is too low to get the full benefit of EPR anyway to help with that exhale problem it sounds like you are maybe having.

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Re: New here with questions of course

Post by Chris333 » Mon Mar 09, 2015 1:08 pm

I have the EPR set on 3. I think the start pressure is on 4, the lowest it would go.

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Pugsy
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Re: New here with questions of course

Post by Pugsy » Mon Mar 09, 2015 1:34 pm

Happy Birthday...if today is your birthday and the cpaptalk forum birthday cake icon means it thinks today is your birthday.

With your starting pressure of 5 and your EPR setting of 3 you aren't really able to feel the full benefit of EPR because the machine can only go down to 4 cm from that 5 cm starting point....and it really won't go above 5 until you fall asleep and any airway collapses start driving the pressure up. The airway shouldn't collapse while you are awake.

You are going to think I am crazy but try something for me while you are awake and not under the gun to go to sleep.
Try setting the minimum starting pressure from 5 cm to 6.0 and 6.5 and 7.0 and see how you do. Leave EPR set to 3 for the time being but try those other settings and just see how it feels to you.....see if one of those settings is more comfortable or not.

And it looks like your ramp time is set for 45 minutes...set it to 5 minutes or better yet..just turn it off. That 4 cm is the starting point for the ramp feature and you get zero benefit from EPR at that setting and most people find that they can't breathe comfortably at that low of a setting. If I use below 6 cm starting pressure it feels like I am trying to breathe through one of those coffee stir sticks...not comfortable at all.

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robysue
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Re: New here with questions of course

Post by robysue » Mon Mar 09, 2015 1:59 pm

Chris333 wrote:Well last night was a little bit better. I used the mask for 3 hours!
Judging from the regularness of the flowrate graph it also looks like you actually slept with mask for a significant chunk of that time. How much sleep do you think you got while the mask was on? And how long do you think it took you to fall asleep with the mask on your nose?
With the low at 5 and high at 10 I got an average pressure of 6.7. AHI was 6.41. I set the ramp for 45 min and all of the AHI's came after the pressure ramped up.
The S9 that you are using does NOT record events during the ramp up period as I recall. So unless you do a careful breath by breath analysis you can't be completely sure that no events occurred if you fell asleep before the ramp period ended.

Since you are only ramping up from 4cm to 5cm, you might want to either skip the ramp completely (if 5cm doesn't seem overwhelming to you) or cut the ramp time in half.

There's a bunch of centrals scored between 7:00 and 7:30. But judging from the flowrate graph, it looks like you might have been semi-awake at that point. When do you think you first started to wake up and how restless were you during that half hour? At this point, I don't think I'd be worried about those centrals---they're probably sleep transitional or (semi) wake breathing being misscored.
I still did a ton of swallowing and woke up with a sore throat, but at least I got something.
Does the air stay in your mouth or does it get into your stomach and cause a stomach ache as well?
Wearing the mask itself doesn't bother me, its the air. It's like hanging your head out a car window on the freeway and trying to breath. But it was much better with the pressure down.
You're going to hear a lot of people telling you that "no-one can breathe at 5cm because there's not enough air coming through the mask to be comfortable". While a lot of people do feel like there's not enough air to breathe comfortably at 4-6cm, that's just not true for everybody. For some of us, even 5-7cm of pressure does feel overwhelming---as in there's too much air coming through the mask to breath comfortably. I've been PAPing for 4 1/2 years, and I still don't like the feel of air being pushed down my throat, and I'm at very low pressures---my Auto BiPAP starts at 6/4, which is at low as it can be set. It's not as bad as it used to be, but if my stomach is already grumbling at me for any reason, well, the threat of aerophagia is still there after all these years. So if you are really feeling overwhelmed by the air being blown down your throat, you may find increasing the pressure makes it even harder for you to keep the mask on long enough to get to sleep.

It looks like your APAP range is from 5-10cm. Even with EPR = 3, your pressure on exhalation will never go below the min 4cm setting. You won't see the full 3cm drop in pressure on exhalation until the pressure reaches 7cm, and that didn't happen until about 6:50 according to the graphs.

The pressure increase at around 6:50 was likely triggered by the combination of the single OA scored just before 6:50 and some things that you didn't show us: What's the snore graph look like at that time? What's the Flow limitation graph look like at that time.

There's another sharp pressure increase right before you turned the machine off---i.e. just before the pressure graph ends. That increase was probably triggered by pair of OAs that happened right before you turned the machine off.

Good questions to be asking yourself: Did you sort of wake up after the first pressure increase and lie in bed dozing and getting more and more uncomfortable because the pressure was over 6.5 cm, which feels high to you? Or did you sleep through that first pressure increase and only wake up around 7:30 when you turned the machine off? In the later case, we need to consider whether it was the pair of OAs that woke you up (and you then noticed the relatively high pressure) or whether it was the pressure spike that woke you up.
Also I have a nasel pillow mask coming so that may work better.
You may indeed find that the nasal pillows will work better. Or not. The choice of mask is highly personal. Me? I use pillows. I won't say that I love them, but I can't stand to have the top of my nose covered. Hubby is also a PAPer. He can't stand the feeling of air being blown directly into his nose and strongly prefers his small nasal mask.

Image[/quote]

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Chris333
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Re: New here with questions of course

Post by Chris333 » Mon Mar 09, 2015 2:30 pm

Thanks for the replies. I will try with the EPR off tonight.

A lot of the questions about sleep I just cannot answer. How long did it take to fall asleep? Sometimes it take 45 min, but I really don't know. I know it seems harder to sleep when I'm "trying" to sleep. Sometimes I fall asleep and swear I wake up in the exact spot, other nights I wake up 6-7 times look at the clock and fall back asleep. I get up to use the bathroom about once a year so that isn't a problem. In the winter I bundle up and sleep on my side. In the summer if I'm hot I sleep on my back.

The last night shown on the graph I took melatonin (I work night shift) and a Unisom pill. The Unisoms are over 10 years old because I don't feel they do anything, but I gave them a try last night.


The snore on the graph was a .02 average with a .08 high.

I think a lot of the graph is me still awake.

I do not know if I woke up because of the mask, breathing, or just normal sleep. But once I'm up I just pull off the mask and shut off the machine. The spike at the end could be me pulling off the mask, I don't know.

After that I slept till 1:30pm and woke up 4-5 times during that period.

I really think I need a full nights sleep with the machine running to figure anything out.

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Re: New here with questions of course

Post by Chris333 » Mon Mar 09, 2015 2:32 pm

BTW my current and only mask is a Resmed amara mask. It is a small, so that may be a problem.

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Bill44133
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Re: New here with questions of course

Post by Bill44133 » Mon Mar 09, 2015 3:51 pm

Chris333 wrote:BTW my current and only mask is a Resmed amara mask. It is a small, so that may be a problem.
Masks are important part of the battle. If it is not comfortable then you are going to have problems with it.

Keep plugging though sounds like you are on your way.


I wish you well...

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Re: New here with questions of course

Post by archangle » Mon Mar 09, 2015 9:02 pm

Pugsy wrote:Are you using EPR? If so at what setting? I can't read the numbers on the report you posted and I can't enlarge it.
You only get the fuzzy blue mask pressure line if EPR (or bilevel) is on. The width at 6:50 looks like it's set to 3.


---

Chris, welcome.

Let me suggest you use imgur.com instead of photobucket. Photobucket screwes with things, making it hard to look at your graphs.

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Re: New here with questions of course

Post by Chris333 » Tue Mar 10, 2015 9:21 am

I really think this is a complete failure.

Ramp off
EPR off
max 12
min 7
I laid in bed for 2.5 hours without any discomfort from the air or mask, but couldn't fall asleep. I got out of bed for 2 hours and tried the machine again. This time I was on the machine for 1.5 hours and started to fall asleep, but the air blowing kept waking me up. If feels like air blowing right in my face. So I pulled the mask off and here I am with no sleep at all.

In that last 1.5 hours:
AHI 2.26
average pressure 11.8

Now that I think back I don't think I have ever fallen asleep with this on. Right now I feel like I need a gas mask to knock me out.

How does the sleepyhead show when I actually fall alseep?

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Pugsy
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Re: New here with questions of course

Post by Pugsy » Tue Mar 10, 2015 9:45 am

Chris333 wrote:How does the sleepyhead show when I actually fall alseep?
SleepyHead (nor your machine) can know if you are asleep or not. SleepyHead just reports what the machine reports and the machine has no way to know if you are asleep or not. Now sometimes we can spot probable sleep time from the regular breathing air flow pattern because asleep breathing is much more regular than awake/semi awake breathing.
All the machine can report is changes in air flow and breathing because that is what it senses.

So...the big question is why couldn't you fall asleep? Do you commonly have problems falling asleep or staying asleep? Is this something new to you that just started happening with the beginning of cpap therapy or is this something that has been happening long before starting cpap therapy?

I will let RobySue try to help with the insomnia issues as she is much better at those problems than I am but one more question and forgive me if it has been answered previously....
do you take any meds of any kind and if so..what are they?

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Re: New here with questions of course

Post by robysue » Tue Mar 10, 2015 9:54 am

Chris333 wrote:How does the sleepyhead show when I actually fall alseep?
It doesn't.

But normal sleep breathing is both somewhat shallower than wake breathing and much, much more regular than normal wake breathing. So as a proxy, you can look at when the breathing settles down into a very regular pattern. It's easier to see if you zoom in on the flowrate curve to the point where you can see the individual breaths. But even in the data you posted earlier in the thread, you can see that the breathing settles down and becomes a bit more shallow and far more regular (no "spikes") around 5:10 and it stays exceptionally regular until around 6:50, when the cluster of events starts to happen. That's why I suspect that you were asleep between 5:10 and 6:50---the breathing is just too regular for wake breathing.


I really think this is a complete failure.

Ramp off
EPR off
max 12
min 7
I laid in bed for 2.5 hours without any discomfort from the air or mask, but couldn't fall asleep. I got out of bed for 2 hours and tried the machine again.
Don't lie in bed for 2.5 hours NOT sleeping. If you're not asleep within about 30 minutes, it's time to get up and go do something else. And NO clockwatching while you're trying to get to sleep---that feeds the insomnia monster you are dealing with.
This time I was on the machine for 1.5 hours and started to fall asleep, but the air blowing kept waking me up. If feels like air blowing right in my face.
This is a pretty common problem for some of us, but it can be dealt with. If it feels like air is blowing in your face, you have to determine where the air is coming from---beyond "It's the CPAP obviously")

The mask vents intentionally leak air. Some masks vent in a rather diffused fashion and others vent in what feels like a jet engine stream of air. If the mask you are using has a strong, well defined airflow coming out of the vents, you may need to switch to a mask that has a different set up for the exhaust vents.

Once you know where and how your mask is intended to vent, then you need to consider these things: If the exhaust flow hits the covers or a bed pillow, it can be reflected right back into your face and eyes. It's a disturbing feeling and, yes, it can cause you to wake up just as you are starting to drift off to sleep. When I was a newbie, this was a huge issue for me. It still can be an issue if I'm under a lot of stress in my daily life. What I've found that helps: Hose placement and paying attention to the cover arrangement. Sometimes moving the hose or the swivel with the exhaust flow will fix the problem. Sometimes moving the covers helps. I find that I tend to have fewer problems if I have my whole head under my covers. I've also found that draping a cotton handkerchief over my eyes helps tremendously.

But you also need to be aware that not only does the mask have an intentional exhaust vent, but you may also be dealing with mask leaks as well as the exhaust vent. Feel around the edges of the mask you are using. If any air is leaking out of the mask from anywhere EXCEPT the exhaust vents, then that air may be leaking directly onto your face OR it might be bouncing off the bedcovers and back into your face. In either case, fixing the leak (no matter how small) should help with getting rid of the annoying and disturbing sense of wind blowing into your face.

Now that I think back I don't think I have ever fallen asleep with this on. Right now I feel like I need a gas mask to knock me out.
Studies have shown that many people suffering from insomnia vastly overestimate the time they are lying awake in bed and vastly underestimate the time they are asleep.

If you continue to be unable to fall asleep with the mask on your face in a timely fashion, you need to report it to the doctor treating you. The doc may suggest a short course of sleeping medication. If you have no problems with the idea of taking something like Ambien for a week or two, that may be very useful in getting you over the hump you are facing. If you don't want to take the Ambien, you should ask for tips on how to keep the insomnia from becoming a long term problem. Sleep hygiene is part of the usual suggestions, but there are other behavioral things that can also be useful in trying to tame a CPAP-induced insomnia monster.

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