New to PAP therapy

[nynj2008]

Bear with me here, I’m new to the whole PAP therapy thing.

I was diagnosed with borderline mild to moderate sleep apnea. Once in 2016 and again in 2017. First time I had AHI of 12, second time around it was 14. Really low compared to most here.

Doctor prescribed me an APAP, heated tube and a nasal mask in August 2017.

I’ve been pretty religious in terms of being compliant with the therapy. However it is extremely discouraging because I don’t see any improvement. I sleep in extremely the same way I did prior to getting the machine: poorly. I can only remember a hand full of nights I slept ok, meaning I only woke up once during the night.

I have no troubles falling asleep most of the time. I try to keep a regular sleep schedule per doctor’s orders. The problem lies in the fact I suddenly awake for seemingly no reason. I check the machine and most of the time I see it hovering around a pressure of 8 to 8.5. I will usually wake up about 2 or 3 hours after falling asleep. Once I am awake it is very difficult for me to fall back asleep. If I do fall back sleep which is difficult, I wake up again in the same interval, about 2 or 3 hours later.

I usually wake up to use the bathroom during the night and have really bad morning headaches.

Does anyone have any tips or ideas for me on what exactly I am doing wrong?

[Pugsy]

Your machine profile is showing the AirStart 10 autoset machine.
Is this correct or do you have the AirSense 10 Autoset?

This is very important because the AirStart machine is a bare bones basic machine with no data and the AirSense 10 is a full data machine.

You need to be able to at least make sure your therapy is optimal and for that you need data.

If you do have the AirSense 10 AutoSet.....get SleepyHead
https://sleep.tnet.com/equipment

Otherwise...some questions.
How many hours of sleep are you getting?
When you wake up during the night do you have trouble going back to sleep?
Do you take any medications, if so, what?
Any other health conditions going on?
When you say you don't see any improvement....can you be more specific as to what you are experiencing that you haven't seen improvement in?

[Julie]

What are your pressure settings - sounds like they're inadequately low to be therapeutic. Also, if you sleep on your back (or flip to that overnight) do whatever you can not to, as it provokes more apneas. A towel stuffed backpack etc. can help until you no longer do it.

[nynj2008]

Cigna denied my doctor's request for CPAP titration because I am borderline. So no one knows what my pressure actually is. They will only authorize an in-lab sleep study (without CPAP).

The machine is actually an AirSense 10 AutoSet and yes I do have Sleephead. I'm using a nasal mask.

I'm guessing I maybe get 4 hours of sleep total fragmented.

I also suffer from IBD and take a whole host of other medications.

So to clarify what I mean by no improvement: I mean that it makes no difference whether I use machine or not. There is no change in my sleep.

If I'm compliant, my sleep is fragmented, I wake up about 3 times a night, need to use bathroom, typically have insomnia, have morning headaches.

If I'm non-compliant the same thing occurs, my sleep is fragmented, I wake up about 3 times a night, need to use bathroom, typically have insomnia, have morning headaches.

I'll work on posting those Sleepyhead screen shots when I get home. I think last night was the worst since I got the machine with and average of 4.5 AHI. One would assume it should be zero or close to it.

[nicholasjh1]

Cigna denied my doctor's request for CPAP titration because I am borderline. So no one knows what my pressure actually is. They will only authorize an in-lab sleep study (without CPAP).

The machine is actually an AirSense 10 AutoSet and yes I do have Sleephead. I'm using a nasal mask.

I'm guessing I maybe get 4 hours of sleep total fragmented.

I also suffer from IBD and take a whole host of other medications.

So to clarify what I mean by no improvement: I mean that it makes no difference whether I use machine or not. There is no change in my sleep.

If I'm compliant, my sleep is fragmented, I wake up about 3 times a night, need to use bathroom, typically have insomnia, have morning headaches.

If I'm non-compliant the same thing occurs, my sleep is fragmented, I wake up about 3 times a night, need to use bathroom, typically have insomnia, have morning headaches.

I'll work on posting those Sleepyhead screen shots when I get home. I think last night was the worst since I got the machine with and average of 4.5 AHI. One would assume it should be zero or close to it.

I have bowel issues too, (IBS/"leaky gut"), and have a lot of the same symptoms you do (like I wake up a lot, but then again, many of us do). when you "have to get up to go to the bathroom" do you mean urinate or poop? because urination would imply that you may have inadequate therapy (also the AHI of 4.5), and you can test for a difference in that pretty easily, look up how to go to clinical mode on your machine, and raise the starting pressure night over night and see if your AHI goes down... 3-5 nights and bingo - you just did your own titration study at a fraction of the cost. In addition you can get an overnight oxygen test to see if the therapy is working... remember CPAP therapy is not just about "sleeping" it's about not slowly dieing every night from oxygen deprivation and CO2 poisoning, as well as the metabolic changes that the suffocation events cause such as increased energy metabolism at night (raised Creatine levels), as well as a host of other things. Just look at my sig for my opinion about it. Doctors all say it's a sleeping disease that interrupts your sleep like the "not breathing" and "low O2 saturation levels" don't exist.

[nynj2008]

Here are my Sleephead stats from last night.

https://imgur.com/a/PR426

https://imgur.com/a/BfUAO

[Pugsy]

Where's the stuff on the left side of the detailed data report?

See this thread for examples of what we like to see all in one image.
viewtopic/t103468/Need-help-with-screen-shots.html

You are averaging approx 6 1/2 hours on the machine. Is a lot of that time spent awake? How much fragmentation? Any idea why the wake ups?

Your host of medications...have you looked at the side effects for all of them to see if they can mess with sleep quality and/or effect how you feel during the day?

6 1/2 hours of minimally fragmented sleep isn't enough for most people to feel the good numbers...add in a lot of fragmentation and feeling better is unlikely to happen until your sleep is more solid and you get more hours.

[Mogy]

Hi nynj2008,
My experience is that I had to be very patient. I have been at it for about 8 months. I still don't sleep through the night, every night, but I am at about 1 in 3.
Before PAP I had to urinate about 3 times per night. Now I only have to use the washroom once or not at all. The first time I made it through the night was about a month and a half in.
I feel a lot better. It has been quite slow but well worth it.
Make sure you bladder is empty before going to bed, even if you don't feel the urge.

[nynj2008]

I'll post numbers again tomorrow following the guidance in the thread posted.

However I typically go to bed around 10 and wake up at 5:30.

Problem is I know for sure I'm laying in bed restless, but I can't exactly say how long I've been laying there. Clock watching will only make whatever insomnia I think I have worst. So I have no clocks in the bedroom on purpose.

I can sort of piece it together by looking at the graphs. For example somewhere between 1:30 and 2 I woke up. It appears I took about 45 minutes to hour to fall asleep again judging by the fact I had an apnea at around 3:30. Hard to tell when I fell asleep after that. The final wake up was around 5 where I see another apnea and I turned the machine off.

[Pugsy]

When you wake up and lay there and can't sleep reach over and just turn the machine off and then right back on again. This will give you a marker so you can see when it happened. If you find you are laying there for quite a while...reach over and do it again.
This way you can get an idea how many times and how long without having to clock watch.

Sleep maintenance insomnia is a tough one to crack. It's not all about sleep apnea or cpap therapy. It can be any number of factors being involved.

[TedVPAP]

When you wake up and lay there and can't sleep reach over and just turn the machine off and then right back on again. This will give you a marker so you can see when it happened. If you find you are laying there for quite a while...reach over and do it again.
This way you can get an idea how many times and how long without having to clock watch.

Sleep maintenance insomnia is a tough one to crack. It's not all about sleep apnea or cpap therapy. It can be any number of factors being involved.

What I do is pull the mask away for a second so I get a large leak. I find searching and pushing buttons tends to wake me up more than needed, making it harder to fall back asleep.

[Pugsy]

What I do is pull the mask away for a second so I get a large leak. I find searching and pushing buttons tends to wake me up more than needed, making it harder to fall back asleep

For my machine a brief pulling away of the mask to make a big leak doesn't seem to show up easily.
It won't even spike when I take the mask off and reach over to turn the machine off in the AM (Auto off with my Smart Start won't turn off with my mask and my pressures).

But a person could use either method or both if they wished.

[TedVPAP]

What I do is pull the mask away for a second so I get a large leak. I find searching and pushing buttons tends to wake me up more than needed, making it harder to fall back asleep

For my machine a brief pulling away of the mask to make a big leak doesn't seem to show up easily.
It won't even spike when I take the mask off and reach over to turn the machine off in the AM (Auto off with my Smart Start won't turn off with my mask and my pressures).

But a person could use either method or both if they wished.

I didn't realize that manufacturer made such a difference - that is very good to know. We (at least me) tend to think that the data we see is actual, when in fact all digital data has been processed to some extent.

[nynj2008]

I'm going to try turning the machine off to set a flag.

I had a poor sleep night last night. Couldn't tell you exactly how much I slept. Horrible headache.

https://i.imgur.com/a/PhiZH

For some reason when I use the img tag, the image does not display so I apologize ahead of tag.

[Pugsy]

To do the embedded image you have to choose the bottom line in the box of addresses.
The one that says "linked to bbc boards" and copy it AFTER you click on the Large thumbnail choice.