Insomnia w/ CPAP?

[dutchbrown]

Hey all. I'm a new CPAP user (~ 3 weeks), currently using a Restronics Remstar on Auto setting in order for them to figure out my constant pressure setting. I have moderate sleep apnea... my oxygen levels never dropped much, and I was able to get into REM sleep, but my deep sleep sessions were almost non-existant and I had a lot of arousals during the night.

Before CPAP, I would often take 15mins - 1hr to get to sleep each night. This seems to be the same with CPAP, maybe just a little longer as I get used to the mask. (I first used the Optiflex nasal pillows, which was terrible for me, so I've switched to the ComfortGel, which is much more comfortable.)

Ironically, I have very few problems with leaks or whatever, so that's good. I basically have 2 problems right now:

1. without CPAP, I would wake up plenty during the night, but once I originally fell asleep (my insomnia was always just getting to sleep initially), I would be able to get back to sleep almost instantly, even through the morning. Now... with the CPAP... I will sleep for a few hours then wake up, and have a very difficult time going back to sleep. For whatever reason, when I wake up with the CPAP mask on, I wake up "further" and then will be awake for 10-30 minutes, sometimes longer. In the morning, I will often be up hours before I need to get up... and no, i'm not awake because i'm rested, because I'm still very tired. I'm trying to stick with this by using the CPAP at all times, but I find myself having to take it off ~ 5-6am and sleeping without it the last few hours.

I think I am sleeping better when I am asleep, but I'm probably getting 1-2 hours less sleep a night, so I'm actually more tired. I actually, for the most part, LIKE the mask and the airflow now (my muscles and breathing have adjusted), but ... still having these problems.

Guess my question with this is, is this just acclimating to the CPAP still, or something else? I've never had a problem with insomnia that keeps me up in the middle of the night, just had problems "turning my mind off" and getting to sleep initially. Anyone else had these problems?

2. other problem is with my autoPAP... sometimes I'll wake up the middle of the night with the CPAP at a pressure that's high enough that I just cannot keep my mouth closed. I think it's ramping way above the pressure I need, and can't figure out why. I think this will go away when they set my constant pressure, but ... what causes this? I have nasal allergies and for the most part the CPAP actually helps me breath through my nose, but if I'm congested enough it makes it worse, and it seems like the autoPAP overcompensates for SOMETHING I am doing.

Anyway, this "overramp" just makes the first problem worse, because I have to wake up to restart the machine... then I'm awake and have to do the whole initial "falling asleep" all over again.

Is there anything I can do in the short term for the next couple weeks to stop this? (a setting?) And in the long term, should I push to get a full face mask in addition to the nasal mask to use for the few days a month I get a cold or get congested and need to breathe through my mouth? I would like to use a nasal mask most of the time when I can, but... is this common for people to have multiple masks to use during different times?


Thanks in advance for any comments or help. Still trying to adjust to this thing and wondering if it'll eventually be worth the hassle.... (that said, at least I don't snore anymore and my WIFE is getting better sleep lol)

[rwalther]

Regarding #1: Do you use the "Ramp" feature? I wake up a couple of times a night and the system on "Auto" continues to pound air at me when I'm awake and breathing normally. I find pushing the "Ramp" button (mine is set to 15 minutes from 4 to16) helps a lot.

Regarding #2: Do you work out? I had a similar problem, then I went to a regimen of a 45 minute workout in the mid-evening (7-ish), then a hot shower before bed (10-ish), followed by insisting on a dark and quiet room (no TV, Radio, etc.) ... and the combination really worked for me to get to sleep quickly.

Not saying it will work for you ... just answering for me.

Rusty

[Joffive]

What are your auto settings at? I'd guess there's too much range for you to sleep through.

[MartyR]

concerning using your mask and not being able to sleep:

often i have trouble falling alseep, or waking up and having trouble going back to sleep.

my question is this- do most of you keep your mask on while laying there awake...or do you take it off until you feel you are about to fall asleep...

[dutchbrown]

Regarding #1: Do you use the "Ramp" feature? I wake up a couple of times a night and the system on "Auto" continues to pound air at me when I'm awake and breathing normally. I find pushing the "Ramp" button (mine is set to 15 minutes from 4 to16) helps a lot.

Regarding #2: Do you work out? I had a similar problem, then I went to a regimen of a 45 minute workout in the mid-evening (7-ish), then a hot shower before bed (10-ish), followed by insisting on a dark and quiet room (no TV, Radio, etc.) ... and the combination really worked for me to get to sleep quickly.

Not saying it will work for you ... just answering for me.

Rusty

Actually, the ramp feature on mine will not work when it's set on auto (it has an automatic ramp at the beginning of the cycle). Just sitting up and leaning over to hit the button starts my body into "ok, we have to wake up now?" Doesn't help that I've trained by body to get up whenever for the past few years since I have a 3 yr old...

I do work out in the evenings... try not to work out too late otherwise I really can't get the sleep, usually read prior to bed. It's not so much the getting to sleep that's the issue (I've dealt with that my entire life), it's the middle of the night stuff, when the house is already pitch dark and quiet...

Thanks for the thoughts and suggestions....

[dutchbrown]

What are your auto settings at? I'd guess there's too much range for you to sleep through.

5-20 cm

yeah, 20 is way too high, but my understanding is that the auto is supposed to detect settings and adjust itself? that if it doesn't need to go to 20 it won't? my gut says that I'm doing something, whether it's sniffling or shifting or whatever that is telling the CPAP to keep increasing pressure, even though I don't need it.

The one night that I had a great night sleep I think the average pressure was around 9 or 10.

Maybe it's the auto adjustments that are actually waking me up? How fast is the response when it adjusts? I thought it was a slow process, but... ???

I would like to adjust the top end down but I also don't want to "ruin" the doc's results for my follow up in a few weeks. (Plus, I'm not sure how to change it, I have the feeling I'm "locked out" of changing it under the auto setting.)

[Wulfman]

To repeat Joffive's question......What are your pressure settings in your machine?

Since you're using a nasal mask, and from the other things you described, I'd guess you're leaking air out your mouth......causing the machine to jack up the pressure to compensate......and thus, waking you up.

Did you have a prescribed/titrated pressure from a sleep study?

Den

[dutchbrown]

concerning using your mask and not being able to sleep:

often i have trouble falling alseep, or waking up and having trouble going back to sleep.

my question is this- do most of you keep your mask on while laying there awake...or do you take it off until you feel you are about to fall asleep...

I usually put the mask on after reading for a while and start to get tired (still 15-20 mins usually before i actually fall asleep). Problem is my falling asleep isn't really like falling off a cliff (either awake or asleep), more like a long slow ramp into sleep filled with a bunch of daydreaming and tossing and turning... peaks and valleys and all that. Usually don't even know I'm "falling asleep" until I am asleep. And if I do anything during that period where I am just dosing off, such as roll over, it's like I have to start over (my heart rate and breathing jumps up again).

I sometimes use sleep aides to fall asleep, but that doesn't help me stay asleep past the first couple hours. I know there are extended release versions, but as I never had that problem in the past, I'd like to avoid a dependency on them, ya know?

[Wulfman]

OK.....we were both typing at the same time.

Your bottom pressure of 5 is (in my opinion) WAY too low.

Den

[dutchbrown]

To repeat Joffive's question......What are your pressure settings in your machine?

Since you're using a nasal mask, and from the other things you described, I'd guess you're leaking air out your mouth......causing the machine to jack up the pressure to compensate......and thus, waking you up.

Did you have a prescribed/titrated pressure from a sleep study?

Den

5-20

that actually makes a lot of sense, as this usually happens when I start getting stuffed up. I'm still learning how to adjust the humidifier as per the weather and the humidity in the house, which I'm sure doesn't help.

My sleep study they didn't set a pressure for me, because my index was too low for the technician to do it (or something like that), it was only after the DR reviewed the records did she say that even though my oxygen level didn't drop much (1-2%) and my index was low for OSA, I had a higher index when they factored in my interruptions to deep sleep, etc. Basically, because I'm otherwise healthy, my body still fights the apnea enough to not have it be too harmful for me, it's still not healthy.

Anyway, they put me on AutoPAP instead of another sleep study to figure out the pressure settings. My worry is that I am somehow effecting the results (the data collected) when this "overpressure" happens...

[dutchbrown]

OK.....we were both typing at the same time.

Your bottom pressure of 5 is (in my opinion) WAY too low.

Den

Yeah, I feel the same way (now... when I first started it was plenty but now I feel like it's not even pressuring).

Maybe this will all take care of itself when they take me off of the auto... and maybe fit me for an "alternate" full mask for when I'm congested or whatever (does insurance typicall pay for mutliple masks? My insurance is good, but ... got the impression I had to choose just one mask to use...)

[Wulfman]

So, are you still using this machine as part of your home titration?.....or is it YOURS?
If you're still undergoing the titration and this is a "loaner" machine, then it might not be a good idea to change the bottom pressure without your doctor's permission. On the other hand, I'd be thinking about calling him/her and getting permission to do so.

Next step is to make sure your mouth stays shut. Get some tape that's designed for this or some Polident adhesive denture strips to seal your lips. Then, you and your doc will get a truer picture of what's going on. Leaks will screw up the data.

Den

[dutchbrown]

So, are you still using this machine as part of your home titration?.....or is it YOURS?
If you're still undergoing the titration and this is a "loaner" machine, then it might not be a good idea to change the bottom pressure without your doctor's permission. On the other hand, I'd be thinking about calling him/her and getting permission to do so.

Next step is to make sure your mouth stays shut. Get some tape that's designed for this or some Polident adhesive denture strips to seal your lips. Then, you and your doc will get a truer picture of what's going on. Leaks will screw up the data.

Den

Yeah, it's part of the initial study (is that what home titration is) to determine my correct pressure. That said, it IS my machine... I rent it for two months then buy it after the trial period. I wouldn't think changing the settings would be a problem... EXCEPT for compromising the data for the DR. (which it sounds like I am anyway)

Ironically, I think that the increased pressure is what makes me mouth breathe. I don't do that unless the pressure is high.

[Wulfman]

There are actually two terms we use to describe this situation.
One is "mouth-breathing", which would be if a person was having the feeling of not getting enough air (usually at lower pressures) and opening their mouth to get more.
The other is "mouth-leaking" which is when a person's mouth falls open (for various reasons) and the air escapes.
Both will limit or negate the therapy which is designed to hold the airway open so you can breathe and to minimize apneas and hypopneas.

You're lucky in that they may have discovered your condition before you have more serious effects.
However, the pressure needed to treat sleep apnea is not linked to the severity of it. Some people with severe cases don't necessarily need high pressures and then some with milder conditions may need more pressure. It all depends on the person.

The following is the instructions for the setup of the machine that's showing in your profile. It might be a good idea (if you haven't done so already) if you would go through the setup on the machine you have and just write down on paper ALL of the settings that are in that machine. I wouldn't advise changing anything at this point. However, if you can post a list of all the settings for all the screens that appear, that might help us give you some advice. In some cases, we've seen some of those machines that were incorrectly configured for the users by the DME providers or RTs.

Den



REMstar Auto w/C-Flex Setup

When in the Setup Menu, the humidifier ^ and ramp v buttons operate as up and down keys to change the settings, the left/right user buttons < > allow you to go to the previous/next question or setting, and the pressure start/stop button is used to exit the Setup Menu. Holding the humidifier or ramp buttons down will cause the values to change more quickly.

To enter the Therapy Setup Menu, hold the two top user buttons < > down while plugging in the power cord.
Continue holding the buttons down until the REMstar Auto w/C-Flex beeps twice.

Note: The word "setup" will appear on all of the screens indicating that you are in the Therapy Setup Menu.
(If you press the Pressure start/stop button, you will exit the Setup Menu.)

A. Compliance hours/nights: (recommend leaving alone, but CAN be cleared at this point)
Select next setting with >

B. Therapy mode: (CPAP/CFLE/APAP/AFLE) select with ^ or v
Select next setting with >

B1. If CPAP or CFLE select pressure setting: Select with ^ or v
Select next setting with >

B1a. C-Flex mode (if you chose CFLE mode): Select setting 1, 2 or 3 with ^
Select next setting with >

B2. If APAP or AFLE, select minimum pressure setting: Select with ^ or v
Select next setting with >

B2a. If APAP or AFLE, select maximum pressure setting: Select with ^ or v
Select next setting with >

B2b. C-Flex mode (if you chose AFLE mode): Select setting 1, 2 or 3 with ^
Select next setting with >

C: Ramp time setting: Select with ^ or v
(ramp time will be turned off with a setting of 0:00)
(if using APAP or AFLE mode, Ramp setting MUST be set to 0:00)
Select next setting with >

D. Ramp pressure setting: Select with ^ or v (use only in CPAP or CFLE mode)
Select next setting with >

E. Patient disconnect setting: 1 = on 0 = off Select with ^ or v
Select next setting with >

F. Buttons lights setting: 1 = on 0 = off Select with ^ or v

(Last setting. Use On/Off button to exit Setup)

[dutchbrown]

Good info... thanks... I will repost my settings. However, I just looked and I was mistaken about the unit I put in my profile. I actually have one that isn't listed... the RemStar Auto M-series A-flex (btw, what is the difference between C-flex and A-flex? Which is better?)