Can't stay asleep

[MattV]

Hi I started using a cpap machine in January with the pressure set at 10. I have no problem falling asleep but I still wake up numerous times throughout the night & feel exhausted. My doctor then prescribed me an auto cpap which I have been using for the past two days. I still wake up a lot. I thought this thing is supposed to keep me asleep once I fall asleep. Now everyday I'm exhausted, aggravated, pissed off & have no interest in anything. The days are starting to blend together. I need help. The doctors & DME company are basically useless. If anyone can help I'd love you.


FYI when I did the sleep study they said I had 275 arousal's, 270 were respiratory related. My AHI was 42. The longest apnea I had was 37 seconds. According to them I have severe OSA.

[MattV]

Wow no help at all?

[redjoe]

For people to be able to help, we need to have a place to start. What machine and mask do you have? Are you having leaks? Do you find it difficult to adjust to breathing against the pressure? Do you find the mask irritating? Try to describe to us what's going on so we've got some idea of what kind of help you need.

[Pugsy]

Patience Matt....we are all volunteers here...we do have a life outside the forum.

Would you please take the time to register formally here at the forum....then add your equipment to your profile like I have mine. Here's how
wiki/index.php/Registering_Equipment_in_User_Profile

Once we know which machine you are using (the APAP brand) we then can point you to software to use to make sure that at least your therapy is optimal.

To better help you we need more information.
You feel lousy and wonder why the machine isn't helping.....
How many hours of sleep using the machine do you get each night? Very important to answer this question. If you are only getting a handful of hours on the machine...even if therapy is optimal you won't feel any better?
Are you waking often during the night?
Do you take any meds of any kind? Even OTC? If so..what.
Do you have any other health issues that can impact how you feel that are unrelated to sleep apnea?
Pain?
If you aren't getting much sleep (hours)....any idea why? Mask comfort? Mask fit? Leaks? Trouble falling asleep? Trouble staying asleep?

So you see there are lots of things that can be impacting how you feel and to help you we need a lot more information. Finally....even under the best of circumstances...great therapy.....good hours of sleep using the machine..no other complicating factors...sometimes it just takes quite a while before we feel better.

But lets start with software reports to make sure that things are going well.
Do you know your pressure settings? Use ramp?

[SleepyMatt]

Ok sorry I'm going crazy.

I started with the resmed s9 escape set at 10. I used the ramp set at 30 min. @5. Tried that for two months using the swift fx nasal pillow mask. It fits fine, feels fine, breathing is fine & I can fall asleep as if i wasn't wearing it.

Then within two hours I wake up, up to five times throughout the night. I feel as if I'm constantly dreaming when I am sleeping. My hours of sleep varied from 2.5 to 7 hours with the Cpap. Sometimes I couldn't tolerate the pressure & took it off.

Now I have the equipment below since this Monday. I'm using the same mask. It starts at 4. For the past two nights I slept with it on for 7 hours but I still wake up multiple times. It says my ahi is 3.0. No periodic breathing.

I'm just not getting into the right sleep stage for rest. I don't have any other health issues. Not stressed, except for this. I'm 38 & just barely overweight. I've actually lost 40 lbs. over the past couple years. I exercise 3+ days a week.

When I read how people here feel so energetic after Cpap it makes me feel so envious of them. I want this to work so bad so I appreciate any help at all. Thank you!

[Pugsy]

My hours of sleep varied from 2.5 to 7 hours with the Cpap. Sometimes I couldn't tolerate the pressure & took it off.

This is part of the problem. Fragmented sleep and taking the mask off. Can you isolate what is causing the wake ups? Do you go right back to sleep or are you awake for a while?

The PR S1 APAP machine is a full data machine. The data available on the machines LCD screen is sorely limited. Fortunately we have easy got get and easy to use software.
Look in my signature line...read the user guide and download SleepHead software.

Let get some reports to evaluate. Can you get me an image of your report that looks like this.
You an detick some of the graphs that you don't really need right now. You can also click and drag the graph bottom line so that what you want to see is there is one image.
We use screen shots for posting images of reports. This is how I do it.

Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

And this is what it looks like...so see if you can do this.

[SleepyMatt]

Wow thanks for the help about the software. You're a treasure trove of info! Let me get this software & some screen shots going.

I have noticed that with this new machine, I can tolerate the pressure & mask all night. I do tend to sleep for an hour after taking off the mask. It's like I wake up, realize I have an hour left and take off the mask to get an hour of "real" sleep. I know it's dumb.

Anyway thanks again. I'll post my results soon, hopefully today.

[kgresgott]

I'm a newbie, and am still learning. I wake up a few times a night too. I am using the same CPAP and humidifier as you are. Even though I wake up a lot my AHI's are down to zero. So, something is working right, even though I still feel tired a lot. I don't feel any different.

-Kathryn

[ameriken]

I'm a newbie, and am still learning. I wake up a few times a night too. I am using the same CPAP and humidifier as you are. Even though I wake up a lot my AHI's are down to zero. So, something is working right, even though I still feel tired a lot. I don't feel any different.

-Kathryn

Down to zero? Not to rain on your parade, but 0 usually indicates something not right with the software. Even before you had sleep apnea you had an AHI, everyone does and 5 and under is considered normal sleep. It's when it gets above 5, and especially 10 or higher that they make the diagnosis of sleep apnea.

I'm not saying it isn't possible to have a zero, but if that is consistently happening, I would tend to think something isn't jiving in the software.

[hades161]

Welcome to the Forum !



Pugsy has you on track so I can't add much there, but I will say that getting the mask and machine to work right as well as getting your subconscious mind adjusted to treatment is going to take some time.

The AutoPap was a good move and you can use it to figure out whats going on and what you need. I know you have been at this since January but until a few days ago you really weren't able to track and tweak things well. So now with the new machine it's kinda like starting over but at least this time you have the ability to adjust things. I won't blow smoke up your butt and say things will be perfect in a few days, even with the Apap and the boards help it might take weeks or months before you feel better.

All I can say is stick with it and learn, learn, and learn some more about your treatment and your options. If the Doctors and DME aren't as helpful as you would like look for better ones. If that's not an option then by all means take control and do it yourself.

One tip I have for you is practice when your awake. Put the mask on 30 minutes to an hour before bed. Read or listen to something like an audiobook or watch TV, let your body and mind get use to the idea that the mask and the air is good and normal. With time your subconscious will adjust and behave better at night.

After that waking up many times a night can be caused by many things like Ramp, Pressure Changes, Rapid Leg Movements, Mask Leaks, limited movement due to the hose, Machine Noise, and of course the environment, IE someone playing Heavy Bass music when your trying to sleep. Identify each issue and correct them as your can. I like Ear plugs

I do not like Ramping, I find the lower pressure to be not enough for me to feel comfortable. Others love it and it helps them ease into treatment. The range of pressures the Autopap is set to also can be an issue if say its set to 4cmH20 - 20cmH2O and your pressure is 10 or 11 then when you lay down its going to kinda suck waiting for the apap to adjust up 4-10.

Leaks, I hate it when a mask leaks and blows air into my eyes making them dry out even closed, or blow out around the edges and make my face cold this wakes me up right away. So leaks must be stopped not only for effective treatment reason but also so as to not wake you up.

Over the course of the next month or so watch everything and correct all the fast fix stuff you can. Remember though when it comes to pressure changes those must be done slowly and over time. 1 or 2 nights of data is great for leaks and huge problems with pressure but the fine tuning you will need to give each change you make a week or 2 to see the more accurate results and do the changes only 1 at a time.

[SleepyMatt]

Thank you very much! I have a lot to learn.

[SleepyMatt]

Ok I finally got 6 days worth of data. When you get a chance let me know what you think. Thank you!






This spike is when I yanked the mask off, where I then opened my window to yell at someone who woke me up that knows I've been having sleeping issues.

[SleepyMatt]

My leak seems fine but not sure if I understand how to interpret the other data.

[Pugsy]

Which part are you having trouble understanding?
Leak is fine...well below large leak territory which is around 90 L/min.
AHI is less than 5.
Is your pressure 4 to 15 range? Do you find the pressure changes disturbing at all? Wake you up?
If so you might talk to your doctor about increasing that minimum from 4 up a little bit. You are still kinda all over the place with some time near the top of your pressure setting but those might just be rare things. Need more nights to really evaluate that aspect.
Are you using ramp?

The other graphs. Those tidal volume and minute volume things. Those have a wide range of normal values and you can google them to get the definitions and ranges of normal. They aren't really that critical to your therapy. Just happens to be some values that the machine records. Norms will vary between men and women...short people and tall people...altitude that they live at.
Mainly if something was way off from norm it might point to some sort of lung problem and you would already know it if you had a major lung problem. These values are more important for the people that use the ASV type of machines and since you don't. I wouldn't worry about them.

The AHI hourly graph..right below the flow rate graph..that's just showing an individual hourly AHI.
Looks worse than it is. I don't even bother looking at it myself. Instead I prefer to watch the top even graph (above the flow rate)...so I deselect the AHI graph. My main interests when I look at my reports are the top event graph (maybe look for clusters)..the flow graph...pressure graph if using variable pressure like you are, just to see where it is wanting to go and then the leak graph to make sure no really bad prolonged leaks.

For being new to all this. Your reports are quite decent. The only thing that I might consider doing (if it were me) would be increasing that minimum from 4 to probably 6 or 7 and see how things go. Since you are so new to all this you may be more comfortable talking with your doctor about this as we don't want to make them mad. If you are comfortable at 4 cm there is no urgent need to increase the pressure at this point unless you don't feel like enough air is moving or you find the pressure changes disturbing. I can sleep right through going from 10 cm to 18 but others find even a 2 cm change disturbing. The machine won't go where it doesn't think it needs to go for some reason. Those excursions to near 15 cm could be perhaps extra stubborn events while supine or in REM sleep.
You may find that you have some nights where you don't ever get much above 9 or 10 cm and other nights you go near 15.. I had that happen...my minimum was 10 and most nights I was around 12 but some nights I would go to 18. I just laughed and said that the pressure was responding to some super duper events on steroids.

Now this is the on paper analysis...how you feel, that also is important.
Give it some time and you will soon see your own pattern develop and understand it better.

If you have specific questions about what you see..ask...it is easier to answer specific questions than it is to try to give a general comment when we don't know what is unclear to you..

I think you are doing very well...at least on paper. The other stuff will take some time.

[hades161]

If it were me, I would give it one more week, check the data and if the same pattern is going on, then talk to my doctor about trying to narrow the ranges.
I do not know how well you deal with pressure but for me I would go:

8 cm H20 - 15 CM H20
No Ramp,
No A-Flex or A-Flex of 1.
For a 1 month time frame. Then I would go over the data again with my Doctor to see if I could narrow the range even more.

Why? Your still jumping around a bit on the pressures almost nightly around 10 ish and 13 ish so 8 to 15 allows for this. Also you still need time to adapt, your mind might be cool with things now, but not your body.
Over time your pressures should settle down as your body adapts, into more constant numbers, hopefully.

The reason for no ramp is personal for me but I think trying to adapt to wide ranging pressures for some at the start doesn't always help, it didn't for me but YMMV. You have a wide range as it is.

The reason for No or Little A-Flex is again personal but I find for myself if have to many pressure variables my sleep seems to suffer and I think it's due to pressure related arousal's.
I like to limit them but still keep the flexibility of Apap mode.

Again this is what I would for myself, you might adapt to pressure changes better then I and the ramp / AFlex might work for you. Its something you will need to explore by feel and numbers to see what works for you.

You seem to have the mask usage, leaks under control, and software down so all in all Kudos !

Keep up the good work !