On the brink of desperation - Can not stay asleep still

[koy]

First post here and thank you for valuable info you post here. I have been having some sort of apnea for almost 5 months, i started waking up in the middle of the night ( not gasping for air) just my eyes open, and it took me all 4 months to figure out it was related to my acid reflux causing throat inflammation causing sleep apnea ( specially on my back) i did not suspect apnea first because i wasn't gasping for air but rather sometimes hear myself snore right before i wake up.
After i failed home study a lab sleep study showed 17 AHI with following data :
total sleep time : 321 mns
Sleep efficiency : 61.25%
23 arousals/hr
13 arousals associated with Apnea & Hypopnea
6.5 RERA/hr
3.5 spontaneous/hr
Delayed REM onset
SPO2 duration of less than 90% was 0.4
Lowest SPO2 waas 88%

I got the Resmed airsense 10 autoset, tried first night the P10 mask but could not handle the nose pillow. tried the Dreamwear nasal, and when changing the frame to large it was good, very minimal leaks and comfy.
My problem is i still keep waking up at night, which makes me very groggy in the morning and sleepy although my AHIs are all low ( below 1) i can not figure out why i wake up, from the graphs i see that a sudden increase in pressure wakes me up, i restarted the machine each time i wake up to mark the time, and i tried adjusting the pressure, it looks like most of my pressure is around 5-5.5 nut then machine increase sometimes suddenly, i suspected this is because i'm a side sleeper and maybe i tuck my face in the pillow which closes the air ? also tried without EPR and it woke me up, i have to set the EPR to on full time and to level 3 and ramp time has to be very close t min pressure otherwise the sudden increase wakes me up.
the Only thing i did not try is a CPAP pillow which is coming in a week, but i wanted to show you the screenshots to see if i missed something or if you see something else.
It's been almost 5 months of horrible sleep quality so i was really hoping the CPAP will fix it, but now i'm loosing hope..
thanks you










all screenshots : https://imgur.com/a/XkQ7Gh6

[Mark55]

Looks like they have you on the default 4/20 settings. Myself,....I would bump the min up to 7cm, and the max to 15cm with EPR of 3. You will probably spend 90% of the night at 7 where you will get full benefit of the EPR.

I am no expert, so wait for those opinions. I am only saying what I would do for myself if those were my charts.
Good luck!

[bombayone]

Sorry about your sleep problems. Your charts look good. I would follow the previous post's recommendations about limiting the range. Some of the Forum's more knowledgeable members should weigh in soon with additional good suggestions. Wishing you improved sleep in the New Year.

[squid13]

You could just leave your max pressure at 20, just because it's set to 20 doesn't mean it will go to 20. Your pressure will only go as high as it needs to go, and I agree I would bump the Epap up to 7 or maybe even 8, I'd try 7 first.

[Jas_williams]

Hi


Your numbers whilst using the machine are great Are you on any medication ?

Your issues sound more like sleep maintenance insomnia rather OSA there are some users on here who can provide great advice on helping you get better sleep, everything that gets treated with a machine is not obstructive sleep apnoea.


As others have said setting the machine to fixed pressure may help to reduce wake ups but if the arousals are not related to disrupted breathing then the changes will make no difference to your sleep quality

[koy]

I'm not taking any meds.
Thanks, as I mentioned earlier the sleep lab showed that I had 22 arousals per hour, 13 of them were due by apnea.
I was sleeping on my back in the lab, and I think it increases the number but I'm a side sleeper.
The thing is without the machine I still wake up, and with it, any pressure increase wakes me up.
The only thing I didn't try is fixed pressure , but I don't know if also the pillow was causing blockage of air that's why the machine is increasing the air.
Like I said, without machine sometimes I wake up as soon as I fall asleep from the noise of my throat once it closes.
If CPAP is not the right solution, what else can I do?
And if it is, based on my graphs, what pressure do you recommend and EPR level, ramp, etc..
Thanks

[bombayone]

Pugsy or Pale Rider - Please help this person. Thanks

[Pugsy]

Okay....let's back up and try to address the fragmented sleep itself and keep the OSA stuff on the back burner for now.

Since you feel like it's the pressure increases that are causing the wake ups...how about we greatly reduce the machine's ability to increase the pressure with a really, really tight range. Not quite cpap fixed but close.

My suggestion is to try 7 cm minimum...EPR set to 2 or 3 whichever is more comfortable for you...with the max limited to 9.
Yes the machine might briefly max out at 9 but for right now let's not worry about that because the reason it might be wanting more pressures might not be as big of a problem as the higher pressures might be causing.

Use the ramp only if you aren't comfortable with the 7 minimum....but with 7 minimum and EPR of 2 or 3...most people won't need ramp.
If you don't need it..turn it off. If you feel you need it...keep it short like 10 minutes or so.

Let's see if you still have highly fragmented sleep when the pressure can't do much but it's at a higher baseline to start with in an effort to better hold the airway open to start with...minimize the chance of the machine trying to fix something that happens after the fact. Prevent it from happening first kind of thing.

[Pugsy]

Do you drink any alcohol in the evening?
Any recreational drug usage? You don't have to make that public if you don't want to but I have to ask because it can impact sleep architecture in a negative manner.

[koy]

Hey, thanks for answering this, no I don't drink any alcohol or use drugs or take any meds. It all started bc of the inflammation damage in my throat bc of acid reflux. I used to sleep 8 hrs straight like a rock, so now my body is really suffering from the awakenings at night.
I don't have problem falling asleep without the CPAP or with it. It's staying asleep now. I also stopped coffee for almost a month already.
As you can see I kept trying to reduce the gap, till 5.5 to 8 and still woke me up.
Tried turning off EPR but that was not comfortable and woke me up.
I increased ramp to 45 mns bc I had it to 4 pressure before and min pressure is 5 and the increase in pressure while I'm still awake or few minutes into falling asleep woke me up.

I did not try to sleep without ramp at pressure 7 so I'll see how this goes.
Also I was told to try fixed pressure of 7 with EPR of 2 not 3.
Or fixed pressure of 6 with EPR 2
Or 6-8 range with epr 2.

Right now I'm waiting to get a cpap pillow bc I'm also suspecting that I bury my nose in my pillow and that increases flow limit and hence pressure or it cuts the air and disturb my sleep. But I can't know how to prove it from the graphs.

I find dreamwear comfortable I'm using large frame with small attachment, I tried other variations and this seemed the least amount of leaks.

I'm only wanting to sleep through the night and get back to function in the morning and not stay like a zombie through the day so I appreciate all your advices
Thank you and happy New year

[Pugsy]

EPR isn't much help with the drop during exhale if you are starting out at a relatively low pressure anyway.
The machine can't drop below 4 cm so if you are using 5 cm minimum...even with EPR set to 3 it only can drop 1 cm to the 4 cm.
If you like EPR and want to use it then you need to be starting at a minimum where the full benefit of EPR can be felt while awake.
To feel the full benefit of EPR set to 2....you need to be using at least 6 cm minimum
to feel the full benefit of EPR set to 3...you need to be using at least 7 cm minimum

I personally like EPR myself. It just feels more natural to me and the more EPR the better for me. EPR use is another one of those YMMV things that pretty much all cpap stuff comes with. Use what feels good to you.

When you use the ramp feature it starts the minimum at 4 (unless you change the ramp starting pressure) and thus you don't get the full benefit of EPR. Now it may not matter to you while awake...and that's fine.

Just wanted you to know how EPR works and it's limitations when using low starting pressures.

[dojiscalper]

Are you diagnosed and taking medication to treat GERD (acid reflux). I used to wake up choking on acid but have been on Omeprazole and ranitidine for many years now and I have no issues with that.

[koy]

Pugsy thanks fir the EPR info.
I'll try starting with 6 or 7 right away and see how it feels with corresponding EPR.
How do you feel about setting fixed pressure of 6 or 7 vs 6-8 or 7-9 ?

I'm not taking any meds now for acid, I'm on acid diet which limits the heartburn. I developed what is called LPR which is not really better with PPIs. Diet is best course, I'm hoping that if throat heals, my apnea heals, but meantime I'm trying to sleep.

[stevezoller]

There is another aspect to this to consider. If it turns out to be true that it’s the higher air pressure that is waking you up, then the recommendations to narrow the range are good. But also consider this, you can lower the pressure range even more and let your AHI go up a little bit. An AHI score below 0.5 is great but isn’t medically necessary. You might try a pressure range of 4-6 and see what happens. You may find your AHI goes up to 1 but you may sleep like a baby and feel much more rested.

[Pugsy]

How do you feel about setting fixed pressure of 6 or 7 vs 6-8 or 7-9 ?

I like to see if the machine even wants to respond which is why I tend to at least use a tiny range but it really doesn't matter which you try first...I would suggest trying both....strictly fixed and with a tiny range and see if either way makes any difference in your sleep quality.