Nightly arousals -cpap vs. apap?

I am trying to figure out the best treatment for me due to nightly arousals.

My question is, when I use the apap at a pressure of 4/10 (was titrated at 9) if the machine is sensing to add more pressure is my brain not sensing that I am in need of more air and arousing me slightly at the same time until the pressure is raised?

I have tried CPAP and APAP and am very comfortable using APAP with Mirage FF mask (100% compliant) but have many nightly arousals.

Thanks for any help in this.

Hi stunned,

I'm not a doctor, but if I were prescribed 9 as my pressure, and I were using an autopap...I'd set the autopap's range for 7 - 13 or 8 - 13.

That's just the way I'd do it...putting the low pressure up very close to the "prescribed" pressure so my throat would be kept well and truly open all night right from the beginning. That's important to me because I can actually feel my throat wham shut when I deliberately let it relax. So, I figure it's definitely closing off completely when I start drifting off to sleep.

One night I experimentally tried several different straight pressures from 6 on up, while lying there awake. I consciously relaxed my throat as much as possible while trying to breathe in with the machine going. I found that my throat shuts off at 6; 7 almost keeps it open, and 8 does keep it open. So, I use 8 as my low pressure; setting the range 8 - 14. Rarely does my autopap have to use anything more than 10 or 11 during any night, but I put a margin up there for the ceiling "just in case."

If I were you, I'd definitely put the low up at least a little higher than the 4 you currently have it set at.

As for waking up repeatedly during the night, that could be for reasons that might not even have anything to do with pressure per se. Yes, the arousals could be due to pressure being too low for the machine to cope with sudden apneas or sudden hypopneas. Or even from the movement of pressure changes up and down throughout the night, if you happen to be very sensitive to such changes.

But the arousals could just as easily be from other causes - mask jabbing the face, a wispy air leak hitting the face, aches or pains from underlying health issues like arthritis. Saggy mattress, room getting too warm or too cold, siren off in the distance, dog barking or thump-scratching, bed partner turning over, squirrel clattering across roof, sound of furnace kicking in....any number of things.

Did they note PLMs (periodic limb movements) during your sleep study?

putting the low pressure up very close to the "prescribed" pressure so my throat would be kept well and truly open all night right from the beginning.

I'm with Rested Gal on this... I keep my lower APAP pressure up close to the titrated pressure. In this way, I have very few events, and those that I do have are managed by the APAP. Keeping the lower pressure close to your titrated pressure means that many events are avoided.

Thanks Rested Gal and Will Succeed for your advice.

I will change my settings from 4/10 to 8/13 and see if this helps tonight. I am not sure if I can handle the 8 right off so I will try and may have to go up from 4 to 8 over a week or so.

I know on straight CPAP I could use a ramp but on the Remstar Auto with Clfex set at 8/13 is there a ramp option to go up to the 8?

Rested Gal: regarding the check for restless leg, my first sleep doctor never mentioned it and have since changed to a new sleep doctor at Mt. Sinai Hospital in Toronto. I had a new sleep study done in September and have my followup visit Dec. 1 and will ask at that time.

Thanks again to both of you for your help.

sorry, the last post was from me.....forgot to log in.

Does anybody have the "change the settings" info on the Resmed Spirit? If you do and can help out, would you PM me?

Thanks,
Jan in Colo.

Forget about the Resmed Spirit thing...got my information. Thanks.

Jan in Colo.

WS & RG,

I have a question. Let me first say, tonight I will go back to CPAP just to see if what has been happening is due to keeping my machine on auto for almost a month, which it may not be. But I feel much more tired and my AHI's show a rise, too. This was the worst month on therapy for both I've ever had.

I was on auto for a long time keeping the machine at 4-12. Gave me much better sleep as far as aerophagia goes and leaks, but I slowly during the weeks became very tired and my AHI's went up and stayed higher the entire time. The thing I can't understand is, if I need more pressure to control the amount of episodes and have the machine set to go to my titrated rate (10), then why does the machine stay so low at 6 and under? If controlling the events would take a higher pressure and the auto is supposed to be able to pick up on that, why doesn't it? Or would this be how it should react with the machine doing whatever it needs to to just stop what occurs?

Last night I set my machine at 6-12 and had the same results. It stayed low, this time between 6-8, and I am tired and had a lot of events. I mean, I am TIRED! I don't know why the machine never, ever goes to 10 to allow me to have less events. Here I go again...

In any case, I am going to see tonight if my good old friend 10 CPAP brings me back again because I am seriously tired. Maybe it's the change in seasons and I will still have higher numbers and feel more tired until the season passes regardless. After all, this is my first year going through all the changes from season to season. I have a lot to experience still as far as CPAP/AUTO, etc. and my outside surroundings. But I'm going to put up with the unpleasantries of straight 10 for a week or two and see if I go back to my energetic and chipper self. I'm not even worried about the numbers right now as I've learned they are not as important as how you feel. But I need to go back to feeling good again.

Any input on this is welcome.

Forget about the Resmed Spirit thing...got my information. Thanks.

Jan in Colo:
So, where did you find the info? I need it, too!

Thanks,
Allen