Another Newbie Struggling With CPAP

Hi All,

Instead of giving up on my CPAP after a week of "use", I figured I would give the forum a shot to see if anyone could help. Overall I'm a healthy active 37/m with normal blood pressure, body weight, etc...I had a sleep study done after my wife commented for years on the fact that I stop breathing during my sleep from time to time and I had a history or waking with a mild headache. Never felt like I was perfectly rested, but have never had a history of falling asleep during the day or feeling like I was going to for any reason. I had trouble falling asleep during the sleep study and the few hours of data they got showed mild sleep apea of 5 AHI.

Like the majority of people, I'm really struggling getting used to wearing scuba gear to bed. I accessed the clinical settings on my machine and it looks like it's set to a range of 4-14. My biggest problem isn't the comfort of the nasal pillows, but the labored breathing that is created when trying to breathe through the mask. I often feel like I'm breathing out through a clogged straw when I first put the mask on and usually lay in bed unable to relax. I've seen some other posts about lower levels making it difficult to breathe and am wondering if that is part of the problem if it's just related to my body not being adapted to the difference in pressure yet.

I was also wondering if there are any other people out there that have a low apnea index and have actually found relief with a CPAP. I've never felt as poorly as I have this past week and am finding it hard to do my job during the day and have been so exhausted I'm unable to do my normal exercise routine.


Thanks in advance,
Chris

The combination of the low 4 cm starting pressure and the P10 nasal pillow mask is very possibly the bulk of your problem.
Between the low volume space in the pillows and the low pressure...it can feel like not enough air is moving or that it hard to move the air.
While some people are okay with 4 cm pressure...most feel like it is suffocating them.

2 things...try increasing the pressure to 6 cm and see if that helps.
also...try going up a size in the nasal pillow and see if that helps...if you are already using the large...can't go up from there so stick with increasing the pressure.

If you are using EPR...it can't even kick in at 4 cm anyway and EPR might help with the breathing rhythm and comfort but it can't work at 4 cm at all.

I bet you haven't been sleeping so great with the mask....lots of wake ups maybe....short hours of sleep and maybe taking the mask off sleeping without mask for little while? If any of those things are going on...there's no chance of feeling better until your overall sleep quality improves.

Thanks, I'll bump the pressure up to 6 and see if that helps. I am using the medium nasal pillows (the large are too big and the seal fails when I lie down). The lack of sleep is definitely what is killing me. I'm averaging 4 hours of sleep the past week and usually get 9.

Would you notice a big difference in how you felt by reducing your AHI from 5 down to less than 1? The few times I've gotten some sleep with that thing on my AHI is below 1. I'm just wondering if the hassle of adapting to this thing is worth it

crtello wrote:Would you notice a big difference in how you felt by reducing your AHI from 5 down to less than 1?

AHI of only 5 on the diagnostic study by itself doesn't really tell me much...I would want to know what the oxygen levels were. On the surface it doesn't sound bad enough to even be on the cpap machine but maybe there are other factors involved like a lot of arousals or significant Oxygen level drops.
It sort of depends on what was going on prior to the use of the machine.

People do report significant improvement in symptoms just from going from a diagnostic AHI in the single digits (like 8 ish) with cpap therapy and then there are people whose AHI is much worse and don't see a big improvement (usually because they have other issues that the machine can't fix).

It all depends on what symptoms a person has prior to cpap therapy and what is/was causing those symptoms.
CPAP can't fix problems unrelated to sleep apnea...no matter how much we want it to.
If a person only sleeps 4 hours...sleeping 4 hours with cpap isn't going to work the miracle simply because 4 hours isn't enough no matter how low that AHI is. If a person wakes up a gazillion times during the night for some reason unrelated to sleep apnea...the machine can't fix that and a person will feel like crap.

I would want to see the full report from your diagnostic sleep study if I were in your shoes. AHI of 5 barely meets the diagnostic criteria and it doesn't sound like you had very much of the usual symptoms.
The one thing I would for sure want to know would be O2 levels. I would want to know how long those 5 per hour events lasted. 5 of the 10 second events wouldn't likely do much to the O2 levels but if those events were lasting a long time it might be a different story.

Example...my OSA is worse in REM sleep (53 per hour) but in non REM sleep it is only 12 per hour...not a horrible number that 12 per hour but in non REM sleep my O2 levels dropped to 73% and I had some massive long events in non REM sleep.
I don't care how many I had..that 73% was scarey low.

Also...you might have UARS...Upper Airway Resistance Syndrome...google it. The symptoms mimic sleep apnea but usually the AHI is rather low and unremarkable. Treatment is still cpap but it is harder to evaluate because the AHI is already low and thus seeing a low AHI on the software reports doesn't really tell us much and people have to go by how they feel even more.

I think you need to get the full reports of both your diagnostic sleep study and your titration sleep study (if you had one) and check to see what for sure was going on in terms of sleeping position and oxygen levels and sleep architecture and did you have any REM sleep which may be where a person's AHI is higher but if you didn't get much REM then that possibility is hard to evaluate.
There's more than AHI of 5 going on I suspect or the insurance would have maybe had some trouble coming up with a reason for paying for the machine....or at least most insurances would have wanted more than AHI of 5 all by itself.

FWIW, I was started a similar way...4-20 cm. I tried for the first 30 days to cope, but just couldn't. I got no support from the Supplier, and came here before grabbing the bull by the short hairs and taking charge of my own therapy. I have yet to think I made a mistake. I got rather loud with the DME a couple times, and swore if they even THOUGHT about resetting my machine to "prescribed settings," that I would remove the modem (and their access) and find an alternate way to get my readings to them.

I've tweaked my settings for MYSELF comfort. That translates at the moment to 7-15 cm. I also use the EPR set to whatever is comfortable at the time...I think it's a 2 right now. I found that going from a minimum of 4 to 7 took time, though. Maybe try 5-5.5 for the first jump, give it a few days or a week if you need time to adjust. This will also give you a chance to see if your numbers improve. I find the first night or two after a change COMPLETELY changes my numbers...then things settle back to normal.

Whatever you change, it's for your comfort...and not feeling like you're suffocating is part of that.

Oh...if you are using the ramp function...turn it off as you don't need it and it starts at 4 cm anyway which compounds any suffocation feeling.
Now if you ended up needing higher minimum pressures (higher than 6)..then ramp might come in handy but we would want to change the starting pressure for ramp to something a little higher.

Sometimes the ramp is useful but sometimes it compounds any suffocation feeling a person might be having at that 4 cm pressure.

Thanks for all the info...I didn't see the full results of the sleep study myself, just spoke with the Dr. the morning after my study (and it was an at home sleep study so there was much less data), . My blood oxygen levels dropped a little, but were still fairly normal throughout the night. The Dr. said based on the results he isn't concerned with it leading to heart disease, stroke, etc...but suggested I give the CPAP a try to see if it improved how "refreshed" I feel in the morning. The other factor was that since I didn't get much sleep, the at home sleep study isn't as accurate in determining the number of events per hour, more of an avg. based on the time I usually go to bed and get up (9pm-6am). But that night I got it into my head I HAD to fall asleep and couldn't sleep for shit. For whatever reason when I sleep better throughout the night, I usually wake up feeling foggy with a mild headache. It's like the more I sleep normally, the worse I feel?

I cranked up my starting setting to 6 when I went home for lunch and breathed through it for a while and it actually felt much better. I'm going to give it another go tonight and see what happens.

I was also wondering if the place that gave me the CPAP was going to bitch at me about changing the settings but I'm honestly more concerned with being able to sleep than I am about them giving me grief for messing with the prescribed settings.

Pugsy wrote: AHI of only 5 on the diagnostic study by itself doesn't really tell me much...I would want to know what the oxygen levels were. On the surface it doesn't sound bad enough to even be on the cpap machine but maybe there are other factors involved like a lot of arousals or significant Oxygen level drops.
It sort of depends on what was going on prior to the use of the machine.

People do report significant improvement in symptoms just from going from a diagnostic AHI in the single digits (like 8 ish) with cpap therapy and then there are people whose AHI is much worse and don't see a big improvement (usually because they have other issues that the machine can't fix).

It all depends on what symptoms a person has prior to cpap therapy and what is/was causing those symptoms.
CPAP can't fix problems unrelated to sleep apnea...no matter how much we want it to.
If a person only sleeps 4 hours...sleeping 4 hours with cpap isn't going to work the miracle simply because 4 hours isn't enough no matter how low that AHI is. If a person wakes up a gazillion times during the night for some reason unrelated to sleep apnea...the machine can't fix that and a person will feel like crap.

I would want to see the full report from your diagnostic sleep study if I were in your shoes. AHI of 5 barely meets the diagnostic criteria and it doesn't sound like you had very much of the usual symptoms.
The one thing I would for sure want to know would be O2 levels. I would want to know how long those 5 per hour events lasted. 5 of the 10 second events wouldn't likely do much to the O2 levels but if those events were lasting a long time it might be a different story.

Example...my OSA is worse in REM sleep (53 per hour) but in non REM sleep it is only 12 per hour...not a horrible number that 12 per hour but in non REM sleep my O2 levels dropped to 73% and I had some massive long events in non REM sleep.
I don't care how many I had..that 73% was scarey low.

Also...you might have UARS...Upper Airway Resistance Syndrome...google it. The symptoms mimic sleep apnea but usually the AHI is rather low and unremarkable. Treatment is still cpap but it is harder to evaluate because the AHI is already low and thus seeing a low AHI on the software reports doesn't really tell us much and people have to go by how they feel even more.

I think you need to get the full reports of both your diagnostic sleep study and your titration sleep study (if you had one) and check to see what for sure was going on in terms of sleeping position and oxygen levels and sleep architecture and did you have any REM sleep which may be where a person's AHI is higher but if you didn't get much REM then that possibility is hard to evaluate.
There's more than AHI of 5 going on I suspect or the insurance would have maybe had some trouble coming up with a reason for paying for the machine....or at least most insurances would have wanted more than AHI of 5 all by itself.

Oh...you had a home study?
Depending on which type of home study the data gathered could be extremely limited and if you slept poorly...even more limited.
If they just used a little thingy in your nose (checks for air movement) and on your finger (that's a pulse ox to measure O2) the data is pretty limited.
More of a screening tool really.

The more you sleep the worse you feel..might be a REM stage sleep thing...the more REM you get the worse it is like me.
If you didn't sleep well...then you likely didn't get much REM.

I suggest proceeding with cpap then and let's see if it helps but first get you comfortable so you can sleep and then see what happens.
Get SleepyHead ...links in my signature and as soon as you have some decent blocks of sleep on the reports we can look and see what is happening.

The doctor shouldn't be upset for raising the minimum...he has already had the machine set to go higher anyway.
If he should get upset...just tell him you were suffocating at that lower pressure and couldn't sleep. It won't be the first time he has heard that complaint. If anything he will be more upset that you figured out how to do it than that you really did it.. They seem to prefer that it remain the national secret.
It's your therapy though...and he works for you..not the other way around.

Thanks again for the help!! I'll grab the SleepyHead software and a data card reader this week and will keep an eye on my numbers (once I get some sleep). I'm hoping just bumping the initial start up level will help a bit tonight

I made sure the ramp up is turned off and noticed the EPR level was set to 3

crtello wrote:EPR level was set to 3

Yeep, i think epr set to 3 will not work if the min.pressure is 6, but epr = 2 maybe it's ok.

With EPR of 3...even with 6 cm starting pressure you can leave it at 3...but it will only reduce down to 4 cm because that is as low as the machine can go but in auto mode the pressure will likely go higher than 7 and when it does then the full 3 cm reduction will kick in. So you don't have to change EPR to accommodate the 6 cm starting point.