Adjusting

This is my first post, although I am not a newbie to CPAP machines. Here is my story.
I was initially diagnosed in 2004 and was prescribed a cpap machine. I had difficulty adjusting to the incoming pressure, and after 2 weeks of feeling like a zombie, walked back into the sleep doctors office and said, "this is not working.. you got to do something, Doc.".

So he gave me a script for a sleeping pill, which I took every night for a couple of years. After 2 years of successful sleep, I started having the same problem.. I would not be able to exhale against the incoming pressure, and thus would wake up. (yes, I had ramp turned on, starting at 4.) Even with the pill.

But by this time I had also lost some weight and felt that my OMA was not as acute anymore, so I just quit using the machine. Fast forward to the present.
I have moved to a different location, new doctors, etc. In the last year it seems my OSA has gotten worse again. Back for another round of sleep studies.
New sleep doctor. Told him my story of difficulty with adjusting to the machine. He assured me that the machines have improved, etc.

So long story short, I now have a Resmed Airsense10. . Very quiet, very small. Apparently it's an Apap, which means the ramp feature isn't timed, it is pressure sensitive, I think.

Last night was my first time using it. I think it took me about an hour to get into my first sleep phase, and woke up about 10 minutes in, found that once again, I had quit breathing, not because of apnea, but because I was not exhaling against the incoming pressure. I checked the pressure at the time, and it was at 10.5

(My doctor set the machine for 12)

I reset again, so I could start with 4 while I go to sleep again, and once again, it took a long time.. and within about 10 minutes of going to sleep, I awoke again for the same reason. This time the pressure reading g showed 11.

It was around 1:30 in the morning and by this time my fatigue beat out over commitment, and I removed the mask and slept the rest of the night without it.

What is the secret? Is it that I have such a weak diaphragm that I just cannot blow back in a relaxed state?

My previous sleep doctor told me that 10 percent of his patients never manage to adjust to the machine...

Any help would be appreciated.

Your machine has an EPR feature...exhale pressure relief.... Be sure that it is turned on and set it for 2 or 3. If your pressure is set to 12 on inhale it will be reduced by 2 or 3 on exhale. It makes a big difference.

Are you using EPR (Exhale Pressure Relief)?
If you are...at what setting?
If you aren't...might want to try it.
If you don't have any idea what I am talking about read the manual as it explains EPR and how to turn it on and adjust.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

I have now read the manual. I was wondering why they gave me the model labeled Auto set for her, but it seems that different algorithms are used for the women, although I am a guy. Perhaps this was done because of my telling them that I have a history of difficulty adjusting.

So yes, EPR was enabled, but set to 2, so I changed it to 3 and not just during ramp.
Don't know if it will make much difference, but we will see.

.

The regular AirSense 10 AutoSet has 2 modes of operation....cpap and regular apap
The AirSense 10 for Her has 3 modes of operation...cpap, regular apap and the for her special apap.
While they market that 3rd special apap mode as being "for women" there no reason for a man not to use that mode if it is more comfortable or they do better with it.
Or you can just use the regular apap mode which works just like the regular apap mode on the machine that isn't the for Her model.
I don't know why they gave you the for Her model but maybe it was because they thought the additional mode might be useful in your situation.
It never hurts to have that additional mode available just in case in might come in handy.

I also had/have a major issue with exhaling into pressure. I started with the machine you are on and am now using the VPAP Airsense 10 and no longer exhale into pressure, very nice. Still fighting other issues but that one is gone.

You just need to find your threshold of tolerance so you can sleep with the machine.

Do keep an open mind that more than one thing could be contributing your trouble. Just wondering if a combination of the change to the EPR plus increasing that early pressure of 4 might help. Having the EPR in full use might make upping the pressure more tolerable. We all tend to see the situation of others through the filter of our own experience and that's all I'm doing here. Any time I hear someone say they have difficulty so early in their sleep I think too low of pressure. Now, if you have some sort of physical compromise to your exhale strength, that's another story. But if not, maybe consider your early problems could be the brain sensing the need to stay on heightened alert due to insufficient air flow. That was my issue and that one tweak to my treatment began my turnaround from CPAP failure to CPAP becoming a comfortable experience. Good luck figuring out what will work for you.

Seems counterintuitive to up the pressure when it is the higher pressure that wakes me up. Help me understand this.

Alright! 6.08 hours of usage

With the help of 5 MG of Imovane,. Tonight I will take 1/2 dose.

The machine tells me I had .3 events per hr

So I don't know what the following numbers mean.
Score overall 77
Good mask seal 7/20

Not sure if 7/20 is good.
One question I do have though. When I woke up, I noticed the pressure was only at around 6.5 and the doctor prescribed 4-12

Does the Apap just determine the minimum pressure needed to keep my breathing passage open, based on my events? How does this work?
My old machine would, d go up to the max pressure after the ramp period, and stay there..

Slim1950 wrote:Alright! 6.08 hours of usage

With the help of 5 MG of Imovane,. Tonight I will take 1/2 dose.

The machine tells me I had .3 events per hr

So I don't know what the following numbers mean.
Score overall 77
Good mask seal 7/20

Not sure if 7/20 is good.
One question I do have though. When I woke up, I noticed the pressure was only at around 6.5 and the doctor prescribed 4-12

Does the Apap just determine the minimum pressure needed to keep my breathing passage open, based on my events? How does this work?
My old machine would, d go up to the max pressure after the ramp period, and stay there..

Yes sir, I believe you are correct.

Slim1950 wrote:Does the Apap just determine the minimum pressure needed to keep my breathing passage open, based on my events? How does this work?

The auto adjusting pressure algorithm (APAP mode) uses a complicated measuring system evaluating not only events but flow limitations and snores and how many of each might happen within a certain time frame.
It won't adjust pressure during an apnea event that is all by itself with nothing else going on unless other factors or involved.

Slim1950 wrote:One question I do have though. When I woke up, I noticed the pressure was only at around 6.5 and the doctor prescribed 4-12

The doctor prescribing a range means that he is willing to let the machine decide the optimum pressure.
Doesn't really matter much what the maximum range is if the machine doesn't think it needs to go there then it won't go there. The maximum becomes a moot point.

Slim1950 wrote:The machine tells me I had .3 events per hr

So I don't know what the following numbers mean.
Score overall 77
Good mask seal 7/20

Not sure if 7/20 is good.

These sound like numbers from the online MyAir website. I think the overall score of 77 is just something they come up with based on hours of sleep and how many wake ups you might have or how many times you may turn the machine off and on.

I have no idea what 7/20 for leak might mean.

I suggest you get real software so you can see in much greater detail exactly what is going on.
https://sleep.tnet.com/equipment

Groan. I don't know why one night I can breathe easily into the mask, and the next night I can't. Last night, after fighting the pressure, I finally took the mask off and slept without it. It's as if there is a sweet spot that I need to find... and I couldn't find it.

Tonight I will try again. No surrender...

Slim1950 wrote:Seems counterintuitive to up the pressure when it is the higher pressure that wakes me up. Help me understand this.

Most people have trouble with the lower pressures of 4 and 5. It is uncomfortable and often feels suffocating. It may be harder to fall asleep and thus the reason it takes you so long to fall asleep. Many people find it is better to start at 6. I had trouble with 4 when I started, shortened the ramp on the 3rd day, and turned it off the 4th day. Mine goes straight to 11, and I usually fall asleep in less than 10 minutes. It is like the mask and refreshing air are a cue for me to drift off to sleep.

The key is to figure out what works well for you. Getting the sleephyhead or ResScan software (both free) will help as you can see what is going on. You can see what your pressure is doing, if it staying at one level most of the night, going up and down a lot, etc. You can also see if there were events, leaks, etc right before you wake up. You can see how long the events are, what type they are, etc. There is a LOT of useful information available.

I too am new to CPAP, but I did a few things that have helped me adjust over just a few days.

1. Never sleep without your mask. If you can't sleep, get up, and come back to bed in 1/2 hour or more. You need to teach yourself that sleep=mask. Allowing yourself to sleep even 1 hour without the mask is a recipe for CPAP induced insomnia. Starting on a long weekend helps (even if you have to take a day off to make it a long weekend). If you are exhausted from not sleeping, it will be easier on night 2. Don't bother with the sleeping pill. It will just make you feel worse the next day. I took one for my Titration, and I will never take one again. Take some melatonin if you like.
2. Don't mess with your prescription level (ramp excluded). When you are asleep, your body will adjust easily to your prescribed level.
3. Use auto-ramp. It is very good and will ensure the ramp happens at just the right moment, and when you are least likely to notice it.
4. Set your ramp pressure at at least 7. Your machine is not capable of an EPR final pressure below 4, so if you have EPR, it will not kick in until the actual ramp. You will go from 4 to (12 in your case) over a few minutes, with the EPR kicking in when you are not used to it, and then kicking off at the end. It may actually be the EPR that is waking you up, not the pressure itself. If your prescribed pressure is 12, you may way to have ramp pressure a little higher to help make the transition less noticeable. I find that my setting of 7 with an EPR of 4 is actually very relaxing because the machine practically breaths for me.
5. If you wake up, and cannot get back to sleep, refer to number 1. If you take off your mask, get out of bed, even if just for a few minutes.

Thanks for your replies. So far my average sleep time with the mask is 4.5 hours. Last night I did almost 5. So that's progress. And it's the bladder that wakes me, I think. Then I cannot get back to sleep. So I go the last couple of hours without the mask. I will cutalk back on the fluids in the evg to see if that a helps.