Pressure adjustment needed?

So I am in my 3rd month of Pap therapy. I have made numerous strides getting to this point based on how poorly my titration sleep study went. My results showed that I needed a pressure of only 6. After 10 restless nights, I joined groups, asked for advice, upped my pressure gradually to where it is now at 11. I have tried 5 different masks and just yesterday realized that it's not so much the mask as to why it leaks as it is the bed pillow I was using. I guess my biggest issue now is this snoring. I thought the Pap would control it but so far, it isn't. Any suggestions based on this data? http://imgur.com/a/4thQo

Welcome to the forum,
I don't think your pressure needs to be any higher because it never goes above the 11cm. You might even get by with a lower range and then see if the pressure ever increases from the minimum. The spikes you see on the pressure graph are pressure probes where the machine is just checking the airway.
Do you breathe ok through your nose? Are you mouth breathing? If you jaw is dropping during the night and you are mouth breathing you might try a soft cervical collar to hold your airway in a neutral position.

Your machine is a fixed pressure machine that has an "auto trial" feature. Your machine is currently set at 11min 15max and your pressures are fluctuating greatly during the night. The idea of this feature is to determine what your fixed pressure should be. It looks like the machine should set 11-12 as your fixed pressure based upon this example. Possible that your snores will diminish. This was a 30 day feature....I don't know why it is still set on auto after 3 months.

Auto-Trial

The DreamStation Pro features and auto-trial mode which can be used for up to 30 days. During this period, the machine will function as an auto-adjusting machine that will automatically adjust pressure during the night to provide optimum pressure on a breath-by-breath basis. After the auto-trial is complete, the machine will provide the pressure the user was at or below 90 percent of the time. Please Note: This is not an auto-adjusting machine. Once auto-trial is complete, the machine will not adjust pressure during the night.

Good catch LSAT. I saw the Variable pressure and missed CPAP Pro. On some of the auto trial machines you could reset it for a certain amount of times. Not sure on the Dreamstation.
I think I would set it to CPAP mode at 11cm and see if that makes a difference in how you sleep. Those sudden pressure spikes may be causing arousals. Give it a few days after you make a change so you will know which change made the difference.

OkyDoky wrote:Good catch LSAT. I saw the Variable pressure and missed CPAP Pro. On some of the auto trial machines you could reset it for a certain amount of times. Not sure on the Dreamstation.
I think I would set it to CPAP mode at 11cm and see if that makes a difference in how you sleep. Those sudden pressure spikes may be causing arousals. Give it a few days after you make a change so you will know which change made the difference.

+1


Den

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Thanks for the comments. I have adjusted my machine over the past 3 months since it was so obvious with headaches, fatigue, etc that my initial pressure wasn't correct. Yes, it's an Auto-Trial and the reason I have chosen 11 is that is the first pressure that I have been at a constant where I don't wake up with a headache. I thought the machine by going to 12 and sometimes even higher (highest said 14.5) was actually stopping apneas. I have tried 2 chin straps and even once taped my mouth but even taped, I snored. Some nights I only have 2 snores and 1 night I had zero. I have the Ruby Red chin strap. I do have a mouth guard that I can wear. I just thought once I was at the correct pressure, the snoring events would cease. I do wear a FF mask so I guess it's not too concerning although snoring is one of the reasons people have studies. I do think I occasionally mouth breathe. I was hoping to be able to wear the pillow mask but I would wake up with my mouth open. I was also told that that would stop when I achieved the optimal pressure. I take it that isn't true? I do breathe fine through my nose but have suffered all my life with seasonal allergies. I take a zyrtec daily and Flonase before going to sleep so it's pretty much under control. I sleep on my side or stomach and have never been a back sleeper other than the naps in my lazy boy chair.

Jasba64 wrote:Thanks for the comments. I have adjusted my machine over the past 3 months since it was so obvious with headaches, fatigue, etc that my initial pressure wasn't correct. Yes, it's an Auto-Trial and the reason I have chosen 11 is that is the first pressure that I have been at a constant where I don't wake up with a headache. I thought the machine by going to 12 and sometimes even higher (highest said 14.5) was actually stopping apneas. I have tried 2 chin straps and even once taped my mouth but even taped, I snored. Some nights I only have 2 snores and 1 night I had zero. I have the Ruby Red chin strap. I do have a mouth guard that I can wear. I just thought once I was at the correct pressure, the snoring events would cease. I do wear a FF mask so I guess it's not too concerning although snoring is one of the reasons people have studies.

Well, for now, the recommendation would be to set it to straight-pressure "CPAP mode" of 11 cm. (not Auto or Auto-Trial) and see how the reports look and how you feel without the pressure bumps.


Den

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Thanks, will do and will share my results. Happy New Year!

Have you had an ENT look at your nose to see if there is something there that might be the cause of your snoring? Is it disturbing your sleep or are you just seeing it on the reports? You don't have a lot on the report. CPAP does help snoring but if it is caused by something structural in the nose, it might not completely eliminate it.

A snore index of 1.0 is pretty minimal. If you have some nasal congestion, that could cause it.
Nasal cleansing before bedtime could help.
Snoring is one of the things that trigger pressure increases with APAPs in ranges of pressures. With straight pressure CPAP mode, it won't be able to increase pressures.


Den

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I do wake up a lot. I never sleep more than a couple hours at a time. Do you suppose it's the snoring that wakes me up? I never gave that a thought. I do use Flonase every night before I go to sleep. I work shift work, both days and nights, so I sleep whacky hours. I also have breathe-right nasal strips that I have worn in the past, not every night. I haven't seen an ENT for snoring. I was really hoping that Cpap would solve all the issues. I believe I was issued a straight Cpap and not an Apap because my results at a pressure setting of 6 was so minimal. Like I said, it was pure hell the first 10 nights and I had therapists in other Cpap groups suggesting I needed more pressure. It worked to a point, just haven't gotten where I need to be, as of yet.

Oh, I meant to say I also purchased an Oximeter thinking that perhaps my oxygen level was getting too low causing the wake-ups but it turns out I am fine.

Jasba64 wrote:I do wake up a lot. I never sleep more than a couple hours at a time. Do you suppose it's the snoring that wakes me up? I never gave that a thought. I do use Flonase every night before I go to sleep. I work shift work, both days and nights, so I sleep whacky hours. I also have breathe-right nasal strips that I have worn in the past, not every night. I haven't seen an ENT for snoring. I was really hoping that Cpap would solve all the issues. I believe I was issued a straight Cpap and not an Apap because my results at a pressure setting of 6 was so minimal. Like I said, it was pure hell the first 10 nights and I had therapists in other Cpap groups suggesting I needed more pressure. It worked to a point, just haven't gotten where I need to be, as of yet.

It was more than likely the pressure changes/bumps from the machine responding to the snores. The other first responses of pressure increases is to Flow Limitations. If you didn't wake up to snoring prior to starting therapy, it probably wasn't a factor then.
Lots of this therapy is finding out what works for each of us. It can take some time and experimenting to find what works.
Nasal cleansing......Neti Pot or something you can come up with if you have nasal congestion before bedtime should help.

Be patient and listen to the little voice in your head (intuition).


Den

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Thanks and I did wake up the same as I do now, prior to Pap therapy. That's what prompted me to have the sleep study. Also, my father passed away at age 59 from an aneurysm and I know he had untreated sleep apnea. He had a study but said he didn't have it. I can remember him gasping for air and extremely loud snoring. I tell people all the time that I would bet a paycheck that people dying from heart disease at young ages most likely have sleep apnea. One guy said 80% of people diagnosed with congested heart failure have sleep apnea.

New data from last night. Prior to sleeping, I used my Flonase and wore a Breathe-right strip. http://imgur.com/a/hVa0Z

Jasba64 wrote:New data from last night. Prior to sleeping, I used my Flonase and wore a Breathe-right strip. http://imgur.com/a/hVa0Z

Lookin' good!
Now you're making progress.


Den

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