Questions from a newbie

Hello everyone. Last night marked the end of my second week on CPAP. This has been a challenging experience, but I seem to find it to be more of a mental one and then a physical one. I seem to slowly be adapting pretty good to the nasal pillows (though I certainly would rather not use anything!). The mental struggle comes in, I think, because I didn't really think I had sleep apnea and was pretty shocked when the doctor said it was severe-- my sleep study showed an AHI of 30. I felt like my whole world turned upside down in two days – the diagnosis on a Wednesday and on a machine Friday night. I don't have my second sleep study (titration?) until June. I told the doctor I was not going to wait that long to start the machine since he told me I was at four times a greater risk for heart attack and stroke. So I started on machine and will have the next sleep study in a couple weeks. Anyways, sorry for so long winded but here are some of my questions --

1). I am having a very difficult time getting to sleep. ( and usually didn't until all this started). Some nights I've taken a sleeping pill and all goes well, but I realize I can't keep that up ( and I don't want to ). Decided last night was a no pill night. I was in bed for eight hours bu I think I slept maybe three. After a lot of nights of a good AHI (.7, .7, .4, .5, .3, .5, 2.2, .4, 2.2, 1.2, .5, .9, .4, ) , last night it was 7.7! And since I wasn't asleep for eight hours and probably just three, I realize the AHI would be a lot higher. I know at one point I ended up on my back because I was tossing and turning so and I just felt more comfortable on my back even though I am a pretty consistent side sleeper. So my question is, can sleeping on your back for just a little while raise the AHI? Is that a concern?

2). Also, what's the opinion on taking sleeping pills while on CPAP therapy?

3). I've read a lot of posts on here and see a lot of comments about Sleepytime software. My machine did not come with the SD card and I was told they no longer do. All I can access is that my air.resmd data on my computer. Can I buy one to put in the machine and if so what kind and how do I access the Sleepytime software. Is it worth doing? i'm not very tech savvy.

4). I am wondering about the nasal pillows when I have a cold and can't breathe through my nose. Should I go back and get a mask to use in those times? Do you suggest having more than one mask? How long can you use a nasal pillows before you have to replace them?

5). My machine has an auto ramp set at 4–20. When I get up during the night and take my mask off, it resets back to four when I put the mask back on. At that time I kind of feel like I'm not getting enough pressure, as it seems a little hard to breathe through the nose.Do I go back to my supplier and ask them to reset that? Is it normal to feel the four is too low?

I do realize I should go back to my supplier and talk to them about a lot of this. I did call on Friday to talk to someone but had to leave a message and no one got back to me. I will pursue that next week. In the meantime, would appreciate it if anyone had a moment to answer some of my questions. I am Posting here because I have found this board to be quite helpful.

Firstly, welcome to the forum, you will learn a lot here on how to optimize your therapy.

Wearing a mask does take a little getting used to, and many find it helpful to run their machine and get used to breathing with the mask while awake watching TV or reading, until it feels second nature. You will then feel less anxious about your bedtime routine.

To answer some of your questions:

1. Sleeping on your back is more likely to raise your AHI slightly but you should not be over concerned at the moment as you are still adjusting and your events are being treated reasonably well. Always better so side sleep if you can stay comfortable but quality of sleep is important.

2. I have never taken sleeping pills, but would consider it short term if I had a real problem with sleeping.

3. The Software is called Sleepyhead, there are tutorials in 'Pugsy's Pointers' in the sticky post at the top of the home page. You will need a standard SD card, it doesn't have be high capacity as the data uses little memory.

4. It may be a good idea to have a Full Face Mask as a back up for those occasions.

5. Your machine is an 'AutoSet' and the 4-20 means that your starting pressure is 4cmH20 and your Highest pressure is 20cmH20, this is as low and as high as your machine will go. You may want to adjust the lower pressure up a little if you're having trouble breathing at low pressure. Both of your pressures may need to be adjusted over time to optimize your therapy to suit you. Auto Ramp is a comfort feature which may be switched on, it starts you at a low pressure and gradually builds up to your stating pressure. As your starting pressure is already as low as the machine will go (4cmH20) then Ramp would not be useful at the moment.

We can show you how to access the clinical menu if you are happy to make changes on your own with our guidance. You may be a little nervous about this at first but in time you will find it is better to have more control over your own therapy.

Good luck.

mirakaja wrote:So my question is, can sleeping on your back for just a little while raise the AHI? Is that a concern?

It can but is usually fixable with more optimal pressures so you can sleep in any position that promotes good sleep.
As you found out...gotta sleep first.

BUT...3 out of 8 hours with AHI of 7.7...I am betting a good bit of that AHI is awake/semi awake breathing event flags.
These machines don't know if you are asleep or not, they just measure air flow and air flow/breathing while awake is much more irregular than asleep breathing and it's fairly common to see some "false positives" when we have a lot of awake time on the machine.
I wouldn't worry too much about that AHI at the moment.

mirakaja wrote: Also, what's the opinion on taking sleeping pills while on CPAP therapy?

Sigh...rock and a hard place for sure. My personal opinion is that there is a time and a place for any medication and I feel that this is best left up to a discussion with your doctor about the pros and cons and what do you feel is needed in your situation.
Obviously no sleep aid is probably preferable but sometimes we just need some help and I think that short term to help us get through all this adjustment stuff is one of those "time and place" for some help.
There are risks and rewards to any medication for any reason and I think that people should discuss these risks and rewards with their doctor.
You gotta get some sleep somehow.
Talk to your doctor.

mirakaja wrote: My machine did not come with the SD card and I was told they no longer do. All I can access is that my air.resmd data on my computer. Can I buy one to put in the machine and if so what kind and how do I access the Sleepytime software. Is it worth doing? i'm not very tech savvy.

Not so sure about the statement that "they no longer come with SD cards" because I don't think that is true but if you don't have a SD card....any SD card will work. Just get the smallest generic SD card you can find for the cheapest money. The smallest is going to be a lot larger than you really need but finding 1 or 2 GB cards is next to impossible.
And yes...it is VERY MUCH WORTH DOING.
It's not that difficult either.
https://sleep.tnet.com/equipment
and some examples of what you can see
viewtopic/t103468/Need-help-with-screen-shots.html

and very important because software shows the breakdown of that AHI.
BTW...it's SleepyHead and not SleepyTime

mirakaja wrote: I am wondering about the nasal pillows when I have a cold and can't breathe through my nose. Should I go back and get a mask to use in those times? Do you suggest having more than one mask? How long can you use a nasal pillows before you have to replace them?

Pillow life longevity varies between people depending on facial oils and whatever cleaning routine they happen to use.
I use the P10 and I can get months and months and months out of 1 nasal pillow.
I have found that the headgear needs replacing more often than nasal pillows.

mirakaja wrote: My machine has an auto ramp set at 4–20. When I get up during the night and take my mask off, it resets back to four when I put the mask back on. At that time I kind of feel like I'm not getting enough pressure, as it seems a little hard to breathe through the nose.Do I go back to my supplier and ask them to reset that? Is it normal to feel the four is too low

If you simply cannot get the nose opened up for whatever reason then a full face mask is obviously going to be needed but let me share this....I have been on cpap coming on 8 years the end of this month and have used nasal pillows the entire time. I haven't ever had a cold so bad that I couldn't get the nose opened up enough to use the nasal pillows. I went 6 years without even having one available because I never found one I liked or could use until a couple of years ago. Finally found one but have yet to need it and I have had my share of colds over the past 8 years.

mirakaja wrote: My machine has an auto ramp set at 4–20. When I get up during the night and take my mask off, it resets back to four when I put the mask back on. At that time I kind of feel like I'm not getting enough pressure, as it seems a little hard to breathe through the nose.Do I go back to my supplier and ask them to reset that? Is it normal to feel the four is too low?

Most people have trouble with that starting 4 cm pressure especially in the middle of the night where they have probably been using higher.
Depending on what the pressure settings are...you might either turn ramp off or set the starting ramp pressure to something like 5 or 6 which would be more comfortable. There's not much air moving at 4 cm and while we won't suffocate it sure feels like it and when we aren't comfortable we have trouble going to sleep...and getting sleep is the number one goal.

Go here and download and read the provider/clinical manual.
https://sleep.tnet.com/home/files/resme ... -guide.pdf
It explains how to get to the clinical setup menu where you can alter things....change that ramp or turn it off or whatever.


Go get a SD card (I got one at Walmart after I lost mine) and download SleepyHead software...it shows so much more than what you can get from the ResMed MyAir website.

Don't worry about that AHI that is a bit high right now...it might have been SWJ (sleep/wake/junk) false positives or it might be that you were on your back and you need higher starting pressures...but let's use the software and figure out exactly what is going on before we worry about how to fix it.