First real night with CPAP. Constantly woken by machine.

SarahB · Post by **SarahB** » Fri Feb 16, 2018 10:27 am

D.H. wrote: ↑
Fri Feb 16, 2018 10:24 am
Since you report discomfort and you show "Clear Airway" events, I suggest turning the max down to 12 or so. You can always turn it back (part or all of the way) up later. The starting pressure of 4 seems to be agreeable, so I'd leave that lone for now. If your min is 4, the ramp is not active as 4 is the min on most machines anyhow (less would not clear the exhaled carbon dioxide from the mask).

Also, don't worry about the AHI for now. You'll need to worry ultimately, but it's more important to be comfortable with the therapy first.

Unfortunately I have no control over the pressure.

SarahB · Post by **SarahB** » Fri Feb 16, 2018 10:31 am

Pugsy wrote: ↑
Fri Feb 16, 2018 9:59 am
No need to redo this image but next time can you turn off the pie chart?
Preferences/Appearance tab and remove the check mark for "show pie chart".
This will let additional statistics move up into view.
No need to redo this image though...what it might show won't be particularly useful anyway.

This report just shows a crappy night's sleep for probably a number of reasons.
The main reason being simply new everything...new machine/new mask/new to therapy, etc.

I know you like the 4 cm starting point because it is comfortable but it isn't doing you any favors in the therapy department.
It's really impossible to get much of a feel for what pressure you might need as a starting point though because the sleep is so fragmented that the machine never really gets time to settle in.
You are going to need more than 4 minimum but I don't know how much more. Often when the minimum is more optimally set the maximum actually reduces when the machine doesn't have to work so hard to keep the airway open.
I know one woman who thought she was going to need 18 cm all night because of where the max went but once we got her minimum more optimally set the max never went above 11...so it can happen.

I suggest that you use the mask and machine while reading or watching TV for a period of time so that you can get used to the feel of it and see what you have to do to prevent the chipmunk cheeks syndrome.

I realize you are in Scotland and thus part of the NHS and they seem to frown on making changes to anything yourself.
The big range of pressures available along with that 4 cm starting point which means the machine has to travel quite a bit to keep the airway open...compounds poor sleep problems.
You need more solid blocks of actual sleep to be able to evaluate the pressures.
I suspect the bulk of your AHI here is awake breathing flags. The machine doesn't know if you are awake or asleep. It can only measure air flow and awake breathing irregularities can easily fool the machine. With so much fragmented sleep here it's very likely that you have a lot of SWJ flags and they don't count. You have to be asleep for any event to be real.

Thanks! You have been very helpful.

I did try to turn off the pie chart as instructed but couldn't find how to do it at the time. I've since worked it out.

I've had a look at the machine and the instruction manual but there is no option to change the pressure settings. I'll just have to get used to it.

Pugsy · Post by **Pugsy** » Fri Feb 16, 2018 10:39 am

Download and read the manual.
How to get to the clinical menu setup area where changes can be made (if you want to do them) is explained in the manual.
It's just a matter of holding down a couple of buttons on your machine at the same time.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

I doubt that your centrals/clear airway apneas are related to your max pressure. I am betting they are more SWJ than anything real.
Until you can sleep soundly you are more than likely going to have centrals flagged.
Hold your breath for 10 seconds...that's pretty much what a 10 second central is. There is no air moving but the airway is open.
When we are awake we pause our breathing all the time and don't realize it. The machine doesn't know that you simply paused your awake breathing. It only measures the air flow and only knows no air is moving.

Maybe consider taking some sort of over the counter sleep aid for a few nights to help you get over the "staying asleep" hump?
Or if you happen to have a RX for a sleep aid...even better.
Until you get more sound sleep....the data is pretty much useless because of so much SWJ potential.

D.H. · Post by **D.H.** » Fri Feb 16, 2018 10:51 am

In the U.S., we are told that it is illegal to adjust the pressure ourselves, but several posters have disputed that. I've never heard of anybody being in any way reprimanded for doing this, legal or otherwise. Many private insurance plans in the U.S. will monitor "compliance," but that's usually four hours per elapsed day, for 70% of days over the compliance period. I'm not aware of anybody ever being "called out" for changing the pressure.

I'm not sure how it works in the U.K., but I doubt it's very different.

chunkyfrog · Post by **chunkyfrog** » Fri Feb 16, 2018 11:15 am

I believe that in the UK, as well as anywhere else, it may depend on the doctor.
Enforcing such a rule would open cans of worms no one wants to handle.
I believe I was my doctor's first proactive patient.
He totally geeked out when I showed him SleepyHead, and now I am trusted to do whatever.
He just enters MY numbers on my chart, to make it official.
IMHO, posters who insist there is such a "law" are self-appointed devil's advocates,
in every sense of the word.

SarahB · Post by **SarahB** » Fri Feb 16, 2018 11:49 am

Those settings are well hidden. No mention of them in the patient handbook either.

The sleep clinic nurse must have set the pressures. I've no idea what they would say if they found I'd been adjusting their machine without authorisation. Still, the machine is there to serve me, not the other way round.

SarahB · Post by **SarahB** » Fri Feb 16, 2018 11:56 am

'Centrals'?

This is a whole new language.

Pugsy · Post by **Pugsy** » Fri Feb 16, 2018 12:04 pm

That's why there are 2 manuals...one for the patient and one for the clinicians.

Us lowly stupid patients aren't supposed to be smart enough to do that stuff...crock of crap.

I actually would work more getting the sleep first if at all possible before I started screwing with the settings.
Now if you complained about the 4 cm setting making you feel uncomfortable/stifled/suffocated then we would want to make you more comfortable because we need to be comfortable to be able to sleep but you say you like it so I guess you are okay with it.

Yes...whole new language but you don't have to learn it all in one day.

The glossary of terms used in SleepyHead is currently down for some reason. I have no idea when or if it will work when they fix it.
http://sleepyhead.sourceforge.net/wiki/ ... p/Glossary

If you will read the manual...the one I gave you...most almost all of what you see mentioned is explained in that manual.

Pugsy · Post by **Pugsy** » Fri Feb 16, 2018 12:08 pm

SleepyHead will call "centrals" as clear airway events.
This is because SleepyHead was originally written for a Respironics machine and Respironics called their centrals clear airway apnea events.
The airway is open but no air is moving.
When ResMed compatibility was added the "clear airway" name stuck. If you were using ResMed's ResScan software you would see centrals mentioned instead of clear airway apneas.

Centrals can be a problem when a person has a lot of them (having a few is normal and not a big deal) but you have to be for sure asleep before we start worrying about them and with your fragmented sleep last night I am betting that most of your "centrals" aren't real.
I suspect a lot of awake breathing flags muddying up the evaluation process.

reolhlains · Post by **reolhlains** » Fri Feb 16, 2018 6:53 pm

Keep checking in Sarah and let us know how you're going - once you settle into it, you'll be sleeping like a baby (although I hope not like either of my two babies as neither were particularly good sleepers!).
Again, I'm no expert, but looking at the pressure movement on your graphs - you can kinda understand that it's not a nice, gentle consistent flow of air to dream about irn bru to - it's up and down and not really getting the chance to settle.
In time, when you close the gap between the 4 and the 20, it'll be much more consistent and your body won't even notice the change - leading to solid sleep and leave you ready to face the next cold, wet morning (sorry!!).
I've been away from Scotland for 12 years now - way before my CPAP journey started, so I have no idea what the standard of care is like - I hope it works well.
Otherwise, you could always do what I did and buy a machine on Amazon and get it sorted with the help from the folk in here

Good luck - and keep in touch!

SarahB · Post by **SarahB** » Sat Feb 17, 2018 12:40 am

Well folks, what do you think of this then?

Sitting upright all night with nasal mask, and bandage round the head to keep my mouth shut.

ajack · Post by **ajack** » Sat Feb 17, 2018 1:52 am

Looks good and you will get use to the pressure in a week or so. So lay down and get some sleep.
I would use the EPR full time setting and have 2, this will make it easier breathing out.
When you are ready, I would set you min on 9 and turn off the ramp, to cut out the junk at the beginning, while your machine went up to pressure.

KLAussie · Post by **KLAussie** » Sat Feb 17, 2018 2:17 am

Well done Sarah!!

I've only been on CPAP for less than a month, and still trying to get used to it. Your graph looks nice and clean for most of the night, which shows the machine is doing what it's supposed to.
Great work. Looks like you're figuring out what works for you. keep it up.

SarahB · Post by **SarahB** » Sat Feb 17, 2018 2:27 am

KLAussie wrote: ↑
Sat Feb 17, 2018 2:17 am
Well done Sarah!!
I've only been on CPAP for less than a month, and still trying to get used to it. Your graph looks nice and clean for most of the night, which shows the machine is doing what it's supposed to.
Great work. Looks like you're figuring out what works for you. keep it up.

It's a pretty graph, isn't it! It's not a long term answer as I don't want to sit upright on the sofa every night and although I obviously did sleep I don't feel rested this morning. If I could manage to lie down and still breathe through my nose I'd be happy.

D.H. · Post by **D.H.** » Sat Feb 17, 2018 9:41 am

Since your pressure never even hit 13, turning the max down would not have had any affect. Also, your clear airway events seem minimal - unless they start getting higher - you needn't worry about them. As sompbody already pointed out, clear airway events are not always caused by higher pressure (although they can be).

First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Re: First real night with CPAP. Constantly woken by machine.

Machine	Mask

Additional Comments: Auto PAP; 13.5 cmH2O min - 20 cmH2O max