Just getting started.

I am a truck driver, a hair over 40 years old. I work on an overnight shift (about 6PM-6AM) 4 days a week. I've known I have sleep apnea for a couple of years but I didn't want to have deal with the extra DOT physical and wasn't sure how much treatment would cost. Finally bit the bullet because driving at night was getting scary. The wife said I would breathe about 3 breaths, stop breathing, then gasp for air, then cycle again.

I went to a sleep study was diagnosed with "severe sleep apnea" and then had a titration a week later. I just got the CPAP machine on Friday and have been using it since. I have a Resmed S9 with a humidifier and a nasal pillow mask. The machine is set at 11cm I believe (it starts at 8 and then ramps up over 20 minutes IIRC). I've just downloaded the sleepyhead software but I'll need to buy a card reader before I can get to the data on it.

So far it's not too bad. I'm generally getting a bit over 6 1/2 hours of sleep in bigger chunks than I used to. I'm hoping to work that up to 8.

Two things: Sometimes when I first start the machine it feels like I'm not getting enough air. I know the feeling isn't accurate (if I open my mouth to breathe air blows out) but it's unsettling. Once the pressure builds a little the sensation stops. I was wondering if I should set the starting pressure higher or turn off the ramp.

Second, I notice on the days following a work shift my sleep is still pretty fractured (i'm up 3 or so times versus 0-1 on other days). I'm not sure if caffeine is messing me up or if I'm under stress. Usually I have 3 24oz bottles of diet mountain dew during the night plus several bottles of water. We have dark curtains and have applied tint to the windows to reduce light pollution. I usually go to bed within an hour of getting home. I do try to stay on the same schedule on my days off to maintain circadian rhythm.

I'd appreciate any advice.

DonRobbie
Welcome aboard may I suggest that you go into User Control Panel and load your equipment that will help with any diagnosis issues. There will be someone along shortly that can answer your question better then I can. As for the "Sometimes when I first start the machine it feels like I'm not getting enough air". You can up the pressure with your starting ramp or shut off the ramp and start at your prescribed pressure if you would like. The ramp is just a creature comfort. Most people once they get use to pap therapy usally just turns it off.

HI - a couple of things jumped out when I read your note- the first being how unfortunate you are to have that kind of schedule - not user friendly to apnea (or anyone for that matter - never heard of such a short span of days/nights). The second was that all that Mt Dew can't be helping anything - I wonder if you were drinking it to try and stay awake (all that sugar... any caffeine in it?), but it also worried me as possibly skating close to a sugar problem down the road, which can go with apnea too, and so can GERD (acid reflux) which you may not be aware of (some people aren't), but which is not conducive to a steady night's sleep - can wake you just like apnea even if you're not fully aware of it or only have heartburn when you wake up (ditto for more than 1-2 coffees even early in your day).

Many, if not most of us stop using the ramp early on unless our pressures are set quite high, there's no 'therapy' to it, just comfort, and if you find it starts off too low, you might want to try not bothering at all... leading me to the last point which is that if the majority of your events take place around e.g. 7, or 11 or 14, you'd probably be ok setting the low pressure at just below whichever number that was, and the high about 4-5 over the highest - you're unlikely to go much below the low number and the machine will have an easier time knocking out high #'s quickly if it doesn't have to climb too far.

Hope you can get switched to a better shift however - that's the worst I think I've heard of!

Welcome to the forum. I would turn the ramp off if you do need have it on. It's a comfort thing (thang') and if it's not comfortable (as you say) turn it off. I'll bet you eventually will. Most folks (including myself) will start out using the ramp, then eventually turn it off. When I first started out, after turning the machine off at night to get up for something, I found out it was frustrating when I got back to bed and turned on the machine. I would "wait" for the full pressure to kick in, so... I flipped it off and never turned back. Your machine has the EPR feature. EPR will drop the pressure when you exhale, so it will make it easier to "blow out"... maybe a poor choice of words. This may or may not be a solution to your problem, but keep it in mind. As far as the Mountain Dews... I love them too! They have a boat-load of caffeine and may indeed be messin' with you sleep hygiene. Get ready... folks here will hammer you for putting an unhealthy liquid in your body. Shame on you! I say screw em'. Go a couple of days without a Dew for a few hours prior to going to bed and see if it helps. If you don't see a difference... chug one as you are getting in bed and enjoy life...

Sheriff

Most cpap machines tend to run from a range anywhere from 4 to 20 and if your big, you will use more air than the 4. Your 8 to 11 isn't too bad but there are a few factors about when it starts. The first is it may not be providing enough air but at 8, it should be enough. The second is when you lay down, your going from higher respiratory rate to a lower one but that takes some time but just laying still for 5 minutes should help that. The third is fear related to using the mask that increases your breathing rate.

If you can adjust the ramp time, try shortening it. I think the range is 5 min to 30 min with 30 being the default. Try it at 10 and see if that works and if not drop it to 5. The ramp feature helps with compliance issues as people get used to the machine. Many people in this forum who use CPAP have turned off the ramp.

Good luck with getting used to this and feel free to ask questions.

Yes, It can be true that with a machine set on a lower pressure than what you need, then you are not getting enough air. This can happen with a machine set with a ramp. This is also a problem with those trying to do an titration using a machine set to auto.

This effect is part of why people complain they had a horrible time in the sleep lab, that is for some to get up to the pressure they need to breathe can take more than an hour.

If you recall, I am pretty sure you were told that most OSA people have a lot more trouble sleeping on their back. Usually to verify that one has the correct pressure, a sleep lab will tell a person to (try) to sleep on their back. In my last sleep titration the RT said that a lot of people were sent back for another titration if they could not sleep on their back during the titration. It is a matter that, early in the morning, that there is not enough time to do that part of the study with a frustrated patient.

There is a difference in how much air one needs to keep the airway open, and the amount of pressure one needs to fill ones lungs at a rate that is comfortable. I suspect I inhale faster when i am awake.

Anyway, you are (probably) not imagining a difficulty. Keep in mind it is, for most OSA patients, harder to sleep on ones back. In a pinch, many can sleep sitting up, but not like laying on ones back in a recliner. Perhaps laying on ones side.

Then again, after awhile, your body adjusts, and calls it normal no matter whatever difficulty it has.

In addition to all the advice already present, stop drinking the Diet Mountain Dew but not because of caffeine. You said diet which means Aspartame. The high doses of neurotoxin you are ingesting are not helping you at all. In fact it's likely doing you great harm. Aspartame passes through the blood brain barrier and does a number of addictive, damaging, and vile things. It will block and inhibit Serotonin production which will impact Melatonin production.

Actually the list of truly devastating things that aspartame does is a long one... and not discussed enough. That is something you need to remove from your life. Do some reading on it and I can't imagine you'll even want to touch the stuff.

Welcome. I am a newbie as well; just started on the machine last Wednesday so just a week now. I also have the ResMed S9. It was a little unclear how long it is taking you for the pressure to feel more comfortable. I have noticed something similar. It seems the S9 does not activate EPR until the starting pressure has built up. EPR is the ability of the machine to decrease pressure on exhale. Once that engages, it is much easier to breath. I have noticed it takes about 10 to 15 seconds to build up to my minimum pressure of 5; at your 8 it might take a little longer. I just breath through my mouth until this settles down. Now if you are feeling uncomfortable for longer than that, then it probably is the ramp feature that others have already spoken about.

It is taking me a while to get acclimated to this whole hosehead thing. I find that if I take a few deep breaths and clear my throat before getting started, it settles me down and I feel less panicky about the whole thing. Hang in there, the folks on here are very kind and helpful as you probably can already see. We will help you!

I would really try to use decaf drinks. It makes the nights hard, but hopefully getting restful sleep will makeup or that.

I worked shift work for years. I always did much better when I kept or shift rather than rotating, so that oo should be on your side.

God luck !

Greg

Hi,

Welcome to the forum. Sounds like you are off to a great start.

Caffeine - the half-life (the time it takes to go down by 50%) is 5 to 6 hours for most adults. That means that those big Dew's are probably putting caffeine into your system faster than you can get rid of it. I have a Diet Coke thirst, but I have had to cut down and try to not have any after breakfast. It does help some. It is hard to taper off, and very hard to quit--this stuff is really addictive, but I also notice that my mood is impacted by caffeine. I wish I could quit completely, but I really like a cold one in the morning.

Overnight shift - if you keep this same schedule over time, consider trying Melatonin. If you take it at the same time each day, about 30 minutes or so before bed time, it really helps to stabilize your sleep cycle. Adding in some D3 might help if you are low on that (many people are and don't know it).

Ramp - if you don't need it, the consider not using it. It doesn't add any value, and it can leave you exposed to events when you first go to sleep.

-john-

jweeks wrote:Hi,

I have a Diet Coke thirst, but I have had to cut down and try to not have any after breakfast. It does help some. It is hard to taper off, and very hard to quit--this stuff is really addictive, but I also notice that my mood is impacted by caffeine. I wish I could quit completely, but I really like a cold one in the morning.


-john-

I'm telling you, it's the aspartame. It is addictive. Far more so than the caffeine.

what are the two numbers my doctor is looking at on DOT physical? one has to be below 5. the other has to be at 70. mine is 62. these numbers come off my mesred s9 cpap. i sleep great but they are still not satisfied. what can i do to bring this 62 number to compliance?? thnx

bigswueezer wrote: the other has to be at 70. mine is 62. these numbers come off my mesred s9 cpap. i sleep great but they are still not satisfied. what can i do to bring this 62 number to compliance?? thnx

Quit cheating and not using your machine when you are sleeping....that's the best way to meet compliance requirements.

The number is more than 4 hours each night for 70% of the nights...21 nights out of 30 you need to be using the machine at least 4 hours....if less than 4 hours..it doesn't count...and works out just bad towards compliance as if you didn't use it at all.
You can't do 8 hours one night and none the next and have the average be 4 between the 2 and have it work.

The below 5 number is probably AHI and that number generally is accepted as acceptable therapy...so AHI under 5 for therapy effectiveness.

Hours of use...must be at least 4 hours within a 24 hour period...70 % of the nights out of 30 nights.

62 % is not quite 19 nights...you only need 3 more nights to squeak by.