Should I increase or decrease pressure?

I keep waking up multiple times a night (4-6) and feeling not well rested in the morning. I am headachey and not super happy right now. My sleepyhead log from last night:
http://i.imgur.com/4RLINQY.png

In picture form:

It looks like you are doing quite well with your therapy.
It would help us if you would remove the AHI graph and include the Evans flag graph instead.

The first thing I would do is increase the starting pressure on the ramp to 5, or maybe 6.
Then you could bump up the max by .5 cm and see what it looks like after a week or so.

robot_head wrote:I keep waking up multiple times a night (4-6) and feeling not well rested in the morning. I am headachey and not super happy right now.

It seems like your range is set too wide and the APAP wants to be up around 8cm. Your minimum pressure could probably be bumped up.

bwexler wrote:It looks like you are doing quite well with your therapy.
It would help us if you would remove the AHI graph and include the Evans flag graph instead.

Here you go:
http://i.imgur.com/TSaGFWg.png

bwexler wrote: The first thing I would do is increase the starting pressure on the ramp to 5, or maybe 6.
Then you could bump up the max by .5 cm and see what it looks like after a week or so.

None of the apnea events occur during the ramp, why do you think this would help?

justinjustin wrote:

robot_head wrote:I keep waking up multiple times a night (4-6) and feeling not well rested in the morning. I am headachey and not super happy right now.

It seems like your range is set too wide and the APAP wants to be up around 8cm. Your minimum pressure could probably be bumped up.

Hmm, I'm not using APAP. I'm using CPAP mode of 10.5cm, but with EPRx3

With that AHI I would not make any changes, though the pressure changes suggested seemed sound.
A lot of people don't like meds, but I think a mild sleeping or antianxiety pill would help you sleep through the night. A non prescription idea is any of the PM meds that contain Benadryl (diphenhydramine HCL). I don't find these change my AHI, but help me sleep all night. An alternative is melatonin.
Any idea what is waking you up?

robot_head,

You ask: Should I increase or decrease pressure?

Until you know what is causing the problem you are trying to fix, you won't have an answer to that question. And, most likely the answer to your question right now is Leave things alone for now.


Here's the thing: You write

robot_head wrote:I keep waking up multiple times a night (4-6) and feeling not well rested in the morning. I am headachey and not super happy right now.

The issue you need to address are the multiple wakes. Those wakes are enough to explain why you are not feeling rested in the morning and are feeling headacey and "not super happy right now."

Your AHI is low enough and there's only one small cluster of events at around 5:20 in the data you posted. So the thing that is driving the excess number of wakes is NOT undertreated OSA. And your leaks are technically under control as well. Meaning the data can be trusted: You are not having large numbers of events that the machine is failing to score because of large leak problems. In other words, your machine is doing its job: You are no longer experiencing a large number of obstructive apneans and hypopneas when you are asleep. That doesn't mean that you are not feeling bad; it does mean that the reason you are feeling bad is bad sleep that's caused by something other than untreated or undertreated OSA.

Important questions for you to think about and answer before you start dial winging the pressure settings:

1) What do you think is causing the wakes in the middle of the night? Is this a new disrupting sleep pattern? Or have you had problems with middle of the night wakes before you started PAP therapy? If the pattern is not new, how long have you had problems with middle of the night wakes? And pre-CPAP, what did you tend to do when you woke up in the middle of the night? And how effective was it?

2) Are you physically uncomfortable when you are trying to get to sleep at the beginning of the night with your mask on? If so, can you describe the kind of discomfort you are experiencing in words?

3) How long does it take you to fall asleep at the beginning of the night with your mask on? 5-10 minutes? 10-20 minutes? More than 20 minutes? More than an hour? And if you are not asleep within about 20 minutes of going to bed, what starts going through your mind?

3) Are you physically uncomfortable when you wake up in the middle of the night with your mask on? If so, can you describe the kind of discomfort you are experiencing in words? Are you feeling overwhelmed by the air pressure when you wake up in the night?

4) You are using a pretty low starting ramp pressure of 4cm. How do you feel right at the beginning of the night and every time you turn the machine off and back on? Are you having trouble catching your breath comfortably at the beginning of the ramp period?

5) What do you do when you wake up? Do you lie in bed for a very long time fighting to get back to sleep? Or are you able to return to sleep relatively quickly after most of the middle of the night wakes?

robot_head wrote: None of the apnea events occur during the ramp, why do you think this would help?

I could be wrong, but I don't *believe* that the machine flags, or responds to events, during ramp, which may be why the suggestion was made. note, I'm not suggesting a change, the only use for ramp is a comfort feature, I personally don't use it.

robysue wrote:robot_head,

You ask: Should I increase or decrease pressure?

Until you know what is causing the problem you are trying to fix, you won't have an answer to that question. And, most likely the answer to your question right now is Leave things alone for now.


Here's the thing: You write

robot_head wrote:I keep waking up multiple times a night (4-6) and feeling not well rested in the morning. I am headachey and not super happy right now.

The issue you need to address are the multiple wakes. Those wakes are enough to explain why you are not feeling rested in the morning and are feeling headacey and "not super happy right now."

Your AHI is low enough and there's only one small cluster of events at around 5:20 in the data you posted. So the thing that is driving the excess number of wakes is NOT undertreated OSA. And your leaks are technically under control as well. Meaning the data can be trusted: You are not having large numbers of events that the machine is failing to score because of large leak problems. In other words, your machine is doing its job: You are no longer experiencing a large number of obstructive apneans and hypopneas when you are asleep. That doesn't mean that you are not feeling bad; it does mean that the reason you are feeling bad is bad sleep that's caused by something other than untreated or undertreated OSA.

Important questions for you to think about and answer before you start dial winging the pressure settings:

1) What do you think is causing the wakes in the middle of the night? Is this a new disrupting sleep pattern? Or have you had problems with middle of the night wakes before you started PAP therapy? If the pattern is not new, how long have you had problems with middle of the night wakes? And pre-CPAP, what did you tend to do when you woke up in the middle of the night? And how effective was it?

This is a new sleep pattern for me, and may be related to quitting medical pot concurrently. I'm undertaking this to keep myself from eating too much and causing gut trouble at night, and dry mouth.

robysue wrote: 2) Are you physically uncomfortable when you are trying to get to sleep at the beginning of the night with your mask on? If so, can you describe the kind of discomfort you are experiencing in words?

I have the mask strapped to my face very tightly to avoid leaks. I would say I'm a bit uncomfortable at the beginning of the night

robysue wrote: 3) How long does it take you to fall asleep at the beginning of the night with your mask on? 5-10 minutes? 10-20 minutes? More than 20 minutes? More than an hour? And if you are not asleep within about 20 minutes of going to bed, what starts going through your mind?

I'd say 10-20 minutes. I take Valerian root before bed and that seems to put me out nicely

robysue wrote: 3) Are you physically uncomfortable when you wake up in the middle of the night with your mask on? If so, can you describe the kind of discomfort you are experiencing in words? Are you feeling overwhelmed by the air pressure when you wake up in the night?

I am waking up feeling sweaty and hot, and usually right after a vivid dream. I do not feel overwhelmed by air pressure no (I have EPRx3 turned on).

robysue wrote: 4) You are using a pretty low starting ramp pressure of 4cm. How do you feel right at the beginning of the night and every time you turn the machine off and back on? Are you having trouble catching your breath comfortably at the beginning of the ramp period?

No trouble, but I could increase that

robysue wrote: 5) What do you do when you wake up? Do you lie in bed for a very long time fighting to get back to sleep? Or are you able to return to sleep relatively quickly after most of the middle of the night wakes?

Usually I go right back to bed, but sometimes I lie in bed for what feels like a long time fighting to get back to sleep. Usually after 3 small wakeups when I know morning is near I'll get anxious and have trouble getting back to sleep

I was unaware that events are not recorded during ramp, thanks!

when I was dealing with headaches related to APAP treatment, it was due to humidity. Possibly you need to adjust it, either higher or lower.

Woke up again 4 times last night, feel awful today, almost zero obstructive apnea events last night:

http://i.imgur.com/NEV6Cse.png