Exhausted

You have an old machine that won't work with newer software like Sleepyhead... most insce. co's allow new machines every 5 yrs, so are you eligible? ******* I dont think i am past the 5 yr mark due to getting the Bi Pap Machine i think 3-4 yr ago but i will call cpapsupply this week (probably Wednesday) and find out


If so we'll recommend what to get... Thanks... I will post more info when i find out.


Your max pressure is quite low, and I'd raise it to 15 for now. The min. may be too low, but you won't know until you have a different machine that allows you to use current software... the low setting is the one that makes a difference to how well you're treated.

I raised the Max to 10 and if that is not enough will raise again tomorrow or Tuesday. Little bumps at a time since i dealt with the Air in the Stomach!

Thanks for all the help.....



The new software (it's free btw) tracks your progress every night, and will show your AHI along with many other factors... but for now check if you can get a new machine and let us know so we can help with choice.

Many people find lowering the low setting (e.g. from 11 to 9, or 7 to 6, etc) helps the aerophagia as long as it does not impact therapy or make AHI shoot up. But I still think you don't quite grasp the significance of high and low settings - the low one is what rises (on an Auto) to respond to high level apneas. The high one just tracks the higher level in terms of how many events get to the setting or beyond it, and many people will have a low setting of e.g. 9, but let the high setting stay high at 15 or 20. The low setting does 'the work', the high one keeps track of the # of events that reach a high level. Your bipap should have been turned in as soon as you realized it wasn't helping (within wks), but if you can afford to buy outright without insurance for a new Apap from e.g. Cpap.com, then we'll recommend which are appropriate and show you how to set up the software.

Good Morning

I am feeling pretty good so far this mornign and it is almost 9am

I tried to turn the Bi pap back in and they told me to just keep it in case.

I turned the Max Pressure to 10 last night, will see later on how i feel

so my min is 6.5
Max is 10

Respironics M Series machine.

AvaM wrote:my auto Max is 9.5
auto Min is 7.0

auto ramp 6.0

system leak 7 day 24.6
30 day 24.7

apn-hyp index 7 day 4.0
30 day 3.5

The leak number...that's average total leak (total leak is the mask's expected vent rate plus excess leak) and your leak numbers are well within acceptable limits. Large leak territory with the M series machine is going to be up around 90 L/min total leak...you are well below that.

There should be another number relating to pressure when in auto mode...do you see anything relating to pressure like 90% pressure is so and so cm?

There is software available so that you can see more details than what is available on the LCD screen but you need a Smart Card and a Smart Card reader to use the software. While we can get you the software (Encore) for free the card reader is a bit pricey but can be found. Do you have a smart card already?
Do you want to try to see more available data?

It's possible that you need a little more pressure (either minimum or maximum or both) but it's hard to know how much without having more information....so what is the 90% pressure number from the LCD reporting?

Julie wrote:Many people find lowering the low setting (e.g. from 11 to 9, or 7 to 6, etc) helps the aerophagia as long as it does not impact therapy or make AHI shoot up. But I still think you don't quite grasp the significance of high and low settings - the low one is what rises (on an Auto) to respond to high level apneas. The high one just tracks the higher level in terms of how many events get to the setting or beyond it, and many people will have a low setting of e.g. 9, but let the high setting stay high at 15 or 20. The low setting does 'the work', the high one keeps track of the # of events that reach a high level.

Do you have any reading material on this? I have the ResMed AirSense 10. My high pressure is 13 and it seems to stay at 13 once it reaches there. I thought the low was 4 and I raised it to 6.

As I wrote in a couple of other threads, I have been on CPAP therapy for 3 weeks now. I am not waking up several times a night as I used to. There was a time that I was waking up once every hour. I am now sleeping about 5 straight hours and sleeping for another 1 to 2 hours every night. While my breathing is much improved, I still feel tired when I wake up. Friends and colleagues say I look less tired but I still feel tired. I was so tired today that I took a two-hour nap this afternoon. I don't normally take naps.

I am hoping to find some more reading material on SleepyHead and read up on this before I download it. I see that there is a thread on SleepyHead and I have read some of it. I will continue to read to understand more.

Can you share some reasons why someone is "sleeping well" with CPAP therapy but is still feeling exhausted? By sleeping well, I mean that my AHI have been between 1 and 3, I have minimal leaks, and I have had several hours of uninterrupted sleep almost every night with the CPAP.

Thank you.

There are so many potential reasons you're not feeling rested (yet), and it would be a mistake for me or anyone else to guess at this point. Get SH going and we'll take a look.

Julie wrote:There are so many potential reasons you're not feeling rested (yet), and it would be a mistake for me or anyone else to guess at this point. Get SH going and we'll take a look.

Thank you.

TeddyBfan wrote:Can you share some reasons why someone is "sleeping well" with CPAP therapy but is still feeling exhausted? By sleeping well, I mean that my AHI have been between 1 and 3, I have minimal leaks, and I have had several hours of uninterrupted sleep almost every night with the CPAP.

You aren't the first to make this statement.
There could be any number of reasons why you don't feel the good numbers you are seeing and it may simply be that you need more time but I always tell people that while they are "giving it time" (like we have much of a choice anyway) they need to use that time to investigate everything they can to make sure they aren't missing something which could be improved upon.
So we start with the software detailed reports to see if anything stands out that could stand improvement.

In general...things to look at
hours of sleep ...need 7 or 8 hours to have much chance of feeling those good numbers...5 or 6 hours won't get it
are those hours fragmented
how is the sleep hygiene
take any medications..if so what?
is it fatigue or excessive sleepiness? People often say they are tired when they mean sleep or they say they are sleepy when it's really fatigue...and they are 2 separate things.
Bed comfort
Any other health issues that could be playing a part in not feeling so great.
Mask issues...comfort or leaks? Even if the leak numbers are acceptable if someone is having frequent wake ups from little leaks we won't feel so good.
There's a lot more to feeling good than just good numbers...getting good numbers is the easy part.

TeddyBfan wrote:someone is "sleeping well"

You are correct to put that in quotes. Humans are poor judges of how well they sleep. You truly need an EEG report to know how well you sleep.

Look into "good sleep hygiene". ChicagoGranny has a good list of rules if you want to look through some of her posts to find it. If she is following this thread, I bet on Monday she will post it here.

Pugsy wrote:

TeddyBfan wrote:Can you share some reasons why someone is "sleeping well" with CPAP therapy but is still feeling exhausted? By sleeping well, I mean that my AHI have been between 1 and 3, I have minimal leaks, and I have had several hours of uninterrupted sleep almost every night with the CPAP.

You aren't the first to make this statement.
There could be any number of reasons why you don't feel the good numbers you are seeing and it may simply be that you need more time but I always tell people that while they are "giving it time" (like we have much of a choice anyway) they need to use that time to investigate everything they can to make sure they aren't missing something which could be improved upon.
So we start with the software detailed reports to see if anything stands out that could stand improvement.

In general...things to look at
hours of sleep ...need 7 or 8 hours to have much chance of feeling those good numbers...5 or 6 hours won't get it
are those hours fragmented
how is the sleep hygiene
take any medications..if so what?
is it fatigue or excessive sleepiness? People often say they are tired when they mean sleep or they say they are sleepy when it's really fatigue...and they are 2 separate things.
Bed comfort
Any other health issues that could be playing a part in not feeling so great.
Mask issues...comfort or leaks? Even if the leak numbers are acceptable if someone is having frequent wake ups from little leaks we won't feel so good.
There's a lot more to feeling good than just good numbers...getting good numbers is the easy part.

Thank you for that. I am learning so much here. Last night, I "slept" a little over 8.5 hours with the CPAP but I woke up several times at night to fix the mask (leaks). I turned off the machine at about 8:00 and slept another hour or two without the CPAP. I felt a lot more rested afterwards. I don't want to make it a habit of sleeping without the CPAP. (Two of my friends use the CPAP and they tell me it has changed the quality of their lives. So, I won't stop using it.)

I might start a thread on this but since a week into using the CPAP, I have had pain on the right side of my head, by my ear, under my cheekbone. I have read in other sites where other CPAP users have experienced the same pain. Is there a thread already dedicated to that? I would like to learn more about why I am getting this pain. I have never had it before.

TeddyBfan wrote:woke up several times at night to fix the mask (leaks).

TeddyBfan wrote:I might start a thread on this but since a week into using the CPAP, I have had pain on the right side of my head, by my ear, under my cheekbone. I have read in other sites where other CPAP users have experienced the same pain. Is there a thread already dedicated to that? I would like to learn more about why I am getting this pain. I have never had it before.

Start a new thread totally of your own with your issues/problems. It's simpler way of following things and not getting confused with all the other people's problems or comments.

Waking often to fix even little mask leaks will totally trash how you feel the next day...that needs to be addressed.
Your pain/discomfort issues could be related to the strap tension of your mask. Might be pressure on a nerve of something.
You are using a full face mask...why? Chronic nasal congestion or DME just said it would be best or whatever?
Are you tightening the straps a lot in an effort to stop the leaks? Tighter isn't always better.
The mask part of this therapy is probably the most difficult.

It's possible that your current mask simply isn't the right choice for your own particular needs.
Start a new thread and we can offer more specific ideas...and in that thread answer those questions I just asked.

There should be another number relating to pressure when in auto mode...do you see anything relating to pressure like 90% pressure is so and so cm?

Pugsy; Sorry to interrupt here but I have a question on this statement of yours. I started on cpap last April and for over 3 mos, was on pressure of 7/7 with AHI average of 5 and still unable to get enough sleep and not much improved in how I felt.

About 2 wks ago, pressure was changed after seeing a sleep clinic NP and my RT. Based on a slight prescription change (to 8/8), the advice of my RT, and advice I received here,
I am now set to 8/11. However, the first night I was on variable 6/20 because my RT had said "that was best". That next morning, my machine showed a reading I hadn't seen before while
on 7/7. It said 90% pressure 11. So, does that mean that my machine pressure rose up to 11, being 90% of some number in order to treat my apneas that night? My apnea is mild on side and severe
in supine position. My best guess is that I sleep on my back up to 50% of the time.

Sylvia54 wrote:About 2 wks ago, pressure was changed after seeing a sleep clinic NP and my RT. Based on a slight prescription change (to 8/8), the advice of my RT, and advice I received here,
I am now set to 8/11. However, the first night I was on variable 6/20 because my RT had said "that was best". That next morning, my machine showed a reading I hadn't seen before while
on 7/7. It said 90% pressure 11. So, does that mean that my machine pressure rose up to 11, being 90% of some number in order to treat my apneas that night?

You need to understand the definition of 90% numbers (Respironics) or ResMed users 95% numbers.
No matter if it is leak or pressure the definition is at OR BELOW that number for 90/95% of the time. People tend to forget or miss the "or below" part of the definition and assume that is where the person spent 90/95% of the night and it simply isn't the case.

When using a fixed pressure like 7min and 7 max or 8 min and 8 max the pressure never varies so it's constant all night and the 90/95% numbers will reflect the fixed pressure.
90/95% pressure numbers are only shown when the pressure is auto adjusting.

The "or below" part of the definition doesn't tell us how much time was spent at any pressure below and it doesn't tell us how high it went for the 10/5% of the night above that number.
For all you know you could have spent the greatest part of the night at a pressure of 9
90/95% numbers are easily skewed by rather short term periods spent higher and for that reason one has to really look at 90/95% numbers long term instead of short term for guidance.
I had nights where my 90% pressure was 17 or 18 and I had nights where the 90% pressure was 11 or 12.
Long term I had more nights with it around 12...and by long term I mean 6 months worth of data.

The 90/95% numbers aren't the holy grail of numbers for much of anything. They can be useful when properly evaluated (long term vs short term) in some situations for some people but as with anything else related to cpap...YMMV. They aren't necessarily the ideal pressure setting if someone were to want to use fixed pressure. It could be but it could just as easily not be the ideal setting for fixed pressure.
90/95% numbers are just one of several tools available and that's about it.

So, does that mean that my machine pressure rose up to 11, being 90% of some number in order to treat my apneas that night?

[/quote]

No matter if it is leak or pressure the definition is at OR BELOW that number for 90/95% of the time. People tend to forget or miss the "or below" part of the definition and assume that is where the person spent 90/95% of the night and it simply isn't the case.

Thanks for the clarification. Maybe I didn't word my question well enough, I just couldn't believe the pressure went that high when my doctor had prescribed only a 7/7 fixed pressure, based on two sleep studies. I did already know that variable machine pressure means pressure rises to control the apnea only as needed, such as when apnea spikes after shifting to my back, machine pressure is up and down, treating the apnea spikes, only as needed. When I shift back to my side, perhaps I don't need any more than 7 cm. Obviously, it's only when I shift to my back that severe apnea spikes occur, making it necessary for variable pressure 11 plus 10% OR BELOW. In my opinion, his initial 7/7 prescription fell far short of what I needed.

When using a fixed pressure like 7min and 7 max or 8 min and 8 max the pressure never varies so it's constant all night and the 90/95% numbers will reflect the fixed pressure.
90/95% pressure numbers are only shown when the pressure is auto adjusting.

Yes, I thoroughly understood this too.

[/quote]
The 90/95% numbers aren't the holy grail of numbers for much of anything. They can be useful when properly evaluated (long term vs short term) in some situations for some people but as with anything else related to cpap...YMMV. They aren't necessarily the ideal pressure setting if someone were to want to use fixed pressure. It could be but it could just as easily not be the ideal setting for fixed pressure. 90/95% numbers are just one of several tools available and that's about it.[/quote]

In the last 10 days or so, my 90% number has varied between 9.5 and 11.0, however yes, that in short time period, the data is not meaningful.

Thanks again.

Sylvia54 wrote: Thanks for the clarification. Maybe I didn't word my question well enough, I just couldn't believe the pressure went that high when my doctor had prescribed only a 7/7 fixed pressure, based on two sleep studies.

Sorry...I didn't thoroughly understand your question.

The fact that the sleep studies didn't get it spot on doesn't surprise me at all. They didn't get it right for me either. We don't sleep the same each night and in my case my pressure needs vary greatly with REM stage sleep and I didn't get much REM (like about 6 minutes) during my entire 8 hour devoted to titration sleep study.

But...there's another reason why your machine might want to go higher and the sleep tech didn't think it needed to...and that is maybe flow limitations or snores because those will also affect what the machine will want to do in terms of pressure needs. The machine not only responds to OAs and hyponeas..it responds to snores and flow limitations and your machine might be increasing the pressure just to kill some flow limitations that maybe either didn't happen in your sleep study or the tech didn't think it was enough to need dealing with.

Also remember... the "or below" thing. If you look at your detailed pressure graphs you may see that the bulk of the night it was at 8 and maybe there was just a 30 minute time frame where higher pressures are needed (usual culprits of course supine sleeping or REM or both) but it was enough to elevate that 90% pressure substantially. So the titration study might not be all that far off in the grand scheme of things. It's never going to be exactly 100% perfect anyway due to the simple fact we don't sleep the same each night anyway and the sleep study isn't a typical night anyway...I mean in a foreign setting with different bed and likely bed pillow and all the wires hooked up to us and all that...let's face it...we aren't going to sleep there like we do at home. That's why I only got 6 minutes of REM...I couldn't sleep well with all the foreign stuff going on.

You need to really learn to evaluate your pressure graphs to understand the ins and outs of 90/95% numbers and how important (or not) they really are.
I have a good example of how a short time with elevated pressures can really screw up the numbers...let me see if I can find it. It shows pretty much not much pressure change at all except for a couple of brief times.