First night with Airsense 10 machine SH chart

[bobyouruncle]

Well it was a rough beginning with new machine last night. First off I was exhausted but after going to bed I just lay awake. After 45 minutes I decided to take something to help me sleep ( my usual sleep drug ). Usually need to take something most nights to get me even 5 hrs sleep. I usually wake up 2 or 3 times a night (bathroom etc.) After feeling like I was drifting off, I put on the mask and started the new machine. The settings were Auto - 7-9 with the Exhalation relief set at 3 (max). The machine was very quiet compared to my 7 yo Respironics . I then noticed that there was a big suction of the mask to my face on the inhale and the opposite on the exhale. Kinda like having a suction cup pushing and pulling. It got worse. I started feeling uncomfortable and had a feeling of my heart beating faster ( not pleasant). After about 20 minutes of this I stopped the machine and wondered whats going on here. Didn't experience this with the old machine and the mask had not changed. I took a break and thought I would change the Exhale Relief to "2" instead of 3 and also changed the Auto setting from 7-9 to 7.8-9, mostly cause I also felt like I was not getting enough air. Anyways, after awhile I tried it again and it was better with Exhale Relief set to 2.

I managed about 6 hrs of sleep ( first 20 minutes were wide awake and hellish) but still my broken pattern. I am attaching the chart from last night ( hope you can blow it up) It seems to be ok, but I am hope for feedback from the pros here. The gaps are me waking up and going to washroom, then probably falling asleep at first without the mask....then waking and putting it on. Thanks for any input

Here is the chart:

[bobyouruncle]

Better?? Still won't blow up from thumbnail...do i copy the Linked BBcode to be able to enlarge from thumbnail??

[Pugsy]

Try something for me please
Log in to your imgur account...go to the image you want to share and click on it...look to the right side for the box of all the addresses to choose from...and below look for the various thumbnail sizes.
Click on Large Thumbnail...then copy the last line in that box of addresses and paste it into the body of your post here.

You should then get an image that is large enough to see the basics but will have a clickable link so that we can click on it and enlarge it if needed.
Your last image is smaller and I can't read much and I can't click on it to enlarge it.
Your very first try was so big it was cut off on the right side.

If you follow my instructions above you will get a nice sized image that we can click on and enlarge only if we need to...sometimes the large thumbnail size is sufficient and we don't need to enlarge.

[bobyouruncle]

OK, here goes....large thumbnail...last link was "Linked BBcode (message boards)

[Pugsy]

That works perfectly. Thank you.

As to your report....nothing stands out except the breaks in therapy.
The bathroom breaks....are you male with the good old prostate issues going on?
You have a sleeping aid on hand already so I assume nothing new about having trouble going to sleep...any idea why?

[bobyouruncle]

That works perfectly. Thank you.

As to your report....nothing stands out except the breaks in therapy.
The bathroom breaks....are you male with the good old prostate issues going on?
You have a sleeping aid on hand already so I assume nothing new about having trouble going to sleep...any idea why?

Thanks Pugsy, I wake up at least once a night to go to the bathroom. yes Male, probably prostate. Even with the sleep aid ( 1x - 0.5 Ativan....sometimes 2-3 ) I find I wake up in the middle of night. On the old machine/readouts/charts there never seemed to be any events at the time of wake up. So really don't know whats going on. I do have PLMD and insomnia and I guess I could throw in the cpap machine as a side "sleep disorder" ( but I use every night. )

It was weird when the Exhale relief was set to 3 last night ( on old machine it was at 3 also ) I really felt uncomfortable including increased heart beats etc. Happy that is was better at the "2" setting.

I felt not to bad this morning after 6 hrs of broken sleep. Better than the night before with my old machine.

So nothing weird on that first report? Pressure settings ok? I don't understand Central Apneas really and my old machine/software did not show them. It seems they happened when I took the mask off...when I was awake??

[Pugsy]

ResMed exhale relief is a little different from Respironics exhale relief.
ResMed setting of 3 means a 3 cm reduction during exhale assuming there is room for a 3 cm reduction...example if you want the full 3 cm reduction then the pressure has to have room to reduce...so if the minimum pressure is say 6 cm...the machine can't go below 4 cm so even with a setting of 3 for exhale relief you are only getting 2 cm drop until your pressure is up to 7 cm and then it will drop to 4 cm.

Respironics exhale relief is flow based and not a per cm straight reduction and even at a setting of 3 for their exhale relief the most you can ever get is 2 cm. I know it doesn't make any sense but that's just the way it is.

So I am not surprised that you had some difficulties with the 3 cm reduction on the ResMed machine because the most you possibly could have been getting with your old machine is 2 cm....so when you reduced EPR to 2 it felt more like what you had been using for such a long time.
The brain and body is kinda funny....you use something for a long time and it becomes the new norm and sometimes even the slightest change from "normal" isn't met with enthusiasm. You were used to 2 cm reduction and your brain didn't like the 3 cm reduction.

The clear airway events...centrals...the machine can and will flag awake/semi awake breathing irregularities as some sort of apnea event and often it is centrals. Hold your breath for 10 seconds...that's pretty much what a 10 second central is...the airway is open but no air is flowing. We hold our breath all the time when awake or semi awake and we don't realize it. The machine can't tell if you are awake or not...it just measures air flow so it's not unusual for someone who spends considerable amount of awake time on the machine to have a few to a large number of centrals get flagged.

Now sometimes we have real centrals and they are normal...like it's normal to have what we call sleep onset centrals when we transition to sleep stage. These are normal and not a big deal unless someone is having a large number of centrals that are causing some sort of problem.

Even if all your centrals were the real deal there's not nearly enough of them to worry about.
The centrals that are awake/semi awake breathing irregularities...we have to remove them from any AHI evaluation we are doing.

The ResMed algorithm is also different from the Respironcis algorithm...so how it goes about its job is a bit different. Again your body is used to one way of feeling and now something new is happening so you need to give the brain a chance to come to terms with the new "norm".

You have chosen an extremely tight APAP range to use and that's fine. It eliminates massive pressure changes possibly affecting your sleep quality.

As to the insomnia....while sleep apnea is one potential culprit you know that it is far from the only culprit.
Your sleep apnea seems to be well treated so I think we can eliminate sleep apnea as a culprit but figuring out what the other culprits might be is a lot harder than fixing sleep apnea.

You already know about one potential culprit...the prostate.
I always suggest that people look at the other potential culprits like medication side effects (I take a pain pill that despite coming with a may cause drowsiness causes insomnia in some people and I am one of those people) or other health issues or pain issues or bed comfort issues....etc...the list is long.
An other potential culprit is some bad sleep hygiene habits...I am guilty of the TV and computer too close to bed time...but I do it anyway.

On the off chance that you are one of the people who find that the slightest change in pressure when using apap pressure ranges has a disturbing effect to their sleep quality you might consider trying a fixed pressure to see if sleep quality improves or not.

Finally you may just need some time for the body to adjust to the new "norm" with this machine so I wouldn't go changing things willy nilly. Give your body a chance to adjust to the new way of doing things with this new machine.

[bobyouruncle]

ResMed exhale relief is a little different from Respironics exhale relief.
ResMed setting of 3 means a 3 cm reduction during exhale assuming there is room for a 3 cm reduction...example if you want the full 3 cm reduction then the pressure has to have room to reduce...so if the minimum pressure is say 6 cm...the machine can't go below 4 cm so even with a setting of 3 for exhale relief you are only getting 2 cm drop until your pressure is up to 7 cm and then it will drop to 4 cm.

Respironics exhale relief is flow based and not a per cm straight reduction and even at a setting of 3 for their exhale relief the most you can ever get is 2 cm. I know it doesn't make any sense but that's just the way it is.

So I am not surprised that you had some difficulties with the 3 cm reduction on the ResMed machine because the most you possibly could have been getting with your old machine is 2 cm....so when you reduced EPR to 2 it felt more like what you had been using for such a long time.
The brain and body is kinda funny....you use something for a long time and it becomes the new norm and sometimes even the slightest change from "normal" isn't met with enthusiasm. You were used to 2 cm reduction and your brain didn't like the 3 cm reduction.

The clear airway events...centrals...the machine can and will flag awake/semi awake breathing irregularities as some sort of apnea event and often it is centrals. Hold your breath for 10 seconds...that's pretty much what a 10 second central is...the airway is open but no air is flowing. We hold our breath all the time when awake or semi awake and we don't realize it. The machine can't tell if you are awake or not...it just measures air flow so it's not unusual for someone who spends considerable amount of awake time on the machine to have a few to a large number of centrals get flagged.

Now sometimes we have real centrals and they are normal...like it's normal to have what we call sleep onset centrals when we transition to sleep stage. These are normal and not a big deal unless someone is having a large number of centrals that are causing some sort of problem.

Even if all your centrals were the real deal there's not nearly enough of them to worry about.
The centrals that are awake/semi awake breathing irregularities...we have to remove them from any AHI evaluation we are doing.

The ResMed algorithm is also different from the Respironcis algorithm...so how it goes about its job is a bit different. Again your body is used to one way of feeling and now something new is happening so you need to give the brain a chance to come to terms with the new "norm".

You have chosen an extremely tight APAP range to use and that's fine. It eliminates massive pressure changes possibly affecting your sleep quality.

As to the insomnia....while sleep apnea is one potential culprit you know that it is far from the only culprit.
Your sleep apnea seems to be well treated so I think we can eliminate sleep apnea as a culprit but figuring out what the other culprits might be is a lot harder than fixing sleep apnea.

You already know about one potential culprit...the prostate.
I always suggest that people look at the other potential culprits like medication side effects (I take a pain pill that despite coming with a may cause drowsiness causes insomnia in some people and I am one of those people) or other health issues or pain issues or bed comfort issues....etc...the list is long.
An other potential culprit is some bad sleep hygiene habits...I am guilty of the TV and computer too close to bed time...but I do it anyway.

On the off chance that you are one of the people who find that the slightest change in pressure when using apap pressure ranges has a disturbing effect to their sleep quality you might consider trying a fixed pressure to see if sleep quality improves or not.

Finally you may just need some time for the body to adjust to the new "norm" with this machine so I wouldn't go changing things willy nilly. Give your body a chance to adjust to the new way of doing things with this new machine.

Thanks a million Pugsy, great info you have given me.

I think my insomnia is the type that wakes you up in the middle of the night. Most nights I can get to sleep, last night was different as I was anxious about the new machine and what it cost me!!! Yes there are many things that disturb my sleep, from outside noise to PLMD, prostate to CPAP machine. I've never been able to figure out why I suddenly awake in the middle of the night with no event taking place. Ativan is a short acting drug. I get maybe 3-4 hrs max on a 0.5 mg dose. I have tried just about every drug out there Rx and OTC. Nothing seems to work except for Ativan. Would like to find a 2nd drug to take to get off Ativan periodically but not found one yet. Any suggestions for something to take would be helpful.

I was on a straight CPAP on my old machine mostly ...between 8.5-9. I thought I'd give this new machine a go at Auto because everyone told me the new machines can respond faster to events than my old 7 yo Respironics. Hope that's true. If not I will go back to straight CPAP fixed pressure after a bit.
My sleep study a few years ago gave me a pressure of 7. When I went home and changed my machine to 7. The next morning I was greeted with an AHI of 11 or 12. Guess all machines are not created equal....

[Pugsy]

The ResMed algorithm is probably a little bit "faster" in the overall response time but it's not speed demon faster.

As for ideas on what to try to help you stay asleep....that's really something to talk to your doctor about but I will share what I take to help with my sleep maintenance insomnia (that's where we fall asleep just fine but find that we wake often during the night for any number of reasons) but I did my homework to try to figure out the cause of my sleep maintenance insomnia and in my case it was pain...some arthritis and old injury pains.
My daytime pain meds work well for daytime pain control but they come with a nasty side effect of causing insomnia for me. I would go to sleep okay but in about 3 hours I would be wide awake and up cleaning the house if I took it at bedtime.

I worked with my doctor in figuring out something that would help the pain situation and not make the sleep apnea situation worse. The end result was I take a very low dose of Amitryptiline (10 mg) and I find that it helps me stay asleep or sleep through the pain and not be awakened 40 times a night. I don't know if this is something that your doctor would feel would help you or not. It's a very, very low dose of a medication that was used years ago for depression but in much higher doses. It was found that in low doses this medication seemed to help people with chronic pain. It will make a person drowsy and there is a bit of a morning after drowsiness if I forget and take it too late in the evening. It's not considered habit forming like the Ativan is and for me I think that the "drowsy" thing with it seems to last longer through the night than Ativan (which I have taken in the past back when I had some bad life stressors going on).

I have also been known to take Benadryl at bedtime. It's the main component in most of the OTC sleep aids.

I still wake several times during the night but it's maybe a handful compared to 40 or 50 without some sort of medication. Normally I just roll over and go back to sleep though or move to relieve whatever is hurting and then I go back to sleep.

In my case I knew what the culprit for my sleep maintenance insomnia was but it still took a lot of trial and error to get it to where it is at least manageable.
In your case you still need to try to figure out the culprit and often that is the hardest part...and there's a good chance that there's more than one culprit involved which makes it even harder.

[palerider]

Here is the chart:

arrange it this way next time: https://sleep.tnet.com/resources/sleepyhead/shorganize post 'em like pugsy got you to do.

[bobyouruncle]

The ResMed algorithm is probably a little bit "faster" in the overall response time but it's not speed demon faster.

As for ideas on what to try to help you stay asleep....that's really something to talk to your doctor about but I will share what I take to help with my sleep maintenance insomnia (that's where we fall asleep just fine but find that we wake often during the night for any number of reasons) but I did my homework to try to figure out the cause of my sleep maintenance insomnia and in my case it was pain...some arthritis and old injury pains.
My daytime pain meds work well for daytime pain control but they come with a nasty side effect of causing insomnia for me. I would go to sleep okay but in about 3 hours I would be wide awake and up cleaning the house if I took it at bedtime.

I worked with my doctor in figuring out something that would help the pain situation and not make the sleep apnea situation worse. The end result was I take a very low dose of Amitryptiline (10 mg) and I find that it helps me stay asleep or sleep through the pain and not be awakened 40 times a night. I don't know if this is something that your doctor would feel would help you or not. It's a very, very low dose of a medication that was used years ago for depression but in much higher doses. It was found that in low doses this medication seemed to help people with chronic pain. It will make a person drowsy and there is a bit of a morning after drowsiness if I forget and take it too late in the evening. It's not considered habit forming like the Ativan is and for me I think that the "drowsy" thing with it seems to last longer through the night than Ativan (which I have taken in the past back when I had some bad life stressors going on).

I have also been known to take Benadryl at bedtime. It's the main component in most of the OTC sleep aids.

I still wake several times during the night but it's maybe a handful compared to 40 or 50 without some sort of medication. Normally I just roll over and go back to sleep though or move to relieve whatever is hurting and then I go back to sleep.

In my case I knew what the culprit for my sleep maintenance insomnia was but it still took a lot of trial and error to get it to where it is at least manageable.
In your case you still need to try to figure out the culprit and often that is the hardest part...and there's a good chance that there's more than one culprit involved which makes it even harder.

Thanks Pugsy for sharing your story. I have tried Amitriptyline (10 mg) prior. It seemed to work awhile but then not so much. I even tried to move up to 20 mg ( Dr suggestion). Did not seem to do the trick. After a few months I tried to take it again one night but it did the opposite reaction and kept me wide awake...an uncomfortable feeling with an elevated heartbeat. I still have some, maybe I'll try again. Tried Benadryl and other OTC stuff and yes they all have the same ingredient and does the opposite of drowsy to me. Tried Melatonin and if I take too much does the opposite. Even tried Gabapentin awhile. Might try again just to break up the Ativan dependency. Like others i'm at the point where I need to sleep through as much as possible. I'm 60 now and my health is sliding mostly because of the collection of sleep disorders I have. One that works in very low doses for me ( kinda) is Zopiclone (sp?). Perhaps try that one again. ...