My First solid night of CPAP, how does this look?

[ladypreneur1]

Thanks for all your suggestions so far. I got my machine this week on Tuesday, and the first night was not great, I woke up and took off the mask like 8 times because I felt like I wasn't able to exhale enough. The second night went much better after I adjusted more and changed the settings from 4 - 12 to 4 - 20. I know 4 is low but I tried a higher starting pressure and it felt off, I like the slow build up I guess. I ended up with an AHI score of 4.67.

First night AHI score was 10 and my sleep study score was 22 so I consider this a major improvement!

Let me know if there's anything I can adjust or change to improve this. I know the mask leaked a bit more this time (I use the Resmed N30i nasal cushion and find it fairly comfortable so far). Getting down to under 1 AHI is the goal, but I'm also happy to be getting better sleep finally after years of this slowly getting worse.

(PS - The data show a short "CPAP nap" I took earlier in the day as well)

https://sleephq.com/public/8f947185-e6a ... 0d0a367da5

[Miss Emerita]

Congratulations on getting started!

Most of your apnea events are non-obstructive. (CAs are clear/central apneas -- pauses in your breathing of 10 seconds or more while your airway is open.) All of those CAs come right after arousal breathing, which is deeper and more irregular breathing than good asleep breathing. You can zoom in on your flow rate and see this for yourself. Select a short interval and take a look. To return to the full night's view, hit the "r" key.

The CAs themselves will probably settle down as you experience fewer arousals during sleep, and that will probably happen as your body gets used to the whole CPAP thing.

I do notice that you have a lot of flow limitations. They may not be giving you any trouble; then again, they maybe they do. One tool for reducing them is EPR. I'd recommend that you increase your EPR to 3. So that you can benefit from the EPR of 3, I recommend that you raise your minimum to 7. (EPR drops your pressure when you exhale, and your machine can't go lower than 4.) Don't worry; if you keep your ramp settings just as they are, you'll keep that pressure of 4 that you like while you're falling asleep.

[ladypreneur1]

Thanks for taking a look. I see what you mean by the ramp settings not being affected. I'll try that! The main issue in getting used to it was feeling "over-pressurized," so I imagine EPR could help. I'll try those settings and see how it goes!

[Miss Emerita]

Excellent, and keep us posted.

[ladypreneur1]

Alright, here is last night's data from SleepHQ. I adjusted the min to 7 cm and the EPR to 3. I felt somewhat rested, it did not feel like a terrible night's sleep. But my AHI went up a bit and I notice a lot more events. I only woke up once and kept the mask on the entire night. These are mostly Clear Airway events - is this normal while adjusting to the machine?

https://sleephq.com/public/aded900c-cd4 ... 42c31e173b

[Miss Emerita]

You're making progress! It's heartening that you felt somewhat rested and also felt your night's sleep wasn't too bad. Your flow limitations are not as heavy now that you're using EPR of 3 and a minimum of 7. You're doing great with leaks, which can be a problem for lots of people starting CPAP.

If you zoom in on your CAs, you'll see that they come after arousal breathing. Arousals can often be brief enough that we don't really remember them, but they're arousals all the same. They may be wake-ups, or they may be changes from deeper sleep to shallower sleep.

I do think you should bracket concern about these CAs for now. You want to give your body a chance to settle down and give you fewer arousals. Your body may also start responding to arousals less frequently with CAs.

Also, whenever you change your settings, it's a good idea to wait around a week before you try to assess the value of the change, even when you're an experienced CPAP user. That's because sleep, AHI, and many other variables are, well, variable from night to night.

Keep us posted!

[ladypreneur1]

I really appreciate hearing this. At first I looked and thought oh no it's worse! But the majority of the "arousals" happened in the time around 5 am when I woke up and took some time to drift back to sleep.

Compared to my first night, this night felt a LOT better comfort-wise and easier to use the machine. It's helpful to see other people's experiences here too and see how there is some kind of adjustment period for almost everyone. I also appreciate having a good comfort level with the mask I have pretty much from the get go.

[ladypreneur1]

Update: Last night was my first night under 1 AHI! It seems like these settings are good, though I'm open to any suggestions. I think the max 20 pressure may be too high since I never use pressure above 15 it seems.

SleepHQ results: https://sleephq.com/public/e40c1eba-ce5 ... ccd8a9fae1

[Pugsy]

I think the max 20 pressure may be too high since I never use pressure above 15 it seems.

Doesn't really matter what the max setting is if the machine never goes there. Having a higher than needed max doesn't affect how the machine functions. If you could set it to 100 cm and it never went to 12 it wouldn't matter but some people think that just because a machine can go higher that it will go higher or that it affects the auto adjusting algorithm in some way....which it doesn't.

You can limit the max if you wish but it won't change anything.

[Miss Emerita]

It's good to see your progress. Every one of your events, including the OAs, were preceded by arousal breathing. So what you'll be looking for over time is fewer arousals. In your place I'd leave your settings where they are.

At this point, you want to be focusing less on the numbers and more on how you feel during the day. As you continue getting used to the new sleep experience, I'm hoping the number of arousals you experience will drop and you'll feel more rested during the day.

About the flow limitations: do you have a stuffy nose?

And it's always worth seeing which of these guidelines for better sleep you might want to focus on:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

For me, the tough one when I started was giving up reading in bed before turning off the light. I also realized I'm a lot more sensitive to caffeine than I used to be and can't drink it past noon. See if there are any of these suggestions you might try.

[ladypreneur1]

Thank you for all the tips! Yes, I have had a stuffy nose - moreso from getting sick recently and general allergies (they were never bad until this year, but I think the CPAP is helping). I take some decongestant if it's bad or steam to clear my sinuses before going to bed, which helps a lot. Also having tissues by my bedside helps.

Sounds like the pressure max is fine, so I'll keep it there!

This is a great list to follow and I will work on these things. I don't drink caffeine so that's an easy one, but going to bed and waking up at consistent times is something I've always struggled with. Things have been hectic lately because of travel and having to adapt to different environments/set up the CPAP while staying with family or in hotels, so now that I'm back home I can focus more on a solid routine.

I went backpacking earlier this week and couldn't sleep with the machine for two nights, and that's when I really noticed quite a difference in my anxiety/energy compared to sleeping with the machine. Even though I was out having a lovely time, the familiar anxiety from not sleeping deeply came back and I definitely felt less energy during the day. For me, I never felt like falling asleep during the day because of sleep apnea, but the massive anxiety and brain fog I felt from lack of good sleep was crippling some days. I don't wake up with anxiety anymore and I'm so grateful for people on this forum helping me to get on the right track. I'll post another update in a week or so!

It's good to see your progress. Every one of your events, including the OAs, were preceded by arousal breathing. So what you'll be looking for over time is fewer arousals. In your place I'd leave your settings where they are.

At this point, you want to be focusing less on the numbers and more on how you feel during the day. As you continue getting used to the new sleep experience, I'm hoping the number of arousals you experience will drop and you'll feel more rested during the day.

About the flow limitations: do you have a stuffy nose?

And it's always worth seeing which of these guidelines for better sleep you might want to focus on:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

For me, the tough one when I started was giving up reading in bed before turning off the light. I also realized I'm a lot more sensitive to caffeine than I used to be and can't drink it past noon. See if there are any of these suggestions you might try.

[Miss Emerita]

You might want to try Flonase for your stuffy nose. It takes a couple of weeks to kick in. Some people also benefit from nasal rinsing. Nielmed is a popular name brand. Feels weird but can clean out irritants. Be sure to use any sprays or rinses at least an hour before bedtime, maybe two.

[ladypreneur1]

Alright, I have more data after a few weeks of using the machine. Unfortunately, I have not been able to get consistent under 1 AHI nights. It's more like 2-5 AHI per night, with a majority of them being clear airway events, and some OSAs. Still better than my sleep study and averages before CPAP. But I still notice a fair amount of arousals during the night. I am already due to get a new nasal cushion so that may help. I try to get in bed before 11 so I can continue to work on the consistency there. Aside from the important sleep hygiene stuff, is there anything else I might want to look at to help with these arousals?

https://sleephq.com/public/4d2e96f6-e1b ... 1c45f4180d Last night's report

https://sleephq.com/public/ca139ab6-0f0 ... 0527664a6c Overall data trends

[Miss Emerita]

All your CAs come after arousals. The arousals are the problem, not the CAs per se or your overall AHI. I see from the summary data that you seem to take a fair number of naps. Can you try not to nap? Difficult at first, I'm sure, but with time this might help you consolidate your sleep. Also, a fair number of nights include breaks in therapy. What is usually happening to cause those breaks?

Some more pesky questions. What meds are you taking, either prescription or over the counter? And did your sleep study include any information about periodic leg movements or restless leg syndrome?

[ladypreneur1]

Good questions! I usually listen to meditations, so I am not sleeping per-se during the "naps", but I like to wear the cpap mask in case I do drift off. But I can try stopping those to see if it helps.

I have noticed recently I sometimes take the mask off in my sleep or barely awake, and wake up later to put it back on. Annoying and pretty unconscious. I think I get congested sometimes and that makes it harder to breathe through my nose. I've also noticed that stress can really impact how restless I am during my sleep, and this has been a period of higher stress recently.

I have ADHD and have read that it can correspond to generally moving around more during sleep and sleep disturbances. I am not on medication for that, but have considered it since it may help with my sleep. I do not take anything other than vitamins and small amount of thyroid medication in the mornings. I usually take magnesium before bed, and try not to drink too much water in the last hour before sleep.
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Here's data from my sleep study:
Arousal Statistics:
A total of 122 arousals (22.4/hour) were observed during the analysis period as follows, 106 respiratory arousals, 2 Leg Movement arousals, 14 spontaneous arousals

The patient had a normal number of Periodic Limb Movements of Sleep during this Polysomnogram.
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