Arrgghh! APAP not working for me evidently!

[napagirl]

Lately, I've been lightly awake many times during the night. You know, that light sleep when you keep waking from apneas and can't get into deep sleep. I posted a week or so ago about my APAP, and having obstructive episodes. I did raise the pressure. My pressure RX is 9. I have the APAP set at a range of 4-15. I thought that would take care of things.. no luck. My husband actually heard me obstructing while on my back and woke me up. I am confused why this is happening now. I do have the option of setting the machine to CPAP mode vs. APAP, and will try that tonight. But husband told me that he heard the same things with my old CPAP machine (which is why I bought the APAP).

Again, I am not working with DME.. buy everything on my own. Primary care dr. wrote the rx, but isn't a specialist. My "home" sleep test, which was terribly flawed, showed only mild OSA, so insurance denied everything (but they approved titration study- go figure). That is why this board is so helpful, since i have no expert to consult!

I do have some questions that I am VERY curious about.. maybe someone can answer them. I am not the typical OSA patient. I am not overweight. Also, when I had surgery in January, I told the anesthesiologist about the OSA. She examined my throat/mouth, and said I was atypical OSA patient. She said I had tiny tonsils and a small uvula. She was surprised I had OSA. My husband, who hears these events, is convinced that my tongue or jaw is falling back and causing the obstruction. So a big question I have is that if one's tongue/jaw is collapsing back, does that make the CPAP useless?? Could that be what my problem is? this all started after I had my daughter a few years ago... husband thinks the pregnancy "relaxed" various tendons/muscles triggering the OSA.

I know I shouldn't sleep on my back... this will be very hard for me, as I fall asleep best this way. I do meditations lying flat on my back, and have gotten used to relaxing for sleep that way.

I would genuinely appreciate any advice, as I am soooo tired!!

Napagirl

[BeanMeScot]

That pressure range is too large. In using an APAP, once you find your titrated pressure, you want to set the ranges to be fairly close to your titrated pressure. Since you say your pressure is 9, I wouldn't set the low number on the APAP less than 7 or about 2cm below your titrated pressure. When the machine is set too low, it can take the machine too long to get from 4 to the 9 you need to stop the apnea allowing the apnea to happen before it can get the pressure up.

[napagirl]

Thanks for that info! The reason I had the low end set so low was for the ramp up period. APAP does not have a normal ramp setting like CPAP, so I had to set it low, or lay there with a wind tunnel until I could fall asleep. But if that works, I'll do it. I am not convinced, tho, that this will work since I had this same problem on my last machine which was a CPAP (set to a fixed pressure).

[BeanMeScot]

I don't know about your machine but most have a seperate ramp feature so you can set the low end at 7 and still ramp. Most people don't need or want ramp after a while. I never used ramp because my pressure is 7. My APAP was set at 5 and I changed it to 5.5 because 5 was such a low pressure I felt like I was suffocating. I have since upped the low number to 6 and that feels like nothing.

[mdbarthe]

Although it is much less common than OSA, your apneas could be what is referred to as "central apneas" and not caused by obstruction of your airway. You might type "central apnea" in the search box above and read what you find.

[Julie]

If your husband thinks your tongue is falling backward (which is a standard cause of OSA), could it be because you sleep on your back - a bad position, as more apneas occur that way. Can you try sleeping in another position, even maybe using something behind you (pillows, a tied on tennis ball) to keep you sideways? Also, have you considered that your mouth may fall open when you sleep and all the good air is coming out that way instead of going down? If so, you need to look into full face masks like the Quattro, Ultramirage, etc.

[bonjour]

the Ramp feature on this machine is on the CPAP mode only. The APAP mode holds the low set for a defined period of time.

I am in he process of switching from a CPAP with no data recording to an APAP with data recording. My Rx is 19cm and the APAP was set for 10 (at my request) to 20. I figured it would autoadjust up to the 19 I was Rx'd at with no problem. This yielded a max of 13 cm with 11.2 avg and 4.9 AHI (mostly HI). Not bad numbers.
I then left town and set it in Automode 19-20cm and generated 13.5 AHI, THAT was a real shock when I got home.

I do need to add that I had the worst cold I've had in 10 years.
My conclusion, keep working at it.

Fred

[ww]

Lately, I've been lightly awake many times during the night. You know, that light sleep when you keep waking from apneas and can't get into deep sleep. I posted a week or so ago about my APAP, and having obstructive episodes. I did raise the pressure. My pressure RX is 9. I have the APAP set at a range of 4-15. I thought that would take care of things.. no luck. My husband actually heard me obstructing while on my back and woke me up. I am confused why this is happening now. I do have the option of setting the machine to CPAP mode vs. APAP, and will try that tonight. But husband told me that he heard the same things with my old CPAP machine (which is why I bought the APAP).

Again, I am not working with DME.. buy everything on my own. Primary care dr. wrote the rx, but isn't a specialist. My "home" sleep test, which was terribly flawed, showed only mild OSA, so insurance denied everything (but they approved titration study- go figure). That is why this board is so helpful, since i have no expert to consult!

I do have some questions that I am VERY curious about.. maybe someone can answer them. I am not the typical OSA patient. I am not overweight. Also, when I had surgery in January, I told the anesthesiologist about the OSA. She examined my throat/mouth, and said I was atypical OSA patient. She said I had tiny tonsils and a small uvula. She was surprised I had OSA. My husband, who hears these events, is convinced that my tongue or jaw is falling back and causing the obstruction. So a big question I have is that if one's tongue/jaw is collapsing back, does that make the CPAP useless?? Could that be what my problem is? this all started after I had my daughter a few years ago... husband thinks the pregnancy "relaxed" various tendons/muscles triggering the OSA.

I know I shouldn't sleep on my back... this will be very hard for me, as I fall asleep best this way. I do meditations lying flat on my back, and have gotten used to relaxing for sleep that way.

I would genuinely appreciate any advice, as I am soooo tired!!

Napagirl

Auto machines work quite well for most of us. You should consider buying the software for the machine so you can monitor your therapy and see the day to day results you are getting. In general the auto at first should be set for the minimum pressure to your titrated pressure (to eliminate any time lag) (9cm) and the maximum set to 13cm (to allow a little more pressure if your setting is not quite right for your conditions that night). You can then check the 90% curve and see how well the range is working for you.

You describe a lot of wind blowing around in your mask. That is usually caused by poor sealing of the mask to your face. Normal precautions are to wipe the mask sealing surface with a warm washrag as well as the part of your face where the mask touches. When you first put the mask on, hold it securely in place with your hand as you lie down and take 3 or 4 deep breaths to be sure the seals are sealing well. After that you should have to put your hand up to the mask vents to be sure any air is blowing from the mask. At 9 cm starting pressure, you do not really need a ramp and after a few nights, you should adapt quickly to that pressure (which is medium, but still quite low).

The ResMed masks are better for many people. The Ultra Mirage Full Face is an excellent mask that comes in 6 different sizes. ResMed (myresmed.com customer service) will send you a set of 3D templates to be sure you can fit the mask correctly. Choose the size that just barely is large enough as too large will leak into your eyes and that is never good for sleeping). The ResMed Quattro is also a good mask once you take a piece of plumbers teflon tape and stop the swivel from leaking!) A really good full face mask solves a lot of problems!

If you have never had a full formal sleep test, get the software as soon as you can afford it and learn to read it daily!

Go to the MyResMed.com website and watch the movie of apneas and you will see that everyone has the tongue and soft pallet closes off the air passage during an apnea. The CPAP/APAP machine holds the passage open all the time you are asleep if the pressure is set properly. I assure you it is not due to pregnancy as about 50% of the members on the board are male!!! I also assure you that no one can diagnose sleep apnea looking down your throat, although some people pretend that they can. Use your auto to it's best advantage with software to optimize your therapy.

[napagirl]

Thanks, everyone!

I want to say that I do have a full face mask. I have always used a FFM. I am unable to tolerate the nasal mask personally. I have tried many, and just end up wasting my money.

I also don't think these are centrals, because my husband hears the obstruction. It is a noisy, gasping, choking sound. I would think that means obstruction, but maybe I'm wrong.

I will try to fight the insurance for another sleep study. I will also try not to sleep on my back, though that seems very difficult.

I thought having a CPAP/APAP to the correct titration meant you could sleep on your back. Is this not the case??? Do you all have apneas on your backs even with treatment? That doesn't sound too good to me...

Napagirl

[Goofproof]

To find out what is really going on you need the software and reader, there can be many reasons why you are having problems. without the software you have little in the way of tools to see the problems. If you think it's APAP not incorrect setting of it causing the problem you could use CPAP mode, and maybe get it set correctly. Jim

[napagirl]

Thanks, Jim. I think you're correct.

Is this software and reader specific for certain machines, or does one have many choices? Can I purchase it on CPAP.com?

Thanks again,

Napagirl

[dsm]

Thanks, everyone!

I want to say that I do have a full face mask. I have always used a FFM. I am unable to tolerate the nasal mask personally. I have tried many, and just end up wasting my money.

I also don't think these are centrals, because my husband hears the obstruction. It is a noisy, gasping, choking sound. I would think that means obstruction, but maybe I'm wrong.

I will try to fight the insurance for another sleep study. I will also try not to sleep on my back, though that seems very difficult.

I thought having a CPAP/APAP to the correct titration meant you could sleep on your back. Is this not the case??? Do you all have apneas on your backs even with treatment? That doesn't sound too good to me...

Napagirl

NapaGirl,

Just a thought but some Apaps have what is called a 'settling period' - I don't know that model you have, but the purpose of the settling period is to let pressure stay at the lowest setting for say 20 mins before it starts monitoring events.

It is clear that your lower setting is too low & you are saying that if you set that lower limit up higher it prevents you going to sleep. Settling time (if it is on your machine) would merely delay responses.

I would be surprised though if there isn't some form of lowered pressure to help you start sleeping.

DSM

[Goofproof]

Thanks, Jim. I think you're correct.

Is this software and reader specific for certain machines, or does one have many choices? Can I purchase it on CPAP.com?

Thanks again,

Napagirl

Yes, the machine and software has to match. According to your ICONNY, yours takes https://www.cpap.com/productpage/devilb ... ystem.html. Without the software, I'd want my pressure 2 cm under my CPAP pressure and not more that 2 over my CPAP pressure, and you will do better if you can sleep on your side, on your back makes it too easy for gravity to close the airway off. It's good that you use a FFM, less to worry about with leaks. Jim

[napagirl]

You are awesome, Jim! THanks!!!!!!!!!!!!!!!

Now if I could just find a way to stay off my back... balls don't work.. end up with severe muscle spasms, disrupted sleep due to pain-waking up to get rid of the ball. I guess in my state of unconsciousness, I am a pretty stubborn back sleeper! I cannot even begin to imagine what would keep me off my back. Pillows are a joke...they get tossed off the bed in my sleep! For an attractive woman (if I do say so myself), I must look like quite the sight in bed! LOL! Mask on, gasping, choking... throwing pillows, balls flying across the room!!

[TerryB]

Napagirl,
I had a problem with my auto machine for months. It had been set up for a "split titration study". That is, it was running, but was set up to run at minimum pressure for 4 hours before starting to titrate the treatment pressure. So for the first 4 hours of every night until the problem was identified here, the machine was not doing what I expected it was doing. I don't know whether that is a possibility with your machine or not.

Good Luck and
regards,
TerryB