Do I Really Need CPAP?

[zoocrewphoto]

I agree about the nightmares - those are not normal treated-sleep dreams, but more likely untreated ones.

I have only ever had one nightmare while using cpap. And it was very different. The untreated nightmares usually dealt with me being chased by somebody bad. Sometimes by myself, or sometimes with somebody. Like trying to run carrying a child. The brain is trying to make up a story that explains being out of breath or holding one's breath. Running and hiding tends to cover those two very well.

[BlackSpinner]

Post some of your data and let people see what is happening.
AHI is not everything - if your events are long and only happen during REM then that could be a problem.

You have an autoset - what is it set to?

[palerider]

a sign to me that your sleep apnea treatment is not as effective as it should be.

Do you read what people post?

According to SleepyHead, most nights my AHI is between 1.5 and 2.

could have happened during excessive ramp times, and thus now tainting the ahi.

[Laurora]

Hey all--Sorry for disappearing yesterday. I'm afraid I don't have any graphs to post; all the info is on my fiancé's computer at home and I only ever remember to log in here when I'm at work (ha!). Anyway, I think yesterday was pretty telling for me. I felt great when I woke up, but it didn't last. I got a headache that lasted almost all day, and I was dragging by the afternoon. In the evening I was crabby and grouchy, and didn't have the energy to even make my daughter's lunch. So I went straight back to my machine last night. I had more nightmares--this time, there were intruders outside of the home, but I couldn't dial 911 on my cell phone. I kept misdialing, and then eventually my keypad disappeared. Another nightmare involved someone leaving sticks of dynamite on the ground and my dog picking up one in her mouth. I've had nightmares my whole life, since I was a young kid (loved ones dying, runaway cars without brakes, etc) so nightmares aren't unusual for me, per se, but the frequency has definitely increased since I've been on my machine.

My pressure is set between 10 and 15, and I think usually hangs out around 12 most nights. My biggest annoyance with the mask itself is that anytime my face tilts down (bringing my chin closer to my chest), I get huge leaks from the bottom of the mask. This happens no matter how tight or loose it is (sidebar: the whole "floating the mask on your face" trick completely eludes me). So this means I have to be sure to sleep with my head up, which isn't the most comfortable. I found a new DME who is actually friendly and helpful, and will be going on Friday for help with my mask.

Thanks again to all of you for your input--it's tempting to believe you've found an easy answer, but that's not usually how life is, eh?

[Laurora]

Ok, got the fellow to do an image for me: http://imgur.com/a/s7zVB

[Julie]

Hi, what you need is a soft cervical collar - it'll keep your head up (but not tooo much), and your airway more open, plus help with leaks... a bunch of people here now use them and find they can really help.

[ChicagoGranny]

Hi, what you need is a soft cervical collar

Well that came out of the blue. Are you wearing one Julie? Mine does a great job for me.



http://www.walmart.com/c/kp/soft-foam-cervical-collar

[ChicagoGranny]

Used with CPAP of course.

[Sleeprider]

Someone mentioned the use of a nasal pillows mask. They are much smaller and easier to sleep on your side without being dislodged. I think using something like the Airfit P10 would have the biggest impact on your comfort of anything else you could do, and might head-off the need for a cervical collar. Many of your sleep disturbances/ awakenings are leak related.

As far as sleep events go, you're having mainly CA events, with no apparent flow limitations or snores, and a low level of hypopnea. Your EPR is on a level of 3, and I'm curious what your results would look like with less EPR, and perhaps a lower minimum pressure. I sometime experience similar looking CA events when I have excessive pressure support (IPAP/EPAP difference). While you have a minimum pressure of 9.0, your exhalation pressure drops to 6.0, then steps back to 9 during inhalation. Try less EPR (1.0) and see if you have a positive result from that. It's very easy to switch back if you find it less comfortable or your sleep disturbance rate does not diminish.

[Laurora]

Sleeprider, I'm afraid I'm not knowledgable enough yet to make sense of what you said! What is EPR and how would I get less of it on my machine?

I'm going to see if I can get nasal pillows at the DME on Friday. They sound pretty appealing, although I (oddly) have very narrow nostrils so I'm curious if they'd work for me.

[Pugsy]

EPR is Exhale Pressure Relief in the ResMed machines.
Your profile shows a S9 machine. Here's a link to the provider/clinical manual that explains EPR (and a bunch of other stuff) along with telling you how to adjust EPR if you want to adjust it. EPR is considered a comfort setting and normally something that patients have control over anyway.
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf

[Macpage]

Sleeprider, I'm afraid I'm not knowledgable enough yet to make sense of what you said! What is EPR and how would I get less of it on my machine?

I'm going to see if I can get nasal pillows at the DME on Friday. They sound pretty appealing, although I (oddly) have very narrow nostrils so I'm curious if they'd work for me.

EPR on your Resmed machine is the setting that determines your exhale pressure as Pugsy and Rider mention. Thus, your minimum inhale pressure (10.0) less the EPR setting (3) gives you your minimum exhale pressure of 7. This is where you start the night. As the your auto adjusts the inhale/exhale pressure move in tandem on Resmed machines differing by the set EPR level choice. So, you start at exhale 7/inhale 10. If your pressure increases by say 2, then your exhale would be 9 and your inhale 12. With your settings, the max inhale is 15 which would result in a max exhale of 12. If you were in straight Cpap mode or if you turn off EPR, inhale/exhale will always be the same. Does this make sense?

In simple terms, your exhale pressure has a lot do with obstructive events, while the inhale relates to snores, flow limitations, and hypopneas. In your case on this evening, your pressure hangs out at exhale 7/inhale 10 a lot and moves to 8/11 some as seen on the 95% mark on Sleepyhead. This means that for 95% of the time your pressures were at or "below" exhale 8/inhale 11. When we look at the median, we see that you were around your start of exhale 7/inhale 10. Thus, you didn't have a lot of movement in pressure to have the result you got.

Were you on your side this night and have you seen this result for a series of nights? If so, you might be able to reduce pressure a very small amount at a time and see what results you get for a few days. Obviously, you can do this as long as your obstructive number, flow limitations, snoring, and hypopnea numbers don't increase. If these start to get too high or any small increases make you feel worse, then it is time to stop adjusting. The point of reduction is to reduce the amount of air coming at you at night. This may help with leaks, and generally can be more comfortable to a lot of folks, especially if you have any air in GI tract. However, if you were sleeping on your side most of this night and you still sleep supine some on others, you will most likely need more pressure for supine and may not be able to lower from your current settings. In many cases, pressures are set to handle the worst case scenario which is good when we need it. If we can eliminate the causes (supine sleeping being one) of these worst cases effectively, we may be able to use less pressure. You can also experiment with the EPR setting as Rider mentions, just keep in mind that lowering the EPR setting is an effective increase in pressure. This is why we do trials, monitor closely, and watch the positional aspect of treatment.

The pillows are a great suggestion from everyone as you have nasal capability. You may find them to be more comfortable, and they are usually less problematic for leaks due to the smaller area to seal. Sometimes, you might even be lucky enough that even lower pressures can be used effectively with pillows. I would suggest starting with the Resmed P10. It comes with several sizes of pillows so you should be able to get a good fit for your situation. If not, there are other pillows to try as well. Best of luck and sorry your day turned for the worse. Might be a good indication to give this a little more time.

Best,

Mike

[Pugsy]

I'm going to see if I can get nasal pillows at the DME on Friday. They sound pretty appealing, although I (oddly) have very narrow nostrils so I'm curious if they'd work for me.

The main nasal pillow manufacturers have sizes that include XSmall in the "for Her" nasal pillow packaging.
Like the Resmed Swift FX nasal pillow or the ResMed AirFit P10 (see link in my profile as that is what I am using now) that should not be a problem with small narrow nostrils.
If you end up still preferring a cushion type of mask...look at the ResMed Swift FX Nano cushion. I think it would be much easier to keep the seal and less likely to wake you up from leaks. It's a huge improvement over the Mirage FX IMHO.

[Laurora]

You all are the best. Seriously! This post has been immensely helpful for me. I'm looking forward to working on my machine a bit tonight and seeing if I experience any difference. Also very excited to try out a new mask--both of the ones Pugsy suggested look much more comfy than what I currently have.

[yaconsult]

It really is a trial and error journey. And all the information shared here is so helpful and useful. There are so many variables, interactions and combinations involved that the collective experience and knowledge of this place is invaluable. All we can do is learn from others and try to find out what works for us, personally.