Changed Pressure 6-7-8 Still a struggle?

[MyJanine]

Please provide any useful comments to what you see here. I have been moving up the base pressure from it's original Rx of 6cm (for 43 days) to 7 (for 3 nights) to 8 (for 2 night). Still troubled sleep. My waking hours are filled with lack of energy, sadness. Just learning the Sleepyhead Glossary of terminology (CA? etc). My assumption when looking at the Sleepyhead data is that when the pressure is at 16cm or more that I am in REM sleep? So, even though the data states 9.5 hours sleep.... my only healthy sleep is in the hours of higher pressures? This would indicate that I'm actually "sleeping" from about 1AM to 4:45? Ugh
Related: Is there a concern here with mask leak rate? It's a mouth/face mask covering both nose and mouth.

[Julie]

I think you need to raise your pressure, because it plainly wants to be higher, and you're not feeling the effects of it.

[Pugsy]

It would be unusual for a single REM stage to last that long.
Check out the hyponogram here...on the right side ...scroll down a bit.
http://en.wikipedia.org/wiki/Sleep
Good sleep is compromised of several cycles through the various sleep stages and isn't solely dependent on REM sleep. The body needs all the various sleep cycles for the restorative powers of sleep and not just deep sleep or REM sleep.

The increased pressures for such a prolonged period of time I would suspect are related more to sleeping position....sleeping on your back.

The first cluster between 12:30 and 1 AM...very well could be REM stage sleep as the first REM stage normally occurs about 90 minutes into the sleep session but it normally doesn't last very long at all.

Probably a little mix of REM and sleeping on your back is the cause for the increased pressure needs.

Those hours of sleep that you are getting....do you wake often during them? I see at least 3 breaks in therapy on this report. Why? Have more wake ups but don't turn the machine off.
Are you taking any meds of any kind, even OTC? If so, what.

What was your prescribed pressure? Did you have an in lab sleep study where they came up with a pressure for you are are you trying to find it with the apap machine? Some people have issues with the changing pressures used with apap mode. If that's the case with your then you may need to severely limit the range or change to cpap mode. Please note that if you change to cpap mode with your machine you lose FL flagging capability. Instead I usually suggest people set minimum to equal maximum in apap mode which gives a single fixed pressure but doesn't lose FL flagging (just in case they might be important and in your situation it appears it is important.

In general it looks like you are going to need higher than 8 cm minimum. Unsure how much more and what impact sleeping position is having because don't know if you always stay on you side or back or move around. It's very common to need more pressure when sleeping on your back...sometimes a LOT more.

[JDS74]

Do you have your sleep study reports? Its is very helpful if you do and you can request them from your sleep doctor.
They will tell you about the number and distribution of you various apneas during the study.

Do you have your original prescription? That is also helpful in that you can use it to order supplies online, etc.
It also provides a benchmark to compare the pressures when you started with where you are now.

Increasing the EPAP pressure just a little bit at a time may help with the OSA's you are seeing.
No need to consider raising the max pressure as you don't seem to be getting there. Also, (good news) the time spent near 20 cm H2O doesn't seem to be creating any central apneas. Sometimes folks see those at higher pressures and you are doing very well in this regard.

Overall, an AHI below 5.0 is a good sign. It may be that you need to get yours down below 2.0 before you begin to feel better. Feeling better is the target, not just the numbers. Keeping with the therapy, making small changes and seeing how they do for a few days is the right track to be on.

[MyJanine]

Thank You, All!
This forum is such a great resource, and such amazingly speedy response times
I am actually posting for my wife, and waiting for Janine to get up from her bed. I will fill in the answers to your inquiries as soon as I see her. I know that she takes a nightly dose of Amytriptalene 20mg, and on probably half of her nights she needs to take Lorazapam (sp?) as an additional kicker.
The original CPAP prescription was I assume "programed" into the the PR System One REMStar 60 Series Auto CPAP Machine when we picked it up... which was 6cm base pressure.
Yes, I can personally tell you that she indeed spends many hours sleeping on her back. Additionally, for years I have been sometimes awakened and listening to her interrupted breathing (during loud snoring) and wondering to myself "Is she still alive?" Every time I've observed this I nudge her and say: "Honey? Please roll over"
Thanks Again, More to come,
Kip (hubby of MyJanine)

[Pugsy]

from hubby:...a nightly dose of Amytriptalene 20mg, and on probably half of her nights she needs to take Lorazapam (sp?) as an additional kicker.

Both of these meds can cause a significant leftover the next morning feelings of fatigue, drowsiness, fog etc...but normally doesn't last all day.....depends on how quickly it is metabolized and when the dose is take before bedtime.
I take Amitryptiline myself...the 20 mg can cause my butt to drag the next day if I take it too late in the evening...For this reason I ask my doc to let me have the 10 mg pills. Less of a hangover the next day and works just as well for helping me sleep through my arthritis pain (that's why I take it). And since I always seem to forget to take it until a bit later than I really wanted to...the 10 mg helps me not be a zombie for 3 or 4 hours after I get up.

Your wife's cpap therapy is not quite optimal just yet. I suspect the supine sleeping is greatly impacting the pressure needs. REM may also be a part. I think once she works her way up to around 10 cm minimum pressure that the therapy itself will be better and the reports look better in general and I am hoping those higher pressure needs will come down a bit. That part just remains to be seen what happens once see gets up to that 10 cm minimum.
Once her therapy settings are closer to optimal...then if symptoms persist we might look closer at the meds as being a potential factor in how she is feeling during the day.
Gotta fix the therapy stuff anyway....then see what's left over that's a potential problem in how she might feel.

She could try staying off her back but that's easier said than done and sometimes those higher pressures aren't totally related to supine sleeping...REM stage sleep can be a huge factor. That's my situation...I sometimes would need twice the pressure in REM sleep and I confirmed this with a month long experiment where I built a wall to keep me on my side all night....I still would see the big pressure changes sometimes.

[MyJanine]

That's my situation...I built a wall to keep me on my side all night.....

Interesting... I've heard of sewing in a row of tennis balls onto the back of your nightgown to prevent supine sleeping. HA! I cannot imagine how else to accomplish this.

[Pugsy]

Interesting... I've heard of sewing in a row of tennis balls onto the back of your nightgown to prevent supine sleeping. HA! I cannot imagine how else to accomplish this.

I refused to do the tennis ball thing....heck, I have enough pain already that messes with my sleep...just what I need...adding tennis balls and more discomfort and more wake ups to my already fragile sleep.

What I used was a buckwheat hull pillow positioned up against my back. The weight of the hulls helps prevent the pillow from sliding out from under me. Now the pillow wasn't high enough to be a big wall but enough that I couldn't get totally flat on my back.
Plus when I would sort of roll back against the pillow ...sort of halfway on my back and half on my side...the support from the pillow on my back actually felt very, very nice....didn't hurt like tennis balls would hurt and I slept very well...no wake ups from pain.
I actually do this quite often with my buckwheat hull pillow (I have 2 now)... because sleeping on my back hurts my back (old fractured back and pelvis injury) since the hulls offer support which feels good and keeps me off my back which helps lessen my back/pelvic pain.

I tried other various "walls" but they all slid out from under me. Even bought a fancy and expensive foam wedge but I would move that sucker out in my sleep and never know it until I woke up with back pain and flat on my back.

Now if someone wants to use the tennis ball trick and they don't care that they wake up every time they land on their back...in pain so that they go back to their side and they are okay with doing that multiple times a night for weeks until they create a habit where they never go onto their back...more power to them but to me it's just stupid to add something to already fragile sleep that is going to make things worse.

[JDS74]

FWIW: Amitriptyline has a half life of 10 to 26 hours so that a 20mg dose taken at 10 pm will have a minimum of 10 mg still circulating at 9 am the following day. After 15 days, the blood serum level will be between 30 mg and 40 mg depending on the rate the individual excretes the drug.

It is one of many drugs that cause QT interval prolongation. This is a heart rhythm function (reported on an ECG) that is not a problem with folks who have a normal QT interval. If the interval is on the longer side, this can cause problems. A simple ECG can tell if this will be a problem. For more information on this issue:
https://www.crediblemeds.org/everyone/a ... l-woosley/.

Dr. Woosley is a great person and helped me personally with some meds issues related to this issue.

In my drug registry, the following note is made of the interaction between Amitriptyline and Lorazepam:
"Caution advised: combo my increase risk of CNS depression, psychomotor impairment(additive effects).
Perhaps a discussion with the prescribing doctor about these symptoms is appropriate.

[Julie]

You can buy (online as well) foam wedges to put behind you for sleeping that will keep you on your side.

[Jim-Bob]

Please provide any useful comments to what you see here. I have been moving up the base pressure from it's original Rx of 6cm (for 43 days) to 7 (for 3 nights) to 8 (for 2 night). Still troubled sleep. My waking hours are filled with lack of energy, sadness. Just learning the Sleepyhead Glossary of terminology (CA? etc). My assumption when looking at the Sleepyhead data is that when the pressure is at 16cm or more that I am in REM sleep? So, even though the data states 9.5 hours sleep.... my only healthy sleep is in the hours of higher pressures? This would indicate that I'm actually "sleeping" from about 1AM to 4:45? Ugh

Actually, no. Sleepyhead can't determine when you are actually asleep or not. The "sleep" hours in the software is really just hours the machine is running. If you had a sleep study, then the report from that (which you are entitled to have and can get from your doctor) will have quite a bit of important information about the details of what kinds of events you have.

Don't get too discouraged. You are making progress.

Paul J.

[palerider]

You can buy (online as well) foam wedges to put behind you for sleeping that will keep you on your side.

Julie I bought one of those (don't remember which one) and it wasn't a cheap one either. It easily just slid right out from my body. I couldn't get it to stay in place no matter what I did. Works great until it starts sliding around.

VELCRO!!! *lol*

seriously, though, some are stickier than others, or you could use something like that rubberized drawer liner stuff to give it a bit of grip.

[Pugsy]

VELCRO!!! *lol*

seriously, though, some are stickier than others, or you could use something like that rubberized drawer liner stuff to give it a bit of grip.

And stick the velcro to what? My 1200 count Egyptian cotton sheets? I don't think so. I am a princess when it comes to my bed linens. I like things to feel a certain way. I'm worth it.
Besides...I gave the wedge away. The buckwheat hull pillow is less intrusive and more offers (at least to me) comfort as it offers a very comfortable support for my back issues anyway. Win - win for me. Allows a little movement which I need anyway. For me staying in the exact same position all night long is very uncomfortable.

My point about the wedge is that it can move and that's a potential problem. How someone might want to address that problem is up to them. I prefer to use a solution that doesn't create a problem that requires more work fixing...I'm lazy.
And I am sure not going to mess up my sheets with sticky stuff.

[palerider]

VELCRO!!! *lol*

seriously, though, some are stickier than others, or you could use something like that rubberized drawer liner stuff to give it a bit of grip.

And stick the velcro to what? My 1200 count Egyptian cotton sheets? I don't think so. I am a princess when it comes to my bed linens. I like things to feel a certain way. I'm worth it.
And I am sure not going to mess up my sheets with sticky stuff.

well, ok, the velcro comment was just there to get a laugh... but the drawer liner idea could work

[Pugsy]

well, ok, the velcro comment was just there to get a laugh... but the drawer liner idea could work

Okay...you had your laugh. The drawer liner idea might offer enough traction. Never thought of that one. Not interested in trying it myself since I no longer own the wedge and don't really want to go buy another one...I will let someone else take on that experiment if interested.
I do know that I went through several different attempts at building various walls before I hit on the idea of using the buckwheat hull pillow to see if it would work and I already had one since I was using it for my neck and cpap mask comfort. I would be using the buckwheat hulls even if I wasn't using cpap because it helps me with my cervical spine issues which are significant. Regular pillows pretty much always give me a bad "neck headache" in the AM and sometimes even now if I sleep in a weird position I still get one.

I have no real need to stay on my side anyway. The experiment I did was to figure out if it was just the REM sleep or supine sleeping that caused the pressure increases and once I figured out it didn't matter because REM was the culprit, I just let the machine do what it thinks it needs to do no matter what position or sleep stage I am in and I merrily sleep right through all of it.