CPAP Waking Me Up After 5 Years

[tbowspen]

I have been on CPAP for 5 years, and received wonderful information and support from this site at that time. Truth be known, I have not logged on here for nearly 5 years, but feel I need some answers to what is going on with me for the past 3 months. Thanks in advance to anyone who reads and responds to my post.

I have been a very compliant CPAP user over the years, but was negligent in getting any follow up monitoring of my therapy (not on Medicare), and the MD who started me on it lost his MD license a few years ago, with no forwarding referral to another MD. I was able to neglect how the CPAP therapy was going, because I was doing just fine, until about 3-4 months ago.

I have been under tremendous stress over the past 9 months, with a major move (1,000 miles after 30 years in one place), high-stress job, and some personal issues. Admittedly I became exhausted physically and emotionally. About 3 months ago I was aware of less and more broken sleep, and some mornings when I had "rubbery legs". After an especially difficult week, in January I developed serious insomnia-not able to fall asleep or stay asleep (fewer he 3-4 hours sleep per night for over 2 months since then).

I thought perhaps my old CPAP machine (S9 Elite) was not performing correctly (it was making lots of noise), so, in my new location, I was referred to a DME for my CPAP support. They said my AHI for the previous 3 months was up to 11.6, and increased my pressure from 7 to 9. I (independently because my insurance would not pay for a new one) purchased a new S-10 Autoset, and sent the old S-9 in for maintenance. I have been using the S-10 for about 5 weeks.

So, HERE'S THE PRIMARY ISSUE: For about a month before I became acutely insomniac I had become aware of a new experience with my old S-9. It would occasionally actually wake me up with a significant increase in pressure (no mask leak), that I could stop just by exhaling. That had never happened since on CPAP. Now, in the past 5 weeks with the S-10 this is occurring every night, sometimes many times per night out of both light and deeper sleep. My husband says it sounds like an airplane engine revving up (new to him, too). Once I wake up with that, I cannot fall back to sleep (this may be because it freaks me out). I have tried researching but to no avail.

Can anyone give me some information on this? Is it that I may have developed more serious apnea? When my data has been run in the past, I always had low apnea occurrences, and more hypopneas. My inner fear is that this is endangering my life, when my CPAP was supposed to keep me from stopping breathing.

Again thanks for reading this, and giving me some info. I'm sort of at the end of my rope with the insomnia and this.

[robysue]

I have been under tremendous stress over the past 9 months, with a major move (1,000 miles after 30 years in one place), high-stress job, and some personal issues. Admittedly I became exhausted physically and emotionally. About 3 months ago I was aware of less and more broken sleep, and some mornings when I had "rubbery legs". After an especially difficult week, in January I developed serious insomnia-not able to fall asleep or stay asleep (fewer he 3-4 hours sleep per night for over 2 months since then).

While you may need to do some work to optimize the CPAP therapy, you may also need to work on treating the insomnia as its own separate issue. The kinds of major changes that you've been through in your life in the last year can (and do) trigger some pretty severe insomnia issues. You can try to self-treat by paying a lot of attention to sleep hygiene. But if it doesn't resolve itself, you may want to consult a doctor. A short course of sleeping pills may be suggested. You'll have to decide whether you're willing to do that. You might also be able to get a referral to someone who can work on a CBT-Insomnia program with you. It's not easy and it may not be your cup of tea, but for some folks CBT-Insomnia can work wonders.

So, HERE'S THE PRIMARY ISSUE: For about a month before I became acutely insomniac I had become aware of a new experience with my old S-9. It would occasionally actually wake me up with a significant increase in pressure (no mask leak), that I could stop just by exhaling. That had never happened since on CPAP. Now, in the past 5 weeks with the S-10 this is occurring every night, sometimes many times per night out of both light and deeper sleep. My husband says it sounds like an airplane engine revving up (new to him, too). Once I wake up with that, I cannot fall back to sleep (this may be because it freaks me out). I have tried researching but to no avail.

Are you running the new Resemd AirSense A10 Autoset in AUTO mode? Your S9 Elite did not have an auto mode. It's possible that you and your hubby are noticing the Auto algorithm kicking in. Also, what are the settings on the new machine?

Have you looked at the data from the new machine? Do the times hubby says he's hearing the airplane engine revving up correspond to times when the new A10 is increasing the pressure?

Also do you use the ramp? The A10's ramp algorithm is different, and once the A10 thinks you are asleep, it ramps up the pressure to the min pressure setting pretty rapidly.

Can anyone give me some information on this? Is it that I may have developed more serious apnea? When my data has been run in the past, I always had low apnea occurrences, and more hypopneas. My inner fear is that this is endangering my life, when my CPAP was supposed to keep me from stopping breathing.

It's possible that your *untreated* apnea has indeed gotten worse. It's also possible that your *pressure* needs have changed over time. The CPAP is NOT endangering your life right now, but if your treated AHI was running in the 11+ range for 3 months on the old S9 Elite, that does indicate that your old setting of 7cm was not providing full protection for you. It's important for you to find out what your *current* treated AHI on the new machine is running.

I'm sort of at the end of my rope with the insomnia and this.

Dealing with both insomnia and CPAP troubles is difficult. But with some help in getting the settings right on your new machine, the OSA should be properly treated again. Getting help with the insomnia should then help you get the sound sleep you deserve.

[Pugsy]

How about using the software and let's see exactly what the pressure is doing?
Do you know about your software options?
Some examples of what we like to see on the reports is shown here in this thread and also in this thread are instructions on how to post images of your reports so we can see what you are seeing.
viewtopic/t103468/Need-help-with-screen-shots.html

SleepyHead information is in my signature line and if you want ResScan just send me a private message but be aware that ResScan is Windows only software so if you are using a Mac you will need to use Sleepyhead (it has both Windows and Mac versions available) or have Windows on your Mac.

[OkyDoky]

If she has The Autoset CPAP machine what info can she get on Sleepyhead?

[Pugsy]

If she has The Autoset CPAP machine what info can she get on Sleepyhead?

Pretty much the same stuff you get with your machine...
I was especially wanting to see if the pressures were really going sky high (and if they were then why do they go there) or if they were just perceived to be high and especially wanted to see the AHI even category breakdown.
Just wondering if it was really the pressure changing causing the wake ups or maybe the apnea events causing the wake ups or the apnea events causing the pressure increases which might then cause the wake ups.
But first need to see just what the pressure was really doing because what we perceive is happening doesn't always translate into what is actually happening.

[OkyDoky]

If she has The Autoset CPAP machine what info can she get on Sleepyhead?

Pretty much the same stuff you get with your machine...
I was especially wanting to see if the pressures were really going sky high (and if they were then why do they go there) or if they were just perceived to be high and especially wanted to see the AHI even category breakdown.
Just wondering if it was really the pressure changing causing the wake ups or maybe the apnea events causing the wake ups or the apnea events causing the pressure increases which might then cause the wake ups.
But first need to see just what the pressure was really doing because what we perceive is happening doesn't always translate into what is actually happening.

Right I was thinking Airsense and thought with those the CPAP was the old Escape. My mistake.

[Pugsy]

Right I was thinking Airsense and thought with those the CPAP was the old Escape. My mistake.

You would be correct if the AirSense 10 CPAP was the model machine being used as it is pretty much like the old S9 Escape except I think it shows overall AHI (but nothing else useful which is like what the S9 Escape Auto showed).
OP here in this thread is showing AirSense 10 AutoSet which of course is a full data machine.
I think OP just mentioned CPAP initially just like we might mention xpap and didn't mean the actual machine model in this instance.

[tbowspen]

Thank you to all who responded to my post.

I know now that I need to learn more about my new CPAP machine A10 Autoset, my settings and how to access the reports from it. Can someone explain how this machine is different from my old S8 Elite? If I have an apnea episode, would the A10 Autoset be more likely to rev up the pressure to compensate? It atually did happen a few times with the S8 Elite just before I stopped using it.

I know with the A10 my pressure is set at 9 cm, and I have the the ramp at 5 cm for 15 minutes mostly because I was used to that, and because of my current inability to fall asleep within a reasonable period of time. I found having the CPAP running at a ramp of 5 cm for up to 45 minutes waiting for me to fall asleep was not helpful.

I asked the DME Respiratory Therapist what my AHI was after the first week with the A10 Autoset, and she reported it was down to 3.6. The caveat to that is that I was NOT SLEEPING more than 1/2 the time I had the CPAP on during that week, so I'm assuming that dilutes the AHI by quite a lot.

[Pugsy]

The S8 Elite was a single fixed pressure machine with no ability to auto adjust the pressure in response to anything.
Now it did have ramp and EPR but no auto adjusting capabilities at all.

As to your AirSense 10 AutoSet...it may be set in cpap mode and if that's the case it works just like your S8 Elite worked but if it is set to APAP (auto adjusting) mode then the pressure can change as needed in response to whatever the machine senses within whatever parameters have been set.

You need to figure out which mode you are using along with the settings.
Do you have the provider/clinical manual for this machine? If not I would suggest that you go get it and read up on what all it can do and what you can see.
You can go here and request it...just make sure that you request the correct model...instructions are down near the bottom of the page.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual
and this is what you will request
ResMed AirSense 10 AutoSet, AutoSet for Her, Elite & CPAP (combined manual)

[OkyDoky]

Here is a copy of your Clinical manual. https://sleep.tnet.com/home/files/resme ... -guide.pdf

[Guest]

I noticed after about 4 years of nightly CPAP use with the S9 auto that I would wake up feeling like I was choking for air. Saw a new sleep doctor as my neuro had previously been treating me and she ordered a new sleep study. Did the study and had an AHI of 25 with 19 obstructive and 6 central events. When they initiated CPAP, my obstructive events went to 2, but centrals up to 18. Doctor said my apnea had changed to complex sleep apnea with the initiation of CPAP therapy and wanted to do another sleep study with an ASV machine. Went in 2 weeks later and had an no events with the ASV. I just got my new ASV machine and my AHI has been under 1 every night. Not sure if this could be going on with you, but in some people CPAP actually causes centrals. You would need a sleep study to confirm.

[RogerSC]

Just a quick thought, "ramping up like an airplace engine" sounds like it might be mouth breathing, since that would be noisy and it would cause the cpap to try to compensate...just a thought. On the other hand, the "no mask leaks" part makes me wonder if you're looking at your sleep data to know that?

Anyways, I agree that the insomnia is most likely a different issue, more related to stress. I remember back when I was in a very stressful job my sleep was disturbed, too...it was hard to get to sleep and I didn't get enough hours of sleep, also. One thought about that (other than sleep aids), exercise was a big help for me relative to stress. It gave me a different focus, and when you do it long enough before bedtime, it also makes you more tired by bedtime.