Newbie, but oldie with frequent night awakenings

[joannebc]

Well the process of figuring this out is long and hard. I just got my CPAP and was excited that I would possibly have my first night of sleep. Sadly no. I installed the sleepyhead and will insert screen shots. Can someone help? The thought of another 30 days of only sleeping an hour at a time is daunting. TIA!
http://imgur.com/a/SdFgC

[joannebc]

Also, if I didn't screen shot the right thing, let me know.

[palerider]

Also, if I didn't screen shot the right thing, let me know.

ok:
https://sleep.tnet.com/resources/sleepyhead/shorganize

[joannebc]

Thank you!
http://imgur.com/a/rscz8

[palerider]

you've got a great machine, chained up and prohibited from doing anything (6cm cpap mode)

your events indicate that more pressure would help, if it were me, I'd set the machine to auto for her mode, 6-20, and see how the next night goes.

[joannebc]

Thanks for the advice. I'm going to do as you suggested... Setting my machine to auto adjust. I'll research how to do that. Are there any ramifications in doing so? I'm not going to ask my doctor because I know I'm going to get a no. I literally just got the machine, after suffering with sleep issues for 16 years. I can get to sleep, I can't stay asleep.

[palerider]

Thanks for the advice. I'm going to do as you suggested... Setting my machine to auto adjust. I'll research how to do that. Are there any ramifications in doing so? I'm not going to ask my doctor because I know I'm going to get a no. I literally just got the machine, after suffering with sleep issues for 16 years. I can get to sleep, I can't stay asleep.

you should get the clinical manual from http://www.apneaboard.com/adjust-cpap-p ... tup-manual scroll down to section 3 'how to get manuals by mail', there's a list of machines, and instructions.

you want to ask for: ResMed AirSense 10 AutoSet for Her

[joannebc]

Here is my data from last night. I set the machine to auto adjust for her. Still lots of awakenings.

[robysue]

joannebc,

I've looked at both night's data.

It's not completely clear to me why changing to APAP is going to fix your problem of frequent wakes. Different people respond differently to constantly changing pressures. Some people do better on APAP, and some do better on CPAP. And changing pressures can cause some people to have more frequent arousals/wakes than they would have at straight pressures.

Looking at the two nights of data that you posted, here what I see:

On CPAP: The AHI was acceptable (perhaps not great, but certainly pretty good). For the most part the obstructive events were pretty well isolated from each other. The snore curve was at 0 for almost the entire night. The flow rate curve was a bit busy, but stayed under 0.33. And the leak curve was excellent except for one very brief, exceptionally Large Leak. In particular, the 95% leak rate was 0.0, which means that for at least 95% of the night, your machine could detect NO excess leakage.

On APAP: The AHI is great, but there's more to getting a good night's sleep than just getting an AHI < 1.0. The snore curve is excellent. But that flow rate curve is worse than it was on straight CPAP: There's now a lot of activity between 0.33 and 0.66. And the leak curve is MUCH worse on APAP than on CPAP: While all of your leaks are below the 24 L/min Resmed Red Line which defines an official Large Leak for your machine, there is detectable leaking for at least 30-40 minutes during the night. There's also evidence that the leaks may have caused at lease some of the wakes:

• You turned the machine off and back on at around 22:20, right after a 5 minute leak with a leak rate of just over 20 L/min. (That's a not quite in Large Leak territory, but it may very well have been large enough to factor into the wake.)
• You turned the machine off and back on at around 3:30, right after a series of rather small, but potentially irritating leaks that may have disturbed your sleep.
• There's quite a bit of leaking going on between 4:15 and 7:15. The flow rate is kind of ragged during this time frame and several centrals are scored as well. And you report "still lots of awakenings", so I'm wondering if you were very restless during this time frame. And if you did have a lot of wakes or restlessness during this time frame, it's worth asking whether the leaks were one of the factors in causing the restlessness/wakes

All of this is not to suggest that you should go back to straight CPAP. But it does seem that if you are going to use your machine in APAP, you are going to need to see if you can do a better job of getting the mask to seal since it seems that the leaks may be disturbing your sleep even though they are not large enough to worry about in terms of the efficacy of your therapy.

And then there's the very real issue that the varying pressure has lead to more flow limitations being scored rather than few flow limitations. That's counter-intuitive, and it's just possible that last night was a "fluke" and that if you continue to use APAP that the flow limitation curve may settle back down. But you also have to be aware that the only thing that is triggering the pressure increases in this night's data is the activity in the flow limitation graph. And it the increased pressure is causing more problems (in terms of leaks, restlessness, or aerophagia if you get real unlucky) than its solving (in terms of reduced AHI and increased sleep efficiency), then a good case can be made to either switch back to straight CPAP or reduce the max pressure and just ignore or tolerate a lot of activity in the FL graph as long it stays pretty low (say < .25) most of the time.

[joannebc]

RobySue -

Thank you for the info! The two times I turned of the machine were times I had to go to the bathroom. I was incredibly restless from about 3:30 til 6:15, getting virtually no sleep during that period. Then I slept well from 6:15 til about 8:00. I had two other good periods of sleep... from 10:45 til 11:55 and then from 12:00 to 1:00. I am trying to understand why I have so many awakenings...

Should I keep it on auto detect, or adjust the CPAP setting to 8? I do think 6 was too low. Typically I am restless for an average of 200 minutes, restless from 16-24 times... according to the fit bit. The restlessness matched up with the sleep study.

I have had sleep issues for the last 16 years. I've been taking meds - the last 7 years was temazepam, but in the last year getting no real rest. It's been especially bad since this summer when it seemed the temazepam was no longer working. I had the sleep study, that diagnosed the apnea, and have been on the machine a week. I was so hoping to wake up refreshed, only to be disappointed.

I recently was prescribed Remeron and Trazadone, which made me incredibly sedated! The last three nights I took trazadone hoping to catch up on sleep. So not the case. I lie in bed longer than I am up only because I am so tired and heavy. I use to get up out of bed when I woke and could not get back to sleep. (2ish) I just don't have the energy for that anymore. My cognitive abilities are greatly declined, and I am frustrated. I do not have an unhealthy relationship with sleep, or the bed. I am actively trying to get some good quality sleep.

I appreciate any and all help and advice!

Joanne

[Wulfman...]

RobySue -

Thank you for the info! The two times I turned of the machine were times I had to go to the bathroom. I was incredibly restless from about 3:30 til 6:15, getting virtually no sleep during that period. Then I slept well from 6:15 til about 8:00. I had two other good periods of sleep... from 10:45 til 11:55 and then from 12:00 to 1:00. I am trying to understand why I have so many awakenings...

Should I keep it on auto detect, or adjust the CPAP setting to 8? I do think 6 was too low. Typically I am restless for an average of 200 minutes, restless from 16-24 times... according to the fit bit. The restlessness matched up with the sleep study.

I have had sleep issues for the last 16 years. I've been taking meds - the last 7 years was temazepam, but in the last year getting no real rest. It's been especially bad since this summer when it seemed the temazepam was no longer working. I had the sleep study, that diagnosed the apnea, and have been on the machine a week. I was so hoping to wake up refreshed, only to be disappointed.

I recently was prescribed Remeron and Trazadone, which made me incredibly sedated! The last three nights I took trazadone hoping to catch up on sleep. So not the case. I lie in bed longer than I am up only because I am so tired and heavy. I use to get up out of bed when I woke and could not get back to sleep. (2ish) I just don't have the energy for that anymore. My cognitive abilities are greatly declined, and I am frustrated. I do not have an unhealthy relationship with sleep, or the bed. I am actively trying to get some good quality sleep.

I appreciate any and all help and advice!

Joanne

Looking at the amount of flow limitations you're having in proportion to your actual "events", I'd suggest going back to straight pressure and try 8 cm. for a few nights and see what those reports look like.
You've got a pretty good AHI, but if you're getting bumped out of your restorative sleep stages and into lighter ones, the sleep "quality" won't be there.


Den

.

[palerider]

actually, flow limitations *ARE* actual events and *DO*, in and of themselves, disturb sleep, and can contribute to "getting bumped out of your restorative sleep stages and into lighter ones".

research has shown this to be a fact. they should not be ignored.

[joannebc]

I don't understand this fully. What do I set the machine to tonight?

[Wulfman...]

I don't understand this fully. What do I set the machine to tonight?

Go with your gut instinct of setting it to 8 cm.


Den

.

[Wulfman...]

Looking at the amount of flow limitations you're having in proportion to your actual "events", I'd suggest going back to straight pressure and try 8 cm. for a few nights and see what those reports look like.
You've got a pretty good AHI, but if you're getting bumped out of your restorative sleep stages and into lighter ones, the sleep "quality" won't be there.

wulfman refuses to acknowledge that flow limitations *ARE* actual events and *DO*, in and of themselves, disturb sleep, and can contribute to "getting bumped out of your restorative sleep stages and into lighter ones".

You lying piece of .......... You can't stop mischaracterizing and lying about things people say.
You ARE the "forum bully" that many have complained about.........and RIGHTLY SO!

Yes, I KNOW they are actual events (breathing anomalies in the shape of the airflow) which the APAP machine algorithms are programmed to increase pressures in anticipation of POSSIBLE apneas. They're believed to be POSSIBLE clues to impending airway collapses. The algorithm predictions of impending apneas are many times false because of the users' breathing characteristics due to nasal structures. For many users with these nasal structure issues, NO amount of pressure can reshape the airflow and can cause much sleep disturbance from the resulting pressures.

And, Flow Limitations are so "BAD", that practically NO in-lab sleep studies check for them or make note them in the sleep studies.


Den

.