First night pressure question

[jgcrain]

So last night was first with APAP machine. I will read up on posting Sleepyhead data today but for now a short question. I had my machine set with no ramp, min pressure of 6.0, max of 18.0. My median pressure was 7.6. So my question is why the pressure jumped up to 15.6 within minutes of starting and then over the next 90 minutes dropped way down and stayed relatively low rest of the night.

I showed an AHI of .78 over 5.5 hours of sleep so that looked great. Can anyone possibly explain why the pressure was so high at bedtime? Could I make some changes to the settings so that I don't get blasted by so much pressure right off the bat? The leak rate stayed low over the night.

I know a picture (or chart) is worth a million bucks and will post some Sleepyhead stats later but any thoughts on lowering the initial pressure?

I would probably not gotten to this point without this forum, so my thanks to all the folks that hang out and offer their help

Thanks
Greg

[LSAT]

Could have been a large leak problem while adjusting or readjusting your mask....machine tried to compensate.

[Pugsy]

Are you saying you were awake when the pressure increased so dramatically or are you saying that you saw it on the software report that you looked at this morning?

While awake the machine shouldn't be sensing anything that would be causing such a dramatic increase.

[jgcrain]

I felt like the pressure was high but this was my first night on my machine. I saw the high pressure from Sleepyhead this morning. Maybe the data can better illustrate when I can get it posted
Thanks,
Greg

[Pugsy]

Approx how long do you think it took you to fall asleep?
Let's see exactly when the pressure increased and try to figure out if you were awake or asleep when it increased.
These machines don't normally increase pressure so dramatically in an effort to "fix a big leak". Normally when faced with a big leak these new models will reduce the pressure in an effort to bring the leak back under control.

When asleep the 2 most common culprits for pressure changes are sleeping on your back or REM stage sleep or maybe a combination of both. That's pretty much all there is to cause rapid dramatic pressure changes with the regular auto adjusting machines. Now there is a type of machine that will respond to centrals with rapid dramatic pressure changes but you probably don't have that type of machine. The regular apap machines don't respond in any fashion to centrals. They only respond to perceived reductions in air flow because of airway tissue collapse.

If we can see what you are seeing it would help us get an idea what might have happened.

[palerider]

Could have been a large leak problem while adjusting or readjusting your mask....machine tried to compensate.

machines *DO NOT* raise pressure due to large leaks. they just *don't*.

in fact, they *LOWER* pressure to try and get the mask to seal.

it's something else, snores, flow limitations, hypos, something, but not leaks.

[palerider]

Maybe the data can better illustrate when I can get it posted

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

read all three pages.

as it is, you're just asking for wild guesses and speculation.

[jgcrain]

Ok, Going to try first attempt at posting SleepyHead charts. As originally noted, I am trying to find out why the pressure started out so high (or so it seemed as a first time user). Can I change any settings to make my second night more comfortable? The Ramp was turned off last night and maybe that would have helped some. Maybe I should just chalk it up to being the first night and hope it gets better on down the road. Thanks for any comments

Greg

[palerider]

Ok, Going to try first attempt at posting SleepyHead charts.

please go back and reread, AND FOLLOW that first page on how to organize your charts.

you've got redundant stuff on there, and missing important stuff.

[jgcrain]

How does this look?

[palerider]

How does this look?

excellent! well done sir.

and, I believe it answers the question of why your pressure rose. if you look at the flow limitation chart, they're pretty high right at first, for whatever reason.

if you zoom in on the first few minutes, you'll see that the breaths are flattened at the top, showing a narrowing of the airway, which makes it more work to inhale. the pressure goes up, that opens up your airway, and the tops of the breaths will round out, flow limitation goes down, and then the pressure drops off.

whatever it was that was causing that didn't reoccur, and that's why the pressure stayed low the rest of the night.

[jgcrain]

I did have some nasal congestion so possibly that was the issue? So, should I just leave the settings as they are for a few days as I get used to using the machine & mask? I did take it off after 5 hours but I guess that's part of the adjustment period. This is all really overwhelming when you first start. It really helps to have a little help and encouragement

Thanks for taking the time to comment....Greg

[Pugsy]

Hmmm....my first thought is that maybe it was the snores and/or flow limitations that drove the pressure up.
It wouldn't be the leaks as previously discussed.
It happened again to a lesser degree around the 2 AM time frame when you had briefly turned the machine off and presumably were awake for a brief period of time.

The machine is supposed to respond to snores/flow limitations and reduction in air flow that earn an OA flag or hyponea flag. Flow limitations are air flow reductions that don't meet criteria for an OA flag or hyponea flag.
Snores are usually associated with the beginning stages of air flow reduction or a sign of air flow reduction so that's why the machine will respond to snores.

Did you start off the night on your back and then turn over onto your side?

Approx how long do you think you might have been awake initially? Is it possible that you were sort of drifting off to sleep and on your back and maybe did a little snoring?

How is the nose situation? Are you experiencing any nasal congestion which could have maybe impeded the air flow and caused the machine to think the air flow reduction was related to airway tissue collapse?

How to prevent this from happening again? Kinda hard to know what to do because we don't know what caused it. Airway tissues won't collapse while awake so the pressure won't normally increase while awake.

If you were on your back you might try starting out on your side. Often people need more pressure when sleeping on their backs so side sleeping can lessen pressure needs sometimes. If you were on your side and this happened then maybe you were drifting off to sleep and the airway tissues started to collapse and if that is the case then perhaps a little more baseline pressure (minimum pressure) would be something to consider in an effort to prevent those snores and flow limitations.

In general these machines won't increase the pressure without it thinking it has a good reason and it's rare that there's not a good reason. Something happened to make the machine think you were either snoring or having flow limitations (seen on the graphs as increased during the time at higher pressures) or maybe a little of both and that's why the machine increased the pressure. Figuring out why the abrupt change in air flow would be the next step should this pattern continue.

In the meantime if it happens again and the higher pressures happen when drifting off to sleep try reaching over and turning the machine off and back on again quickly so that the pressure will drop back down and perhaps you can get into sound sleep before it happens again.
Or consider using the ramp for a period of time in hopes of getting to deep sleep before the increases happen.
I wouldn't use ramp starting at 4 though...I would use ramp at something closer to that 6 cm minimum and just let it go for a long time so hopefully you can get into sound sleep when the pressure increases are less likely to be so annoying. I wouldn't set ramp for a prolonged time though. Maybe try starting at 5.5 and allow 15 minutes to get to the minimum of 6 cm. That way you won't be spending much time at potentially sub optimal pressures and the machine not being able to respond optimally.

Finally it's the first night and you already did a lot better for a first night than a lot of people do...myself included. I was so hyper aware of everything my first night that I swear I woke up with the least little thing happening.
I wouldn't worry about making any major changes right now though.

You could also limit the maximum and see if it allows any OAs or hyponeas to develop and cross the more pressure bridge later when you have become more accustomed to the air pressure...like maybe keep the minimum of 6 and limit the max at 10 and see what happens. I think that's what I would probably do if it were me and I was brand new to this therapy and having trouble with higher pressures wanting to wake me up.
That way you can take your time getting used to the changing pressures and in the meantime figure out why you only seem to have those marked flow reductions and snores at the very beginning of sleep and not so much the rest of the night.
It's too early in sleep to likely be related to REM stage sleep pressure needs so that leaves sleep position as primary culprit.

[palerider]

I did have some nasal congestion so possibly that was the issue? So, should I just leave the settings as they are for a few days as I get used to using the machine & mask? I did take it off after 5 hours but I guess that's part of the adjustment period. This is all really overwhelming when you first start. It really helps to have a little help and encouragement

Thanks for taking the time to comment....Greg

I'd suggest leaving it, though like Pugsy says, you could reduce the max pressure some, if the pressure bothers you.

but overall, things look pretty good, so far.

[Pugsy]

It's very possible that the nasal congestion confused the machine into thinking the air flow was compromised.

If you continue to have issues with nasal congestion I would suggest working on doing whatever works for you in terms of opening up the nasal airway. You might try playing around with the humidity setting to see what your nasal tissues like. My nose needs a lot of added moisture but some people find they do better with minimal or even no added moisture. There is no right or wrong when it comes to what each person might need as it is entirely and individual preference. So that's something you can play with.

If the congestion is primarily upon bedtime you might try using something like Simply Saline nasal spray or if you are one of those people who like to do the Neti pot nasal rinses you might try that.
Avoid the Afrin like nasal products if at all possible because they can create their own set of problems if you use it too much for too long. A teeny tiny spray of Afrin only at bedtime probably wouldn't be a huge problem but it is real easy to get into the habit of using a little more...then a little more often and before you know it you end up with Afrin rebound if you don't use it. So just a word of warning from someone who has been there and done that with the Afrin Rebound thing and it's no fun getting off it.

At this point I think just limiting the maximum to maybe 10 should allow you to get to sleep and not be bothered with the dramatic pressure surges and cross the bridge of maybe having it be sub optimal later once/if it is proven you really need more. Sometimes there is a really good reason for more pressure but sometimes what the machine thinks is a really good reason isn't necessarily that critical.