First Couple Nights On CPAP Have Been Pretty Bad, Advice?

[cpapuser55]

I was diagnosed with mild sleep apnea from a Lofta at home sleep test with 2.1 AHI/11.1 RDI, (REM AHI/RDI 4.1/23.3), 92% min oxygen saturation, 95% average, and a 40 - 95 BPM pulse rate range, and 56 BPM average. I am a fit, athletic, 28yo male, 5'9" at 153lb, ~14.5" neck circumference. I understand that my numbers may reflect UARS more than Sleep Apnea, but unsure of how that changes things for me in terms of therapy. Also, as I received some negative comments about this on another message board: I understand my non-managed AHI/RDI are "mild" or "low" but I have experienced all the classic sleep apnea symptoms of morning headaches, consistent concentration / brain fog issues, among others, as well as some downstream effects I've read that can be caused by Sleep Apnea / UARS, such as IBS, cold extremities, lengthened time dealing with illness, etc. All of these symptoms have been experienced for years, but I've noticed them getting slowly, progressively worse, so I finally decided to get tested for Sleep Apnea. So I would appreciate sparing any belittling comments about the mild numbers from the sleep test, again I only ask because it happened before.

I slept with the ResMed AutoSense 11 and N20 mask the last two nights for the first time. Falling asleep took a little longer than normal, but not awfully so. During my sleep, I woke up several times, for no good discernible reason. The first night was worse than the second night, but the second night I still woke up three times (as you can see in the OSCAR data below). It also took me a decent amount of time to actually fall back asleep after the third awakening. So I ended up getting only about 6 hours of sleep. I would normally only consciously wake up once a night to pee, so this was a particularly bad night for me.

Night 1 Settings:
4-20 pressure (set by Doctor)
EPR Level 1
Ramp On

Night 2 Settings:
7-14 pressure
EPR Level 3
Ramp Off

At-Home Sleep Test Data and Night 2 OSCAR data:
https://imgur.com/a/5ijwebg

I have felt like a total zombie the last two days, and have the classic sleep deprivation symptoms I would get on a "normal" bad day of sleep w/o CPAP (which would happen at least twice a week). I certainly feel worse than an average non-CPAP night. Is this just a regular "getting used to" period with the CPAP (in regards to waking up in the middle of the night)? I don't really find the mask uncomfortable or anything when I put it on before bed, so something must be disturbing me in my sleep.

Additionally, I'm feeling chest tightness on Day 2. I've read that sometimes people will experience this when they begin CPAP therapy due to the increased airflow into the lungs and chest causing muscle/lung soreness. How typical is this? The tightness isn't particularly localized, and feels pretty similar to the tightness I've experience when I went through an unrelated anxiety spell for several weeks a couple years ago. (I am not generally very anxious).

Does anyone have any suggestions on CPAP settings or recommendations otherwise for me? I've included as much information and data as I thought would be useful, but can add more as an edit and reply if more is needed.

[Pugsy]

Short on time so can only address this for now.

I'm feeling chest tightness on Day 2. I've read that sometimes people will experience this when they begin CPAP therapy due to the increased airflow into the lungs and chest causing muscle/lung soreness. How typical is this?

Actually fairly common but it's not from the increased airflow into your lungs. You breathe in the same amount of air as always but what happens is you are exhaling against the incoming pressure and your chest wall muscles are getting a bit more of a workout than they normally get and like any muscles...when you give them more of a workout than usual then they get a bit sore. With a bit of time your chest wall muscles get used to the extra work load and won't be sore anymore.

It's sort of like going to the gym and doing a new workout and getting some sore muscles from the new routine. Sore until you get used to the new workout and then the soreness goes away....until you try something new again.

It does sound like you might be a prime candidate for considering if you might have UARS.
The data your machine will give you will be zero help though in trying to dial in any therapy for UARS....if that is what you have. These machines just don't deal with or look for the very subtle changes that constitute UARS.
You will have to rely on subjective feelings and that's a tough order especially at first when just the newness of using the mask and machine is likely to mess with sleep quality.

Do you have OSCAR yet? If not, get it. Let's look at what might be going on and see if by chance something shows up.

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

viewtopic/t158560/How-to-post-images-for-review.html

[cpapuser55]

Actually fairly common but it's not from the increased airflow into your lungs. You breathe in the same amount of air as always but what happens is you are exhaling against the incoming pressure and your chest wall muscles are getting a bit more of a workout than they normally get and like any muscles...when you give them more of a workout than usual then they get a bit sore. With a bit of time your chest wall muscles get used to the extra work load and won't be sore anymore.

It's sort of like going to the gym and doing a new workout and getting some sore muscles from the new routine. Sore until you get used to the new workout and then the soreness goes away....until you try something new again.

Should I continue with the all-night therapy or try to ease into it more? i.e. take a night off or take the mask off if I wake up again. The shortness of breath / tight chest symptom is super annoying. I was able to play soccer today just fine and it basically melted away as soon as I started moving, but as soon as I stopped it came back. Feels more like unabated anxiety about it more than anything, to be honest.

It does sound like you might be a prime candidate for considering if you might have UARS.
The data your machine will give you will be zero help though in trying to dial in any therapy for UARS....if that is what you have. These machines just don't deal with or look for the very subtle changes that constitute UARS.
You will have to rely on subjective feelings and that's a tough order especially at first when just the newness of using the mask and machine is likely to mess with sleep quality.

Do you have OSCAR yet? If not, get it. Let's look at what might be going on and see if by chance something shows up.

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

viewtopic/t158560/How-to-post-images-for-review.html

Yes, I have it in my original post, but reposting as well here: https://imgur.com/a/5ijwebg

The Lofta Sleep Test results are in there as well.

[Pugsy]

Nothing of great excitement on that OSCAR report.
I can't adjust the OSCAR image to see the hours of sleep. Is it possible you just didn't get the hours of sleep that you need?
I don't see anything that points to needing some sort of setting change that might work a miracle.
Sorry... I know that wasn't what you wanted to hear.

It's not always easy to adjust to sleeping with the mask and machine. Is it possible that your poor sleep quality could be made worse by the newness of the mask and all that?

Do you take any medications of any kind? If so, what?

[cpapuser55]

Nothing of great excitement on that OSCAR report.
I can't adjust the OSCAR image to see the hours of sleep. Is it possible you just didn't get the hours of sleep that you need?
I don't see anything that points to needing some sort of setting change that might work a miracle.
Sorry... I know that wasn't what you wanted to hear.

It's not always easy to adjust to sleeping with the mask and machine. Is it possible that your poor sleep quality could be made worse by the newness of the mask and all that?

Do you take any medications of any kind? If so, what?

No medications. Yes, definitely likely it's hours of sleep issue given the disturbances. I guess I'm just confused as to what caused them. I do notice CA events happening pretty soon before them? Or it could just be acclimation to the mask: body thinks it's foreign, jars me awake. I didn't notice anything in particular that would've woken me up, like the hose tugging on me, or a leak or anything.

Is there a general time period that it usually takes for the chest symptoms to abate?

[Julie]

Lots of people get some clear airway 'centrals' just as they're going to sleep and just as they wake up... nothing to worry about - they're called 'sleep-wake' junk here. And the chest thing will get better in time (however long it usually takes your muscles to feel better after being strained - can't predict for an individual of course).

[Pugsy]

Is there a general time period that it usually takes for the chest symptoms to abate?

Not really any set time frame but from what I have heard from people it is rare for the chest wall soreness to persist past 3 or 4 weeks.

Don't worry about the centrals. I am 99% certain that they are a symptom of the poor sleep quality and not the cause of the poor sleep quality. If you didn't have a few I would be more likely to wonder why you didn't after just 2 nights on cpap.
The machine flagging your irregular breathing or pauses in breathing as some sort of central apnea.
These machines can and will flag irregular breathing as some sort of apnea event because all they measure is air flow.
If you want to learn more about false positives go here and watch the videos.
Bear in mind that while it talks about centrals getting flagged that are more arousal related...it can happen to the OAs and hyponeas as well. I have seen them myself because I don't or didn't sleep so great because of pain issues and I have had nights where pretty much all of my flagged events were awake/arousal related.

http://freecpapadvice.com/sleepyhead-free-software

Also bear in mind that it is also quite normal to have a few centrals that are real asleep centrals...they happen during the transition to sleep and are called sleep onset centrals. It is also normal to wake up after a REM cycle is over with...and there's always a chance for a sleep onset central to happen when we go back to sleep after the REM cycle awakening.
When people have a lot of awakenings or arousals and then they go back to sleep it is very possible to have more sleep onset centrals just from the multiple transitions back to sleep.

I doubt the centrals caused the awakenings themselves but are probably a symptom of false positive flagging or just a sleep onset central happening. In OSCAR go to the Events tab...click on it and you will see the 3 categories of events.
Click on the CA/Central category and look for when each flag happened. At the end of the time look at the number you see in parentheses. That number is the duration of the "central" that got flagged be it real or not.
I am 99.99999% certain that the time frame is barely going to meet that 10 second criteria for earning a flag.
Hold your breath for 10 seconds...that's a 10 second central and there won't be any distress associated with it.
About the only time it might create a problem is if you have 2 or 3 of the 10 second centrals in a 60 second period of time and for several minutes in succession. Or in other words a very dense cluster of flagged centrals. Yours doesn't even come close.

I would bet my last dollar that your centrals are most likely a symptom of your poor sleep quality and not the cause of the poor sleep.

I have a good example of false positives I like to show people so they can see that not everything flagged relates to sleep.
I have circled the asleep flow rate in red. The other breathing is arousal related and be aware that we don't always remember these arousals but they can and will happen. This is one of my own reports from way back.

A zoomed in section


and a not so zoomed in section of that same time frame and again asleep flow rate/breathing circled in red


If we aren't asleep they don't count except to point to arousals or awakenings that we may or may not remember but if we have a lot of that sort of breathing it means we aren't sleeping so great for some reason or another.

Now here below is an example of a real asleep flagged event. Note the very rhythmic pattern to each breath both before and after the flagged event.



I am betting that if I were to zoom in on your flow rate that we would see LOTS of evidence of arousal/awake breathing with or without flagging and all that means is crappy sleep quality. We can't always tell what caused the crappy sleep though but when someone has only been on cpap for 2 night....my first suspect would be the newness of everything and second suspect would be some unknown cause that disrupted sleep.
I am very familiar myself with seeing lots of arousal breathing segments because I know that I have pain issues during the night. I remember waking often and having to change position to relieve the pain.
When I have a really bad night in terms of pain I might see 30 to 40 segments of arousal breathing.
Sometimes with a high AHI. Last summer I overdid things working outside in my flower gardens and had a really rough night in terms of sleep quality and an AHI of 9.4 and I went through the flow rate to see how much of my AHI was a false positive.
I scrolled through the entire night zoomed in and 95% of that AHI was arousal related flagging.

Sleep onset centrals...when transitioning to sleep are real centrals but normal to see and usually not a problem unless someone is having a truckload of them (you aren't) or they are causing desats (which I doubt yours are).

Sleep/Wake/Junk is when we have flagged events and we aren't asleep....like the ones you see on my example above where I wasn't asleep when the events got flagged.

So what to do? Give it time and do the best you can to make yourself comfortable and just sleep.
Don't stress out or worry about things if at all possible because that will just make things worse in terms of sleep quality.
Accept the fact that it takes time to adjust to all this. Do the best you can to make the mask not a factor if it is the least bit uncomfortable..
Sometimes it just takes a while for the brain to come to realize that this mask and machine is it's new best friend and not some weird alien stuck on our face and it just has to wake you up to warn you about it.
It took my brain at least 3 months to quit waking me up a gazillion times a night just to alert me to the mask and machine.

[cpapuser55]

Is there a general time period that it usually takes for the chest symptoms to abate?

Not really any set time frame but from what I have heard from people it is rare for the chest wall soreness to persist past 3 or 4 weeks.

Don't worry about the centrals. I am 99% certain that they are a symptom of the poor sleep quality and not the cause of the poor sleep quality. If you didn't have a few I would be more likely to wonder why you didn't after just 2 nights on cpap.
The machine flagging your irregular breathing or pauses in breathing as some sort of central apnea.
These machines can and will flag irregular breathing as some sort of apnea event because all they measure is air flow.
If you want to learn more about false positives go here and watch the videos.
Bear in mind that while it talks about centrals getting flagged that are more arousal related...it can happen to the OAs and hyponeas as well. I have seen them myself because I don't or didn't sleep so great because of pain issues and I have had nights where pretty much all of my flagged events were awake/arousal related.

http://freecpapadvice.com/sleepyhead-free-software

Also bear in mind that it is also quite normal to have a few centrals that are real asleep centrals...they happen during the transition to sleep and are called sleep onset centrals. It is also normal to wake up after a REM cycle is over with...and there's always a chance for a sleep onset central to happen when we go back to sleep after the REM cycle awakening.
When people have a lot of awakenings or arousals and then they go back to sleep it is very possible to have more sleep onset centrals just from the multiple transitions back to sleep.

I doubt the centrals caused the awakenings themselves but are probably a symptom of false positive flagging or just a sleep onset central happening. In OSCAR go to the Events tab...click on it and you will see the 3 categories of events.
Click on the CA/Central category and look for when each flag happened. At the end of the time look at the number you see in parentheses. That number is the duration of the "central" that got flagged be it real or not.
I am 99.99999% certain that the time frame is barely going to meet that 10 second criteria for earning a flag.
Hold your breath for 10 seconds...that's a 10 second central and there won't be any distress associated with it.
About the only time it might create a problem is if you have 2 or 3 of the 10 second centrals in a 60 second period of time and for several minutes in succession. Or in other words a very dense cluster of flagged centrals. Yours doesn't even come close.

I would bet my last dollar that your centrals are most likely a symptom of your poor sleep quality and not the cause of the poor sleep.

I have a good example of false positives I like to show people so they can see that not everything flagged relates to sleep.
I have circled the asleep flow rate in red. The other breathing is arousal related and be aware that we don't always remember these arousals but they can and will happen. This is one of my own reports from way back.

A zoomed in section


and a not so zoomed in section of that same time frame and again asleep flow rate/breathing circled in red


If we aren't asleep they don't count except to point to arousals or awakenings that we may or may not remember but if we have a lot of that sort of breathing it means we aren't sleeping so great for some reason or another.

Now here below is an example of a real asleep flagged event. Note the very rhythmic pattern to each breath both before and after the flagged event.



I am betting that if I were to zoom in on your flow rate that we would see LOTS of evidence of arousal/awake breathing with or without flagging and all that means is crappy sleep quality. We can't always tell what caused the crappy sleep though but when someone has only been on cpap for 2 night....my first suspect would be the newness of everything and second suspect would be some unknown cause that disrupted sleep.
I am very familiar myself with seeing lots of arousal breathing segments because I know that I have pain issues during the night. I remember waking often and having to change position to relieve the pain.
When I have a really bad night in terms of pain I might see 30 to 40 segments of arousal breathing.
Sometimes with a high AHI. Last summer I overdid things working outside in my flower gardens and had a really rough night in terms of sleep quality and an AHI of 9.4 and I went through the flow rate to see how much of my AHI was a false positive.
I scrolled through the entire night zoomed in and 95% of that AHI was arousal related flagging.

Sleep onset centrals...when transitioning to sleep are real centrals but normal to see and usually not a problem unless someone is having a truckload of them (you aren't) or they are causing desats (which I doubt yours are).

Sleep/Wake/Junk is when we have flagged events and we aren't asleep....like the ones you see on my example above where I wasn't asleep when the events got flagged.

So what to do? Give it time and do the best you can to make yourself comfortable and just sleep.
Don't stress out or worry about things if at all possible because that will just make things worse in terms of sleep quality.
Accept the fact that it takes time to adjust to all this. Do the best you can to make the mask not a factor if it is the least bit uncomfortable..
Sometimes it just takes a while for the brain to come to realize that this mask and machine is it's new best friend and not some weird alien stuck on our face and it just has to wake you up to warn you about it.
It took my brain at least 3 months to quit waking me up a gazillion times a night just to alert me to the mask and machine.

Going to read over this a few times to make sure I fully understand, thanks for the detailed writeup. While I do so, here is the zoomed in view of two CA events happening within a minute or so of each other: https://imgur.com/a/hePuTic

[Pugsy]

If those 2 centrals were on my report I would count them as arousal/awake related.
The first one for sure is arousal related and while the second one is more iffy.... the breathing just prior to that second flagged event doesn't look enough like asleep breathing. It's still a bit irregular.
You might have been trying to fall asleep though and it might be a sleep onset (the second one)...I hate those "iffy" ones that aren't so easy to identify.
Either way though...very brief and not anything I would worry about.