Help-frequent awakenings, usually as pressure is decreasing

[SleepCatz]

I've had the APAP for a week and a half now and although the sleep I'm getting is more restorative, i'm still not feeling great. I am waking up frequently, 3 to 6 times a night. When I look at my sleepyhead graphs, it looks like I wake up after the pressure reaches the maximum, like after a flow limitation, of about 8.5, and is then going down for a half an hour or so and approaching five or four. When it gets low is when I wake up. Machine is set to 4.6 - 20. I have severe sleep apnea and had 42 events an hour at my sleep study. My AHI has been under 1with the machine. I know I should probably raise the minimum pressure, but when I first go to sleep it's hard to go to sleep with a higher pressure. Any thoughts on how to fix this? Or perhaps it's just a matter of getting used to using this machine.

[palerider]

raise the minimum.

[SleepCatz]

And what would your suggestion be on getting to sleep? A long ramp time?

[Wulfman...]

And what would your suggestion be on getting to sleep? A long ramp time?

With the low pressures you're talking about, Ramp shouldn't even be necessary.
Try raising the minimum and take some naps or use it while you're awake or watching TV.
Maybe even straight pressure would help. It sounds like pressure changes are disturbing your sleep.


Den

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[Julie]

The longer you put off getting used to no ramp, the harder you're making the process - and don't forget while the ramp is ramping, you're being under treated relative to your prescribed pressure.

[Pugsy]

The machine doesn't go below 4 cm anyway.
You have several options...increased that minimum at little and increase the ramp time.
With 4.6 minimum EPR can't kick it and if you haven't tried EPR to help with breathing comfort you might play with EPR but you need at least 5 cm minimum to be able to use the setting of 1 on EPR so that on exhale the pressure could drop to 4 cm. Try it while awake..you might find that is is more comfortable.
So you can lengthen ramp time...add EPR or change EPR if you are using it...or do both.

Some people are indeed sensitive to pressure changes up or down. You might be one of those people so limiting the ups and downs is a worthwhile experiment.

Try the various EPR settings but just remember that to use a setting fully there has to be that big of a gap to start with.
Example....EPR settings are a per cm reduction during exhale..setting of 1 is a 1 cm reduction and setting of 2 is a 2 cm reduction and the highest at 3...that's a 3 cm reduction you you can experience it unless the pressure is 7 then it can drop to the 4 minimum which is as low as the machine will go.

Some people really like the way EPR works and feels...some don't. Give it a try at all settings to see how you feel about it. I think it is more comfortable than ramp myself because your breathing with EPR is much more normal feeling.

Play with the settings while awake to see what you like or don't like and when you aren't feeling under the gun to get right to sleep.

If you don't know how to change EPR...the manual shows and explains that feature
https://sleep.tnet.com/home/files/resme ... -guide.pdf

[SleepCatz]

Thanks for the enlightening info so far! I had assumed EPR was working since it is turned on, good to know it hasn't been contributing yet. I will play with this before bedtime and see what I can get comfortable with.

[SleepCatz]

Another quick question- the ramp is on auto, do you know what that setting means?

[Julie]

Did you not get even a basic manual (vs the 'clinician' one that tells how to change pressures, etc.)?

[Pugsy]

Read that clinical/provider manual I linked to above but I think that ramp on auto will change and go back to ramp starting point if it thinks you are awake...and it may be doing it while you are asleep and that could be a factor in the pressure changes happening and maybe disturbing sleep. Meaning with it on auto there's a potential for a lot more pressure changes than normal and more abrupt changes.
There is a section about auto ramp in the manual. They make out like it's the greatest thing since sliced bread but for some people who happen to be sensitive to changes...not so great of thing.

[PoolQ]

As a user of ramp and auto, used to love it but now on my new machine I have it turned off.

Auto will start at the reduced starting pressure, this is a setting in the menus and is different from EPR, and do its best to detect when you fall asleep and then start ramping up to therapy pressure. For me this was about 10-15 minutes. If the machine cannot detect sleep onset it will start the ramp after a fixed amount of time anyway, I think this is 30 minutes. I am pretty sure I also read that if you have an apnea event during this pre-therapy pressure time, the machine will respond just like if the ramp was not being used.

The ramp feature will only be active when you push the start button, if you wake up during the night and are having problems and want to turn the auto ramp back on (reduce pressure) you will need to push the button again to turn off the blower and then again to start it up again- Auto ramp will then be reactivated. I did this many, many nights.

My pressures were 8-14 and I had EPR set to 3, I had my ramp pressure set to 5.6-5.8 (yes I was that sensitive to exhaling into pressure). It took me about a month to get used to my new air supply and now I don't miss it.