New to cpap, 3 weeks in, now falling asleep at work.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
xistos
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Joined: Mon Mar 20, 2017 6:50 pm

New to cpap, 3 weeks in, now falling asleep at work.

Post by xistos » Mon Mar 20, 2017 7:09 pm

I am starting week 4 of being on my CPAP. I have been lurking on this forum for a while and I see a lot of posts about feeling worse for a few days being normal etc. My question is that my AHI is generally low <1. I have been using the machine religiously because I have been sick and tired of being sick and tired. My issue has been that 3.5 weeks in, I have been getting worse. I never had issues falling asleep at work prior and never had issues drifting off while talking to people or sitting and playing a video game. This all started after I began using the machine.

I have been putting my data in to sleepyhead and it looks like it should be helping me but I just keep getting worse and worse. Is there something I am missing with this whole process? My doctor is basically saying "keep at it, see you in 3-4 more weeks." I am worried I am going to have a mental break down due to sleep deprivation. The biggest issue I see is the "Vibratory snore."

What is more annoying is a few weekends I have worn the machine 7-8 hours, then ripped it off and slept for 4-5 more hours. My pulse ox never went below 90 during that time. I also feel much better than I have in a long time.

I am at a loss about what to do. Any help would be appreciated. I added my gear to my profile.

I hope the image below works:

Image link: https://goo.gl/photos/enryUDaL8qxTArcN9
Image

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Pugsy
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Re: New to cpap, 3 weeks in, now falling asleep at work.

Post by Pugsy » Mon Mar 20, 2017 7:17 pm

Please review the organization hints...3 pages...read all 3 please
https://sleep.tnet.com/resources/sleepyhead/shorganize

Some examples of how we like to see the image can be seen in this thread.
viewtopic/t103468/Need-help-with-screen-shots.html

How to use imgur to host the images
https://sleep.tnet.com/reference/tips/imgur

How was it determined that you should use these pressure settings? Did you have a sleep study in a lab where they hooked you up to a mask and machine and tried to figure out the pressure needed or did they just give you the auto cpap with settings 4 to 20 which are the default settings...and those gazillion snores along with the OA stuff...the pressure settings you are using aren't working out so great. You need more minimum starting pressure.

As for feeling worse...are you waking often during the night? If so, any idea why?

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Sleeprider
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Re: New to cpap, 3 weeks in, now falling asleep at work.

Post by Sleeprider » Mon Mar 20, 2017 9:03 pm

Looks like you're using a minimum pressure of 6.0, and your AHI is under control, but plenty of snores and flow limitations, that seem to be related to the dip in SpO2. Nothing serious, but I agree with Pugsy that an increase in minimum pressure looks like a good idea. I would go for a minimum of 7.5-8.0 and hopefully that feels better. Philips machines tend to work better with a higher minimum pressure.

It would be a big help if you would organize the charts as shown in Pugsy's post above. We don't have much sense of leaks or any of the summary data that is displayed in the left column.

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xistos
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Re: New to cpap, 3 weeks in, now falling asleep at work.

Post by xistos » Mon Mar 20, 2017 9:06 pm

Thanks Pugsy.

I did a sleep study, the doctor called in an order for those setting. I was never attached to a CPAP during the study itself. From the study (sorry if I miss something) 0 Apneas, 0 mixed Apnea, 0 Central apnea, 111.0 hypopneas for AHI of 13.9. Diagnosis OSA 327.23. There as also 1 pulse ox event where I got down to 75% SPo2. Just as a note (since it seems to matter from what I read here) I am a side sleeper almost exclusively. They had me on my back for some of the study which seems to make this worse. The bed was one of the worst pain inducing beds I have slept in in years.

Basically I find myself waking up far more often. Typically 4-5 times isn't irregular. There are times where if I look at the clock and it is past about 3am (have have that 4 hours compliance....) I will just turn the machine off and toss the mask on the dresser and go back to sleep and sleep solid until my alarm goes off for work. Some times the machine wakes me up, normally when it does, the pressure is up around 10.5 cm/H2O and the whistling of the vent on the hard plastic piece (not a leak) wakes me up. Other times I get hooked on the hose. I tend to sleep on my side with my nose in the pillow a bit and it pushes on the mask, which often wakes me up. If I roll over, the mask jerks on my head, I wake up. It has been leading to a lot of frustration. This whole process has lead me to buying a pulse ox which I configured to alarm at 88 because I have begun napping a lot more than I used to and I nap with out the unit because it generally is the only way I feel awake and I was worried about the low sleep pulse ox readings.

Hopefully this is better, I couldn't find "flow limit" as a graph.

Image

-edit-
Thumbnail.... URL until I figure this out. Success?

I'll set the machine to 7.5 and see how that goes. Since my doctor couldn't bother to get me in for another 3 weeks... guess I have to take it in to my own hands.

xistos
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Re: New to cpap, 3 weeks in, now falling asleep at work.

Post by xistos » Tue Mar 21, 2017 12:59 pm

Sleeprider wrote:Looks like you're using a minimum pressure of 6.0, and your AHI is under control, but plenty of snores and flow limitations, that seem to be related to the dip in SpO2. Nothing serious, but I agree with Pugsy that an increase in minimum pressure looks like a good idea. I would go for a minimum of 7.5-8.0 and hopefully that feels better. Philips machines tend to work better with a higher minimum pressure.

It would be a big help if you would organize the charts as shown in Pugsy's post above. We don't have much sense of leaks or any of the summary data that is displayed in the left column.
I will post the SleepyHead graphs when I get home from work. Setting the lower limit to 7.5 pushed my AHI to 0 and the VS / VS2 was very reduced. I assume to use this setting for a few days and the if the number is still really low back the lower to 7.0 and test again? I am mostly curious about the "testing procedures" for these settings.

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Julie
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Re: New to cpap, 3 weeks in, now falling asleep at work.

Post by Julie » Tue Mar 21, 2017 1:05 pm

Your low pressure setting is too low, and for most almost impossible to breathe naturally with and you're not getting treated. It needs to be raised to 6 or 7 for now and possibly more in future once your results are posted from Sleepyhead and we can see more after a trial of a couple of days at the new pressure. Don't worry about the high setting... not important for now. Doctors are not educated properly, thinking that at wide open settings of 4 and 20 the machine will automatically find the right level, but if you have events at higher ones (higher than e.g. 10) it will take too long for the machine to address them from 4, and so is a waste of time, your energy and will discourage you from using Cpap... happens over and over again!

xistos
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Re: New to cpap, 3 weeks in, now falling asleep at work.

Post by xistos » Tue Mar 21, 2017 6:35 pm

Here is last nights sleepyhead screen shot. I didn't sleep all that well and woke up a lot but the VS and VS2 is way down. Do you think it is just "getting used to the pressure?"

Image

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Pugsy
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Re: New to cpap, 3 weeks in, now falling asleep at work.

Post by Pugsy » Tue Mar 21, 2017 6:43 pm

When you say you didn't sleep well and woke up a lot.....any idea why?
How many wake ups? Rough estimate.
Any mask fit/comfort issues?
Is having frequent wake ups something new to you or a problem you have had for a while now?

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xistos
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Re: New to cpap, 3 weeks in, now falling asleep at work.

Post by xistos » Tue Mar 21, 2017 9:12 pm

Prior to the machine I typically woke up once a night typically around 3am. Most of the time I can just turn over and go back to sleep. Last night I woke up at 1:30, 3:15~3:30, 5:30ish. On the machine, I have noticed a pattern in general that I seem to wake up around 11:30, 1:30, 3:30, 5:30 +- 15 minutes. I started jotting them down in week 2.

I have noticed that most times I wake up to a leak hiss. I tend to lay in my pillow with my nose "in to the pillow" which I think eventually disturbs the mask and makes it hiss which wakes me up. I then find I need to fiddle with the mask again to get it situated. Similarly when I turn over I seem to yank on the hose which makes the mask come loose, then I need to wake up enough to get it back on. The mask doesn't hurt and feels ok. I am told I am "odd" by the sleep tech because I like the pillow mask but am not claustrophobic. The only issue I have with the mask is every once in awhile I fall asleep and roll on to it (IE nose to pillow) I'll eventually wake up with a sore spot on my nose.

Sorry I am prattling on a bit but I am hoping that something becomes apparent because I really am going to need to figure this out or stop using it since I am heading towards a mental break down due to lack of sleep. Work is noticing my drifting off in meetings... (which is entirely new since the machine.) Part of the sleep study was the Epworth scale, I scored a 2. I feel like a 7 now when I rescore it. I am sleeping on the train, nodding off at work and feel asleep game controller in hand at 2pm on a Saturday etc.

--edit--
PS: Thanks for the help!

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Pugsy
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Re: New to cpap, 3 weeks in, now falling asleep at work.

Post by Pugsy » Tue Mar 21, 2017 9:17 pm

How many masks have you tried?
You mention the "pillow" mask but the mask you are showing in your equipment profile is not what we normally call a "pillow" mask but instead we refer to it as a nasal cushion mask.

Pillow masks are like what I use...see the link in my profile.

Fragmented sleep for any reason is going to trash your sleep architecture and make you feel like crap.
Fixing the fragmented sleep isn't always so easy though. Gotta figure out the cause first and then see what can be done to address the issue.

If you think it is mask related...try a different mask.

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xistos
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Re: New to cpap, 3 weeks in, now falling asleep at work.

Post by xistos » Tue Mar 21, 2017 9:23 pm

It is a Nuance gel mask. I'll check my profile. The sleep center kept the bag so I though the blue gel thing was it

I also have a Phillips wisp they gave me but I am pretty sure the head gear is the wrong size. The mask won't seat right and makes it hard to breath through and the machine goes crazy with flow restrictions even when the head gear is on the largest size. Is there any way to identify which size the (the velcro adjustment part) gear is? I was looking online and it isn't super clear I just need larger head gear or a larger version of the face plastic (whatever it is called, not the silicone rubber nose piece itself.)

--edit--
This guy here:
http://www.usa.philips.com/healthcare/p ... illow-mask

Fixed it in my profile. I missed them the first time I was going through the list.

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Pugsy
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Re: New to cpap, 3 weeks in, now falling asleep at work.

Post by Pugsy » Tue Mar 21, 2017 9:32 pm

The Wisp is usually packaged with the "original" size headgear but has a reduced size and a large size available as a separate purchase.
https://www.cpap.com/productpage/headge ... sk-pr.html
I have no idea if the size is marked anywhere...I returned the only Wisp I ever tried because I only lasted 90 minutes with the damn thing.

The Nuance is a nasal pillow mask and actually a fairly decent one but the headgear kinda sucks.

Sounds like your supplier is stocking mainly Respironics masks...too bad...I think ResMed's nasal pillow masks are superior and I have tried several of the various Respironics nasal pillow masks over the years.

Mask leaks (even those that are tiny and either don't show up on the leak graph or are so small it barely makes a blip) that cause us to wake up need to be fixed if for no other reason than the fact that the leaks are disturbing our sleep.

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I may have to RISE but I refuse to SHINE.

xistos
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Re: New to cpap, 3 weeks in, now falling asleep at work.

Post by xistos » Tue Mar 21, 2017 9:47 pm

Pugsy wrote:The Wisp is usually packaged with the "original" size headgear but has a reduced size and a large size available as a separate purchase.
https://www.cpap.com/productpage/headge ... sk-pr.html
I have no idea if the size is marked anywhere...I returned the only Wisp I ever tried because I only lasted 90 minutes with the damn thing.

The Nuance is a nasal pillow mask and actually a fairly decent one but the headgear kinda sucks.

Sounds like your supplier is stocking mainly Respironics masks...too bad...I think ResMed's nasal pillow masks are superior and I have tried several of the various Respironics nasal pillow masks over the years.

Mask leaks (even those that are tiny and either don't show up on the leak graph or are so small it barely makes a blip) that cause us to wake up need to be fixed if for no other reason than the fact that the leaks are disturbing our sleep.
I'll send them an email tomorrow and see what they say. I think it is silly that I can't get the mask kit without a Rx but can basically buy all the parts to build one. Worst case I built if off Amazon.

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Pugsy
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Re: New to cpap, 3 weeks in, now falling asleep at work.

Post by Pugsy » Tue Mar 21, 2017 10:08 pm

xistos wrote:I think it is silly that I can't get the mask kit without a Rx but can basically buy all the parts to build one. Worst case I built if off Amazon.
Our government making no sense as usual but it is the way it is and not much we can do about it.
Check EBay too. I have seen some smoking hot deals on various mask parts on EBay.

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xistos
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Re: New to cpap, 3 weeks in, now falling asleep at work.

Post by xistos » Sun Mar 26, 2017 2:39 pm

I have been running 7.5cmH2O - 15cmH20 as suggested. The first couple of days the VS / VS2 was way down, at the end of this week, the number is slowly climbing. The AHI is generally below .40. I still am waking up multiple times a night and last night just got so annoyed that I shut the machine off and threw the mask on the floor and went back to sleep and slept 5 more hours.

I'll post the data if you are interested. I am planning to try bumping it to 8.0mmH2O or throwing it out the window. Not sure which.
Last edited by xistos on Sun Mar 26, 2017 6:41 pm, edited 2 times in total.