1 Month in and I just feel worse.

[Stom]

Aha! You've answered my biggest question I think. I was assuming that since I had an APAP machine it should be able to adjust "on the fly" to resolve my OAs and hypopneas while they were happening. So while I knew people report that raising the lower minimum pressure helps, I didn't fully understand why (if, in theory the machine could auto-adjust immediately anyway). This all makes a lot more sense. This will really help guide my discussion with my doctor this week!

That was my biggest misconception about APAPs. Turns out they don't work like a toilet plunger and can't blow open your airways once closed during apnea. However, they can adjust pressure when the flow of your breathing is showing signs of partial obstruction. This 2015 paper discusses the math different APAPs use to score events and what they do to determine when to increase pressure:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629962/

[jamesbond007]

Can you try elevating your upper body by just a few degrees during sleep? Either get an extra pillow or something and try if it helps? Of course, all other points that Pugsy made are, obviously, valuable. Just one low hanging fruit to prove or disprove. In my case, just adding another pillow under my head meant a dramatic change in my AHI. Doesn't hurt to try.

Good idea! I saw that this had helped someone in another thread so I tried putting a few folded towels under my pillow last night. Not sure if it helped at all, may try adding towels until it's uncomfortable or things improve.

Update: I raised my min pressure to 6 last night, I'm not sure if it helped, I didn't notice the difference in pressure which is nice, but for some reason my machine upped it to 8.5 automatically while I was reading in bed and I had some weird anxiety that I had somehow messed up the machine and it would just keep going up and up and up and not stop (irrational, I know, it's weird what our brain does when on the edge of sleep...). I had more mask issues last night and a lot of mask-related wakeups but this could be a combo of higher pressure + propping up my pillow into a different position (as mentioned above) + weird anxiety. AHI was 5.2, but I haven't had a chance to load the data into sleepyhead yet to really see how the extra pressure affected things.

I think tonight I'll up it to 7, adjust my ramp settings (which are currently on the default of a 5 min ramp from 4 pressure to 5 pressure... not very useful) just in case I get weird anxiety again, and see how it goes.

I'm still curious to try a different mask, even though everyone says mine is the most comfortable one. I just have so many mask issues at night related to lying on my side, which causes the air tubes on the side of my face to shift the nosepiece or block air. I just can't seem to get a good fit with this mask. If I pull the straps really tight then the nosepiece feels like it's too far up the tip of my nose... but also the tubing on the top and sides still shifts around. If I loosen the straps then the whole mask really shifts around and I get leaks all over my face. My Amara View parts came int he mail today... but my attempt to save money backfired and I realized I was missing a key piece (the part that holds the mouth/nosepiece on and clips into the headgear). Should've just bought the whole mask together.

Aside from the mask issues, what probably happened last night with your speedy ramp was that your machine thought you were asleep and ramped up. I have mine set to auto and ramp from 4. It barely stays there for a few seconds before it goes to 6 and then to 8. This shouldn't startle you. But again, it's the brain we are talking about. It looks like you should learn to trick your brain into thinking that things are OK. A few of things come to mind that you could try:

1. Don't read a book with the mask on. Here is why. You get relaxed because you probably like to read books and your breathing pattern changes. Your machine thinks you are falling asleep and ramps up like it's no one's business. Read the book how much ever you want and when you feel like going to bed, then put on the mask and sleep right away.

2. Also, while putting on the mask imagine the LOW pressure you are comfortable with enabling you to sleep better and imagine you waking up well the next morning. Do it deliberately. It sounds ridiculous but studies have shown that you CAN rewire your brain this way. (Since you already read books, read this book called Re-Wire). It takes a little time but not too long.

3. Don't put towels. Put something soft and cushy. You don't want to wake up with a sore neck the next morning.

[palerider]

but for some reason my machine upped it to 8.5 automatically while I was reading in bed and I had some weird anxiety that I had somehow messed up the machine and it would just keep going up and up and up and not stop

wake breathing is often very irregular and will confuse the machine, once you get to sleep, it'll go back to normal.

[palerider]

Aside from the mask issues, what probably happened last night with your speedy ramp was that your machine thought you were asleep and ramped up.

No, it didn't 'ramp' up, it just caught irregularities in breathing and auto adjusted. 'ramp' is a different thing.

1. Don't read a book with the mask on. Here is why. You get relaxed because you probably like to read books and your breathing pattern changes. Your machine thinks you are falling asleep and ramps up like it's no one's business. Read the book how much ever you want and when you feel like going to bed, then put on the mask and sleep right away.

NO! You're making false assumptions and giving bad 'advice'.

Reading in bed with the cpap is fine, I do it every night.

"ramps up like it's no one's business. " NO!

Learn more about how the machines actually work before you give "advice".

[jamesbond007]

Aside from the mask issues, what probably happened last night with your speedy ramp was that your machine thought you were asleep and ramped up.

No, it didn't 'ramp' up, it just caught irregularities in breathing and auto adjusted. 'ramp' is a different thing.

1. Don't read a book with the mask on. Here is why. You get relaxed because you probably like to read books and your breathing pattern changes. Your machine thinks you are falling asleep and ramps up like it's no one's business. Read the book how much ever you want and when you feel like going to bed, then put on the mask and sleep right away.

NO! You're making false assumptions and giving bad 'advice'.

Reading in bed with the cpap is fine, I do it every night.

"ramps up like it's no one's business. " NO!

Learn more about how the machines actually work before you give "advice".

With all due respect, mine is a hypothesis. I am a scientist and I'd like to test my hypotheses to either prove or disprove them. This is one of those. The basis for my hypothesis is that the breathing pattern is different when you are asleep from when you are awake.

[Pugsy]

With all due respect, mine is a hypothesis. I am a scientist and I'd like to test my hypotheses to either prove or disprove them. This is one of those. The basis for my hypothesis is that the breathing pattern is different when you are asleep from when you are awake.

It's no hypothesis...awake breathing can be very different from asleep breathing...much more irregular. I have breathing flow rate graphs that prove it.
The machine has no idea if you are awake or asleep...it just measures air flow and sometimes our awake breathing irregularities can cause the machine to think something is going on with the airway air flow and cause it do make changes in pressure while we are awake. It is what it is.

Reading in bed with mask on...is fine...yeah, our awake breathing might change and be a little irregular and cause the machine to do something...it's not the end of the world if it does something while we are awake. If it is too annoying..turn it off and back on again so that it goes back down.

What is worse is reading in bed without the mask and machine on because there's a real good chance that we will fall asleep before putting the mask on and untreated apnea events from no mask is much more of a problem than minor annoyance with the machine wanting to increase the pressure a little while awake.

The big rule...if laying in bed ...mask and machine is on. No matter if reading or watching TV.
Only exception...sex.
I don't ever lay down without my mask being on. I put it on while sitting on the edge of the bed. I never give myself a chance to fall asleep without my mask. I know that I might have all the greatest intentions of putting the mask on just when I am starting to feel sleepy but I learned a long time ago that it is simply too easy to not get the "I am sleepy warning".

[Sova]

Yeah, I like reading with the mask on because it eases me into the pressure and helps me relax (without having to wake myself up again to fiddle with it and put it on).

I finally loaded up the data into Sleepyhead and interestingly had a ton of "RE Arousal" flags during the time I was reading when the pressure was going up to 8 (it was easy to tell because I turned the machine off for a minute when I started getting anxiety). I think what triggered this was me opening my mouth for a bit to push air through my sinuses (?). I'd been having sinus headaches and a stuffy nose during the day and the guy at the supplier said that (in his experience) this would clear out his sinuses the same way a neti pot does. Anyone know if this is an actual thing? Anyways, I decided I'd try it to see if it would work, then the machine must've interpreted this as a need for more pressure and then I started breathing weird as I got a bit of anxiety.

As mentioned I'll adjust my ramp settings tonight so that I can just hit the "ramp" button on the machine to bring the pressure back down if I need to instead of having to turn the machine on and off to reset.

I realized that I actually DO feel better today! My tiredness has really been hitting me worst in the afternoon and that didn't happen to me at all today! Granted it was an odd day and I had to leave work early for a (non sleep) Dr appointment, but I'm hoping this was an improvement! Sleepyhead showed that I still had hypopneas and OAs, (AHI 5.5 when excluding the "first session" while I was awake, I can post the data later), but my pressure wasn't going crazy all over the place all night. Could just be placebo, but I'm feeling encouraged and excited to experiment with a min pressure of 7 tonight.

[Pugsy]

Anything you see flagged when you know you were awake you simply have to ignore it...mentally remove it from any evaluation process.
Tell yourself...awake stuff simply doesn't count...I have to be asleep for it to matter.

[jamesbond007]

Reading in bed with mask on...is fine...yeah, our awake breathing might change and be a little irregular and cause the machine to do something...it's not the end of the world if it does something while we are awake. If it is too annoying..turn it off and back on again so that it goes back down.

FWIW, this is precisely what I mentioned in my original response and suggested the OP not read the book with the mask on. Instead, finish reading and then put the mask on when feels like sleeping. I get your point that the OP might fall asleep while reading the book without the mask on. Sure. But, I thought common sense would prevail. Oh well...my mistake.

[palerider]

Aside from the mask issues, what probably happened last night with your speedy ramp was that your machine thought you were asleep and ramped up.

No, it didn't 'ramp' up, it just caught irregularities in breathing and auto adjusted. 'ramp' is a different thing.

1. Don't read a book with the mask on. Here is why. You get relaxed because you probably like to read books and your breathing pattern changes. Your machine thinks you are falling asleep and ramps up like it's no one's business. Read the book how much ever you want and when you feel like going to bed, then put on the mask and sleep right away.

NO! You're making false assumptions and giving bad 'advice'.

Reading in bed with the cpap is fine, I do it every night.

"ramps up like it's no one's business. " NO!

Learn more about how the machines actually work before you give "advice".

With all due respect, mine is a hypothesis. I am a scientist and I'd like to test my hypotheses to either prove or disprove them. This is one of those. The basis for my hypothesis is that the breathing pattern is different when you are asleep from when you are awake.

Wake breathing is different from sleep breathing, it's more irregular.

However, your other statements are wrong.

[palerider]

I get your point that the OP might fall asleep while reading the book without the mask on. Sure. But, I thought common sense would prevail. Oh well...my mistake.

People fall asleep while reading... all the time.

"common sense"

[Pugsy]

People fall asleep while reading... all the time.

Yep...they sure do and often without any warning.
Also..when playing on the computer or watching TV and sometimes even sitting upright on the couch. Been there and done that without warning sometimes. I can't do much about the upright on the couch accidents but when I go to bed I put the mask on before I even lay down. It's just a habit I got into because I learned a long time ago that I don't always get a warning that I am about to nod off.

[Sova]

Update: slept last night with min pressure of 7 and there didn't seem to be any change, AHI is pretty constant at 5.5 again. I suppose I'll try a min pressure of 8 tonight! My appointment with the sleep doc is tomorrow.

I'm wondering if I need a new mask at this point? I keep trying to order new mask parts and failing. My last Amara View part won't come for another week (amazon but not eligible for prime shipping). Tried to order a different mask off of CPAP.com since they have free return insurance if you don't like it, but they require a prescription (which is dumb) and they couldn't get ahold of my doctor, so I need to call them to see if they will fax over my Rx and ugh it's just a pain in the butt. I suppose I could try going through the supplier my doc works with again.

Posted my sleepyhead data from last night and the night before. The one with AHI of 5.51 is with min pressure of 6, the one with AHI of 5.52 is with min pressure of 7.

[Pugsy]

When you share your reports from last night or whenever please include how your think you slept in terms of sleep quality like fairly soundly or fragmented with multiple wake ups...along with how you feel in general.
That's as important as the numbers.
The numbers don't mean squat without how you feel and sleep.
The best most perfect AHI in the world doesn't mean much if you slept horribly and feel like crap.

[Sova]

When you share your reports from last night or whenever please include how your think you slept in terms of sleep quality like fairly soundly or fragmented with multiple wake ups...along with how you feel in general.
That's as important as the numbers.
The numbers don't mean squat without how you feel and sleep.
The best most perfect AHI in the world doesn't mean much if you slept horribly and feel like crap.

Good point! I'll do that in the future! Both nights I slept "well", the definition of "well" being only a few minor wakeups to adjust the mask that I barely remember or registered. Both days (yesterday and today) I felt slightly better than my average day before starting with cpap, but not dramatically. This, however, is an improvement because with 2 or 3 exceptions I've been feeling worse than my average day before starting with cpap.

Yesterday (after sleeping with AHI of 6) I woke up on my own around the same time my alarm was set to go off. Today I was woken up by my 3 year old through the baby monitor around 20 minutes before my alarm was set (7am).