Hi all, new user self diagnosing while waiting for sleep study

[trimmer274]

Hi,

I've been studying this site for a week or so now (including all newbie howtos, so hope I get it right ) and had my first CPAP experience last night (and it didn't go well...).

Quick background - I'm 36M in Washington state and have tossed/turned and woken up frequently as long as I can remember. Snoring comes and goes - it's been a few months since my wife said I snored, but when I did it was earplug-worthy and lasted a few months. Within the last few months I've noticed waking up 1-3 times a night with elevated heart rate, a few times racing (120+). It's certainly worse on my back so I've been forcing myself to lie on my left side, which seems to minimize, though not eliminate it. As I've tuned into this it's become nightly and I notice as soon as I wake up I just calmly breath and heart rate returns to normal. On a couple occasions I think I felt myself gasp as I woke up. My wife has never noticed any gasping or pausing in breathing (though she's a deep sleeper and we have little ones that wake us up frequently anyway). Though it's often hard to get out of bed in the morning, once I get going I feel fine. I have had occasions in the past where I fell asleep on the couch or sitting at a friend's house, but like the snoring that seems to come and go in seasons and hasn't happened for a while.

Since my sleep study was a couple months out when I scheduled (Sept. 28), I've been researching and borrowed a PR System One Auto A-Flex with heated humidifier and a Dreamwear mask (M) with nasal mask (L). I started with min pressure at 4 and max at 20, but throughout the night changed min to 8, then 6, then back to 4 with no improvements. I had A-Flex at 3.

I never fully got to sleep with the mask on, at best I made it "half way" before my oxygen dropped out and my oximeter buzzed me. I also seemed to feel the breathing drop outs and could feel the pressure kick up a bit. The strange thing is before the CPAP my oxygen would drop and alarm would go off a few times a night and at worst got to 93 (see the second oximeter chart below). With the CPAP my oxygen dropped constantly, even while I was still awake, and got to 87 (see the first oximeter chart below). The gaps with no drops were when I took off the mask and instantly fell asleep (only to be awakened with elevated heart rate as usual). Though I hardly slept, I don't feel terrible (maybe I'm just used to it). I may be imagining it but my chest feels a little "tired", maybe just the newness of working with the machine?

I played with the nasal mask frequently, sometimes airflow was good, sometimes bad. I also wonder if I was pinching it off or it was pinching my nose closed? But I'm pretty sure I remember my oxygen buzzer going off when I felt like I was breathing just fine. I've been forcing myself to lie on my side(s) lately but last night tried both sides and back with no luck.

Any thoughts? I'll be trying a AirFit P10 mask with nose pillows tonight to see if that makes a difference.

Thank you!

[Pugsy]

Some of those oxygen desat alerts are loss of contact artifacts.....the sensor came loose. Do whatever you can to make it less likely to come loose.

Flex exhale relief doesn't even engage until you are using at least 6 cm pressure.

Going to sleep with a mask on and blowing air up your nose....not the easiest of things to do and it does take a bit of adjustment and time.

Try these settings
Minimum pressure 6
Flex at 2 or 3 whichever is more comfortable for you
Maximum pressure 20
Mode...auto
Ramp....off
Use them during the day while reading or watching TV so you can get more accustomed to them and actually be able to fall asleep.
If you aren't asleep....none of the data seen matters. The machine only measures air flow and our awake breathing is very irregular compared to asleep breathing and anything it flags or responds to while awake doesn't really count. It has zero way to know if you are asleep or not.

If you can safely take some sort of OTC sleep aid to help you get over the hump....do it.
Until we have actual asleep data to review we have zero way to evaluate anything. You have to be asleep for the data to matter.

[trimmer274]

Thank you for the review Pugsy.

The next night (Thursday) I switched to nasal pillows on an AirFit P10 mask and it made all the difference - instantly asleep and "slept" through the night (still numerous of my normal wake ups). I also took the mask off for a large portion of the night, so I'll skip that chart.

Below is my chart from last night (Friday). I still took the mask off a couple times and both times my oximeter buzzed me a couple times with oxygen drops. I still woke up at least a dozen times but much of that is because I'm still in experiment mode so I find myself waking up to check on myself and log whatever is going on.

A few notes to go with the chart:
After the horrible first night I decided to ease into the pressure, so last night I had min: 4 max: 6.5 (previous night max: 6.0). Aflex 3. Resistance: X2. I feel significantly refreshed after the last two nights.

22:16:33 - 22:56:18 "Practicing" before bed while reading
23:25:15 Bed start
23:48:00 Brief wakeup
12:42:47 Brief wakeup, took mask off (felt like I wasn't breathing enough?)
02:49:13 Brief wakeup, took mask off (felt like I wasn't breathing enough?)
04:16:00 Brief wakeup
04:49:00 Oximeter buzzed twice while mask on, readjusted mask, was laying on back
05:37:00 Lots of movement noise recorded (snoring app), don't recall waking up or at least didn't log

Hopefully this data is a little better to gain some insight / recommendations?

Thank you!

[Pugsy]

Your O2 levels are fine. That one sudden drop...loss of contact artifact.
It is normal to see an overall drop of 3 to 4 percent in oxygen levels while asleep...so don't panic when you see those drops.
Sudden drops and sudden recovery...loss of contact. Real desats don't go down that fast and they don't come up that fast either.

You just need to get more used to the mask and the pressure and that simply takes time.

Also that minimum of 4 is keeping you from actually getting the full benefit of the Flex exhale relief and a more natural breathing rhythm and likely contributing to waking up feeling a bit air starved. I suggest making the minimum at 6 cm and keep Flex at 2 or 3 whichever feels best and use the mask you like the best and sleep in any position that let's you sleep more easily. Maybe do a modest range so you won't be scared of big pressure changes if it eases your mind...like 10 max. The machine won't go anywhere without a good reason.

Without sleep itself...none of this stuff matters.

Patience and time.......figure out what it is that is most comfortable for you so you can actually fall asleep and have the best chance of staying asleep first. Worry about tweaking of the settings later though I don't expect much tweaking will be needed if you use a bit higher minimum.

[Miss Emerita]

Your O2 levels are fine. That one sudden drop...loss of contact artifact.
It is normal to see an overall drop of 3 to 4 percent in oxygen levels while asleep...so don't panic when you see those drops.
Sudden drops and sudden recovery...loss of contact. Real desats don't go down that fast and they don't come up that fast either.

One moral is that you can turn off the buzzer!

[trimmer274]

Thanks again Pugsy. And thank you Miss Emerita, I'll get there this has been a bit unnerving for me and before getting the CPAP the buzzer kept me from going straight to a racing heart beat several times a night, so I'll have to ease away from it.

When I expand that oxygen desat it takes about 1 min to drop from 97% to 91% (after a slower trending decline) and about 20 sec to recover - is that still too fast to be real?

Can I ask a bit more why having the min set at 4 could leave me feeling a bit air starved? That seemed to happen a couple times last night, once where I woke up and heart rate jumped to 100, and another time where I woke up and discovered the tube had slipped under the corner of the pillow and pulled the tube down which I think restricted airflow leaving me short of breath. I'll give that higher minimum a try tonight.

Are you able to see those two events in the data below, or what might have led to them? The first (100 heart rate) was approximately 2:23 and the second (tube caught) was approximately 5:21. In both cases I removed my mask for a few minutes just to feel that I was fully caught up on air.

Thank you again!

[Pugsy]

When I expand that oxygen desat it takes about 1 min to drop from 97% to 91% (after a slower trending decline) and about 20 sec to recover - is that still too fast to be real?

Yep...too fast to be real.

Hold your breath for as long as you can possibly hold it (my guess is you will be lucky to do it for 30 seconds).... then watch the O2 meter for 5 minutes.....does it change?

Real desats related to real oxygen levels in the blood take many minutes to drop and come back up...many minutes. Blood oxygen levels don't change rapidly at all....10 to 15 minutes at a minimum unless you hold your breath for 30 seconds...every minute for 10 minutes in a row and then you might see a change. You aren't having those sort of apnea events to cause that sort of reaction.

Can I ask a bit more why having the min set at 4 could leave me feeling a bit air starved?

Combination of things...the body getting used to the low pressure to start with and the physics of simply not much air moving and what seems like a lot at the beginning of the night feels like nothing in the middle of the night because the brain has become accustomed to it. Then there is the actual volume space within a mask that is a factor.

4 cm is a nothing pressure...not much air moving. Heck, when I had the in lab titration they started me out at 5 cm and I was feeling air starved at that pressure. Simply not enough air movement for comfort. Now I knew I wouldn't suffocate and wasn't....but it sure felt like it. When I first started therapy my minimum was 10 cm...it always felt like a hurricane when I first turned the machine on but often in the middle of the night I would wake up and wonder "is the machine even on" and would have to pull the mask away from my face to confirm the machine was even on. It doesn't surprise me one bit that you feel air starved in the middle of the night at such a low pressure. I felt air starved at 5 cm my very first night using cpap during the in lab titration study.

Wean yourself off the O2 meter.....you don't need it or at least do what Miss Emerita suggested...turn the damn buzzer off. It's not doing you any favors and you don't need it.
What you need is a higher minimum and maximum pressure settings and more trust in the machine to do its job.