Need help

[magpie]

I've been on Cpap since June. I have never had issues with my mask in the past but find myself taking it off alot recently both consciously and while sleeping. In addition I am still not sleeping well I tried trazadone first at 50 mg and then at 100mg but it didn't work out for me. I have started on Rotorum about a week ago along with 6mg of melatonin. I get to sleep rather quickly but it doesn't keep me asleep and I sleep for about two hours and then wake up It then takes me ah hour or more to fall back to sleep only to awaken about an hour later and then the insommia kicks in full blast. It's even worse beause I am really tired from taking the medicine and can't fall back to sleep so I get really irritible. When this happens I really cannot tolerate my mask. I try so hard to get past that but usually end up taking it off after a couple of hours lying awake with it on but not sleeping. I then turn over to my stomack and fall back to sleep for an hour or two. I know that i'm not supposed to do this but if I don't I do not sleep at all. I'm getting so frustrated. My soctor won't perscribe any other sleep medicine because of the addictive nature of it. He says that it will only work for about 6 weeks and then will stop. I just want to sleep and wonder if he perscribes something short term if it will get my circanian rythm working properly so I can go without any meds. I went out and got a small CD player for my room and will play my sleep CD continously tonight.
I hope it helps I'm so exhaustd.

I'm also thinking about seeing an endocrinologist to see if there is anything going on that is preventing me from sleeping. I'm thinking also that maybe I need a new cusion for my mask? Could it be breaking down so soon I wonder?

[cflame1]

When you're sleeping, what does your machine report? Is it leaking alot? Is your AHI high?

[ozij]

The 420E with Silvelining software is a great machine for tracking things like this.

When you wake up, hit the stop button. The restart.
Next morning, look at the details screen and see if you can find any breathing events - or prominent leaks just before you stopped the machine.

What do you graphs look like - what's your range, and how does the machine range across it?

Could you be waking up from pressure changes?

Have you tried other masks?

Have you tried 300 micrograms melatonin - instead of 20 times that amount?

And yes. it could be the masks cushion.

O.

[annie123]

Has anything else changed? Your weight? I had no idea why I was mouth breathing after 11 successful months of therapy. It was because of weight loss that my pressure was no longer correct for me and was essentially forcing the pressure out of my mouth.

[Guest]

I did really well with my Comfort Lite 2 for 5 months and then started seeing my AHI go up. I ordered a new cushion for it and that solved the problem. A few weeks ago, I started feeling lilke I couldn't breathe through my CL2 (bad allergy season) and switched to the Swift, which has a much stronger airstream (if only in my mind). Now I'm back to the CL2 again and it's great. I think a lot of the really experienced CPAP folks have mentioned that they keep a few masks around and interchange them. I've sure found it helpful to have a couple to work with, and I plan to order a third (Nasal Aire II) as soon as I can.

Sleepergal

[magpie]

My AHI is at 1.3 , which is .1 higher than it had been I guess that isn't too bad considering I am now taking medicine to help me sleep. My leak rate does seem to be slightly elevated. not terrible but a bit more than it was a month ago. So I guess I will try to get a new cushion and see if that makes a difference.

[magpie]

Osij, I started out at 3 mg of melatonin but it didn't do anything so I upped it to 6 mg. My pressure range is set very narrow (8-10) because I have some centrals. Right now my apneas are evenly split between obstructive and centrals. Pressure seems to be at 9 most of the time. My ramp starts at 4 and is only for 10 minutes I frequently don't use it. I only keep the machine in Apap mode to record my information. My rep told me that it won't record in Cpap mode.

Annie, My weight is the same (unfortunately). I was hoping that sleep therapy would help me with that but it hasn't so far.

[ozij]

Your rep told you half the story.

If you keep the machine in APAP mode, and set the top and bottom pressurre to equal each other, You'll get straight pressure thearpy with APAP quality recording.

If you frequently don't use the ramp, you can use it to monitor your wake up reasons:

The PB ramp can be set at a min. of 5 minutes, and you can start it very close to your bottom pressure. Then when you're really awake, and feel the need to record it, you press the ramp. I do that to distinguish between the times I wake up, and can't fall asleep again, and the times I wake up and have to go the bathroom. Machine off mean's a bathroom break. Ramps means a restless night, whithout having to get up.

I asked about less Melatonin because of the following http://web.mit.edu/newsoffice/2005/melatonin.html

O.

[Guest]

Osij, I started out at 3 mg of melatonin but it didn't do anything so I upped it to 6 mg. My pressure range is set very narrow (8-10) because I have some centrals. Right now my apneas are evenly split between obstructive and centrals. Pressure seems to be at 9 most of the time. My ramp starts at 4 and is only for 10 minutes I frequently don't use it. I only keep the machine in Apap mode to record my information. My rep told me that it won't record in Cpap mode.

Annie, My weight is the same (unfortunately). I was hoping that sleep therapy would help me with that but it hasn't so far.

_________________

My suggestion(s)/opinion: (in effort to sleep more solidly/soundly):

1. Disable the checkbox for "command on FL" or 1FL parameter.
2. Next, lower the "command on apnea" parameter from default 10cm to 9.0cm.
3. Initial pressure of 8.0 is okay (if you breathe comfortably there, with that machine I would use 7.0 or 7.5 cm), but I would increase your Maximum pressure to 14 cm (I know you mention centrals, you can ignore those with these settings).

And here is what those new settings should do:

When you disable the 1FL it tells the machine not to respond to FL (Flow limitation) when seen alone or "by itself". Some of those CA's you are seeing may be just from shallow breathing. If you are a shallow breather you will know it, having that parameter enabled can drive the avg. auto machine nutso with pressure increases which seems to make your breathing more unstabil.

When that box is unchecked/disabled, the machine now needs to see a hypopnea associated with that FL (Hypopnea+FL) before it is allowed to respond higher with pressure. Look on your reports what is it responding to?

Basically we are telling the machine you NOW have to look at 2 parameters before you can respond to the event. So why is that better? The more parameters you can introduce or force the machine to look at before it can respond with pressure the more accurate it becomes at differentiating the event.

We want the machine to respond to obstructive events and snores yet avoid any response to anything resembling a CA (central apnea).

Now there really is not much worry with the 420e responding to centrals (other autopap machines, yes, 420e no). When responding to apnea, the 420e will always listen first for "cardiac oscillations" before it increases pressure. Basically, you have stopped breathing, your airway is open and the machine can hear your heart beating thru the hose, a sensitive little bugger it is.

Only problem with that theory is only about 60% of CA's seen have an associated open airway, so for the other 40% of those CA's the airway can be closed just like with an obstructive apnea.

Keep in mind with a closed airway the machine can no longer hear cardiac oscillations. So if it responded to that, then it would be responding possibly to a CA with a closed airway, those may even show up as "mixed" apnea. If you look on your 96-hr report you may even see a few, the Apnea tic on line 1 will be perfectly aligned with a CA tic on line 2, chances are that is a MA (mixed apnea).

Now if no cardiac oscillations are seen (like with an obstructive apnea) it then reverts back to the "command on apnea" parameter setting, it says okay I cannot hear any cardiac oscillations, and I see an apnea, looks at current delivery pressure if at 9.0 or below it responds with pressure, if above it ignores that event for fear it may be a CA. The risk of you having a CA below 10 cm pressure (default) is low, the risk of you having one at 9.0 is even lower. By default that parameter was set at 10cm pressure. We lowered the machine's threshold.

So why did I lower it? You have to know your own CA threshold (pressure where CA's start to apear, look at your 96hr detailed reports of past, you should see at what pressure you were at when those CA's appear. Now if you are like Ted the Titrator and you know you don't have any problems with those you can actually increase that parameter (not suggested unless you know what you are doing).

But for the majority of the population that threshold is 10 cm or higher. Some machines like the Remstars have another parameter that kicks in at 12cm. For the Resmed AutoSet that is the A10 parameter built into its algorythm, it functions very much the same, but we can change it on the 420e.

Now with command on apnea set lower, we told the machine if pressure is at 9cm or above do NOT respond to a apnea. Now, since only about 60% of CA's are associated with an open airway (to hear the cardiac oscillations, rest may be closed like with a obstructive apnea liked blocked by the tongue.

If the machine sees what it thinks is an apnea, it hears the cardiac oscillations which says the airway is open, it logs the tic on line 2 and drops pressure. If you look at your past reports that is what you should see happen.

So with that machine you should safely be able to increase the Maximum pressure to 14 without worry of the machine confusing a obstructive apnea for a central apnea.

Probably the only CPAP-Auto on the market you can tweak that with.

Watch your cycle runs, you want to see those go down and/or Normal cycles go up, I stay in the 95% range now.

Seems some of us with those centrals can have them sporatic through out sleep, we actually need a machine that does a better job at avoiding a true central yet responds with obstructive when we need it. We need one that isn't so aggressive in response to FL's because we are shallow breathers. We can have apnea requiring pressure above 10 cm, so the machine needs to be more precise at differentiating those events. My opinion the 420e does a very good job at it.

6 mg Melatonin:
Keep in mind in using 6mg of melatonin that it "may" contribute to some daytime fatigue (especially after lunch hour like in the 1PM to 3PM time frame), if the fatigue "hits" all of a sudden you know it may be from too much oral melatonin, that is because that is about the time frame that your natural melatonin levels begin to kick in and increase. If you are having any daytime fatigue, you might try taking melatonin a bit earlier than you normally do, take it 1-2 hours before bed instead of 30 minutes or less.

If you have a digital clock in your room try to correlate those night time awakenings with events seen on your 96-hr report. So if you suddenly awoke at 2:10AM look at the report, was it a CA that caused the awakening? What was the pressure doing at that time. If you observe FL's, Hypopnea and snoring you know the events that led up to that awakening were either obstructive or central.

Your goal should be not to have any of those CA's. IF you are having a lot of CA's or shallow breathing you might try a Soyala mask. Reason is it retains more CO2, retaining more CO2 fakes the body out in thinking you are suffocating so it increases respiratory drive or causes you to breathe. If you are flushing out too much CO2 then you will start to shallow breathe.

[Snoredog]

oops that was me above.

Note: forgot to mention in my long winded post above that the 420e will still respond to apnea it sees above 9 cm pressure, it looks at any precursor events leading up to it like Hypopnea or snores. When you are snoring you are right on the verge of having an apnea.

[magpie]

Thanks Ozij for the link it makes sence so I will try reducing my melatonin.

Snoredog as usual you give alot of information. I am not very proficient at reading my reports so it will take me a while to sort it all out. Is there an easy way to seperate one day from the next in your 96 hour reports? The running hours makes it hard to see what is going on as far as waking and falling asleep for me since I wake up so frequently. sorry to be so ignorant but eventually I will catch on. It would be easier if I slept more and could get rid of this brain fog LOL

[ozij]

Separating the sessions on the details screen:

Click on the red pencil button.

Look to the left, click on "Select accordin to sessions"

Go to the bottom of the screen the open, choose the one but last session, and the choose the last - by doing that you'll clear all the preselcted sessions, and you can start selecting those you want - but the have to be consectutive,

If you can use the ramp as a "wake up indicator" you'll have less sessions of course.

After selecting click OK, and the use the right an left arrows (it will usually be right) to get to the clear area where you can get your details.

On the bottom, near the red pencil you have a square shaped magnifiying glass, if you click on that, the graph will fill the screen.

When you see the full screen, use the crossbar tool to pinpoint the event you are interested in. Click on the crossbar, then click on the event When you point at the event, you'll see the exact time it happened at the bottom left, in small black letters. You can drag the croosbar to the next event. Very nifty, as Rested Gal says.

I preferr using the ramp to report my awakenings, because there is no way I could remember the exact times I woke up - and just thinking of the need to remember anything when I'm trying to sleep would make me restless. I don't even keep a clock in the bedroom.

O.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): Ramp

[magpie]

Thanks ozij, I did figure it out but not the magnifying glass thing I mean I did magnify it but didn't see the times. Like I said brain fog, I've been feeling more and more like the sterotypical blond when my IQ is actually quite high LOL.

Snoredog I made the changes you suggested and will see how things go tonight. What I am noticing is that I have ALOT of runs that occur all night long and am wondering if they are what is waking me so often and if there is anything I can do to reduce them They average about a 6.0. Apneas are pretty much evenly sprinkled throughout my night with a slight increase in the first hour after falling asleep and the hour before waking up.