Hello all...
I've been on CPAP for about a week now. During this time I don't think I've slept for more then 2 hours at any particular point in time. Five of these first seven days I've used my gear all night long (8 to 9 hours or so). Two nights I did not use the gear for a few hours, once somewhat by accident, the other time I was just so tired and frustrated I had to attempt sleep without it for a few hours.
It seems that ever hour to a hour and a half I awaken... many times I get back to sleep within 15 minutes or so. The first night or two, each time I awoke I remembered having a dream. On the second and/or thrid nights it seemed I only remembered a having a dream maybe two of the 5 or so times I woke up on those nights.
When I spoke with my Dr about this constant waking he was asking about having a dry mouth, etc... I told him I did have a dry mouth, but that I pretty much always have had a dry mouth even before using CPAP. His only idea was that possibly I was awakening during a apnea event and/or opening my mouth and then waking up. He suggested a chin strap... I did get a chin strap, but after reading some info on this forum and elsewhere I opted for taping my mouth shut. Well, the past two nights I slept the entire time on CPAP with my mouth taped, yet I still awaken ever hour or so...
Other symptoms are that I'm awakening with a headache (and then it stays with me most of the day). While to some degree on some of the better days I've had on cpap, my total sleep time is probably close to what it was before using CPAP, I feel much worse... almost as if I have had much less sleep then I really have. I feel like I've only slept maybe 4 hours, where I think I'm actually getting close to 6 or 7 hours on some of these 'good' nights. I feel like I've been in a constant fog since trying to use CPAP.
Just today I received a smart card reader and have been trying to see what might be happening based on data I've retrieved, but I'm all new to this data and the use of the Encore Pro software and it's reports... I don't see anything too obvious that could be a problem... for instance no big leaks showing up on a regular basis... My AI average is .6 , HI 3 average and many of these nights no HI were recorded. All of the OA events and the larges number of HI events were during one early morning hour long period where I was in 'ramp' of 5cmH2O pressure most if not all of that hour...
For the most part, I think I'm doing OK tolerating the CPAP operation and my Apnea events seem reasonably well controlled... It's just I can't get any extended periods of sleep for some reason. My guess is that I'm awakening pretty much every time I go into a REM period or sometime during one. However I have no way to know this for sure, only that from what I've read, the cycle of sleep would be between 60 and 100 minutes, which is pretty darn close to the periods of time that I'm sleeping/waking... and the fact that I feel so darn terrible leads me to believe I just aren't getting enough REM sleep...
Now I've read and/or heard of REM rebound... I somewhat doubt that is what's going on with me... simply because I just don't think I'm spending all that much time in REM sleep... but again I really have no way of knowing for sure. For all I know I might be getting lots of REM and little other types of sleep.
Anyone ever hear of someone with my problem? and/or anyone have any good ideas on what I might do to help get though this problem? It's getting REALLY frustrating...
BTW... my prescribe pressure was 9cmH2O, I found that very hard to tolerate on the first night and lowered it to 7cm eventually raised it back up a bit to 7.5. I'm more or less avoiding using ramp now and/or any pressure bellow 6cm. My Dr seemed to be OK with me lowering my pressure while getting used to it, even telling me he would tell me how to do it myself... (I had already figured it out on my own however). Based on the data I've seen, 7.5cm is able to keep my OA events at zero and my HA events are also pretty low (under 3).
Constantly waking up...
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Lots of people have had your problem. You've only been on CPAP a week, so it's really to early to see much improvement yet. Most people don't report real improvement for the first month.
You're on the right track checking your reports and jumping on the possiblity of mouth leaks, but your body has trained itself to deal with your condition. Many of these wakings may be nothing more than your body checking on itself. Once your subconsious gets used to not having to wake you up to breath, the wakings should let up.
This therapy can be frustrating. It is not and immediate gratification therapy. Your body will heal itself on the inside first and then comes the noticable improvements. The first ones will be so vague that you'll wonder if they are real. Grab on to these to help bolster your morale.
I know this suggestion is hard to do, but I elimated some of my wakings with this. When you wake up, think hard on what woke you - did you wake up for no reason or did something wake you. Doing this, I identified that some of my wakings were because of rainout and was able to correct that. I know it's hookey, but it's worth a try.
"be patient, don't give up, some people are harder to fix than others"
You're on the right track checking your reports and jumping on the possiblity of mouth leaks, but your body has trained itself to deal with your condition. Many of these wakings may be nothing more than your body checking on itself. Once your subconsious gets used to not having to wake you up to breath, the wakings should let up.
This therapy can be frustrating. It is not and immediate gratification therapy. Your body will heal itself on the inside first and then comes the noticable improvements. The first ones will be so vague that you'll wonder if they are real. Grab on to these to help bolster your morale.
I know this suggestion is hard to do, but I elimated some of my wakings with this. When you wake up, think hard on what woke you - did you wake up for no reason or did something wake you. Doing this, I identified that some of my wakings were because of rainout and was able to correct that. I know it's hookey, but it's worth a try.
"be patient, don't give up, some people are harder to fix than others"
as I understand it, your pressure is 9.0, you lowered it to 7.5 because it was difficult to fall asleep?
You set up a Ramp at 5 cm pressure, so your ramp to pressure is 5.0 to 7.5.
If your pressure is too low on Ramp (5 is in my opinion) you will rebreathe too much CO2 and this can contribute to the symptoms you are reporting.
My suggestion is:
1. Put CPAP pressure back to 9.0
2. Setup the Ramp with starting pressure of 6.5 for 30 minutes.
3. Consider taking 3mg of Melatonin before bed.
What that should do is:
1. Puts your pressure back up to where it can address apnea during periods of REM sleep, if you wake every 90 minutes or so you are most likely waking during REM which is where we expect to see the most severe apnea, but your pressure of 7.5 is not high enough to clear those so you are awaken.
2. With Ramp now set to 6.5, you will still have low pressure to fall asleep with, if not asleep after timer expires, hit it again for another 30 minutes. The 6.5 pressure will be high enough to flush out exhaled CO2. If you are disturbed by the mask noise and deliver consider a different style mask interface, those are inherently noisy by design.
3. Taking supplemental melatonin would keep you in a state of deeper sleep, hopefully get you past those periods of waking. You take smaller doses for insomnia, higher doses for deeper sleep. Melatonin comes in various doses, suggest 3mg for your situation. If you wake up groggy, you can always cut the pill in half with a kitchen knife for a 1.5mg dose.
You set up a Ramp at 5 cm pressure, so your ramp to pressure is 5.0 to 7.5.
If your pressure is too low on Ramp (5 is in my opinion) you will rebreathe too much CO2 and this can contribute to the symptoms you are reporting.
My suggestion is:
1. Put CPAP pressure back to 9.0
2. Setup the Ramp with starting pressure of 6.5 for 30 minutes.
3. Consider taking 3mg of Melatonin before bed.
What that should do is:
1. Puts your pressure back up to where it can address apnea during periods of REM sleep, if you wake every 90 minutes or so you are most likely waking during REM which is where we expect to see the most severe apnea, but your pressure of 7.5 is not high enough to clear those so you are awaken.
2. With Ramp now set to 6.5, you will still have low pressure to fall asleep with, if not asleep after timer expires, hit it again for another 30 minutes. The 6.5 pressure will be high enough to flush out exhaled CO2. If you are disturbed by the mask noise and deliver consider a different style mask interface, those are inherently noisy by design.
3. Taking supplemental melatonin would keep you in a state of deeper sleep, hopefully get you past those periods of waking. You take smaller doses for insomnia, higher doses for deeper sleep. Melatonin comes in various doses, suggest 3mg for your situation. If you wake up groggy, you can always cut the pill in half with a kitchen knife for a 1.5mg dose.
someday science will catch up to what I'm saying...
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CentralScrutinizer
- Posts: 67
- Joined: Mon Apr 28, 2008 9:04 am
Snoredog got it mostly right... My machine was at 9cm the first night... took me two hours to get to sleep the first night, woke every 1.5 hours or so after that... The machine came with ramp start at 4cm, which on the first night felt pretty good, much better then 9cm.
I tried at those levels again the second night, I soon realized the 4cm was too low to start at, particularly in the middle of the night when I was already somewhat used to breathing at 9cm. I raised that ramp start up to 6 or 7cm...
Prior to the third night, I learned how to lower the steady state pressure and lowered that to 7cm , ramp start was then set at 6cm.
The main reason I lowered the steady state pressure was because I was getting air in my stomach at that pressure. However, I also felt like my lungs were being overly inflated by the pressure when I inhaled, it was quite hard for me to get used to 9cm.
I do also now know that anything less then 6cm is risking re-breathing exhaled air, so I'm definitely not going bellow that any more. I also know that it really doesn't take me any more then about 15 minutes to get used to 8cm...
Right now, I have the steady state at 8cm(tried this today), and I'm starting to feel the air go in my stomach again. Over the past 2 days the pressure was at 7.5 cm, I had zero OA evnets, less then 3 HA events average during that time.
Years ago I tried melatonin in attempts to try and sleep better after long plane trips to Taiwan and back... It never did anything to me or for me. I am willing to try it again, so I'll pick some up today and try again tonight.
I believe I'll keep my pressure at 8CM for now, I'm concerned that if I raise it back to 9cm that I will get more air in my stomach and this will result in discomfort... also, the apneas seemed to be reasonably well controlled at 7.5cm, so I'm not at all sure I need to go back up to 9. Also, the first night at 9cm wasn't good either...
I tried at those levels again the second night, I soon realized the 4cm was too low to start at, particularly in the middle of the night when I was already somewhat used to breathing at 9cm. I raised that ramp start up to 6 or 7cm...
Prior to the third night, I learned how to lower the steady state pressure and lowered that to 7cm , ramp start was then set at 6cm.
The main reason I lowered the steady state pressure was because I was getting air in my stomach at that pressure. However, I also felt like my lungs were being overly inflated by the pressure when I inhaled, it was quite hard for me to get used to 9cm.
I do also now know that anything less then 6cm is risking re-breathing exhaled air, so I'm definitely not going bellow that any more. I also know that it really doesn't take me any more then about 15 minutes to get used to 8cm...
Right now, I have the steady state at 8cm(tried this today), and I'm starting to feel the air go in my stomach again. Over the past 2 days the pressure was at 7.5 cm, I had zero OA evnets, less then 3 HA events average during that time.
Years ago I tried melatonin in attempts to try and sleep better after long plane trips to Taiwan and back... It never did anything to me or for me. I am willing to try it again, so I'll pick some up today and try again tonight.
I believe I'll keep my pressure at 8CM for now, I'm concerned that if I raise it back to 9cm that I will get more air in my stomach and this will result in discomfort... also, the apneas seemed to be reasonably well controlled at 7.5cm, so I'm not at all sure I need to go back up to 9. Also, the first night at 9cm wasn't good either...
CentralScrutinizer -- I can sympathize with the difficult first week. My first week on CPAP was one of the worst of my life. I could not sleep through the night, and felt worse than before I started CPAP. I was ready to ditch the whole thing, but I stuck with it and it did get better. I think one thing that helped me was setting a tighter range for my pressure (started at 4-10, is now at 8.5-11). I think the pressure changes were sometimes waking me up. I know you are on straight CPAP, but if you have a wide range for your ramp, that might have contributed to your awakenings. I never really had problems with feeling pressure in my lungs or stomach, but I do know that starting out at 8.5 is now no problem at all, but when I first started CPAP I thought anything over 6 was horrible! Hang in there, your body will adjust and it will get better and you'll feel better, too. Good luck!
_________________
| Mask: Opus 360 Nasal Pillow CPAP Mask with Headgear |
| Additional Comments: Encore Viewer Software |
The only suggestions I would have are common sense things.
How is your sleep environment? Is there something external waking you up? Could you introduce a fan or some white noise? How is your sleep hygiene? Are you sleeping at the same times every day? No food or alcohol before bed?
What is your caffeine intake? Should be zero after noon. I can't have any all day or my sleep is disturbed.
Are you comfortable with your mask? Does it feel tight, or does it come loose? Would another type of mask make a difference?
How do you feel about sleep aids? If not melatonin, have you tried benedryl? Perhaps your Doc could prescribe you a course of Ambien to get you sleeping better. It may only take a week of drug induced all night sleeping to get your body back in the swing of things.
The headaches could be sinus, and could be from too much or not enough humidity. You could try adjusting it. I had some sinus headaches for a while, then I seemed to adapt. Hopefully you will too.
My first couple of weeks I didn't sleep alot, but I did start to feel better. I still often have broken nights. If you are using a cpap and sleeping a total of 8-9 hours, with an AHI of 3.6, thats pretty darn good. I would stick with it and wait for some improvement in how you feel. Regardless of how you feel, your body is healing itself each night that you use your machine, so you are doing good for yourself. Best of Luck
How is your sleep environment? Is there something external waking you up? Could you introduce a fan or some white noise? How is your sleep hygiene? Are you sleeping at the same times every day? No food or alcohol before bed?
What is your caffeine intake? Should be zero after noon. I can't have any all day or my sleep is disturbed.
Are you comfortable with your mask? Does it feel tight, or does it come loose? Would another type of mask make a difference?
How do you feel about sleep aids? If not melatonin, have you tried benedryl? Perhaps your Doc could prescribe you a course of Ambien to get you sleeping better. It may only take a week of drug induced all night sleeping to get your body back in the swing of things.
The headaches could be sinus, and could be from too much or not enough humidity. You could try adjusting it. I had some sinus headaches for a while, then I seemed to adapt. Hopefully you will too.
My first couple of weeks I didn't sleep alot, but I did start to feel better. I still often have broken nights. If you are using a cpap and sleeping a total of 8-9 hours, with an AHI of 3.6, thats pretty darn good. I would stick with it and wait for some improvement in how you feel. Regardless of how you feel, your body is healing itself each night that you use your machine, so you are doing good for yourself. Best of Luck
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CentralScrutinizer
- Posts: 67
- Joined: Mon Apr 28, 2008 9:04 am
Well last night I did sleep a bit better... I had two sleep periods that were a little over 2 hours each, two others that were about 1.5 hours each... I think this is the first morning I've woken up feeling about as good as I did before being diagnosed with severe sleep apnea. I'll try and give a few more details later...
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CentralScrutinizer
- Posts: 67
- Joined: Mon Apr 28, 2008 9:04 am
So... My sleep environment is pretty good, quite, pretty good temperature, nothing that should or ever would keep me from sleeping good (aside from this new CPAP thing). I go to bed pretty much the same time every night, wake pretty much the same time daily (10pm till about 7am). I don't really ever use an alarm clock... I don't drink alcohol or smoke cigarettes, etc... I drink about two cups of relatively strong green tea each morning, sometimes have a cup of coffee but always well before noon. Lately and most days I don't drink any caffeine after noon. I have been taking some bendryl around 9PM due to some lingering sinus congestion from a cold I had three weeks ago, outside of this I have been taking no other drugs.
The mask is pretty comfortable, I do have a little trouble finding a good position to lay my head on my pillow... I sleep on my side mostly and this is a bit of a challenge but I think I've managed this pretty well.
So, I know the headaches could be sinus... or they could be possibly related to REM rebound or something like that... Quite honestly, waking with a headache is a major pain in the.. head for me. It seems if/when (which usually is pretty rare) I wake with a headache, it seems like I have it most of the day. This was or is one of the most frustrating parts of my sleep problems so far. The good news is that this morning I did not have a headache, so with any luck this issue is going away or has gone away.
Last night... I got a fair bit of exercise in yesterday... played 18 holes of disc golf. I was a bit sore afterward... took some Ibuprofin when I got home and also took a hot bath.
I also tried a bit of Melatonin before bed last night. Felt a bit groggier then normal in the morning which I will attribute to taking the Melatonin before bed...
So, anyway... I now have my CPAP set at 8cmH20, ramp start is 6cm and ramp time is 15 minutes. I fell asleep in no more then 20 minutes... slept for roughly 2hours and 15 minutes (a new record I think). I was awake for maybe 10 minutes and remember no dream from that point. I slept for another 2 hours after that and when I awoke I remember a bit of a dream. I again fell asleep in a short period of time and then slept for about 1.5 hours . This time I took a bit longer to get to sleep, probably at least 20 minutes perhaps more like 30 minutes... I think I actually fell asleep on my back at that point, which is quite rare for me. The next time I awoke it took me about 10 or 15 minutes to fall asleep again and slept a little more then a hour and when I woke the next time it was close enough to my normal time to get up that I did not try to sleep again.
So, if you've been following all this... Last night eighth night on CPAP, was my best night of sleep on CPAP. I did not have a headache when I woke up... I felt almost as rested as I ever did before being diagnosed with SA. It would seem I'm making some progress.
If I had not woken up between the two 2+ hour sleep periods early last night, I think I would have considered my night's sleep as good as I ever had in the past 10 years without CPAP.
According to my REMstar Pro data from last night... I had three obstructive apnea events during the night (0.4 average) and had maybe 20 or so hypnoapnea events... (avg 2.7)...
So, I perhaps maybe I've turned the corner on my sleeping problems...
(the gaps in the pressure are where I briefly turned the machine off during times when I was awake. (I wish there was a button to push that could get recorded as a 'awake' moment, rather then having to turn the machine on and off to create a gap like this)
The mask is pretty comfortable, I do have a little trouble finding a good position to lay my head on my pillow... I sleep on my side mostly and this is a bit of a challenge but I think I've managed this pretty well.
So, I know the headaches could be sinus... or they could be possibly related to REM rebound or something like that... Quite honestly, waking with a headache is a major pain in the.. head for me. It seems if/when (which usually is pretty rare) I wake with a headache, it seems like I have it most of the day. This was or is one of the most frustrating parts of my sleep problems so far. The good news is that this morning I did not have a headache, so with any luck this issue is going away or has gone away.
Last night... I got a fair bit of exercise in yesterday... played 18 holes of disc golf. I was a bit sore afterward... took some Ibuprofin when I got home and also took a hot bath.
I also tried a bit of Melatonin before bed last night. Felt a bit groggier then normal in the morning which I will attribute to taking the Melatonin before bed...
So, anyway... I now have my CPAP set at 8cmH20, ramp start is 6cm and ramp time is 15 minutes. I fell asleep in no more then 20 minutes... slept for roughly 2hours and 15 minutes (a new record I think). I was awake for maybe 10 minutes and remember no dream from that point. I slept for another 2 hours after that and when I awoke I remember a bit of a dream. I again fell asleep in a short period of time and then slept for about 1.5 hours . This time I took a bit longer to get to sleep, probably at least 20 minutes perhaps more like 30 minutes... I think I actually fell asleep on my back at that point, which is quite rare for me. The next time I awoke it took me about 10 or 15 minutes to fall asleep again and slept a little more then a hour and when I woke the next time it was close enough to my normal time to get up that I did not try to sleep again.
So, if you've been following all this... Last night eighth night on CPAP, was my best night of sleep on CPAP. I did not have a headache when I woke up... I felt almost as rested as I ever did before being diagnosed with SA. It would seem I'm making some progress.
If I had not woken up between the two 2+ hour sleep periods early last night, I think I would have considered my night's sleep as good as I ever had in the past 10 years without CPAP.
According to my REMstar Pro data from last night... I had three obstructive apnea events during the night (0.4 average) and had maybe 20 or so hypnoapnea events... (avg 2.7)...
So, I perhaps maybe I've turned the corner on my sleeping problems...
(the gaps in the pressure are where I briefly turned the machine off during times when I was awake. (I wish there was a button to push that could get recorded as a 'awake' moment, rather then having to turn the machine on and off to create a gap like this)
I don't need my ramp - so I set it at 5 minutes and hit it when I think the machine should record "boy, I'm really awake and annoyed at it, and I'm not getting up".
I turn the machine off when I get up in the middle of the night.
I may be semi awake, aware of being awake and rolling over to continue sleeping - I don't hit the ramp under those conditions.
O.
I turn the machine off when I get up in the middle of the night.
I may be semi awake, aware of being awake and rolling over to continue sleeping - I don't hit the ramp under those conditions.
O.
_________________
| Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
| Additional Comments: Machine: Resmed AirSense10 for Her with Climateline heated hose ; alternating masks. |
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.
Antoine de Saint-Exupery
Good advice is compromised by missing data
Forum member Dog Slobber Nov. 2023
Antoine de Saint-Exupery
Good advice is compromised by missing data
Forum member Dog Slobber Nov. 2023
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CentralScrutinizer
- Posts: 67
- Joined: Mon Apr 28, 2008 9:04 am
Great idea... I too am pretty much to the point where I don't need ramp much... I currently have it set to 15 minutes I could very likely lower that without causing me any issues... Thanks for that idea...
[quote="ozij"]I don't need my ramp - so I set it at 5 minutes and hit it when I think the machine should record "boy, I'm really awake and annoyed at it, and I'm not getting up".
I turn the machine off when I get up in the middle of the night.
I may be semi awake, aware of being awake and rolling over to continue sleeping - I don't hit the ramp under those conditions.
O.
[quote="ozij"]I don't need my ramp - so I set it at 5 minutes and hit it when I think the machine should record "boy, I'm really awake and annoyed at it, and I'm not getting up".
I turn the machine off when I get up in the middle of the night.
I may be semi awake, aware of being awake and rolling over to continue sleeping - I don't hit the ramp under those conditions.
O.
I could send you a crude "pattern" of my dorky home-made pillow if you'd like. Finding a comfortable place for my head and all its new "decorations" has been one of the biggest challenges for me. Without your head and neck feeling comfortable, it's hard to settle down to this new business way of getting to sleep.The mask is pretty comfortable, I do have a little trouble finding a good position to lay my head on my pillow... I sleep on my side mostly and this is a bit of a challenge but I think I've managed this pretty well.
Seems like you are doing everything right!! It does take some getting used to all this new stuff, but it sure looks like you are well on your way to success!!
Peggy
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onewaypockets
- Posts: 1
- Joined: Fri May 02, 2008 10:00 pm
Hi CS,CentralScrutinizer wrote: I do also now know that anything less then 6cm is risking re-breathing exhaled air, so I'm definitely not going bellow that any more. I also know that it really doesn't take me any more then about 15 minutes to get used to 8cm...
Years ago I tried melatonin in attempts to try and sleep better after long plane trips to Taiwan and back... It never did anything to me or for me. I am willing to try it again, so I'll pick some up today and try again tonight.
CPAPopedia Keywords Contained In This Post (Click For Definition): Ramp
I wondered if you had some more information on the "re-breathing exhaled air" at low pressures? My machine is set to 5 pressure and I had not heard this.
Also, from what I have personally experienced with melatonin, lower doses are much better than the typical doses people take and find at their health food stores. Most people take around 3mg, give or take, sometimes lots more. I have found that it works well at first, then stops working. I have had excellent incredible sleep taking 500 micrograms rather than the larger MG doses.
Melatonin isn't really a sleeping pill, you don't just go "out" like with Ambien, etc. I take it around an hour before I want to sleep and and then just complete my household stuff. Around 20 minutes before sleep I get in bed, fit my mask, and watch TV with very little lights on. Then right at 10pm I start to feel sleepy, turn the lights out and go right to sleep.
I guess what I am saying is that melatonin just lets nature work better, it is a natural chemical (hormone?), that is naturally secreted by the pineal gland. In most folks over 40 though, we just don't make as much as it as we did when we were young.
Here are a couple of links that may explain it better than I can...Neil
http://www.lef.org/magazine/mag2001/may ... ducts.html
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