Pressure Increases Unnecessarily While I am Awake

[Cassandra]

Mornin', everyone. Last night was night two of my APAP therapy.

I didn't go to sleep immediately last night. I was up for an hour or so reading, then not as sleepy. So the first hour or so... maybe two hours of wearing my mask I was quite awake. What I noticed was the pressure kept increasing the whole time. It just went up and up until it was 16 at one poing. (My pressure from the night before was around 7.) I realize that pressure can be wildly different from one night to the next . But I seem to only be having this issue while I am awake. The first day I got the unit, I was wearing it for the practice hour and it did the same thing. The pressure kept going higher and higher until I turned it off.

Last night once the pressure got up to 13 or 14 I was pretty uncomfortable and this is what kept me awake. At a pressure of 16, the mask was leaking badly. Feeling like something was just not right, I turned off the machine and took removed the nasal pillows.. just left them propped up on my nose. Then, soon after that I did finally doze off but was aroused shortly after with an apnea indicent. I woke up enough to put the mask back on my nose, then fell asleep.

When I woke up this morning, the pressure was a little over 7 again and I felt completely comfortable. I wasn't troubled with any leaking or uncomfortable pressure while I was sleeping. (Though my AHI was higher last night than the night before.) I feel like I slept well, but my AHI was a little higher than the night before. And my smartcode data was skewed by the waking hours pressure.

I think my question is, What is the APAP machine looking for to decide the pressure is high enough, and why isn't it finding that while I am awake. It doesn't seem to have any trouble finding my right pressure while I am asleep.

Thanks,
Cassandra

[ozij]

I'm trialing an Intellipap since last week - and it's doing the same to me - rasiing the pressure to the upper limit even though I'm awake and breathing.

I have no idea what causes it.

O.

[sepool]

Could it be that your breathing is more irregular when you are awake, and the machine is reading that as hypopnea events, or flow restrictions? Is this a data-capable machine? What would the data say?

[Cassandra]

Could it be that your breathing is more irregular when you are awake, and the machine is reading that as hypopnea events, or flow restrictions? Is this a data-capable machine? What would the data say?

Sepool, that is very much a possibility. It is data capable, but I'm not sure what part of the data would be relevant. I'm not very familiar with it as yet. The only thing different was the 90 & 95% pressure, which was twice as high. And the AHI went from 5 to 7.5 which doesn't seem statistically significant to me. I only have two nights of data to deal with. If I had a few weeks worth, it would be a lot easier to pick out abnormalities!

As you say, though. I do experience some shortness of breath during the day. It doesn't seem like much, but maybe the machine is picking up on it. It's just trying to help. LOL

Cassandra

[Cassandra]

I'm trialing an Intellipap since last week - and it's doing the same to me - rasiing the pressure to the upper limit even though I'm awake and breathing.

I have no idea what causes it.

O.

Ozij, maybe we have uncovered a bug... errr... "undocumented feature." LOL

This could simply be a peculirity of this particular machine. I may end up calling customer service to discuss it with them if I don't get any insight here. Seems like a simple solution would be to not wear it while awake. And I can do kind of like I did last night: while reading, and until just before I doze off, wear the nasal pillow above my nose and only start the machine just before I go to sleep.

That would be a shame, though. I found that lower pressure very relaxing and sleep inducing. It will be a real balancing act to put the mask on and start the machine before I go to sleep, but not so long before that the pressure gets too high.

Cassandra

[roster]

Cass,

Did you have a titration study? What was your prescribed pressure?

Regards,

[twasbrillig]

OK - this thread has many areas of interest. Thanks for asking this great question, Cassandra!

One - I have heard someone else opine that your daytime breathing is MUCH different than your nighttime breathing. You breathe much slower and deeper, and I gather, it is not within the programming of the xPAPs to cover that much territory. (Your tidal volume is increased greatly because the metabolic demands of being awake even when quiet are huge compared to sleep) This person found that they were recording apneas as they were laying in bed awake in the morning and it was screwing up his average.

Second - do AutoPAPs have some kind of ramp feature that provides both the auto and a slow increase in pressure? I thought I wanted an AutoPAP, but if I have to go straight into that environment (constantly adjusting pressure) as I fall asleep, I am not sure that will work for me.

[Cassandra]

Cass,

Did you have a titration study? What was your prescribed pressure?

Regards,

Nope! No study.

I suppose I am sort of doing that now. I have no insurance and all that. My NP and I decided that I'd get an auto-cpap and see what happens. I feel like that makes me a somewhat complicated patient and customer. (I mean, I feel a bit guilty that I don't have a bunch of information that would make this situation easier to address.) But, there ya go.

Rooster, were you going to suggest that I lower my maximum pressure? It is currently set at 20. If I keep my 90% around 7, I may set the max to 12 or so, which is tolerable.

Cassandra

[BeanMeScot]

Cass,

Did you have a titration study? What was your prescribed pressure?

Regards,

She didn't have a sleep study due. This is her original thread viewtopic/t42909/Second-Guessing-My-Purchase.html. Her doctor felt she had sleep apnea and got her a machine.

[roster]

Cass,

Here is how I would self-titrate if doing this for the first time (with the knowledge and experience I have now):

1. Set the pressure range to 7 - 9 cm.
2. Check the data the next day, looking first at leaks.
3. If leaks are under control, look at apneas, hypopneas, snores.
4. If AHI or snores is unacceptably high and the machine spent much of the night at 9 cm, increase the pressure for the second night to 8 - 10 cm.
5. Repeat until a sweet spot is found.

If you raise the pressure and AI increases you need to be cautious about centrals.

Let's think about Positional Sleep Apnea viewtopic/t40307/viewtopic.php?f=1&t=40 ... 94#p352594 .

What position(s) do you sleep in? Are you sure?

[john5757]

Normally the auto CPAP should not increase the pressure while you are awake my old ResMed auto S7 did not do this while I was awake.

One possible solution is to increase the ramp time while you are up and reading for example. In auto mode the ramp time just means that the machine will stay at the lower pressure longer. Would that work for you?

[roster]

Thanks Beanie for the link to the post about Cass's sleep positions.

Cass,

If you sleep most of the night on your tummy, why do you start out on your back?

I recommend becoming a fulltime tummy sleeper using the Falcon position http://www.uarsrelief.com/sleeppositions.html .

If you look at my post on Positional Sleep Apnea, you will see an example of where the pressure needs vary greatly according to the sleep position. If this is true in your case, then your pressure needs will be higher on your back.

Regards,

[Cassandra]

Thanks Beanie for the link to the post about Cass's sleep positions.

Cass,

If you sleep most of the night on your tummy, why do you start out on your back?

Regards,

Thank you, rooster for your previous suggestions and the information on sleep positions. This is a great big experiment on myself, so I will try just about anything I am able to do!

As for why I start out on my back... Well, I am historically a thrasher. If I start out on my back, it is because I am reading. Also, I will often practice various relaxation techniques to help me fall asleep. For whatever reason, they seem to work better when I'm on my back. I usually end up on my stomach pretty quickly. It is the most comfortable position, as far as relieving the RLS goes anyway. But, very often, I will literally turn over and over and over while I am trying to go to sleep. Any time I spend on my back is coincidental. I usually wake up on my side. However, these last two nights that I've been using the APAP, I've awakened on my back, very comfortably I might add! But I didn't go to sleep that way.

I'm going to read this article about sleep positions. Thanks for taking the time to respond.

[BeanMeScot]

It is quite possible that once you are on CPAP and have your AHI and leaks under control, you won't thrash anymore. In fact, many people have the opposite problem. They find they become so still that they start having pain from not moving all night.

[Cassandra]

Normally the auto CPAP should not increase the pressure while you are awake my old ResMed auto S7 did not do this while I was awake.

One possible solution is to increase the ramp time while you are up and reading for example. In auto mode the ramp time just means that the machine will stay at the lower pressure longer. Would that work for you?

You know, that might be very helpful, John. I can set my delay time up to 45 minutes. That would allow me to enjoy the low pressure for quite a while before going to sleep. I