Sick and tired of being sick and tired

[nedi]

Hello all,
From what posts I've read this seems to be a great group with fantastic people, thanks for being a part!
I'm writing as someone who has suffered from CSA for at least 10 years, and have recently been diagnosed and using an APAP for about a month.
I use it faithfully and have no trouble adapting to sleeping positions, mask wearing, etc., but I cannot seem to dial it in to sleep through the night and/ or feel rested the next day.
I keep to a fairly consistent sleep schedule providing 7-9 hours of sleep a night. I've changed my diet and lost about ten pounds. I'm trying everything I can to get sleep.

I was told to set my machine to a 5. I have always been doubtful of that number due to the sleep study. I had less than 2 hours REM sleep for both diagnoses and prescription of 5.
When I wake up, my APAP is typically set between 9.5 and 10. I've tried setting the auto to function starting at 9 for about a week, but experienced exhalation through the mouth. Last night I brought the lower setting down to 6 and feel awful this morning.

I use the pillows, but have a full face as well. I figure the full face would prevent the mouth exhalation, but I can't seem to get a tight fit with my goatee and it always feels like I'm sucking the air through just to breathe.

Anybody know of a proper way to dial this in?
Would shaving and wearing the full face be a good start?

I am desperate and depressed, and my main goal in life now is to get a good night's sleep.
Any advice would be followed and appreciated,
Thanks

[Pugsy]

You have an APAP? You have data available most likely. Might help you if you saw your data and did your dialing in based on facts.

Don't know which APAP you are using but if you would go to your profile and add your equipment to your profile we could hopefully tell you about which software might work with your machine.

SleepyHead (information is in my signature) software works quite well with the ResMed S9 and PR System One machines.

Finally...even if things are dialed in optimally and you are sleeping soundly throughout the whole night..it can take more than a month to feel better. Often...a lot more than a month...which is not what you wanted to hear but it is the truth. There are lots of folks who improvement sneaks up on them and they don't see any huge major improvements quickly.

[adrianne]

I'm not experienced with an APAP, but I would definitely set your minimum higher. I've got straight CPAP set at 10 and I don't even use the ramp feature because I don't get enough air.

As for the full face mask - you could use that to address your mouth breathing. There are mask liners made by CPAP users that might help. I use a homemade mask liner with my nasal mask. The other route you could go is with a chin strap to keep your mouth closed. I've seen some people here reference taping, but I personally wouldn't. I mouth breathe a little on my nasal mask, but it's not enough to prevent me from getting good therapy.

Do you have a data capable machine? Have you looked at your data? Sometimes your data is better than how you're actually feeling.

[nedi]

Thanks for the replies! I have posted my equipment list.
I do have a memory card, but can't access it from my computer (it just won't recognize the darned thing). I'm sure I can find another student with a reader. Can I dump the data and use the software here?
So do you feel i should switch to the full face? Wouldn't a chin strap still let air out through the mouth?

[Pugsy]

Are you using EPR? If so, at what setting?
You have APAP...set at 5 minimum and what maximum?
Do you normally breathe through your nose just fine during the day?
Perhaps the addition of just a chin strap will help you keep your mouth closed during the night.
Full face masks are harder to seal due to surface area.

Your computer won't see the SD card? So you have SleepyHead installed but it just won't import? Which version of SleepyHead? Mac or Windows? Or does it just not find the data?

[nedi]

Im not familiar with the term. EPR. I set the APAP max to 20 thinking that it "knows what it's doing". nose breathing is fine during the day. If I keep my mouth closed, air still escapes between teeth. I'll try it though.
Perhaps I'm assuming too much re: card reader. I insert it and nothing happens. I expect windows (7) to alert me of a new device. I'll install sleepyhead and see what comes up.

[nedi]

After cleaning out my sd slot on my computer (mainly using the card, lol) I got sleepyhead to work.
No idea what to look for however.
Also noticed an EPRx3 in the data. Is that the humidity level?

[Pugsy]

EPR Exhale Pressure Relief. The machine will reduce your pressure by 1 cm per setting in EPR..example EPR set at 2 will reduce the pressure by 2 cm during exhale. It is a comfort feature. It won't ever allow the pressure to go down below 4 though (which normally is rather stifling anyway). Sometimes using EPR lets the pressure go a little too low and events can sneak past the defenses.

Does your computer have a SD slot? If so there is no need for a card reader. If no SD slot then any generic cheap SD card reader/adapter for a USB port will do. I have Windows 7 computer. All it does when I insert the SD card is give me a little pop up about how do I want to open this device. I close that window because I don't use any of those choices. You may not be getting that pop up for some reason or you just may not have seen it.

Best way to check to see if your computer sees the SD card is to go to MyComputer and navigate to the drive letter that the SD card is in and look from there. This is also how you point SleepyHead to where the SD card is to import the data. Make sure only the drive letter (Like E drive) shows in the import selection. If you go to the folder in the SD card you have gone too far. This is all explained in the User Guide along with pictures. The most common error is that people go one step too far in the folder selection process.

Setting APAP wide open 5 min and 20 maximum is sometimes a recipe for disaster. Especially for newbies. The pressure changes can really mess with mask seal. A fit that works great at 5 cm...doesn't work so great at a pressure of 10 cm. Going from 5 cm to 9 cm minimum...a bit of an adjustment and yes, likely to have some pressure trying to exit the mouth. I control this by placing my tongue to act like a door and the pressure doesn't try to exit my mouth. Works great while awake but when we sleep the tongue doesn't always make a good door....with time most of us have trained the tongue to stay where it needs to be to block the air from entering the mouth.

Some people have a habit of mouth breathing at night probably from gasping for air during apnea events.
They don't really need to breathe through their mouth (like with nasal congestion) but instead just have a habit of opening their mouth. Sometimes a chin strap is enough of a reminder that the mouth no longer needs to open to get enough air. With time some people can relearn the habit to keep mouth closed. For me that is preferable to trying a full face mask. But there are some people who just can't keep their mouths shut for whatever reason and they will need to use a full face mask.

You might do better with a higher minimum (but not 9 cm) say maybe 7 cm and perhaps work up to a higher minimum if the reports point to a need. At a pressure of 7 minimum...I wouldn't even use EPR. Now if your minimum ends up needing to be 10 or higher...yeah maybe use EPR if you need to. Not everyone needs EPR though. You might also want to reduce the maximum so that you don't have wild pressure fluctuations while you are getting used to things and dealing with leaks and such. Perhaps later increase the pressure if it needs to have more room. If it were me just starting out....I would do 7 cm minimum and 12 or 13 maximum...no EPR.. and look at my reports and see where the pressure wants to go. If it wants to stay around the 9 or 10 cm average...then perhaps use 8 cm min and base maximum on where the pressure tends to want to go for occasional super tough events.

Since you were given an APAP with a wide range I assume your doctor hasn't prescribed a set pressure and is okay with making a few adjustments to tweak the settings. When using APAP the minimum pressure is critical...it needs to be high enough to get to where it needs to be to effectively prevent the apnea events. These machines do not go from 0 to 60 in a blink of an eye. They go up in stages rather slowly and if the minimum is too low the events come and go before the pressure gets to where it needs to be.
Also..sometimes these pressure variations can be disruptive to some people. If we limit the variations in pressure we get a pressure that has enough of a head start to effectively deal with the events and not so much variation as to disturb sleep.

[Pugsy]

EPR X 3 means that EPR of 3 is on...your machine will reduce your pressure by 3 cm upon exhale.

At this point leave that alone till we see your other reports.

I like daily details and not summary statistics because we see the graphs on daily details.

You can post an image so we can see what you see. Here is how I post an image to make it seen here at the forum. I use Screen shots. Windows 7 ...use the Snipping Tool...much easier...it is found in your StartMenu/All Programs/Accessories....find it...right click on it...choose "pin to start menu" and it will always be on your start menu so you don't have to go hunting for it each time.


Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.

Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

[chunkyfrog]

Welcome, Nedi.
Mask fit is very important. Some guys have used a mask liner to help with the beard leakage, others have shaved it off.
My dear husband likes to leave his 'fur' intact all winter.
He has so-so fit with his Fisher-Paykel Flexifit 431 and excellent fit with his Respironics Fitlife Total face mask.
If you really want to use the nasal pillows, you may need a chin strap.
Many of us breathe through our mouths consistently, and will power is not enough when we are asleep.

[nedi]

Thanks all.
Pugsy, I'll try those settings tonight and post a pic soon.

[archangle]

Does it say "AutoSet" next to the power button on your machine, or "Escape Auto?"

The equipment listing will show this as "S9 AutoSet...."

You may need a chinstrap to keep your mouth closed. If all else fails, use a full face mask that covers both the mouth and nose.

[Starlette]

Good evening Nedi.

Welcome to the forum *offers cup of hot chocolate with a slash of hooch*. Sit back, relax, and read, read, read when you have a minute or two.
There is LOTS to learn about sleep apnea and how to control it. Lots of great peeps to help you through the process.

Starlette

[Guest]

"Sick and tired..." a familiar phrase. Are you a friend of Bill W? sandman19

[nedi]

Does it say "AutoSet" next to the power button on your machine, or "Escape Auto?"

The equipment listing will show this as "S9 AutoSet...."

You may need a chinstrap to keep your mouth closed. If all else fails, use a full face mask that covers both the mouth and nose.

Yes, It reads "escape auto".
I don't believe the chinstrap will help simply because I sleep, and breathe, with my mouth closed. Air only escapes when, in the the past, the blockage caused exhalation or, now, when pressure is too high. I may be missing something being new to all this, but it seems if my jaw was wired shut, air would still escape in these situations.