Help for new Auto-Cpap user

[NadiaR]

Hi

I have just started treatment on auto-cpap. I've used it for four nights now and I wake up with a headache, even more tired than usual, and a terrible mood all day. I've already bitten off the heads of several family members I'll save you the long story and just mention that I am self-treating so I am worried I am not doing things right. I am hoping people on the forum will be able to advise me on how to proceed. (Please skip the part about advising me to see a sleep doctor - there aren't any where I live).

I have an auto-cpap which is set to the wide range of 5-20 and I was hoping the machine would be able to adjust to my needed pressure. I read about EncoreBasic and SleepyHead and I've imported the data into both programs. I'll admit I don't understand everything the program is telling me. My AHI numbers seem to be down in a great range now (4.05, 2.26, 4.35, 3.29 for the four days). My 95% pressure according to sleepyhead was 8.40, 10.50, 9.10, and 7.50 on the four days. So it looks to me like the machine is working well?

My question to you guys is should I be doing something else to improve my therapy? Or are my symptoms normal and I should just hang in there? If so, how long before I should expect to feel better in the morning?

Thank You

I have a System One by Philips Respironics 60 Series REMstar Auto w/ Humidifier and a Swift FX Nasal pillow mask.

[robysue]

I have just started treatment on auto-cpap. I've used it for four nights now and I wake up with a headache, even more tired than usual, and a terrible mood all day. I've already bitten off the heads of several family members

Some of us do feel (a lot) worse right after starting PAP therapy. When this happened to me, my sleep doc could/would not offer any explanation as to why.

Sleeping with a hose attached to your nose is not natural and it takes some of us a lot longer than average to start feeling better.

I have an auto-cpap which is set to the wide range of 5-20 and I was hoping the machine would be able to adjust to my needed pressure. I read about EncoreBasic and SleepyHead and I've imported the data into both programs. I'll admit I don't understand everything the program is telling me.

I'm in the process of writing an extensive Guide to SleepyHead. One section that should help you a lot is 4. Basic data interpretation: Daily Detailed Data.

My AHI numbers seem to be down in a great range now (4.05, 2.26, 4.35, 3.29 for the four days). My 95% pressure according to sleepyhead was 8.40, 10.50, 9.10, and 7.50 on the four days. So it looks to me like the machine is working well?

The numbers look good, provided the leaks are under control. What do the leak numbers look like? Also what's the distribution of events in the AHI? How much is the CAI? Given where those 95% pressures are, you might feel better (and the AHI might go down a bit) if you raised the minimum pressure from 5 to 7 as long as the bulk of the events your machine is registering are NOT CAs.

My question to you guys is should I be doing something else to improve my therapy? Or are my symptoms normal and I should just hang in there? If so, how long before I should expect to feel better in the morning?

To improve therapy takes some time: You need to make sure the leaks are under control and that the mask is comfortable. And post some detailed data so that we can see whether a slight increase in minimum pressure is called for.

As for how long it will take to start feeling better. It depends. A few lucky souls feel better almost immediately, but don't. For most people it takes several weeks to a couple of months to start feeling better. For some of us, it takes longer---as in 4-6 months. For an unlucky few, it can take a year or more.

And most people improve gradually rather than waking up one morning feeling fantastic. The signs that things are improving can be subtle at first. For many people the first sign that things are turning around is that they start making few trips to the bathroom during the night. For me, the first sign PAP was doing something positive was when I noticed that I was waking up without hand and foot pain every morning.

[NadiaR]

Thank you robysue for your answer and reassurance!

I'm not sure if you mean leak rate or total leaks. There's a huge difference between the two in terms of numbers. Last night might Leak rate was min. 0.0 med 0.0, 95% 3.00 and Max 20.00. Total leaks last night were Min 6.00, Med 17.00, 95% 21.00, Max. 38.00.

By detailed data, do you mean sleepy head graphs? I'm sharing last nights graphs here - I hope I'm doing this right:
14-07-12 16.43.04 by Nadia.hm.rah, on Flickr
14-07-12 16.43.15 by Nadia.hm.rah, on Flickr
14-07-12 16.54.55 by Nadia.hm.rah, on Flickr

I couldn't find the CAI. Could I ask what that is?

Thank You again

[BuddhaCat]

Robysue,

I'm also new to CPAP and to the forum. Can you explain what you mean by: "For many people the first sign that things are turning around is that they start making few trips to the bathroom during the night." I've read that comment in a few places and I'm wondering why fewer trips to the bathroom would be caused by CPAP therapy. I'd love for this to happen!

Thanks!!

[Tatooed Lady]

adjust your humidity. When I tried using higher humidity, I had headaches...NASTY ones. I dropped to level 2, and I'm good. Yours may need to be raised, but by playing with the numbers a bit, you may find the "sweet spot".

Potty breaks were explained to me with something like...the body gets tense at night when we have sleep events. All that tenseness (is that a word?) causes our organs to go into overdrive...and the bladder winds up being very active. With xPAP therapy, our events get more minor, our bodies relax, and...the bladder no longer is in overdrive at night. When I was told that I'd make fewer trips to the bathroom at night, I panicked, thinking that I'd be an adult bed wetter. Nope. It turns out that my bladder just doesn't fill as quickly, even when I drink the same/similar amounts during the day/evening. It's like a miracle, only with less Divine Intervention.

I don't much care, so long as it works, and I know how to make it continue.

[NadiaR]

Ah, very interesting Tattooed Lady. I will try changing the humidity setting for tonight. I just left that on the default level, whatever that was. I also didn't bother with pre-heating or anything like that. I was only thinking about pressure. Thank you for the advice

[palerider]

I'm also new to CPAP and to the forum. Can you explain what you mean by: "For many people the first sign that things are turning around is that they start making few trips to the bathroom during the night." I've read that comment in a few places and I'm wondering why fewer trips to the bathroom would be caused by CPAP therapy. I'd love for this to happen!

here's the cycle, you stop breathing, your body decides you're suffocating, stress hormones flood your system, brain tells heart "need more oxygen! beat faster!" your pulse shoots up, your blood pressure does too, you gasp, get some o2, things settle down a little, and the cycle repeats, raising your bp.

your kidneys, meanwhile, get the signal "bp is too high, get rid of excess water to lower it" and start cranking out pee..

break the cycle, and the kidneys get to nap too.

[robysue]

Thank you robysue for your answer and reassurance!

I'm not sure if you mean leak rate or total leaks. There's a huge difference between the two in terms of numbers. Last night might Leak rate was min. 0.0 med 0.0, 95% 3.00 and Max 20.00. Total leaks last night were Min 6.00, Med 17.00, 95% 21.00, Max. 38.00.

I thoroughly explain all about leaks in 8. Leaks in the SH Guide.

Loosely, every mask has a built in intentional leak rate so that you don't rebreathe CO2. Any leaks detected that are above the intentional leak rate are called excessive or unwanted or unintentional leaks. SleepyHead uses these conventions:

Total Leak Rate = Intentional leak rate + unintentional leak rate = leak rate recoded by your PR machine.
Leak Rate = statistical estimation of the UNINTENTIONAL leak rate

The RedLine in your leak graph is IRRELEVANT since you are using a PR System One machine. The RedLine is to help Resmed S9 users detect large leaks. Large leaks on your PR System One will be indicated by gray bars on a LL line in the event table that only shows up with Large leaks are present and a gray background on the flow rate data.

Your leaks are EXCELLENT and so you don't need to worry about them.

By detailed data, do you mean sleepy head graphs?

Yes. Thanks for sharing them.

I couldn't find the CAI. Could I ask what that is?

CAI = clear airway apnea index. It's the purple line in the event data on the left side bar. A clear airway apnea is presumed to be a central apnea (CA), an apnea that occurs when the airway is NOT obstructed. A few CAs now and then are fine. But a small minority of PAPers run into a problem with pressure induced central apneas, and its important to NOT tell someone with a huge number of CAs to just increase the pressure. Your CAI = 0.39 on the posted night of data, and it appears the machine scored 2 CAs all night long. If this is typical, that means you do NOT need to worry about central apneas. And you might do better if you increased the min pressure up from 5 cm to 6 or 7cm. I'd recommend only increasing the pressure 1cm at a time and leave the new setting in place for a week or so.

The reason I'm suggesting that is the fact that you have a cluster of OAs that kick in around 7:00-7:30, which might be related to your last REM cycle of the night. And a bit higher of a minimum pressure may allow your machine to more gracefully respond to the OAs during the last REM cycle and prevent more of them from happening.

[BuddhaCat]

Thanks to Tattooed Lady and palerider for explaining the potty break phenomenon. Absolutely amazing!! I'm convinced that my TMJ (bruxism and nighttime clenching, pain, headache on waking) are also related to OSA. I recently started TMJ treatment and am really curious to see whether my TMJ abates when my OSA is controlled.

[NadiaR]

Thank you very much for checking my graphs and for your advice. I'll raise the pressure tonight and keep it for the coming week as you suggested. Have a great evening

[palerider]

Thanks to Tattooed Lady and palerider for explaining the potty break phenomenon. Absolutely amazing!! I'm convinced that my TMJ (bruxism and nighttime clenching, pain, headache on waking) are also related to OSA. I recently started TMJ treatment and am really curious to see whether my TMJ abates when my OSA is controlled.

before cpap, when I was exausted all the time, and getting up to pee several times a night, I naively thought "oh, I'm getting some rest now, so my kidneys are working better!"

now, I know better.

[Wulfman...]

Hi

I have just started treatment on auto-cpap. I've used it for four nights now and I wake up with a headache, even more tired than usual, and a terrible mood all day. I've already bitten off the heads of several family members I'll save you the long story and just mention that I am self-treating so I am worried I am not doing things right. I am hoping people on the forum will be able to advise me on how to proceed. (Please skip the part about advising me to see a sleep doctor - there aren't any where I live).

I have an auto-cpap which is set to the wide range of 5-20 and I was hoping the machine would be able to adjust to my needed pressure. I read about EncoreBasic and SleepyHead and I've imported the data into both programs. I'll admit I don't understand everything the program is telling me. My AHI numbers seem to be down in a great range now (4.05, 2.26, 4.35, 3.29 for the four days). My 95% pressure according to sleepyhead was 8.40, 10.50, 9.10, and 7.50 on the four days. So it looks to me like the machine is working well?

My question to you guys is should I be doing something else to improve my therapy? Or are my symptoms normal and I should just hang in there? If so, how long before I should expect to feel better in the morning?

Thank You

I have a System One by Philips Respironics 60 Series REMstar Auto w/ Humidifier and a Swift FX Nasal pillow mask.

Well, you're just starting, but.......
The pressure changes may be wrecking your sleep. The machines have no idea what pressure you "need"......they just respond to events and adjust pressures. The lack of pressure changes indicate that it's found the proper pressure which eliminates most of the events.

My suggestion (for now) is to keep raising your minimum pressure until it stops bumping the pressure. Right now, your minimum is at 5 but it's showing that it's chasing events and going up to at least 8 - 11. It takes time to raise pressures and the more it has to start with means the fewer pressure increases it has to do. In other words, the minimum pressure is VERY important to preventing events.

Since you're using a nasal mask, keep a close eye on your leak numbers. If you lose your therapy air out your mouth it compromises your therapy and the accuracy of the other numbers. There should be a chart that came with the mask (in the user manual) that shows what the "typical" leak rate is for various pressure settings.

If you find your machine is still changing pressures too much and you're still waking up with headaches and feeling unrested, consider switching to a single/straight pressure. When you hit a deep or REM sleep stage, your breathing can change. Those changes can cause the machine to interpret the changes as flow limitations......one of the events that trigger pressure increases. When this happens, the pressure bump could throw you out of that needed sleep stage and into a lighter one. Consequently, you may miss out on the sleep stages you NEED.......and you wake up feeling unrested and worse.


Den

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