Maxing out pressure to test mask fit on A10

[palerider]

We're talking about cathyf. Having seen her current and past reports and how many times she has to reset/restart her machine to lower the pressure because of the "runaways", I'd call that "unnecessary" at the least and "torture" to some degree.

true, we are, and if she'd said that the leaks, and the pressure woke her up, then i'd be all for reducing the pressure. I was just reacting, in this case to her saying she slept through them.

[Wulfman...]

Cathy,

If you're open to suggestions, mine would be to gradually drop (and keep dropping) your maximum pressure setting and see what happens.


Den

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[cathyf]

We're talking about cathyf. Having seen her current and past reports and how many times she has to reset/restart her machine to lower the pressure because of the "runaways", I'd call that "unnecessary" at the least and "torture" to some degree.

Nah, that's not how it works at all! I turn the machine on, and as long as I'm awake I stay at my minimum pressure of 11. Then when I go to sleep it starts chasing flow limitations and snores, and the pressure climbs up into the mid-to-high-teens. Then I transition out of whatever stage of sleep that is, and the pressure falls, and THEN, when it hits about 12-13 or so, I wake up. Before cpap, this would mean a trip to the bathroom because my back teeth are floating, and then back to bed, and/or feeling smothered and needing to sit up. Since cpap started, I don't usually need to hit the bathroom (YIPPEE!) but I am frequently unable to get back to sleep which really just pisses me off. (So even though I no longer have the frequent bathroom trips, there is still lots of pissiness in my life ) When I am lying there not sleeping, and watching the clock, I know that I won't remember any of this exactly and the only way I will know how long I was awake and how often I was awake is if I reach over and hit the stop button on the A10 and restart it. Because I almost never wake up until after the pressures are back down to near minimum anyway, the resetting of the machine to my 11cm minimum pressure isn't really much different than if I let the machine wander back down there because I don't have FLs or snores when I'm awake.

And, ok, I'll admit it, I'm really ornery during bouts of insomnia, and pushing the button is taking out my frustration on the machine! The amazing thing about last night is that I think that it is the first night in years -- maybe decades -- that I have simply slept through the night. 6 hours and 42 minutes and I don't remember waking up once!

Here's the picture from last Thursday -- much more typical with the frequent waking. Interestingly, the big pressure jump had a little short spike in leaks, and the long stretch of leaks came later in the night at lower pressure:

[Wulfman...]

We're talking about cathyf. Having seen her current and past reports and how many times she has to reset/restart her machine to lower the pressure because of the "runaways", I'd call that "unnecessary" at the least and "torture" to some degree.

Nah, that's not how it works at all! I turn the machine on, and as long as I'm awake I stay at my minimum pressure of 11. Then when I go to sleep it starts chasing flow limitations and snores, and the pressure climbs up into the mid-to-high-teens. Then I transition out of whatever stage of sleep that is, and the pressure falls, and THEN, when it hits about 12-13 or so, I wake up. Before cpap, this would mean a trip to the bathroom because my back teeth are floating, and then back to bed, and/or feeling smothered and needing to sit up. Since cpap started, I don't usually need to hit the bathroom (YIPPEE!) but I am frequently unable to get back to sleep which really just pisses me off. (So even though I no longer have the frequent bathroom trips, there is still lots of pissiness in my life ) When I am lying there not sleeping, and watching the clock, I know that I won't remember any of this exactly and the only way I will know how long I was awake and how often I was awake is if I reach over and hit the stop button on the A10 and restart it. Because I almost never wake up until after the pressures are back down to near minimum anyway, the resetting of the machine to my 11cm minimum pressure isn't really much different than if I let the machine wander back down there because I don't have FLs or snores when I'm awake.

And, ok, I'll admit it, I'm really ornery during bouts of insomnia, and pushing the button is taking out my frustration on the machine! The amazing thing about last night is that I think that it is the first night in years -- maybe decades -- that I have simply slept through the night. 6 hours and 42 minutes and I don't remember waking up once!

Here's the picture from last Thursday -- much more typical with the frequent waking. Interestingly, the big pressure jump had a little short spike in leaks, and the long stretch of leaks came later in the night at lower pressure:

And......you had a 0.00 with much less pressure (or spiking) throughout the night. You've made my point about lowering your maximum pressure settings.
I get some leaks, too.....they start abruptly, end abruptly and I never know I had them till I look at my reports in the morning.


Den

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[cathyf]

I'm actually thinking of raising my minimum pressure more, because 90% of the time when I wake up in the night it's when my pressure has fallen. I'm afraid, though, that's not what's going on. I think what's happening is that the normal sleep architecture is something like this:

awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N3 -> N2 -> REM -> N2 -> N3 -> N2 -> REM -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake

But I may be doing something more like this:

awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake

where instead of going from REM directly back to N2 I'm cycling up to all the way awake. Looking at the respiration rates, I think I see REM sleep where it goes up and gets jaggier, and then when that settles down it my pressure comes back down and I wake up. In my sleep study my stages statistics were:

N1: 1.8%
N2: 67.5%
N3: 12.7%
REM: 18.0%

And my first Wake After Sleep Onset was 64 minutes. (The report I have is a summary and doesn't have a lot of information about sleep architecture. Because somehow in all of the layers of referrals and reports, nobody communicated that I was being evaluated for narcolepsy.)

[palerider]

I'm actually thinking of raising my minimum pressure more, because 90% of the time when I wake up in the night it's when my pressure has fallen. I'm afraid, though, that's not what's going on. I think what's happening is that the normal sleep architecture is something like this:

awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N3 -> N2 -> REM -> N2 -> N3 -> N2 -> REM -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake

But I may be doing something more like this:

awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake

I wake up during the night (NO I'M NOT GOING TO SET A CONSTANT PRESSURE!), usually to turn over, or fiddle with the mask and then usally go right back to sleep. now and again I don't, sometimes I'll read, or have a glass of milk or something similar, and then go back to sleep. fortunately, it's the exception rather than the rule that I can't get back to sleep (seemingly) pretty quickly. I imagine that I have a situation like yours with the 'light' sleep turning into 'light' awakening.

my nook simple touch with glow light is quite nice for reading in the dark, just bright enough to read, but not lcd tablet/notebook glaring bright.

[Wulfman...]

I'm actually thinking of raising my minimum pressure more, because 90% of the time when I wake up in the night it's when my pressure has fallen. I'm afraid, though, that's not what's going on. I think what's happening is that the normal sleep architecture is something like this:

awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N3 -> N2 -> REM -> N2 -> N3 -> N2 -> REM -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake

But I may be doing something more like this:

awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N1 -> awake

where instead of going from REM directly back to N2 I'm cycling up to all the way awake. Looking at the respiration rates, I think I see REM sleep where it goes up and gets jaggier, and then when that settles down it my pressure comes back down and I wake up. In my sleep study my stages statistics were:

N1: 1.8%
N2: 67.5%
N3: 12.7%
REM: 18.0%

And my first Wake After Sleep Onset was 64 minutes. (The report I have is a summary and doesn't have a lot of information about sleep architecture. Because somehow in all of the layers of referrals and reports, nobody communicated that I was being evaluated for narcolepsy.)

RIGHT! You MAY be doing those sleep stages (in that order) BECAUSE the increased pressures triggered by your breathing changes (or Flow Limitations or Snores) during REM are bumping you out of your needed sleep stages and into lighter ones and awake. I've been saying that for a long time with regard to how ranges of pressures can mess with one's sleep architecture.


Den

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[palerider]

RIGHT! You MAY be doing those sleep stages (in that order) BECAUSE the increased pressures triggered by your breathing changes

*reconstitutes the dead horse for further beatings*

[cathyf]

RIGHT! You MAY be doing those sleep stages (in that order) BECAUSE the increased pressures triggered by your breathing changes

*reconstitutes the dead horse for further beatings*

But if I don't let the machine chase the flow limitations and snores of REM sleep, then I won't have adequate pressure to keep the apneas and hypopneas away. I have an untreated REM ahi of 45, and a treated REM ahi of essentially zero, so maybe the machine is overreacting, but I somehow doubt it. Interestingly, I see this pattern where during one REM -- often the first REM of the night -- the pressure pops up, but during several other REMs it stays down near the minimum. So I don't think that the algorithm is overreacting.

To return to the original topic, I found the "mask fit" menu option and used it last night. According to the display it was blowing at 20cm during the mask fit, but I sure couldn't tell any difference between that and when it returned to 11cm after I ended the fit. I had it at 20cm for a couple of minutes while I rolled around to various positions. When I first put the mask on and start the air, my ears will pop (which is why I know my mask leaks when my mouth is closed -- I close my mouth to swallow and pop ears, and air squirts out one corner or another.) But it's not different for 11cm and 20cm. Maybe I can tell the difference while asleep, but I sure can't tell the difference when I'm awake!

[Pugsy]

I see this pattern where during one REM -- often the first REM of the night -- the pressure pops up, but during several other REMs it stays down near the minimum.

You know this was something I also saw often and mainly during the first REM stage about 90 minutes into sleep.
I saw it so often I just got to calling it my witching hour. Sometimes nothing at all the rest of the night in terms of pressure increases and sometimes maybe a little during those wee hours of the morning but the first one almost always showed the greatest increase. I always slept quite well though and pressure changes never bugged me so that's why I never wanted to really try fixed pressures...sometimes that witching hour pressure was around 18 cm and the rest of the night it was around 12. I sure as heck didn't want to use 18 all night even if I could get used to it.

I have no idea if the pressure changes you are experiencing are a factor in your fragmented sleep or not.
If you had the fragmented sleep and sort of sleep maintenance insomnia issues prior to starting cpap therapy then I would lean towards it not being much of a factor since you don't seem to be complaining of pressure issues.

You have to be the one to decide if you wish to try a fixed or tight range pressure. It looks like it would involve a higher pressure than you are using much of the night though and that may not be something you wish to do. Sort of like I didn't want to use 18 cm all night just so I had the witching hour covered. There's almost always some sort of trade off with this therapy.

That said...it wouldn't be impossible for those pressure changes to be impacting sleep quality and for that reason perhaps a visit to maybe a really tight range might be worth considering just so you know for sure or not.
I did it with a tight 2 cm range myself to see if I slept any better or not...it made no difference in my situation but I did have some nasty clustering during that witching hour when I limited the machine at 10 to 12. If it had made a substantial difference in sleep quality then I would have had to decide if it was worth the trade off...letting the cluster slide by or not.
It's not something you just have to do tonight though....you are new to therapy and still dealing with mask leaks and generally getting used to the therapy.
It is something that I would at least suggest that you consider just on the off chance that it might help with the fragmented sleep...now if your fragmented sleep issues resolve on their own to the point that you don't have any issue with them...hey if it aint' broke do go trying to fix it.

I still get a few wake ups during the night (maybe 3 to 5) that I remember but I always go right back to sleep and I am 99.9% sure of what my issue is...it's when I wake up on my back and my back hurts like bloody hell. It's the pain that wakes me up and nothing else.

[Wulfman...]

RIGHT! You MAY be doing those sleep stages (in that order) BECAUSE the increased pressures triggered by your breathing changes

*reconstitutes the dead horse for further beatings*

But if I don't let the machine chase the flow limitations and snores of REM sleep, then I won't have adequate pressure to keep the apneas and hypopneas away. I have an untreated REM ahi of 45, and a treated REM ahi of essentially zero, so maybe the machine is overreacting, but I somehow doubt it. Interestingly, I see this pattern where during one REM -- often the first REM of the night -- the pressure pops up, but during several other REMs it stays down near the minimum. So I don't think that the algorithm is overreacting.

To return to the original topic, I found the "mask fit" menu option and used it last night. According to the display it was blowing at 20cm during the mask fit, but I sure couldn't tell any difference between that and when it returned to 11cm after I ended the fit. I had it at 20cm for a couple of minutes while I rolled around to various positions. When I first put the mask on and start the air, my ears will pop (which is why I know my mask leaks when my mouth is closed -- I close my mouth to swallow and pop ears, and air squirts out one corner or another.) But it's not different for 11cm and 20cm. Maybe I can tell the difference while asleep, but I sure can't tell the difference when I'm awake!

The algorithm is REacting.....predominantly to your flow limitations. Basically, your machine is keeping you in a lighter stage of sleep when you need some deeper sleep stages and REM (from what I see)......and if your sleep stage estimations are pretty close.

If you want to try to prove me wrong, progressively decrease your maximum pressure and see if you hit a "sweet spot" of a range or even a single pressure. It seems to me that if you're spending more time in lighter sleep stages, your "events" will be fewer, too.......and that's probably why you're having low AHI numbers.


Den

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