Awakening frequently

[unknown12345]

Hi,

I've been on CPAP for almost 5 years and have not been able to find out why I only sleep (poor quality though) for 2 hours max at a time.
Up after 2 hours then back to sleep in 5 minutes or so & then sleep for a max of 2 hours & cycle continues ... in the morning tired with headache.
I've been using Resmed S9 Auto and have had the leak pretty much in control (95% is about 13).

Anybody has had similar issue? Any ideas/suggestions?

Info regarding me:
59 year old male, 150 lb, no other medical issues, in good shape
CPAP: Resmed S9 Auto
Mask: Swift FX nasal
Pressure: Min: 6.0, Max: 11.8 Auto ... on the average SleepyHead shows that pressure goes up to about 13
AHI range: 0.7 - 4 (depending on leak)

Thank you for your help.

[Pugsy]

Do you use the software available to see your therapy results in detail...especially flow limitations?
And have you ever tried straight cpap fixed pressures to eliminate the changing pressures being a potential factor in causing the wake ups?

[tan]

Hi,

I've been on CPAP for almost 5 years and have not been able to find out why I only sleep (poor quality though) for 2 hours max at a time.
Up after 2 hours then back to sleep in 5 minutes or so & then sleep for a max of 2 hours & cycle continues ... in the morning tired with headache.
I've been using Resmed S9 Auto and have had the leak pretty much in control (95% is about 13).

Anybody has had similar issue? Any ideas/suggestions?

Info regarding me:
59 year old male, 150 lb, no other medical issues, in good shape
CPAP: Resmed S9 Auto
Mask: Swift FX nasal
Pressure: Min: 6.0, Max: 11.8 Auto ... on the average SleepyHead shows that pressure goes up to about 13
AHI range: 0.7 - 4 (depending on leak)

Thank you for your help.

More details like in this post, please (press F12 to capture the image to be uploaded to either imgur or some other file server):
viewtopic.php?p=963296#p963296

[englandsf]

Something sounds odd - you say "Pressure: Min: 6.0, Max: 11.8 Auto ... on the average SleepyHead shows that pressure goes up to about 13"

How can your max be 11.8 but sleepyhead record 13? Isn't that wrong?

[unknown12345]

Thank you all for replying.

Some clarification:

Settings:
Pressure: Initial: 6, Min: 11.8, Max: 20, Ramp: 10 minutes

Below is an image from 2/3/2015 (interestingly: SleepyHead for Win8 (64-bit) shows much higher numbers than Win8 (32-bit))!!

http://imgur.com/faKVBwV

From these numbers I see that may be I should raise the min?
Does CA really mean Central Apnea?
Do I have Central Apnea? If so, do I need to switch to VPAP?
I have an sleep study scheduled in 10 days.

Thank you all.

[tan]

Thank you all for replying.

Some clarification:

Settings:
Pressure: Initial: 6, Min: 11.8, Max: 20, Ramp: 10 minutes

Below is an image from 2/3/2015 (interestingly: SleepyHead for Win8 (64-bit) shows much higher numbers than Win8 (32-bit))!!

http://imgur.com/faKVBwV

From these numbers I see that may be I should raise the min?
Does CA really mean Central Apnea?
Do I have Central Apnea?

yes, you have some Central events.

There are a few problems:
- leaks;
- too low starting pressure;
- flow limitations (although, not show on the charts);

[Pugsy]

Unless you are seeing a lot more centrals than showing here these centrals (CAs) don't mean you have Central Apnea.
There's not enough of them to earn that diagnosis.
Having a few centrals is not alarming and is actually normal. They are a problem when a person has too many of them all night long every night. It's very possible that your centrals are related to awakenings and are either post arousal central or a sleep onset central which is considered a normal happening and only a problem when there's a large number or they keep a person from progressing into deeper sleep stages.

Your leak threshold to avoid is 24 L/min and you can easily see where you exceed that line on the graphs. It's the LL on the events graph and gray.

[unknown12345]

yes, you have some Central events.

There are a few problems:
- leaks;
- too low starting pressure;
- flow limitations (although, not show on the charts);

I read about flow limitations, what do my numbers indicate? Any adjustments needed?

Your leak threshold to avoid is 24 L/min and you can easily see where you exceed that line on the graphs. It's the LL on the events graph and gray.

Question is: Why is the machine decreasing pressure when "LL" block starts? Shouldn't machine be increasing the pressure as leak increases to compensate for the leak?

Thanks.

[Pugsy]

Question is: Why is the machine decreasing pressure when "LL" block starts? Shouldn't machine be increasing the pressure as leak increases to compensate for the leak?

None of these newer machines will increase the pressure to try to fix a leak because in most situations more pressure is going to do nothing more than make the leaks worse. So it won't increase the pressure when you are having big leaks because it isn't supposed to nor is it designed to.

If you could include the flow limitation graph it might be more useful than just the numbers.
In the meantime I will go try to find one of my flow limitation graphs so you can compare yours to mine...and mine is nearly textbook perfect "no or very minimal flow limitations".
It will take me a little bit and I will post it back here in this box when I do.

Here you go. You may need to click on it to enlarge it for better viewing.

[tan]

yes, you have some Central events.

There are a few problems:
- leaks;
- too low starting pressure;
- flow limitations (although, not show on the charts);

I read about flow limitations, what do my numbers indicate? Any adjustments needed?

You better show the chart, but numbers alone indicate that they should be quite noticeable.

This topic is quite controversial. Some sleep well with quite wild flow limitations. I have tried to minimize them and eventually I sleep well, but I can't really tell how much of a factor flow limitation were for I don't want to experiment with them anymore. I know that my APAP pushed pressures up to 14, trying to take care of flow limitations, so I set the increased pressure as a starting point (gradually).

Leaks and mouth drying out, even with FFM, were definitely detrimental to my therapy until I fixed them too.

[unknown12345]

Question is: Why is the machine decreasing pressure when "LL" block starts? Shouldn't machine be increasing the pressure as leak increases to compensate for the leak?

If you could include the flow limitation graph it might be more useful than just the numbers.

Thx for replying ...

Below is another image with Flow Limitation:
http://imgur.com/At3KUhf

What do my numbers mean? Any setting changes I need?

Thanks again.

[unknown12345]

yes, you have some Central events.

There are a few problems:
- leaks;
- too low starting pressure;
- flow limitations (although, not show on the charts);

I read about flow limitations, what do my numbers indicate? Any adjustments needed?

You better show the chart, but numbers alone indicate that they should be quite noticeable.

This topic is quite controversial. Some sleep well with quite wild flow limitations. I have tried to minimize them and eventually I sleep well, but I can't really tell how much of a factor flow limitation were for I don't want to experiment with them anymore. I know that my APAP pushed pressures up to 14, trying to take care of flow limitations, so I set the increased pressure as a starting point (gradually).

Below is one definition I found on "apneaboard":

Flow Limitation Curve
A flow limitation is a change in the inspiration part of the wave flow that is thought to indicate that the patency of upper airway is compromised. In other words, when the upper airway is just beginning to show signs that it is starting to collapse, the shape of the inspirations in the wave flow change in a mathematically measurable way. Sometimes this change is visible to the human eye and sometimes it's subtle enough where it's hard to spot. At any rate, both the Resmed S9 AutoSet and the PR System One Auto will increase the pressure in response to flow limitations since flow limitations indicate that the airway is in danger of collapsing.

The flow limitation data, however, is recorded in very different ways on the two different machines. The PR System One Flow Limitation Data is flagged as tick marks in the event table and there is no Flow Limitation graph. (A note to PR System One users: Flow Limitation data is recorded ONLY if the machine is running in AUTO mode.) The Resmed S9 machines record flow limitation data as a function of time, so you get a graph rather than tick marks.

This next paragraph applies ONLY to Resmed S9 data: On the flow limitation graph, the vertical scale in ResScan is made up of three crypic icons that indicate "an uncompromised airway", "a partially compromised airway", and "a fully compromised airway." Jedimark's vertical scale uses numbers instead of icons. You can roughly think of the numbers as "percents" since a 1 on Jedimark's scale corresponds to "a fully compromised airway" and a 0 on Jedimark's scale corresponds to "an uncompromised airway" and a 0.5 on Jedimark's scale corresponds to the "partially compromised airway" icon in the ResScan graphs. Since flow limitations are thought to indicate that the airway is potentially in danger of collapsing, in theory, you'd like that flow limitation graph to stay relatively close to the 0 line. In practice, however, you may need to find a working compromise between the pressure needed to smooth out the flow limitation line to an acceptable amount and a pressure level that you can still tolerate in terms of mask leaks and aerophagia. In other words, if the flow limitation line is still really, really ragged and you're still dealing with OSA symptoms, increasing the pressure a bit may help smooth out the flow limitation line and you might feel better. But you don't want to just keep increasing the pressure in an attempt to get a perfect flow limitation line if creates problems with mask leaks or aerophagia or other pressure related problems. Flow limitations don't bother everybody equally and if you are more bothered by the increased pressure than the flow limitations, it may be better to accept a more ragged flow limitation line if that allows you to actually get some quality sleep with the mask on your nose.

I am going to read it a few more times and probably compare it with other definitions ...
BTW. I am a mouth breather & I tape my mount (& have no issue w/ it)

[palerider]

Question is: Why is the machine decreasing pressure when "LL" block starts? Shouldn't machine be increasing the pressure as leak increases to compensate for the leak?

why would the machine *increase* pressure?

1) that would be bad because you don't need more pressure because of a leak. the flow will increase to maintain pressure.

2) if the leaks are bad enough, the machine will decrease pressure in an effort to get the mask to seal again. however, that behavior isn't evidenced in your chart.

[unknown12345]

A general purpose question:

From all my readings I see that, e.g., Resmed S9 VPAP Auto's algorithm will detect CSA and possibly suppress that.
I might or might not have CSA ...
What if I just switch from my current S9 Auto to S9 VPAP, use it for a few weeks & see what happens? No harm, correct?

Thx.

[Pugsy]

I think Sludge said FL below 0.40 wasn't horrible..._Please correct me if I am remembering incorrectly...the higher the spikes on the FL graph the worse it is..I know that. So for the most part while you show more activity than compared to what I might see...it isn't horrible. I have seen much worse.

Do you experience a lot of nasal congestion because sometimes nasal congestion is the culprit and a person then needs to address that aspect?

Otherwise FLs are usually reduced with more minimum pressure...how much is unknown and is trial and error.
Are these FLs impacting your sleep quality? Maybe...maybe not but would be worth investigating to see if reducing them help your sleep quality any.

If you have a lot of nasal congestion issues...those need to be addressed because they can cause FL increases.