multiple awakenings in the night

these pictures will show that there has been a lot of activity the last few nights. also, the charts are arranged as best i can. don't forget, devilbiis does not hand over any flow rate info to sleepyhead.



on 3/25 my ahi was 4.14, which is slightly better than usual. i had my min pressure at 12 with a max pressure of 20. was still slightly bloated, but tolerable. still woke up frequently. the last hour before i got up i slept great.



on 3/26 my ahi was 2.98. so, emboldened by being able to sleep with the min of 12, i decided to try min of 13. nope, nope, nope! bloating no worse, but i slept poorly. more like a light trance or doze. very aware of my surroundings. and very difficult to breathe. i was breathing shallowly. finally, at 4:30 am, i gave up and turned min pressure to 10.5. but the crazy thing is, the display panel on the devilbiss said at that point, i was at 17.5 pressure! yet sleepyhead does not show my pressure going up that high. huh? but i slept well the rest of the night.



last night 3/27 my ahi was 2.53. min of 10.5 and for no reason i can remember, max changed to 18. this was the best night by far! slept for long periods at a stretch. and after a pee break at sometime after 4 i slept solidly until after 7!! at this point, i'm leaving the settings alone and see how i go tonight.

i even got to experience something new to my cpap therapy. we had a power outage at 7:19, but it came right back on about a minute later. so i got the thrill of not being able to breath for about a minute, then suddenly, all okay. if that wasn't enough, while i lay there just thinking, the power did the same thing again! hope i never have to go through a full power outage. yuck!

but outside of that, i think i may be on the right path here.

what do you think?

Things don't look too bad, but I seriously think you might want to try a full face mask (or some other fix) because your leak rate is high.

I only saw the LL (large leak) marker once, Mar 19. The leak plots have three traces. You have to look closely in order to see the excess leak plot hugging the bottom.

poppi2 wrote:I only saw the LL (large leak) marker once, Mar 19. The leak plots have three traces. You have to look closely in order to see the excess leak plot hugging the bottom.

I don't see devillbass data that often on the forum.

What are the three traces on the Leak Graph? I get that the bottom one that hugs the 0 line is your SH-computed excess leak. But which of the other two graphs is the Total Leak Rate and what is the third graph? Most machines only generate two leak lines in SH.

robysue wrote:What are the three traces on the Leak Graph? I get that the bottom one that hugs the 0 line is your SH-computed excess leak. But which of the other two graphs is the Total Leak Rate and what is the third graph? Most machines only generate two leak lines in SH.

I also wondered about that. One line makes it look like his leak is under control and another makes it look like it is out of control

.

robysue wrote: .... What are the three traces on the Leak Graph? I get that the bottom one that hugs the 0 line is your SH-computed excess leak. But which of the other two graphs is the Total Leak Rate and what is the third graph? Most machines only generate two leak lines in SH.

SH labels the red trace as "Max Leaks", one green trace as "Total Leaks", and another green trace as "Leaks". I poked around the Devilbiss site and found the Smartlink Sell Sheet (https://www.devilbisshealthcare.com/fil ... 092711.pdf) that shows a leak plot with two traces, labeled 'Maximum Leak' and 'Average Leak.' I don't know if this answers any questions, but this is more info about theDevilbiss machine than I need to know. Earl

Julie wrote:Things don't look too bad, but I seriously think you might want to try a full face mask (or some other fix) because your leak rate is high.

and i think you're high! no, that's just a joke. i have no idea if the leak rate is too high or not. it doesn't feel that way to me and i don't even know if i should worry about it, frankly.

tried a full face mask. tried a nasal mask. both leaked over the bridge of the nose. plus, i have a full beard, which i'm not prepared to shave, so i'm sure i had leaks there with the full face mask.

so i'm thinking i'm sticking with what i have. it's comfortable and doable....

poppi2 wrote:I only saw the LL (large leak) marker once, Mar 19. The leak plots have three traces. You have to look closely in order to see the excess leak plot hugging the bottom.

thanks, poppi2. that seems consistent with what i'm feeling.

<sigh> sometimes i think i didn't make the right selection on cpap machines.

robysue wrote:

poppi2 wrote:I only saw the LL (large leak) marker once, Mar 19. The leak plots have three traces. You have to look closely in order to see the excess leak plot hugging the bottom.

I don't see devillbass data that often on the forum.

What are the three traces on the Leak Graph? I get that the bottom one that hugs the 0 line is your SH-computed excess leak. But which of the other two graphs is the Total Leak Rate and what is the third graph? Most machines only generate two leak lines in SH.

maybe i can post more devilbiss data and we will ALL learn something new! i'm going with what poppi2 says in response to you, because, as i said, it feels right to me. plus that bottom line looked much worse when i was doing the not-nasal-pillows mask.

all i know for now is that sleeping with a min of 10.5 pressure didn't work last night. was back to multiple awakenings. have set min to 11.5 for tonight. we'll see if i can eventually acclimate to increasing min pressures. those higher mins work great on attacking the hypopneas but aren't working so great on the bloating.

it's been a rollicking week as far as cpap goes. i went a little nuts and tried a bit of everything. mostly, i just kept fiddling with my pressure. kept trying to increase the bottom pressure and trying to leave the top pressure alone. here are some graphs for you to point and laugh at-













sorry, that's a lot of graphs but wanted them up in case someone asks. in each instance, my AHI was under 5 and i think mostly above 4.

now, i'm not what you call a slow and methodical man. i get all kinds of antsy about stuff like this. hence, i would end up changing my pressure in the middle of the night.

the problem comes down to aerophagia. when i first started my treatment, it wasn't an issue because my pressure was never turned up enough to cause it to be a problem. my problem then was just getting used to any pressure at all. but now that i've started increasing pressure, the aerophagia rears it's ugly head.

so it seems to me i need to treat that first. i've been looking around the forum here and i see that this is yet another area in which we are all special snowflakes. what works for thee might not work for me. so i just went through what works for thee and i started trying it out.

last night. i tried elevating my head. i already had a wedge pillow around, so why not try that? by trying it out, i found it doesn't work for me. in a way, it made it slightly worse. i tried turning down the pressure, twice i think, but that didn't help.

finally, at slightly after 4 am, i decided to turn the pressure back to 12 and then try the "falcon" sleep position. i had tried this maybe 3 times before, but wasn't comfortable with it as i have never slept on my stomach. well, i've got to say that it worked. i actually fell asleep! at some point, i rolled out of it because i woke up on my side, just long enough to be aware, then went back to sleep.

then that big push of pressure around six woke me. i put on my sleep mask as it was getting to be light out. went back to sleep and slept until 8:40!

so this is success but i know one night doesn't mean much. also, i did the "falcon" before when i first went to bed.and then gave up on it after about an hour. i feel like if i try it again at the beginning, it won't work. but i'm going to try.

besides me just typing away here and mulling this all over, i do have a question.

for those of you who have suffered aerophagia, how did you conquer it?

zonker wrote: for those of you who have suffered aerophagia, how did you conquer it?

Short answer: Switch to bi-level, time, patience, using a max pressure that's high enough to keep the AHI < 4 but low enough to not trigger the aerophagia on a constant basis, and doing everything I can to not promote excessive restlessness during the night time.

Longer answer:
I had extremely severe aerophagia issues right from the start. As in within 3 days of starting CPAP I was waking up in serious pain with a visibly distended stomach that was rock hard with excess air. After the first two weeks of misery, the PA in the sleep doc's office switched me from CPAP to APAP. That helped some, but six weeks later I was still having a lot of problems with aerophagia waking me up at night and it was serious enough to continue feeding my growing CPAP-induced insomnia as well as triggering an absolute loathing of bedtime. That's when the PA suggested a bi-level titration. The first bi-level titration study was pretty bad in the sense of my sleep efficiency (I slept only 25% of the time I was in bed), but I was much more comfortable with the bi-level machine while lying in bed awake and I didn't feel like I'd swallowed a bowling ball when morning came.

It took another 2 months and a second bi-level titration study to fine tune the pressure range that I still use before the aerophagia started to become less of an issue. As the insomnia was reined in and I continued to use the pressure range in my signature, the aerophagia decreased to the point where it is not much of an issue.

There are some compromises with my pressure settings: I get a consistently lower AHI when I bump my min EPAP up to 5 or 6 and my max IPAP up to 9 or 10. The number of nights where the machine detects snoring typically goes down with higher pressure levels. BUT my aerophagia issues come back and with them comes the insomnia and an increase in restlessness. In other words, I feel better with an AHI that ranges from 1.5 to 3.0 with lower pressures and little or no aerophagia than I do with an AHI < 1.5 and pressures high enough to trigger aerophagia on a pretty consistent basis.

My advice to you: Don't just keep increasing the pressure trying to get the AHI down to an absolute min. First work on learning how to sleep well with the machine at a max pressure level that is right at the point where you know it tends to trigger your aerophagia with a min pressure level at least 2-3cm below the pressure level that you know triggers the aerophagia. Leave the pressure settings alone for one week regardless of the AHI. Then evaluate what is going on. If the AHI < 5 at a pressure you can use without getting aerophagia, you might be better off tolerating a slightly higher AHI for no aerophagia than increasing the pressure to reduce the AHI from the 4-5 range to the 0-2 range but triggering aerophagia in the process.

robysue wrote:

zonker wrote: for those of you who have suffered aerophagia, how did you conquer it?

Short answer: Switch to bi-level, time, patience, using a max pressure that's high enough to keep the AHI < 4 but low enough to not trigger the aerophagia on a constant basis, and doing everything I can to not promote excessive restlessness during the night time.

thanks robysue. your insightful and well reasoned long response deserves more than i can type now. so it's off to the printer. then i well keep it near to hand and see what i can take from it.

again, thanks!

robysue wrote:

zonker wrote: for those of you who have suffered aerophagia, how did you conquer it?

Short answer: Switch to bi-level, time, patience, using a max pressure that's high enough to keep the AHI < 4 but low enough to not trigger the aerophagia on a constant basis, and doing everything I can to not promote excessive restlessness during the night time.


My advice to you: Don't just keep increasing the pressure trying to get the AHI down to an absolute min. First work on learning how to sleep well with the machine at a max pressure level that is right at the point where you know it tends to trigger your aerophagia with a min pressure level at least 2-3cm below the pressure level that you know triggers the aerophagia. Leave the pressure settings alone for one week regardless of the AHI. Then evaluate what is going on. If the AHI < 5 at a pressure you can use without getting aerophagia, you might be better off tolerating a slightly higher AHI for no aerophagia than increasing the pressure to reduce the AHI from the 4-5 range to the 0-2 range but triggering aerophagia in the process.

wow, you certainly went through a lot. i don't know if i'd have the gumption to stick to it like you have. good job!
fortunately, my problem is nowhere near what you have described. in fact, i think i may quit calling it aerophagia! maybe more like simple bloating.

last night was the worst yet, though. yesterday, i got pretty busy with other things and didn't read your reply. so i just kept things set as they were. nothing changed settings wise. yet, i had gas throughout the night, but just kept on, again, not changing anything.

so this morning i read what i printed out. i'm going to go with the advice i quoted above tonight. i THINK that sweet spot, the highest i can go without triggering, is 10 or maybe 10.5. so you are saying, if i find that spot is 10, i should drop it to 8? and of course then leave it alone for a week to see what is up.

sounds like a simple plan, one simple enough for me to follow.

zonker wrote:wow, you certainly went through a lot. i don't know if i'd have the gumption to stick to it like you have. good job!

I come from a Southern family known for its stubborness.

so this morning i read what i printed out. i'm going to go with the advice i quoted above tonight. i THINK that sweet spot, the highest i can go without triggering, is 10 or maybe 10.5. so you are saying, if i find that spot is 10, i should drop it to 8? and of course then leave it alone for a week to see what is up.

I'd recommend setting the minimum pressure to 8cm and the max pressure to 10.5. And leave the settings alone for a week. In other words, for a one week period do not worry at all about the AHI. Focus on whether the bloating (aerophagia) is better, worse, or about the same when the max pressure is set to 10.5. And focus on whether or not it's getting easier or harder to get a decent night's sleep with all the equipment. And how you're feeling in the daytime.

At the end of the week you'll want to look at the data pretty closely to determine whether a pressure range of 8-10.5 is high enough to control your OSA well enough. And whether or not there's a strong correlation between how you are feeling on the days with the highest and lowest AHIs.

robysue wrote:

zonker wrote:wow, you certainly went through a lot. i don't know if i'd have the gumption to stick to it like you have. good job!

I come from a Southern family known for its stubborness.

meaning you have grit(s)?

so this morning i read what i printed out. i'm going to go with the advice i quoted above tonight. i THINK that sweet spot, the highest i can go without triggering, is 10 or maybe 10.5. so you are saying, if i find that spot is 10, i should drop it to 8? and of course then leave it alone for a week to see what is up.

I'd recommend setting the minimum pressure to 8cm and the max pressure to 10.5. And leave the settings alone for a week. In other words, for a one week period do not worry at all about the AHI. Focus on whether the bloating (aerophagia) is better, worse, or about the same when the max pressure is set to 10.5. And focus on whether or not it's getting easier or harder to get a decent night's sleep with all the equipment. And how you're feeling in the daytime.

At the end of the week you'll want to look at the data pretty closely to determine whether a pressure range of 8-10.5 is high enough to control your OSA well enough. And whether or not there's a strong correlation between how you are feeling on the days with the highest and lowest AHIs.

that sounds like a plan, robysue. will be back in here next week and let you know what happened.....