New user, need sleepyhead help....PLEASE!!!

Yes, hyponeas are impacted by supine sleeping as well...think of them as baby OAs that didn't get chance to grow up.

My personal feelings about all this supine vs side sleeping....sleep in whatever position you sleep the best in and let the machine sort it out. If you have your pressures set optimally you won't necessarily have any worse problem on your back and if you sleep better in general that way....hey, that's the most important thing. The machine is going to blow the air no matter what position you are in..just make sure it is set optimally and you will do fine.

The only exception might be if you happened to find out that you need extraordinarily higher pressures when supine vs side sleeping and the use of those higher pressures caused problems (aerophagia, etc).
I know one person who needed a pressure of 9 when side sleeping but 18 when on his back...now I can't say as I blame him faced with those numbers.

Besides...while it is common to need more pressure when on one's back it isn't written in stone that you will..nor is it written in stone that if you do need more pressure that it will be a LOT more pressure....and it isn't written in stone that someone's OSA is worse on their back. Mine is worse in REM sleep and unchanged no matter what position I sleep in.

For all this therapy to give you the best chance of feeling better you gotta get the sleep first...and if trying to sleep in a position that isn't particularly your preferred position causes you to not sleep so great then you are defeating the original purpose and swapping one problem for another.

The "avoid supine sleeping" might be more important for someone not yet on cpap therapy.
Once on cpap...get the settings optimal to cover all potential bases and sleep in whatever position allows to sleep better in general.

and as suspected....AHI makes its way back up. As jeff goldblum said....Nature, uh...Finds a way....

I slept 'better' last night. from about 10:30-3AM I was out like a light. Then from about 3AM-'waking up' around 7:10 I was in and out, tossing and turning etc. No idea why. Not sure what happened with the pressure drop around 3...Weird. Feel very tired/fatigued today. Frustrated. Need. Sleep.

SleepyMcgee wrote:and as suspected....AHI makes its way back up. As jeff goldblum said....Nature, uh...Finds a way....

I slept 'better' last night. from about 10:30-3AM I was out like a light. Then from about 3AM-'waking up' around 7:10 I was in and out, tossing and turning etc. No idea why. Not sure what happened with the pressure drop around 3...Weird. Feel very tired/fatigued today. Frustrated. Need. Sleep.

My guess is that you hit the ramp button, possibly thinking it was the on/off button?

Check your clinical settings. If the ramp setting is ON, hitting the ramp button triggers the ramp. On a PR machine, the ramp comes on only if you push the ramp button. (That is different from a Resmed machine, where the ramp comes on when the machine is turned on.)

My guess is the 3am wake was a normal post-REM wake. But then you had serious trouble getting back to sleep after it and tossed and turned the rest of the night. And 4 hours of tossing and turning is enough to leave anybody exhausted.

Since you were tossing and turning from 3:00 to 7:10, it's likely that a fair number of the post 3AM events are "false" SWJ events.

Any chance the drop in pressure caused problems where you felt like "Gee I'm not getting enough air to breath comfortably"? Since you usually do NOT use the ramp, hitting that ramp button should have reduced the airflow into the mask for it to be noticeable to you, but you might not have been able to figure out the the problem was hitting the ramp button.

And by the way, I agree with Pugsy about sleeping on your back: If you can tolerate the pressure needed to control your OSA while sleeping on your back, then sleep on your back since that's your favorite position.

An experiment that I'd suggest: Keep the pressure setting where they are right now, but for tonight go to sleep on your back and stay there as much as you want to all night long. Then look at the data: If you need more pressure when you are on your back, it should show up in the data very clearly. If it's clear you need more pressure to allow back sleeping, then open up the machine by increasing the max pressure to whatever you think you can handle, and sleep on your back as much as you want for several days to find out how much pressure the machine thinks you need.

robysue wrote:

SleepyMcgee wrote:and as suspected....AHI makes its way back up. As jeff goldblum said....Nature, uh...Finds a way....

I slept 'better' last night. from about 10:30-3AM I was out like a light. Then from about 3AM-'waking up' around 7:10 I was in and out, tossing and turning etc. No idea why. Not sure what happened with the pressure drop around 3...Weird. Feel very tired/fatigued today. Frustrated. Need. Sleep.

My guess is that you hit the ramp button, possibly thinking it was the on/off button?

Check your clinical settings. If the ramp setting is ON, hitting the ramp button triggers the ramp. On a PR machine, the ramp comes on only if you push the ramp button. (That is different from a Resmed machine, where the ramp comes on when the machine is turned on.)

My guess is the 3am wake was a normal post-REM wake. But then you had serious trouble getting back to sleep after it and tossed and turned the rest of the night. And 4 hours of tossing and turning is enough to leave anybody exhausted.

Since you were tossing and turning from 3:00 to 7:10, it's likely that a fair number of the post 3AM events are "false" SWJ events.

Any chance the drop in pressure caused problems where you felt like "Gee I'm not getting enough air to breath comfortably"? Since you usually do NOT use the ramp, hitting that ramp button should have reduced the airflow into the mask for it to be noticeable to you, but you might not have been able to figure out the the problem was hitting the ramp button.

And by the way, I agree with Pugsy about sleeping on your back: If you can tolerate the pressure needed to control your OSA while sleeping on your back, then sleep on your back since that's your favorite position.

An experiment that I'd suggest: Keep the pressure setting where they are right now, but for tonight go to sleep on your back and stay there as much as you want to all night long. Then look at the data: If you need more pressure when you are on your back, it should show up in the data very clearly. If it's clear you need more pressure to allow back sleeping, then open up the machine by increasing the max pressure to whatever you think you can handle, and sleep on your back as much as you want for several days to find out how much pressure the machine thinks you need.

You're right. I think I hit the ramp button to try and help me get back to sleep. I dont understand why I'm tossing/turning so much...Its only happened since i increased min pressure to 10...Maybe I'm getting 4-5 hours of good sleep and then, since I dont need much more, I'm strugglng to get back into a good sleep pattern for the rest of the AM...

Also, I slept wherever I wanted last night. Side, back etc.

SleepyMcgee wrote: You're right. I think I hit the ramp button to try and help me get back to sleep.

You don't use the ramp at the beginning of the night. Are you comfortable with the pressure at 10cm at the beginning of the night If so, then going all the way down to 4.5cm with the ramp may actually have contributed to the problem of getting back to sleep. Not everybody feels comfortable breathing at very low pressures.

I dont understand why I'm tossing/turning so much...Its only happened since i increased min pressure to 10...Maybe I'm getting 4-5 hours of good sleep and then, since I dont need much more, I'm strugglng to get back into a good sleep pattern for the rest of the AM...

It's a plausible theory. The sleep data between 10:30 and 3:00 is quite good, although the small cluster of events around 2:45 may be REM-related. If this were my data, that small cluster would be no big deal, but then I can't tolerate additional pressure.

But some people are really sensitive to even very small clusters of events. If the pressure is not bothering you, you might want to increase the min pressure up to 10.5 and the max pressure up to about 12cm. That might be just enough to prevent even the short REM clusters.

You might also want to reevaluate what you do when you start tossing and turning for a long period of time. As a general rule, it's not a good idea to lie in bed not sleeping for long periods of time. But a lot of the time when we're tossing and turning, the problem is not that we're clearly awake the whole time, but rather we fall asleep for 10-20 minutes, then wake up for a few minutes, fall back asleep for a few minutes, and the whole cycle of wake/sleep/wake/sleep continues until we either finally fall back asleep or give up and get out of bed.

You might want to set a "time limit" on how long you stay in bed when you are aware that you are tossing and turning and simply cannot get back to a sound sleep. The quotes around "time limit" are intentional since I don't mean a time limit based on watching the clock. Rather I mean a soft, subjective time limit: If you are consciously aware of the fact that you are tossing and turning and it feels like you've been tossing and turning for 20-30 minutes and you're clearly not settling down, it may help to get out of bed for a few minutes. Go to the bathroom, even if you don't have an urge to go. Get a drink of water. Give yourself 5-10 minutes (or more if needed) to just get sleepy again. And then go back to bed and mask up.

Also, I slept wherever I wanted last night. Side, back etc.

Good. Too many people think they have to change their sleeping position just because they're on CPAP, and that's a mistake.

i'm so exasperated by this whole process lol. All i can do is laugh at this point...Or cry...!

Last night my AHI was ~1 and I am fatigued, tired etc today. I slept from ~11-4 and then in and out of sleep for most of the AM after that..I recall that when I FIRST started with CPAP this happened so I'm wondering if this is just me getting used to the much higher pressure I've set the machine at recently??....Regardless, with a low AHI and 5 hours of sleep + on and off sleep for another few hours...I gotta think there is something else going on here. Almost every week I get a random (not really random I know, I just cant figure out the variables that lead to it yet) amazing morning...

As always, welcome input and thank you for hanging through this process with me!!

oh, one thought...For the issue with waking...Would it make sense to try something to keep me asleep for the night? Tylenol PM etc...I know I know, it will make OSA's worse etc but...

SleepyMcgee wrote:i'm so exasperated by this whole process lol. All i can do is laugh at this point...Or cry...!

I remember feeling that way ALOT during my first 9 months. Still feel that way at times.

Last night my AHI was ~1 and I am fatigued, tired etc today. I slept from ~11-4 and then in and out of sleep for most of the AM after that..

You got out of bed at 7:15. Three hours of tossing/turning and going from WAKE to STAGE 1 is enough to make anybody exhausted. In other words, you may have been working too hard to get back to sleep. I think you ought to try just getting out of bed at the early morning wake and doing something 30-60 minutes and then going back to bed.

When my husband (who is also a PAPer) wakes up super early (and he usually does) he just gets up out of bed. He goes downstairs and does some things. (often getting caught up on email or web browsing) and comes back to bed in about 45 minutes and almost instantly falls sound asleep until it's time to get up. And he feels good throughout the day and has more energy than I do most of the time. He does go to bed earlier than I do, but then he gets up earlier even with the divided sleep thing.

I recall that when I FIRST started with CPAP this happened so I'm wondering if this is just me getting used to the much higher pressure I've set the machine at recently??....Regardless, with a low AHI and 5 hours of sleep + on and off sleep for another few hours...I gotta think there is something else going on here.

I think that what's going on is that your body is trying to tell you that it's ready to get up for at least a little while after 5 hours or so of sleep. I think it's the "on and off sleep for another few hours that's making you so tired.

Google the phrase "two phase sleep." Because I think that's what your body is trying to tell you that it wants. Before artificial lighting was invented, a lot of people would sleep in two distinct phases with an alert, wakeful period between them. People got up during that wakeful period, did some things in the dark, and then went back to bed after about hour or so and slept the rest of the night. It's a perfectly normal sleep pattern for humans, but modern society somehow thinks this kind of a sleep pattern is "wrong" or "unhealthy". But it works for a lot of people. For example, my husband usually goes to bed around 10:30 or 11:00. He wakes up around 3:30 or 4:00, gets up and does things until about 5:00 or so, comes back to bed and sleeps until about 7:00ish. He's getting more total sleep than I do and his sleep is actually much better quality. And he doesn't think there's anything "wrong" with his sleep pattern and he doesn't complain about tossing and turning and not being able to get back to sleep after he wakes up in the middle of the night.

SleepyMcgee wrote: Tylenol PM etc...I know I know, it will make OSA's worse etc but...

be very very careful with acetaminophen, it's easy to accidentally kill yourself with that stuff. a relatively small overdose can put you into liver failure.

robysue wrote:

SleepyMcgee wrote:Three hours of tossing/turning and going from WAKE to STAGE 1 is enough to make anybody exhausted. In other words, you may have been working too hard to get back to sleep. I think you ought to try just getting out of bed at the early morning wake and doing something 30-60 minutes and then going back to bed.

This is reasonable but when I wake up at 3 or 4 I am exhausted, I want to sleep. I have had mornings (after a really good night) where at 5 or 6 I'm ready to jump out of bed and get rolling on stuff. WHen that happens, I dont force myself back to sleep...

palerider wrote:

SleepyMcgee wrote: Tylenol PM etc...I know I know, it will make OSA's worse etc but...

be very very careful with acetaminophen, it's easy to accidentally kill yourself with that stuff. a relatively small overdose can put you into liver failure.

I find that crushing it in a whiskey gets the job done...

KIDDING. I was being too specific with Tylenol PM. I really just mean any sleep aid (without ibuprofen, acetaminophen, other pain meds etc)

SleepyMcgee wrote:

palerider wrote:

SleepyMcgee wrote: Tylenol PM etc...I know I know, it will make OSA's worse etc but...

be very very careful with acetaminophen, it's easy to accidentally kill yourself with that stuff. a relatively small overdose can put you into liver failure.

I find that crushing it in a whiskey gets the job done...

KIDDING. I was being too specific with Tylenol PM. I really just mean any sleep aid (without ibuprofen, acetaminophen, other pain meds etc)

you're quite right, that does get the job done, to the surprise of quite a few people a year "More than 56,000 emergency room visits. 2,600 hospitalizations. An estimated 458 deaths due to acute liver failure."

the dangers of 'tylenol' have been downplayed since it's introduction. I remember flipping through the PDR (Physicians Desk Reference) many years ago, and was reading the entry for Tylenol 4, (tylenol with codeine) and came across a large WARNING section in the entry... I figured it would be a reminder of the dangers of narcotics, but to my surprise, it was warning of small acetaminophen overdose causing liver failure.

My own personal thoughts about the various sleep aids out there.
First disclaimer...always discuss these type of meds with your doctor to make sure that you don't have anything going on that would be a big problem.
You gotta weigh the good with the bad...even an aspirin comes with disclaimers.
Tylenol Pm (minus the tylenol) is nothing more than diphendyramine 25 mg....Benadryl.
Benadryl at the 25 mg dose is pretty benign. Potential bad side effects are minimal and mainly the biggest complaint is the morning hangover the next day.

I look at sleep aids this way....do I feel worse the next day taking a sleep aid or not taking a sleep aid?
Is a bit of a morning hangover (that goes away fairly rapidly upon awakening) preferable to feeling like crap all day because I slept poorly.

I have some other health issues that would cause me extremely fragmented sleep if I didn't take some sort of sleep aid.
We are talking in excess of 30 to 40 awakenings/arousals that I remember. That pretty much guarantees feeling like crap all day.

I did discuss all this with my sleep doctor...this is what I was told.
The OTC sleep aids are unlikely to make much of an impact on the OSA itself. They aren't well known for suppressing respiration or causing the airway tissues to collapse and thus make OSA worse. She told me to try whatever I wanted to try and take whatever works for me if I wanted to do the OTC thing.

Now some of the RX sleep aids maybe not so much but you have to weigh the risk vs rewards. I was told that the worst of the RX meds in terms making OSA worse were the muscle relaxers. RX pain meds...maybe somewhat but she told me that she would rather see me take a good old opiate (Tylenol #3, or similar) than a muscle relaxer for pain management. The opiate having less potential for making things worse than the muscle relaxer. It all comes down to risk vs rewards....and what is the goal.

I opt for sleep aids (and yes, I talked this all the over with my doctor) because the "problems" with the sleep aids are less of a problem than horribly sleep quality is. Do I wish I didn't have to take something...sure I do but if I don't I just can't get any good quality sleep due to the other health issues...and I do the best I can given the hand I have been dealt. I do have Plans A, B and C for my choice of sleep aids so that I don't run the risk of becoming "dependent" on any one Plan.

Benadryl is cheap and might be all a person needs. Worth trying (assuming no health issues that would be a potential conflict and run it by your doctor to make sure).

Thanks everyone.

Pugsy et al. Intersted to get your thoughts on the leak rate? My mask is very comfortable and 'passes' with flying colors on my XPAP leak test...I dont wake up to leaks etc. But sleepyhead software is telling me to get it checked...Thoughts?

SleepyMcgee wrote:Thanks everyone.

Pugsy et al. Intersted to get your thoughts on the leak rate? My mask is very comfortable and 'passes' with flying colors on my XPAP leak test...I dont wake up to leaks etc. But sleepyhead software is telling me to get it checked...Thoughts?

the programmer for sleepyhead, while being clever with respect to deciphering undocumented data, is very lazy, and randomly sticks defaults into sleepyhead that are inappropriate and cause unending confusion for new users.

one such is defaulting all machines to use the resmed 'leaks over 24lpm are bad' rule. you don't have a resmed, this rule does not apply to you.

go into sleepyhead, "file/preferences" and on the cpap tab, uncheck "flag leaks over threshold".

then look for 'large leak' flags on the events strip, that's all you need to worry about.

SleepyHead defaults to the leak statistics (that % of time in large leak) to the ResMed line in the sand and not the Respironcis line in the sand and there is a huge difference in the line in the sand numbers.

Go to preferences/cpap tab and either turn off the "show leak % of time over the threshold" so it won't tell you something about your leak number and how it compares to ResMed or change the 24 L/min line in the sand to something more suitable for your Respironics machine. Respironics never gives us an exact threshold because it can vary with pressure and mask...but for your machine and mask something up around 70 L/min would be more appropriate.

Or just ignore SleepyHead's warning and look at the Events graph...IF your machine senses a large leak it will be flagged on the events graph.

I just looked at your last night's report...no LL (large leak) flags at all and the total leak number (that top line) never comes close to large leak territory. You aren't having any large leaks.
SH is using that 24 L/min line in the sand to do the statistics thing (on the left side under the other statistics) and with Respironics machines that threshold isn't an accurate threshold.
I run into the same problem when I go from my S9 to my PR S1 machine...SH tells me I am leaking like crazy in terms of the % of time over the red line...but I am not. Since the S9 is my primary machine I just ignore the statistic for % of time in large leak when I use the Respironics.

Your choice...ignore, turn it off or change the threshold.