Primokew's Therapy Thread

[Primokew]

Hello from Australia,

After feeling like a zombie and having foggy brain everyday for a long time I went to my GP for a diagnosis in February. The GP recommended a sleep study and I was diagnosed with moderate sleep apnoea. I rented a Resmed AirSense 10 AutoSet from a sleep clinic and after using it for a few weeks I felt an improvement in my sleep quality and other areas, e.g. blood pressure. I bought the same brand of CPAP machine after renting and I haven't been feeling a significant improvement in sleep quality since the trial. I recently had the idea that my machine was probably not adjusted correctly and so I experimented with different settings over the past few weeks and have been adjusting the settings based on how I felt. So far, I'm still not feeling great but I'm feeling slightly better. I'm posting here so that I could get some help with optimising the settings for my machine in order to maximise my sleep quality.

So far the issues that I'm having are:

• I'm waking up frequently during the night and I'm not too sure what's causing it. Before my sleep apnoea diagnosis I had also experienced the same problem but it would be quite periodic: I would wake up during the night for a few months, it would stop for a few months and then come back again.
• When I wake up, I feel fatigued, my thought process feels sluggish and my brain feels quite foggy.

I have a week's worth of SleepyHead data which I've included below (sorry if it's too much) where I've been experimenting with the settings on my machine.

Any help would be appreciated!

[Pugsy]

Welcome to the forum.

Let's fix one thing in your equipment profile first...you have chosen the wrong machine.
You have the ResMed AirSense 10 AutoSet and you have chosen the AirSense 10 CPAP machine.
Probably because you didn't see the AutoSet up in the A's with the rest of the AirSense machines. That's because it is down in the R's because it got stuck with ResMed in the model name on the list and the list is alphabetical. Edit your machine equipment and scroll down to the R section and you will see it to make the correct choice. I mention this only to avoid confusion later when people might tell you that you don't have a full data machine which you obviously do.

Second thing...a few questions.
1...are you experiencing much nasal congestion at all?
2...do you take any medications of any kind? If so, what?
3...do you drink any alcohol in the evenings?

Sleep maintenance insomnia....the list of potential causes is very long and sleep apnea is just one item on that long list.
I don't see anything standing up screaming "fix me and you will sleep better" on your reports at any of the pressure settings you have tried. There's a slight maybe with the Flow limitations being a little bit active but I have my doubts as to how much of an impact they are having...want to rule out nasal congestion as a cause of your activity on the FL graph first.

[zonker]

Hello from Australia,

g'day.

nothing of value to add to advice for your journey. i just want to say, this is prolly the best first post i've seen, format-wise. you've obviously read things carefully here judging by this post. it really does help the experts here (i'm not one!) to give you good advice.

good luck!

[Primokew]

Welcome to the forum.

Let's fix one thing in your equipment profile first...you have chosen the wrong machine.
You have the ResMed AirSense 10 AutoSet and you have chosen the AirSense 10 CPAP machine.
Probably because you didn't see the AutoSet up in the A's with the rest of the AirSense machines. That's because it is down in the R's because it got stuck with ResMed in the model name on the list and the list is alphabetical. Edit your machine equipment and scroll down to the R section and you will see it to make the correct choice. I mention this only to avoid confusion later when people might tell you that you don't have a full data machine which you obviously do.

Second thing...a few questions.
1...are you experiencing much nasal congestion at all?
2...do you take any medications of any kind? If so, what?
3...do you drink any alcohol in the evenings?

Sleep maintenance insomnia....the list of potential causes is very long and sleep apnea is just one item on that long list.
I don't see anything standing up screaming "fix me and you will sleep better" on your reports at any of the pressure settings you have tried. There's a slight maybe with the Flow limitations being a little bit active but I have my doubts as to how much of an impact they are having...want to rule out nasal congestion as a cause of your activity on the FL graph first.

Thanks Pugsy,

I've changed my machine to the correct one, sorry for the mistake. My eyes must've jumped to the word Airsense at the top when I scrolled through which was why I missed it near the bottom.

1. I do have some nasal congestion and I've had it for a very long time. It does feel like I have a blocked nose sometimes but it's not significant enough to impact my breathing when I'm awake.
2. I do not take any medications.
3. I don't drink alcohol in the evenings (I very rarely drink alcohol).

I think your suspicions are correct. It will probably be worth bringing the issue up with my GP next time I see him so I can at least see a specialist for a diagnosis for my nasal congestion.

Hello from Australia,

g'day.

nothing of value to add to advice for your journey. i just want to say, this is prolly the best first post i've seen, format-wise. you've obviously read things carefully here judging by this post. it really does help the experts here (i'm not one!) to give you good advice.

good luck!

Thanks mate! Yeah, I've read through the newbie threads before I posted and I was worried that the image spam was a bit too much but good to know that someone thinks that formatting is at least readable.



I've included a screenshot of my SleepyHead report from last night below. I increased my minimum pressure up to 9 and haven't changed anything else (if SleepyHead indicates that I did, please ignore it since I accidentally changed some of the settings after I woke up). I feel slightly better than last night but I don't feel great. After I woke up it kind of felt like my lungs took a bit of a beating so the minimum pressure might be too high.

[ChicagoGranny]

I'm waking up frequently during the night and I'm not too sure what's causing it.

Do you think it's because you are sleeping with a pressurized hose attached to your nose?

[ChicagoGranny]

Seriously, keep troubleshooting. Here's a checklist that might help.

Good Sleep for CPAPers

- Practice good sleep hygiene (Google it and read several sources; ignore extreme advice.)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Do not listen to your breathing or the sound of the machine as you are falling asleep. (Some people, including me, actually find listening to their breathing and the sound of the machine to be relaxing.)
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy.
- If you are awakening at night, do not be too concerned. It is actually a normal part of sleep. (It does become a problem though for people who, when they awaken, become frustrated and have difficulty returning to sleep.)
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

This is a checklist. Some of the things you already do. Some are easy and can be done right away. Others you can work at over time.

CG

[zonker]

Thanks mate! Yeah, I've read through the newbie threads before I posted and I was worried that the image spam was a bit too much but good to know that someone thinks that formatting is at least readable.



I've included a screenshot of my SleepyHead report from last night below. I increased my minimum pressure up to 9 and haven't changed anything else (if SleepyHead indicates that I did, please ignore it since I accidentally changed some of the settings after I woke up). I feel slightly better than last night but I don't feel great. After I woke up it kind of felt like my lungs took a bit of a beating so the minimum pressure might be too high.

well, it takes most of us "some time" to get to feeling better. i put that in quotes because there is no hard and fast definition to just when you'll feel better. but keep going and get used to the experience first. you'll get to feeling better eventually.

good luck!

[Primokew]

Do you think it's because you are sleeping with a pressurized hose attached to your nose?

I think I've gotten used to sleeping with a cpap machine by now so I don't think that's the issue. I've also had this problem before I was using a cpap machine so it's not a new issue.

Seriously, keep troubleshooting. Here's a checklist that might help.

Good Sleep for CPAPers

- Practice good sleep hygiene (Google it and read several sources; ignore extreme advice.)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Do not listen to your breathing or the sound of the machine as you are falling asleep. (Some people, including me, actually find listening to their breathing and the sound of the machine to be relaxing.)
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy.
- If you are awakening at night, do not be too concerned. It is actually a normal part of sleep. (It does become a problem though for people who, when they awaken, become frustrated and have difficulty returning to sleep.)
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

This is a checklist. Some of the things you already do. Some are easy and can be done right away. Others you can work at over time.

CG

I do watch videos on my tablet while in my bed before I go to sleep so that may be the cause. I find that watching videos makes me more drowsy and helps me sleep but I think I'll try to sleep without watching videos in bed beforehand and see if there's an improvement.

I don't believe I have issues with everything else on the list.

well, it takes most of us "some time" to get to feeling better. i put that in quotes because there is no hard and fast definition to just when you'll feel better. but keep going and get used to the experience first. you'll get to feeling better eventually.

good luck!

Oh for sure, I'm not expecting to feel better straight away. It's just that I felt a significant improvement in energy and mental state when I had been renting a cpap machine and I'm not feeling that same improvement now that I have purchased a machine. I think it might be worth seeing a sleep specialist again to see if I can get some assistance.

[katestyles]

Oh for sure, I'm not expecting to feel better straight away. It's just that I felt a significant improvement in energy and mental state when I had been renting a cpap machine and I'm not feeling that same improvement now that I have purchased a machine. I think it might be worth seeing a sleep specialist again to see if I can get some assistance.

Was your rental followed immediately by your own PAP, or was there a gap?
Did you buy the exact same machine? Are you on the exact same settings?
Sorry if you have already covered this, and I just missed it.

[Julie]

Your chest muscles (not your lungs) are stretching out a bit with more pressure, but that's normal and will lessen in time. You didn't mention humidity, but I imagine if you keep it high thinking it's part of mandatory therapy regardless of ambient local conditions already being relatively humid, it's not necessary and may be causing your congestion. Many don't need it or use it much depending on their climates.

[Primokew]

Oh for sure, I'm not expecting to feel better straight away. It's just that I felt a significant improvement in energy and mental state when I had been renting a cpap machine and I'm not feeling that same improvement now that I have purchased a machine. I think it might be worth seeing a sleep specialist again to see if I can get some assistance.

Was your rental followed immediately by your own PAP, or was there a gap?
Did you buy the exact same machine? Are you on the exact same settings?
Sorry if you have already covered this, and I just missed it.

No that's alright, I didn't mention it before.

• I rented a machine from my local sleep clinic before purchasing my own machine.
• There was no gap between the end of my rental period and when I started using my own machine.
• The machine I bought was not from the same place where I got my rental.
• I requested a copy of the latest sleep report for my rental machine and the peculiar thing is that the settings on my rental were essentially set to their default settings, with an exception. The pressure settings I had was 4-20 autoset and EPR was set to 3, fulltime.
• Something else to note is that I did not have a consultation with the sleep specialist who wrote my sleep study report throughout the whole process. I think the only people who I had interacted with during my appointments at the sleep clinic were sales consultants.

Your chest muscles (not your lungs) are stretching out a bit with more pressure, but that's normal and will lessen in time. You didn't mention humidity, but I imagine if you keep it high thinking it's part of mandatory therapy regardless of ambient local conditions already being relatively humid, it's not necessary and may be causing your congestion. Many don't need it or use it much depending on their climates.

So it's been getting colder where I live recently and I've had to increase my temperature and lower my humidity settings because I was experiencing some rainout in my mask. Is a humidity setting of 2 considered high? I notice that when the humidity setting is low I will wake up with a dry mouth, hence why I tend to leave the humidifier on.





I have a couple of questions that I'm curious about:

1. Is it better to leave the maximum pressure setting at 20 or lower it to your average maximum pressure?
2. How beneficial or harmful is EPR and how can I tell when it would be a good idea to use it?

Here's some screenshots from the previous two nights. For the first night, I tried using an EPR of 3 but I only got about 7 hours of sleep which was not great because I usually need at least 8. For the second night, I increased my minimum pressure since I thought that I had to compensate for EPR. I felt about the same as the first night. These two nights seem to be worse than my previous nights on paper but I think I feel slightly better so I I'll try to lower my EPR to 2 and my minimum pressure to 8 and see how I go tonight.

[Julie]

Both questions (re humidity and EPR settings, if any) fall under "try it and see", because everyone's local climate, season, city block is different when it comes to humidity, and need for exhalation relief. No one can say what will work for you 'when', but change only one thing at a time and give it at least a couple of nights to be sure any difference in results is due to that change and not some other incidental thing.

[katestyles]

I have a couple of questions that I'm curious about:

1. Is it better to leave the maximum pressure setting at 20 or lower it to your average maximum pressure?
2. How beneficial or harmful is EPR and how can I tell when it would be a good idea to use it?

You can leave the maximum pressure at 20 for now.

EPR is mostly about comfort. It can cause some problems, but I don't think it is affecting you from looking at your screenshots.

I have my EPR set at 3. That means that when I am breathing out, the pressure from the machine drops to make it easier for me. As I begin to breathe in, the pressure goes back to the pressure I need to keep my airway open. On the machine you have, you don't need to do math to "compensate" for the EPR.
I would keep the minimum the same for a few days and see how you get on.

[Pugsy]

There's a lot about cpap stuff that comes with a big YMMV sticker.
A lot of sometimes this does so and so to some people and not to other people.
Using EPR and the drop during exhale can impact the therapy effectiveness in SOME people but not necessarily ALL people.
It all depends on where the line in the sand is for above so and so pressure the airway stays open for the most part and below that number the airway tries to collapse too much. Some people are using a minimum pressure that if they add in EPR then the subsequent drop brings them down below that line in the sand that keeps the airway open most of the time. Some people are using a minimum that it simply doesn't matter if they add in a little EPR or a lot of EPR for comfort because it's already a plenty high enough minimum and there's some room to let it drop without negatively impacting therapy.

I don't see your use of EPR negatively impacting therapy and allowing the airway to collapse. I see no need for an automatic increase in the minimum pressure from your around 10ish to make up for the small drop during exhale.

Humidity preferences come with a big YMMV sticker also.
Did you get a heated hose with your machine? That might be a better option for rain out control than trying to adjust humidity delivery.
You do have various options...see posts number 2 and 3 in this thread
viewtopic/t94035/Pugsys-Pointers-3Deali ... -road.html
Humidity is to help the nasal mucosa....some people need a high humidity setting and others don't.
Heck, I know husbands and wives who are both on cpap and one wants maximum humidity and the other wants next to none added humidity. Same household...same ambient humidity...same bedroom temps...same everything except personal preferences as to what the nose wants.

I learned a long time ago that my nose didn't like me messing with the humidity so now I have my preferred setting (close to maximum) and I just adjust the hose air temp as needed for the various seasons and ambient room temps. The amount of moisture my nose gets...always the same though.

[Primokew]

Thanks a lot for your advice guys, I'll see how I feel after a few nights.

Did you get a heated hose with your machine? That might be a better option for rain out control than trying to adjust humidity delivery.

I do have a ClimateLineAir hose and I have been adjusting the temperature to properly control rainout. It's been ok so far but I'll need to adjust the settings a bit to suit my needs.

Random question, what do you guys use to clean your CPAP equipment (hose, mask, etc) every week? I used to use liquid soap but now I started using dishwasher detergent since the handbook for the machine recommended a mild detergent.