Last Night Was First Night

I'm currently in limbo waiting for the insurance to approve my BIPAP machine. In the meantime, I'm at a fixed pressure of 20cm. It works okay but I definitely need it higher.

However, my humidification chamber is always bone dry in the morning. I don't even have it turned up very high, it's at a 3. Is this because my pressure is so high? I have virtually no leaks. I do also live in Colorado which is a pretty dry climate. Any tips on this?

Iancdub88 wrote: ↑

Mon Sep 02, 2024 10:55 am

However, my humidification chamber is always bone dry in the morning. I don't even have it turned up very high, it's at a 3. Is this because my pressure is so high? I have virtually no leaks. I do also live in Colorado which is a pretty dry climate. Any tips on this?

The combination of high pressure and a dry climate are the likely reasons you keep running out of water in the tank since you don't have a leak problem.

Your choices on how to make that water last a bit longer include:

1) Turning the humidifier down.
2) If you are using a heated hose, turning the hose temperature down.
3) Adding a room humidifier so the ambient humidity in your bedroom is not so dry. This is the one that will probably do the most to help with your problem.

Also worth adding: When you have the heater on, keep the bedroom on the cold side. That will increase the relative humidity, which in turn will help the water in the CPAP humidifier tank not evaporate so quickly. With A/C you can try setting the thermostat a bit lower at night, but the real problem with A/C is that it dehumidifies the air as well as cools it.

robysue1 wrote: ↑

Mon Sep 02, 2024 11:14 am

The combination of high pressure and a dry climate are the likely reasons you keep running out of water in the tank since you don't have a leak problem.

Your choices on how to make that water last a bit longer include:

1) Turning the humidifier down.
2) If you are using a heated hose, turning the hose temperature down.
3) Adding a room humidifier so the ambient humidity in your bedroom is not so dry. This is the one that will probably do the most to help with your problem.

Also worth adding: When you have the heater on, keep the bedroom on the cold side. That will increase the relative humidity, which in turn will help the water in the CPAP humidifier tank not evaporate so quickly. With A/C you can try setting the thermostat a bit lower at night, but the real problem with A/C is that it dehumidifies the air as well as cools it.

Thank you Robysue1!

I got approved for a bipap but it could take a couple of weeks. I am so tempted to just take a break from the cpap until then. Is that a really bad idea? It controls my AHI which is over 59 without it but I just never feel rested like I did before treatment.

Iancdub88 wrote: ↑

Tue Sep 03, 2024 3:55 pm

I got approved for a bipap but it could take a couple of weeks. I am so tempted to just take a break from the cpap until then. Is that a really bad idea? It controls my AHI which is over 59 without it but I just never feel rested like I did before treatment.

Personally I wouldn't take a two week break. If you do, you will be starting all over from Square 1 with regards to getting used to the feel of the mask on your face with air blowing into it while you are trying to get to sleep.

Yes, I understand you don't (yet) feel as rested as you did before CPAP. But sleeping without it and allowing those 59 events/hour to again occur while your brain "tricks" you into thinking you got an ok night's sleep because there's none of the disruption caused by still working on getting use to the PAP machine is just going to convince your unconscious that it is still worth fighting against the whole idea of sleeping with the machine.

robysue1 wrote: ↑

Tue Sep 03, 2024 4:20 pm

Personally I wouldn't take a two week break. If you do, you will be starting all over from Square 1 with regards to getting used to the feel of the mask on your face with air blowing into it while you are trying to get to sleep.

Yes, I understand you don't (yet) feel as rested as you did before CPAP. But sleeping without it and allowing those 59 events/hour to again occur while your brain "tricks" you into thinking you got an ok night's sleep because there's none of the disruption caused by still working on getting use to the PAP machine is just going to convince your unconscious that it is still worth fighting against the whole idea of sleeping with the machine.

Any tips on trying to increase comfort in the meantime? Sleeping pills have not worked for me because they've made me feel drugged during the day.

So I have another question. I should have the BIPAP next week. In the meantime, I have finally found a sleeping pill that seems to help called Trazadone. I've had a couple OK nights of sleep despite the fact that I'm still not getting deep enough breaths for REM(that's where the BIPAP comes in). Anyways, I've found that I've been waking up on my back quite a bit and that back sleeping has actually become fairly comfortable. However, I always hear people saying how bad supine sleeping is with CPAP.

Is it really that bad to sleep on your back? I only had an AHI of 0.3 last night.

Iancdub88 wrote: ↑

Fri Sep 06, 2024 8:11 am

Is it really that bad to sleep on your back?

Not for everyone. There are a few people who will have a significant worsening of OSA and/or need a lot more pressure when supine but it's not going to be that big of a deal for most people.
Besides....if in auto mode and a person does need more pressure we can just let the machine sort it out.

My OSA isn't any worse when I am on my back but it sure is worse when I am in REM (quite common) so I really don't worry about back sleeping very much. I don't end up on my back much anyway since laying on my back worsens my back/pelvic pain which in turn will wake me up.

Sleep in any position you can sleep in and let the machine sort it out IF it needs to sort it out.
Doesn't sound like you need to worry about it with such a low AHI.

Your sleep quality itself is your PRIMARY goal.

All that said...I know of one person who needs a pressure of 19 cm when on their back but only 9 cm when on their side.
In that situation I think that trying to avoid supine sleeping is probably a viable option.

Thanks, Pugsy! Super helpful. You rule!

Iancdub88 wrote: ↑

Fri Sep 06, 2024 8:11 am

So I have another question. I should have the BIPAP next week. In the meantime, I have finally found a sleeping pill that seems to help called Trazadone.

If the Trazadone allows you to sleep and you're not feeling groggy when you have to get up in the morning, then I would say keep taking it for now.

I've had a couple OK nights of sleep despite the fact that I'm still not getting deep enough breaths for REM(that's where the BIPAP comes in).

Not sure what you mean here. And I'm not sure your expectation that a bi-level machine is magically going to allow you to get more REM is a reasonable expectation.

Here's what I mean: Sleep breathing is naturally much shallower than normal wake breathing. And to the best of my knowledge, our breathing does not necessarily become "deeper" when we hit REM. It can become more irregular in REM and it can look more like "wake breathing" in the sense of being more irregular, but that does not necessarily mean that it's "deeper" than normal sleep breathing.

And whether switching from an APAP/CPAP to a bilevel will somehow increase time in REM is a very difficult question to answer. In general the only difference between using an APAP/CPAP and an (auto) bi-level machine is that the bi-level allows for a bigger difference between the IPAP (inhalation pressure) and the EPAP (exhalation pressure). The difference between IPAP and EPAP is called pressure support or PS for short. For a person with ordinary old OSA, increasing PS from 3 (EPR = 3) on a Resmed AirSense 10 or 11 AutoSet to a PS = 4 or PS = 5 on a Resmed AirCurve 10 VPAP Auto may increase comfort breathing with the machine when trying to get to sleep and it may help reduce problems with aerophagia. So the switch can lead to fewer spontaneous arousals---if the spontaneous arousals are somehow connected to either aerophagia problems or discomfort while breathing with the machine problems. But I don't think the switch is going to do much to encourage the body to get more REM sleep.

There is another reason that people will be switched from APAP/CPAP to bi-level, but it does not seem to apply in your case: For some people a pressure of 20 cm, the maximum pressure that an ordinary APAP/CPAP can deliver, is not enough to prevent the vast majority of their obstructive events. And a bi-level machine like a Resmed AirCurve 10 VPAP or VPAP Auto can deliver pressures as high as 25cm. But your obstructive events are well controlled with pressures that are significantly less than 20 cm. So that's not why you are being switched to a bi-level machine.

Anyways, I've found that I've been waking up on my back quite a bit and that back sleeping has actually become fairly comfortable. However, I always hear people saying how bad supine sleeping is with CPAP.

Is it really that bad to sleep on your back? I only had an AHI of 0.3 last night.

Here's what you need to know about supine (back) sleeping:

1) In terms of the spine and the back muscles, back sleeping is usually preferable to sleeping in other positions for most people. In other words, most people are less likely to wake up with a back ache when they sleep on your back. (There are people like pugsy where back sleeping tends to increase back and/or pelvic pain, however.)

2) Untreated OSA can often be worse when sleeping on your back, but it's not always worse when sleeping on your back. Go back and look at your diagnostic sleep study. What does it say (if anything) about your untreated AHI when sleeping on your back. Was it about the same as your untreated AHI when sleeping on your sides or stomach?

3) Some people with OSA do need more pressure to prevent the vast majority of the obstructive events when sleeping on their backs. Other people don't. This is only a real issue if you have trouble sleeping with the pressure needed to control your OSA when sleeping on your back.

4) When using an auto adjusting xPAP machine, the machine ought to be able to increase the pressure appropriately if you roll onto your back. But if your OSA is worse on your back or you do need more pressure to control your OSA when sleeping on your back, then it is important to have the minimum pressure setting close enough to what's needed to control the OSA on your back so that you don't wind up getting a significant cluster of events every time you roll onto your back before the machine manages to increase the pressure up to what's needed to control your apnea while back sleeping.

Putting 1-4 together means this: If your minimum pressure is set high enough, then sleeping on your back with an xPAP machine is NOT a problem: When you roll onto your back, the machine will be able to increase the pressure in a timely fashion after one or two events occur and there won't be any nasty clusters of events just because you are sleeping on your back. And your whole body just may prefer sleeping on your back with the higher pressure needed to manage the OSA while sleeping on your back because back sleeping will be easier on the spine and back than side sleeping or stomach sleeping often is, even though less pressure might be needed when sleeping on your side or stomach.

In other words, if you are waking up on your back, your AHI is well below 5.0, and you are waking up feeling pretty decent (i.e you are feeling rested and even refreshed), then your pressure settings are high enough to allow back sleeping and any additional pressure is not triggering problems with aerophagia, then there is no reason at all to worry about the fact that you're doing some back sleeping.

robysue1 wrote: ↑

Fri Sep 06, 2024 3:01 pm

Not sure what you mean here. And I'm not sure your expectation that a bi-level machine is magically going to allow you to get more REM is a reasonable expectation.
Here's what I mean: Sleep breathing is naturally much shallower than normal wake breathing. And to the best of my knowledge, our breathing does not necessarily become "deeper" when we hit REM. It can become more irregular in REM and it can look more like "wake breathing" in the sense of being more irregular, but that does not necessarily mean that it's "deeper" than normal sleep breathing.

I misspoke. From what I understand from what the sleep doctor and sleep tech told me is that even at higher pressures, my airways are still attempting to close and though it's not leading to full on apneas or hypopneas, it is still waking me up. And aerophagia is another reason they're switching me. I know it's not a guarantee to fix these issues but since the airsense 10 Vauto can also handle CPAP/APAP mode, the sleep doc says I can go back to that if needed.

Untreated OSA can often be worse when sleeping on your back, but it's not always worse when sleeping on your back. Go back and look at your diagnostic sleep study. What does it say (if anything) about your untreated AHI when sleeping on your back. Was it about the same as your untreated AHI when sleeping on your sides or stomach?

I was semi-confused because my sleep study shows that supine apneas were way worse. Almost double at 104 AHI but the last two nights I have slept on my back and I didn't go over 0.9 either time.

In other words, if you are waking up on your back, your AHI is well below 5.0, and you are waking up feeling pretty decent (i.e you are feeling rested and even refreshed), then your pressure settings are high enough to allow back sleeping and any additional pressure is not triggering problems with aerophagia, then there is no reason at all to worry about the fact that you're doing some back sleeping.

I wouldn't say I've woken up rested or refreshed since I started CPAP but the last two nights have been encouraging. I'm hoping the positive trend continues and that I am just catching up.

Should I be concerned about these CAs popping up?

https://sleephq.com/public/7867ed94-24a ... 57242bd84c

Iancdub88 wrote: ↑

Sun Sep 08, 2024 9:50 am

Should I be concerned about these CAs popping up?

https://sleephq.com/public/7867ed94-24a ... 57242bd84c

No...even if ever single one of those flagged CAs/centrals was the real deal asleep central would be worry because there's simply not enough of them

BUT....I couldn't find one flagged central that I could say you were asleep when it got flagged.
Instead every one that I saw was a post arousal (meaning you had an arousal breath PRIOR to the flagged event) which means you weren't sound asleep.

That doesn't surprise me after scrolling through your flow rate breaths....TONS of evidence of arousal breathing and not being sound asleep.
I would be more concerned with the CAUSE of those flagged centrals which is the arousals themselves.

Spontaneous arousals....unknown reason but your sleep quality is a train wreck.

Pugsy wrote: ↑

Sun Sep 08, 2024 10:14 am

Spontaneous arousals....unknown reason but your sleep quality is a train wreck.

Oh, I know. I'll see how I do with bipap settings once I get it but I think I'll have to look at options outside of PAP therapy if it doesn't get better. It is just not working so far and it seems like it doesn't work for most people. I am so much worse off than I was untreated.

Can someone tell me it gets better?

Iancdub88 wrote: ↑

Sun Sep 08, 2024 1:25 pm

Can someone tell me it gets better?

It gets better.

But it can take a while. And it can take some work to make this crazy therapy work for you.

I had an initial adjustment period that could legitimately be described as "hellish". I had severe aerophagia every night, along with a case of insomnia that grew to be completely out of control. And the combo of the aerophagia + insomnia caused my migraines to go critical as well as my TMJ pain to skyrocket.

After switching from a Resmed S9 AutoSet to a PR System One BiPAP Auto and working with the PA on a CBT-I program for the insomnia and a headache doc to get the migraines under control and a dental specialist to get the TMJ pain under control, things did finally start getting better.

Keep plugging away and don't give up hope.