Can't stay asleep

personsw3 wrote: ↑

Wed Jan 29, 2025 4:31 pm

Was finally able to fall asleep but only with a cpap starting at 8.4 otherwise fall alseep is a nightmare.

This is a start. You may not feel that way, but it does give an idea of a place to start with finding a set of settings that you can sleep with.

i know a constanct pressure is the ideal solution but not the one i have but I need to be able to fall asleep https://sleephq.com/public/e3fef48c-48f ... b2e8ce86dd

First, a constant pressure setting is not aways the "ideal" for treating sleep apnea. But some people (and maybe you are one of them) do find it easier to fall asleep with a fixed, constant pressure. And that's fine too. The ultimate goal is to find both an xPAP mode (CPAP, APAP, VAuto) that you can fall asleep with and that adequately prevents most of your obstructive events from happening.

As for your data at 8.4 cm H2O: From a sleep apnea point of view, the data is not really as "bad" as you seem to think it is, at least in terms of the AHI. What I see when I look at the data you posted for January 28 is this:

• Multiple pressure changes early in the night.
• Lots of evidence of spontaneous arousals during the night, but many of them are short and you go right back to sleep. You don't need to worry about spontaneous arousals where you go right back to sleep---they may simply be times when you woke up enough to change position in bed.
• Some evidence of genuine sleep between many of the spontaneous arousals.
• Some evidence that leaks may have woken you up a time or two, particularly before you changed to using CPAP at 8.4 cm with EPR = off.
• Lots of activity in the flow limitation graph after you set the pressure at 8.4 and turned EPR off.

Now here's the thing: Flow limitations are not always an easy nut to crack. Some people find increasing the pressure smooths out the flow limitations and they wake up feeling more refreshed and more rested. But other people? The increased pressure needed to treat those flow limitations causes its own problems. From what you've written here, it may be that you are someone who is better off using a fixed pressure with no EPR, and ignoring the flow limitations at least for now.

And it's important to understand: The big problem that you must still solve is learning to sleep with the machine. In the next week or two, I would suggest that you leave the machine in CPAP mode at 8.4 cm H20 with EPR off, and see if you can continue to fall asleep at that pressure, and see if you can get back to sleep quickly when you find yourself awake in the middle of the night. For the next week or two, do NOT focus on the AHI or the flow limitation graph: Simply focus on getting to sleep with the machine every night.

Now, once you are consistently managing to fall asleep with the machine every night, then you can start working on what to do in an effort to improve the flow limitations and the AHI---if they are still a bit high and/or if you are still feeling exhausted when you get up even though you were able to fall asleep with the machine.

I can't even manage to fall asleep with the vauto any ideas of where to start,

Start with what allows you to fall asleep: Using a CPAP mode with a pressure of 8.4 cm H2O and EPR = Off.

VAuto mode may have more flexibility in terms of the pressure settings, but that does not mean everyone finds them more comfortable than using a fixed pressure. If you really want to try VAuto mode again, then I would suggest these settings as a starting point:

Min EPAP = 8.6
Max IPAP = 10.6
PS = 0

This will start you out at 8.6 cm of pressure and the pressure will be the same for both inhalation and exhalation, but it will allow the machine to raise pressure (slightly) when flow limitations or obstructive events are scored. If you find yourself lying in bed unable to sleep because you are worrying about whether the machine is starting to increase pressure on you before you are fully asleep, then consider turning the ramp on, with a ramp pressure of 8.6. This will prevent the machine from raising the pressure until the ramp period is over. (Maximum ramp time is 45 minutes.)

The important thing, however, is that you keep the same settings (either CPAP at 8.6 or the tight VAuto range I suggested) for at least 4 or 5 days (a week or two would be better) and focus your attention on whether falling asleep with the machine is becoming a bit easier with the same pressure on both inhalation and exhalation. During those 4 or 5 days, don't even bother to worry about the AHI or the flow limitations: Only worry about whether your body is starting to learn how to fall asleep with the machine.

Tried the setting thats you recommended well I fell asleep I had a lot of central does that mean I need to decrease the pressure by 1 or 2 and try again. https://sleephq.com/public/5079cfe7-33e ... 16646b6ac3

Decreasing the pressure settings is unlikely to impact those centrals because the pressure isn't the cause.

Probably 90 to 95 percent of those central flags are related to awake/arousal breathing and that makes the cause of the centrals as being awake or not sound asleep.
If you aren't asleep then they aren't "real" centrals and we ignore them except to know that with so many of them our sleep quality was far from ideal.

Your crappy sleep is the problem. Now why the crappy sleep????? that's the million dollar question.