Can't stay asleep

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
personsw3
Posts: 1
Joined: Wed Oct 30, 2024 1:01 pm

Can't stay asleep

Post by personsw3 » Wed Oct 30, 2024 1:05 pm

I feel like I have gotten to the point where i realize I need to stick with cpap as autopap just makes me feel horrible disturbers my sleep more and makes me feel like I am starving for oxygen but i have no idea what settings I should use can someone who is a pro look at my sleep data and give me a starting point because at this point I feel like I am just guessing 13 no 12 no 10 no 9 no 13 and so on doesn't work and I can't think because I have to many emotions attached to my sleep/ fees I just need to set it and forget about it but I know if I trust myself to get the original pressure I won't leave it. Here is my sleep hq link https://sleephq.com/public/teams/share_ ... 19ec44732d

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robysue1
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Joined: Sun Sep 18, 2022 3:39 pm
Location: Buffalo, NY

Re: Can't stay asleep

Post by robysue1 » Wed Oct 30, 2024 4:21 pm

First things first:
personsw3 wrote:
Wed Oct 30, 2024 1:05 pm
can someone who is a pro look at my sleep data and give me a starting point because at this point I feel like I am just guessing
We're not pros. As in we're not people who are professional sleep technicians or anybody else connected with diagnosing sleep disorders or titrating people on PAP devices. If you want a professional opinion about what your CPAP data says, you need to talk to someone in your sleep doctor's office.

Having said that: We are patients who use CPAP devices in our own bedrooms every night. Many of us have done some extensive reading about OSA and about CPAP. Many of us have developed a good eye for what data posted at SleepHQ indicates potential problems might be and we have some sense of what we or others on the forum have done in an attempt to address those problems.

Next, you start your post by writing:
I feel like I have gotten to the point where i realize I need to stick with cpap as autopap just makes me feel horrible disturbers my sleep more and makes me feel like I am starving for oxygen
Can you tell us exactly what you mean when you say you feel like you are starving for oxygen?

Is the problem that you cannot seem to inhale enough air comfortably through the mask, particularly when you are trying to get to sleep?

Or is the problem that you cannot seem to exhale fully when you are wearing the mask, particularly when you are trying to get to sleep?

Or is the problem that the machine seems to be out of sync with your breathing---i.e. it feels like the machine is encouraging you to inhale before you are ready to inhale or it feels like the machine is encouraging you to exhale before you are ready to exhale?

New CPAPers use "I can't breathe" or "I feel oxygen starved" to describe all of these scenarios. But the fix really depends on which description is more accurate for the problem you are experiencing in your own bed.

because at this point I feel like I am just guessing 13 no 12 no 10 no 9 no 13 and so on doesn't work
It sounds like you are making a whole bunch of random changes to the pressure settings without having any idea of what it is you are trying to accomplish each time you change the pressure setting.

Here's the thing: Randomly trying a lot of different pressures in the hopes that something will "work" seldom actually works. In other words, dial wingin' is not usually an effective strategy for learning how to sleep well all night long with a dang cpap mask on your face.

So let's try to take this back to Square 1: Did you have an in-lab titration study? If so, what was the recommended pressure that came out of that study? If you didn't have an in-lab titration study, were you just given a Resmed S 10 AutoSet with a wide open pressure range of 4-20cm? Have you had a follow-up appointment with a sleep doc or a nurse or PA in a sleep doc's office to discuss how your therapy is not going well?

I can't think because I have to many emotions attached to my sleep
A lot of us have been exactly where you are with experiencing an excessive amount of emotion and worry considering the (lack of) quality of our sleep, particularly in the early days when things don't seem to be going well. It's worth remembering that there's nothing particularly natural about sleeping with a six foot hose attached to your nose and with a machine at the other end blowing air down that hose all night long. For some of us, it takes some time (and effort) to teach our body how to accept this crazy new way of sleeping, and some of our bodies put up a more persistent resistance to learning how to sleep with a CPAP.

As hard as it is to accept, sometimes the answer is to find a way to not worry so much about the sleep. And to not worry so much about the CPAP itself. But rather work on figuring out the specific task of how to fall asleep with the mask on in a reasonable amount of time.

I can't think because I have to many emotions attac/ fees I just need to set it and forget about it but I know if I trust myself to get the original pressure I won't leave it.
I'm not quite sure I follow what you are saying.

But I think you're saying that you just don't feel comfortable leaving the pressure setting alone.

Fact is: Our bodies need time to adjust to new CPAP settings. And if you are changing the pressure settings every couple of days in the hope of simply stumbling on a magic setting that just "works", then you are making it far harder for your body to adjust to this therapy.

In other words, quit changing the settings all the time. When you change a setting, you should have a specific reason for doing so, and you should have a specific result in mind that will tell you whether the new setting is making a positive difference or not.
When I look at your sleephq data, this is what I see:

Oct 23: It looks like you were using a fixed pressure of 9cm this night with EPR turned OFF. There is some evidence that you got some decent sleep on this night between 1:30 and 4:30. Also you probably sleep pretty decent between about 5:15 and 6:45. There are some significant flow limitations, and that might indicate that you need more pressure than 9cm. Leaks do not seem to be an issue, either in terms of size & length or in terms of being an obvious cause of arousals.


Oct. 24: It looks like you changed the pressure settings at least once during this night. Also looks like you set EPR = 3 in spite of what SleepHQ reports for the EPR setting. It also looks like on this night you got little or no actual sleep. Lots of short sessions, and it looks like you were using a ramp. It could be that your body could not relax during the ramp periods, possibly because you were worrying about the fact that the pressure was steadily increasing during the ramp. Again, there are a lot of flow limitations, but given how ragged the breathing is, it looks like a lot of those flow limitations are mixed in with so-called sleep-wake-junk breathing (SWJ). So if this were my data, I would not use it to conclude anything about my pressure needs. Leaks were more of an issue on this night, particularly between 7:00 and 8:00. Whether the leaks were making it even more difficult to fall asleep or whether they were waking you up right after you dropped off may not be relevant; the relevant fact about the leaks is that you had a lot of them on a night where you clearly got very little real sleep.

And that brings up a bunch more questions: What mask are you using? How tight are you adjusting the mask? Does the mask feel comfortable when you first try to go to sleep? Are you aware of any leaks when you are trying to go to sleep? Are you aware of leaks when you wake up in the middle of the night? Do you breathe through your nose during the day? Or do you do a lot of mouth breathing during the day?


Oct. 25: It looks like you changed the pressure setting in the middle of the night. The beginning of the night, it looks like you were using a fixed pressure of 9cm with EPR = 3. At the end of the night, it looks like you were using a fixed pressure of 13.8 with EPR = 3. Jumping from 9cm to 13.8cm is a huge jump in fixed pressure, and it's not a surprise that such a large jump might cause some problems sleeping. Having said that, it does look like you got some half-way decent sleep between 11:00 and 12:15, as well as 4:00 and 7:30. Yes, there are still quite a few arousals during those times, but most of the really restless stuff is outside those time frames. It looks like you are capable of sleeping for a full sleep cycle or two with the mask on your nose. But once you have a normal post-REM wake, sometimes your brain just won't relax and go back to sleep; possibly because your body is not yet accustomed to the feel of things because you're still making way too many pressure settings. Flow limitations don't seem to be substantially better during the time when you were using a pressure of 13.8cm. That may mean that your flow limitations are not necessarily an indication that your upper airway is threatening to collapse. It could be the flow limitations are caused by something as simple as nasal congestion. Snoring, however, is better during the session with the higher pressure.


Oct. 26: You switched to Auto mode. Looks like the pressure range you chose was 9.4-15 for the first part of the night and 10.6-15(?) for the second session. Then there are very short sessions at a variety of pressure ranges at the end of this night. Looks like you used EPR = 3 all night long. This is a night where it looks like you never really got any real sleep. Leaks were a huge issue between 12:15 and 3:30. So again, the question is were you unable to get to sleep because of the leaks? Or did the leaks wake you up every time you started to drift off into a real sleep? Flow limitations are also really bad during the first part of the night, but they're a bit better after you bumped the minimum pressure up to 10.6. Overall, however, I would have to ask: Were you lying in bed worrying about the pressure increasing and worrying about or fiddling with the leaky mask?


Oct. 27: There are a couple of very short sessions early in the night where you switched back to fixed CPAP mode. But by the start of the first main session, you've gone back to Auto mode, but this time you are using a pressure range of 5-8cm with EPR = 3. Looks like you got some sleep between 11:30 and 12:15, which is only 1/2 of a typical sleep cycle. It also looks like you got some decent sleep between 1:45 and 5:50. But that 90 minute period of SWJ between 12:15 and 1:45 is enough to make it subjectively seem like you got little or no sleep for much of the night. After you wake up around 5:50 it looks like you make several changes to the pressure settings, but you never really seem to get back to sleep. And lying in bed fighting with the machine from 5:50 to 8:30 would leave you feeling subjectively like you got little or no sleep. It does look like you feel asleep briefly between 8:30 and 9:00. Leaks are an issue between 7:15 and 9:00. Again, the question is: Were you unable to get back to sleep because of fighting the leaks? Or were leaks waking you back up every time you started to drift off? Flow limitations continue to be scored through out this night.


Oct. 28: Looks like you chose to use Auto with a range of 8-14cm and EPR = Off on this night. You got some reasonable sleep between 12:00 and 2:00, as well as 2:20--3:40 and 4:20-5:50. So some of the arousals/wakes probably started off as normal post-REM wakes, but instead of being able to go right back to sleep, you got trapped in extended periods of SWJ. And it looks like you got very little, if any, continuous sleep after 5:50. It looks like you changed the pressure range around 5:50 to a higher range of 9.6-14cm. Leaks were well controlled during the times you were actually asleep, but they become an issue after 5:50. So once again, the question is: Did the leaks keep you from getting back to sleep or did the leaks wake you up every time you were just about ready to drop back into a decent sleep? Flow limitations continue to be an issue, but they get worse during the session that starts around 5:50 with the higher min EPAP setting. Of course, many of those flow limitations are probably just SWJ mis-scored as "flow limitations occurring during sleep."


Oct. 29: It looks like you tried 4 or 5 min Pressure settings on this night. And EPR = Off all night long. This is a night where it really does look like you got almost no real sleep: The longest stretches of what is probably real sleep are 2:30-3:15 and 4:05-5:55. Leaks are not an issue on this night. Flow limitations between 4:05 and 5:55 are what is driving the pressure increases during that interval. And it looks like you got very little, if any, sleep after about 6:00.


*********** Overall impressions ****************

1) You have an intermittent leak problem. When you have leaks there is some evidence that the leaks are interfering with your ability to either get to sleep or stay asleep. So you need to spend some time troubleshooting the leak issue. Any chance you are switching back and forth between masks during the night?

2) You are making way, way too many changes to the pressure settings. By making multiple pressure changes, particularly during the night, you are not allowing your body to settle into a sense of how the pressure is supposed to feel. Also, you have to wake fully up to make a pressure setting change in the middle of the night, and it's clear from your data that once you are really awake, you have some real difficulty falling back asleep. You need to commit to making fewer changes to the pressure settings and stick with a single setting for at least 2-3 days. (4-5 days would be better.)

3) You are getting some stretches of continuous sleep that are long enough to be complete full sleep cycles. But when you wake up, you have real problems getting back to sleep. Sometimes the problem seems to be tied to leaks, but it's not always tied to leaks. In other words, you've got a significant problem with sleep maintenance insomnia. Dial wingin' the CPAP settings is not going to fix your sleep maintenance insomnia issue. (More on this in a bit.)

4) You may have a problem with flow limitations that could be partially responsible for some of the sleep maintenance insomnia problems. Sometimes, but not always, your flow limitations seem to get better with an addition of pressure. The flow limitations don't seem to be changed significantly by turning EPR to Off or turning EPR to 3.


************* RECOMMENDATIONS *************************

1) STOP changing the therapeutic settings all the time. At this point I think it's more important to pick one set of therapeutic settings and stick with it rather than trying to figure out what the best setting is. By sticking with one setting for several days you will give your body a chance to acclimate to the feel of CPAP. That all by itself may help you with your problem of not being able to stay asleep. To pick that one setting you need to ask yourself the following questions:

When you are awake, are you more comfortable when you know that the pressure is a fixed setting or are you more comfortable when you know you are using an Auto range?

When you are awake, are you more comfortable with EPR = 3 or with EPR = Off?

When you are awake, are you more comfortable breathing at a low initial ramp pressure or are you ok with starting at your chosen pressure setting?

Answering those three questions is critical before anyone can make a meaningful suggestion of what pressure settings you might want to use for the next 3-7 days.


2) Troubleshoot the leaks. If you are switching masks in the middle of the night, try to figure out which mask is the one that is leaking. If you are not switching masks, you need to consider whether you are having problems with mouth breathing or whether the leak problem is being caused by mask movement. Only you can figure that out because none of us are in your bed at the time the leaks happen.


3) You need to work on the sleep maintenance insomnia problem. You need to assume that at least part of this problem is not being caused by leaks or sleep apnea related arousals. Good sleep hygiene is where to start. You need to establish a sleep schedule where you spend somewhere around 8 hours in bed. A consistent wake up time is just as critical as a consistent bedtime is. You need to be sure that you are not clockwatching when you wake up in the middle of the night. You need to give yourself what feels like about 15 minutes to fall asleep every time you wake up during the night. If you're not back to sleep within what feels like 15 minutes or so, you ought to get up out of bed and leave the bedroom. Sit somewhere else quietly for a few minutes. (Read or listen to music or do a crossword or something like that if you want to). When you start to feel sleepy go back to bed, put the mask back on and let yourself go back to sleep.

If the sleep maintenance insomnia problem persists for several more weeks, you definitely should mention it to your sleep doctor. If the sleep doc suggests taking a sleeping medication for a short period of time, it may very well be worth doing that. (Some people are more resistant to the idea of taking sleep medication than others, and that's also fine.)

Good luck!
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