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I would do either of the following:

• Keep the pressure at a very narrow range, e.g. 9-11, or at least bump the min. to 10
• Set the machine on a fixed pressure of 10 or so, depending on where the 95% was for the majority of those nights.

My reasoning behind both suggestions is that the changing pressures cause arousals for some people -- you won't be conscious of them, by they affect how you feel.

With the minimum close to the 95% you won't have as many changes.

If you mouth breathe once asleep and lose the Cpap air that way, you're not going to feel a lot better, so if you can try taping for a couple of nights to see if it helps, you may then want to look at full face masks.

Hi Secret Agent Girl

You have three excellent suggestions above, so I will not add to them.

For myself, I was getting good AHi from the start, but it took months for the fog to start clearing, and I have yet to get properly organised with good sleep hygiene.

But the first task is mask and pressure, and you have those suggestions already.

cheers

Mars

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secret agent girl wrote:

ozij wrote:My reasoning behind both suggestions is that the changing pressures cause arousals for some people -- you won't be conscious of them, by they affect how you feel.

I want to understand this better, so my questions are from authentic curiosity, not argumentativeness... xpneas cause arousals, right? (I was found to have only hypops during the study, but let's be inclusive) Would the sleep study document # of arousals? And if I'm experiencing, say, 1/10th as many arousals (I can see a rough number of xneas in the detail, as well as pressure changes, right?) Then, I would expect to be getting better sleep/rest and wake up feeling better, not worse. I guess for some people it just doesn't work that way...?

xpneas are not the only that can disrupt your sleep. So, having reduced those causes for arousal does not mean you no longer have other causes, or for that matter, new ones.

A sleep study would document arousal cause by respiratory effort (Respiratory Effort Related Arousals = RERA's). It will also spontaneuos (as in "we have no idea what caused them") arousals, and movement related ones.

The changing pressures of and APAP can disrupt sleep for some people. Now granted, APAP changes pressure for a reason, but some pressure changes are preemptive, before xpneas ocuur - and the change itself may cause an arousal.

For others, once xpneas are controled, sleep related movement disorders can appear -- disorders that were previously hidden, because sleep was never deep enough to let them happen.

O.

secret agent girl wrote:
I'm pretty sure I don't mouth breath. To elaborate, I hate mouth breathing. Before, I used to suffer sinus congestion...didn't block my nose breathing completely, but impeded it enough that I would wake up, rather than mouth breath. I went through two surgeries because I really, really, really dislike mouth breathing.

Having said that, I decided to change the EPR from 2 to 1. I woke up twice, near morning, because I opened my mouth. I am fairly sure I woke up each time it happened, though others are welcome to disbelieve that. Also experienced a bit more aerophagia than usual. I hypothesize it was because of being harder to exhale against the pressure. I will download my data and see if that shows up, but I want to give it a couple days to see if I adjust.

mars, thanks, I have excellent sleep hygiene - the bits I can control, that is. Sometimes it feels like there's a disconnect between my mind and body in that I'll wake up and my mind says 'great, let's get going'. And I can't fall back to sleep, even if my body feels tired. I probably should try meditating more regularly or something similar.

Being pretty sure you woke up could also means you "woke up" ie arousal for this kind of thing without remembering a dozen or more times. Not good for deep sleep!

Meditation is good too. Try to remember that for years your mind has been keep you alive by keeping alert and not letting you sleep deeply It is maybe still in "Stand on guard for thee" mode (as the Canadian anthem goes) and trusts this thing on your face even less. My doctor said that the mind can hold on to this mode for months. Using meditation and affirmations you may be able to deal with that. You have to persuade (not coerce) your inner self that this is good for you and it is safe to sleep.

Well I have been using APAP for only a little over 6 weeks now. In some respects I agree with BlackSpinner. I often wake up tired on some days even when my numbers are good. I find that I am still acutely aware of the mask and the hose when I go to sleep. I half wake up each time I turn or change position because I am worried about dislodging my mask or worse yet..yanking my Apap + filled humidifier off its stool and onto the floor and effectively "killing it".

The nights I have slept right through are those when I think..leaks and mask be damned (I still keep it on though)...and low and behold I sleep better.

But there are so many factors involved as I am learning and each person is different.

By the way I was horrified when my respiratory therapist mentioned taping of the mouth. I thought no way...that is simply crazy! So only 6 weeks later I am experimenting with my new nasal mask and tape. Go figure!

Secret, I agree with setting a narrow range and the reasons why or setting your machine to a fixed pressure. but what is the highest pressure your machine has reached. It is set to go up to 16 and you say your 95% is around 10/11. Something that everyone forgets is sometimes if you are on a fixed pressure you can go with a lower pressure, simply because that pressure is always there and your machine doesn't have to react. If you are low and it has to react, it's too late and it will probably go to a higher pressure than would have originally been needed.

I am sure you have read on here that having a pressure too high can cause more apneas or cause apneas by inducing central apneas.

I would go back over your data and see what the highest your machine went up to and look at that and your 95% and probably set your machine at a fixed pressure either very close to or at your 95%.

Gerry

I agree with suggestions to narrow the range ... especially if you are using ResMed version of APAP.

ResMed APAP algorithms are much more aggressive, often resulting in arousals without influencing nice looking efficacy stats.

If you are savvy enough to strip actual values out of your Res Scan software, and then plot AHI vs pressure like the plot below


You can switch back to CPAP at optimal pressure (the lowest part of the U-shaped curve in example above = 10.3 cm).

If you can't do the savvy plot ... use your 95% average value and see how that goes in CPAP mode.

Okay, I'll add my two cents' worth. It may actually be worth even less than that, but here goes....

Arousals. I don't think there's any way to really know, while using the APAP at home, just how many times you are being aroused during sleep. You won't remember most arousals, and the data doesn't show them specifically. A pressure increase from one number to another may arouse more than a lesser pressure jump, but arousal may also depend on your sleep state during said pressure jump. And, as has been pointed out, there can be other reasons for arousals. Did you have a lot of limb movements during your sleep study, or other "abnormalities" that could affect your sleep quality?

Another thing to consider is that you weren't on an auto-titrating machine during sleep study titration -- I don't think. The way I understand the sleep study is that they start with low pressure and move it up once you're deeply asleep, raising it until apneas and snoring are stopped. So the experience of an APAP constantly changing pressures at home would seem very different to me. Some people are sensitive to the pressure jumps, and I'm not sure if "arousals" can be compared.

As for mouth breathing.... I don't mouth-breathe either. I was apparently losing therapy air from my mouth mostly when I was in REM sleep. While awake, I could control the "puffs of air" or other air escape by keeping my tongue firmly planted on the roof of my mouth, blocking my airway. But during deep sleep, my jaw and tongue muscles completely relaxed. I don't think I was actually breathing through my mouth though. Air was just going out. I think I slept through a lot of the leaks. I'm not sure if your leak numbers are very significant, but just consider that mouth LEAKS could be a possibility. Symptoms may include dry mouth and/or sore throat.

You've received some great advice regarding either an APAP narrow pressure range or a straight CPAP number. You could always try straight CPAP for a while and see if that makes any difference. Some people do better with straight CPAP, as evidenced by the experience of some members here. It's great that you have a machine where you can try both!

~ DreamOn

I might be able to add something from a different viewpoint regarding the Apap vs Cpap disussion, since I've been the caregiver and "observer"of my husband's therapy from the beginning. He was titrated at 13cms and after several months of trying various apap settings without success and much frustration, with the guidance of the experts here we finally figured out that all his restlessness/arousals(with and without waking) and leaks was being caused by the pressure changes even at narrow ranges of 11-14. His 90% seemed to be 12cms, so we switched to cpap and that made all the difference and he's done well for almost a year. I tried to experiment again in Nov with auto at 11-13 and although the data was the same,after a few weeks on apap he started to display some of his pre-cpap symptoms,so for 2 nights I stayed awake for several hours each night(crazy I know!) and observed how restless he was with heavier uneven breathing (no apneas) and more leaking. At those times when I checked the machine the pressure was always at 13. When he would settle down the pressure would go back to 11 but not for long until the restlessness started again and pressure raised again. He's been back on cpap=12 now and all that has stopped and he's feeling "chipper" again. What's really interesting is that he wasn't even aware of those bad nights he was having(he could have asked me! ), only that he wasn't feeling as well during the day. Sorry for the long post but wanted to give you a good picture of my experience.

Dori, you are such a loving wife, your husband is a very lucky man to have you watching over him, like a guardian angel.

SecretAgentGirl, everyone is different, but I'm also one who does better on cpap than apap. I don't really understand why, but I sleep much better, and the numbers are better.