Need some good advice - sleep crisis I think

Hello all,

I have posted a number of times before and thought I was getting good results with a dental appliance. What I figured out is my throat still closes with the dental appliance and brain wakes me up to breath before oxygen desat beings.

Fast Forward: I am back on APAP with quattro FFM. Settings 10-20 just. I took 1 ambian to make sure I fall asleep which has been a problem for me lately.

Please see results below from last night sleep. Very Scary!! 3-4 hours into sleep the pressure climbs to the MAX 20 to knock out the apnea. I only sleep on my side or stomach because I wear a back back to prevent suppine position.

My Question :: I think I need a BiPAP to be able to deal with this pressure level. If I can get my hands on a BiPAP quickly. What do you advise I run the pressure levels at for both high and low???

Thank you for helpful advice.

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Thanks Max250,

Good information. I will try without ambien tonight or maybe reduced dosage and see what happens.

The reason for taking sleep meds to begin with is because I have multiple awakenings. I think my brain has a fast trigger - the moment it senses restricted breathing, my brain totally wakes me up or wakes me enough that it takes me from deep sleep to shallow sleep. Next day I feel terrible because these awakening destroy normal sleep cycles.

So far I can't seem to find the balance where CPAP/APAP allows me to breath without have multiple awakenings.

Maybe Bipap is the answer??

I can't see your chart very well because it's so fuzzy. But your leaks seem to be high--could that be the cause of your pressures going up? Is there a correlation between high leak and high pressure on your graph?

What was your titrated pressure?

I would suggest setting your machine to CPAP mode at 10 cm. and see what the reports look like. Alternately, you could leave it in APAP mode with the minimum and maximum set at 10 cm.

It's hard to tell for sure what's going on with your reports, but you need to eliminate the pressure changes. You don't know what kind of "chicken or egg" situation you've got.


Den

Hi Everyone,
Thank you so much for trying to help my brother, who has been suffering with this for over ten years. It is entirely possible that it has been living with this even longer without anyone really being aware of it - including Tom. It seems the make up of his throat, tongue, jaw etc. have created the "perfect storm" for severe apnea. Tom is not heavy, however our father has a very thick neck (for someone who is not at all heavy either) and our mother has a very oval shaped face with small features. When you look at the possibility of a thick neck with a small jaw etc., I don't think it is a leap to see that a very bad scenario is possible. I seem to be fine as is our other brother. We are hopeful that the bi pap will help since the c pap seems to be a problem with waking him up. Another issue is that we believe that over so many years of waking up many, many times it is now kind of a "habit" for him to not sleep through the night. I guess we deal with that though after he can find the correct "recipe" setting on whatever machine he ends up with. My brother has literally tried everything suggested at his sleep clinic and has spent countless hours on the internet trying to find the answer on his own. I honestly do not know how he does it and his strength is truly amazing to me. I simply adore him. Please keep your suggestions coming. I think it is wonderful of you all to try to help, and I pray that you all are close to finding, or have found your answer to your sleep apnea. Thank you for being there.

Hello All,

Wulfman wrote: It's hard to tell for sure what's going on with your reports, but you need to eliminate the pressure changes. You don't know what kind of "chicken or egg" situation you've got.

Sorry but the pressure has to change (increase) or it won't clear the apnea. Or I'm missing some of your logic. Possibly Ambien is too powerful sleep med for me throat stayed blocked longer than normal. This is first time I took ambien but have been having multiple awakenings which prompted me to take it.

Today, a great person I met on CPAPtalk has just swapped a Bipap machine for APAP. Tonight I am going to set the Bipap wide open according to earlier advice by Restedgal and see if I can titrate myself. Here is the link from restedgal below.

viewtopic/t49010/M-Series-Auto-Bipap-se ... lease.html

Thank you, Sister for the thoughts and prayers. And Thank you great person at the Einstein Bagel the who just loaned me his Bipap for a trial.

Kind Regards, Tom

Max250 wrote:I recently came across some research that sedative medications and sleep apnea dont mix and can make the apnea considerably worse.

But Ambien, Sonata, and Lunesta are safe with sleep apnea.

They may be theoretically "safe", but every drug has side effects for someone out there, and every OSA patient is different anatomically and otherwise. There is no such thing as one size fits all and you have to keep that in mind.

Thomas F. wrote:Hello All,

Wulfman wrote: It's hard to tell for sure what's going on with your reports, but you need to eliminate the pressure changes. You don't know what kind of "chicken or egg" situation you've got.

Sorry but the pressure has to change (increase) or it won't clear the apnea. Or I'm missing some of your logic. Possibly Ambien is too powerful sleep med for me throat stayed blocked longer than normal. This is first time I took ambien but have been having multiple awakenings which prompted me to take it.

Today, a great person I met on CPAPtalk has just swapped a Bipap machine for APAP. Tonight I am going to set the Bipap wide open according to earlier advice by Restedgal and see if I can titrate myself. Here is the link from restedgal below.

viewtopic/t49010/M-Series-Auto-Bipap-se ... lease.html

Thank you, Sister for the thoughts and prayers. And Thank you great person at the Einstein Bagel the who just loaned me his Bipap for a trial.

Kind Regards, Tom

Oh, yeah.......I can really see how those pressure increases on your report are clearing your apneas........NOT!


Den

Sorry if I touched a nerve Den. I ran my machine in APAP mode with the range 10-20 CM. You can see in the chart that 10 CM is the minimum setting and 20 max. Had my airway remained clear at 10 CM then the machine would remain at that level all night. However my airway restricted enough that the machine continued to the highest level before my breathing began again and then the pressure adjusted back down as it's designed to do. I agree with you that the airway not clearing near fast enough but I'm not following the logic to run the machine at a fixed setting of 10 CM.

KatieW wrote:But your leaks seem to be high--could that be the cause of your pressures going up? Is there a correlation between high leak and high pressure on your graph?

What was your titrated pressure?

Yes the high leaks line up with the high pressure. I will check to make sure the leaks are within normal range for the pressure.

My titrated pressure was 12.

Thomas F. wrote:Sorry if I touched a nerve Den. I ran my machine in APAP mode with the range 10-20 CM. You can see in the chart that 10 CM is the minimum setting and 20 max. Had my airway remained clear at 10 CM then the machine would remain at that level all night. However my airway restricted enough that the machine continued to the highest level before my breathing began again and then the pressure adjusted back down as it's designed to do. I agree with you that the airway not clearing near fast enough but I'm not following the logic to run the machine at a fixed setting of 10 CM.

Unless you were not sleeping during the times when your pressure was at 10, you had more events when your pressure went up from there. You also had some pretty good leakage as your pressure went up.......along with some "NR" (non-responsive) events......which could be Central Apneas. If you'll notice on your reports, when you have the NR events, your pressure drops back down a bit.

If you don't know how the REMstar Auto Algorithm works, go to this link.

http://www.healthcare.philips.com/main/ ... orithm.wpd

(click the blue "Next" below each graphic to progress through the explanations)

Most frequently, clusters of apneas like those are seen when the person is sleeping on their back.

I also believe that for some people, pressure increases can create subconscious resistance, which tends to cause the pressure to further increase until the max pressure is reached or something causes the pressure to drop.

Did you ever have a titration? What is/was your prescribed pressure? Any Central Apneas in your sleep study?

Many times, APAPs can create more problems (or the appearance thereof) than they solve. If you don't know the nature or cause of your obstructions, you probably won't know how to treat them. If "more pressure" was the answer to all of our treatment, we'd all be using CPAPs at 20 cm. or Bi-Levels at 25 cm.


Den

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I'm not an expert here but it seems to me that your graphs are a perfect example of what Den used to explain to me about runaway pressures vs leaks and which comes first(chicken or egg). That's exactly what was happening to my husband when he first started on auto with a wide pressure range. This setup made for very disruptive sleep with many arousals and high AHIs and Large Leaks. BTW, during his restless periods during the night I observed him back sleeping many times. It was only with Den's guidance when we changed to straight cpap close to his titration of 13(setting at 12 which seemed to be his 90%), that we finally achieved good therapy and restful sleep. We stayed with that for a year and now with experimenting we're using a narrow auto range of 10.5-13 which he tolerates very well and sleeps mostly at the lower pressure with low AHI and leak rate. I don't think it's your machine, it's your settings which need tweaking, IMHO. Keep us posted.