OK ... have Encoreviewer and now am totally perplexed!

Yes, 9 or 10 cm is not really a very high pressure. It wouldn't hurt you to put it up to say 8 or even 9 cm right away.

If you do decide to go higher with the minimum right away, you can always drop back and go slower if it seems too much.

I don't have a lot of patience either but I try to tell new people to go slowly. I was titrated at 10 cm and started with it the first night on a straight cpap machine.

I had no software with that machine. You have the advantage of seeing your data and it appears you do need the minimum at 9 or 10 cm.

I had an in home auto test 2 years ago that showed I would be better at 11 cm. I got my own auto and software then and set it a 10.5 cm minmum and 13 cm maximum. Works well for me. I'm still using that range.

So you have the choice of going slowly or putting it up to 8 or 9 cm tonight. Either way I think you will do much better with that 9 or 10 cm minimum. Again don't worry about the maximum yet anyway.

Thanks everyone! I just can't figure out why the machine starts pumping higher for the first few hours and then goes lower for the rest of the night. Waking up 2 hrs, then 1 hr , then 30 minutes before I want to is not what I want to do. Could I be adapting or is something flaking out on me?

I'll be chicken and settle raising it to a 6.5, waiting a few days and then raise it from there. This thing is set to initially ramp from 4.5 to 5.5 and it feels like I am not getting enough air at 4.5. 6.5 sounds like a happy medium. I guess I will have to put faith in the numbers that my machine is giving me - and not be skeptical. Maybe I will turn it to CPAP only at 4.0 and see how badly I can sleep! Good idea.

I've got a pulse oximeter coming next week sometime, and the O2 levels will be the bottom line. I've spent so many years trying to keep myself in the best of shape with exercise that the thought of my O2 saturation going as low as 90% (let alone 78%) is akin to suffocation. That can't be good for you at all!

As far as snoring, covering the hose is a good idea, but perhaps I need to coerce my wife to take a peek or even hang with me for a bit.

One last thing ... Is there any set amount of time to give it to see if symptoms subside? I just don't feel much better after a week of this. Is it normal not to feel better for a while? I guess I expected to be all perky the first day!

Well, I see my pressure is dropping off toward the end - the morning. I also notice that I wake up often sometimes 1 -3 hours before I want to get up. Last night I woke up 3 or 4 times this morning - at a point when I had only slept about 4 hours. Does this perhaps have anything to do with the pressure?

Patience, Grasshopper. I think you are going to have to give this a little more time. You are not sleeping well because you aren't used to CPAP yet, and you may not be getting into that deep REM sleep yet. By it's nature, sleep apnea causes multiple small arousals we are not even aware of because we come up to a lighter stage of sleep, but not fully awake. Now you have a new situation--a chunk of plastic strapped to your face blowing air at you--so you're going to come up to a higher state of arousal and be more aware that you are awake.

That spike about 4 hours in looks like it was triggered by the flow limitations (little yellow ticks on the chart) and a single little hypopnea. It may have woken you because it was a pretty sharp and sudden increase. After a while I think you will stop noticing these. Raising your bottom pressure might help because it won't be so steep a spike in that case.

It took me FORTY FIVE days to really sleep comfortably through the night, so I'd say you're doing pretty well considering. You will find the intervals of sleep will gradually get longer and longer. You must give it more time (I know you're sick of hearing this, but you've had apnea for a long time, so your body needs some time to readjust). One of these mornings you're going to wake up and say "wow, I slept all night and I feel rested".

I wouldn't say I felt like a whole new person from CPAP (you need realistic expectations), but the big thing I eventually started to notice was waking very gently, totally, 100% comfortable like I was floating on a cloud. That was a huge contrast to before CPAP when I'd wake suddenly with the stress flowing.

The only symptom is that I have less achy muscles in the last week

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Yep, I have chronic muscle and skeletal pain from the genetic disorder I have. It was really bad in my shoulders, my constant level of pain was 7 on a scale of 10, with the occasional pain all the way to 10. After a few months on CPAP I noticed the shoulder pain and my general acheyness was GONE. So far it hasn't returned, but I often have less pain in the summer, so we'll have to see how it is come this winter. But even when I have a "good summer" I usually have some degree of pain. This summer (on CPAP), NONE. I may be eating my words come winter, but I really think that the CPAP is helping.

OK ... I need to give it time.

Well, we haven't had much of a summer in my neck of the woods. In fact by Calif. standards it's been downright cold.

You are right about me waking a lot by having this plastic air-blowing monster on my face. I guess it will take some getting used to. When I used CPAP in the late 90's I never could adapt long enough to the machine to make it a second night in a row. Now the machine is not nearly as awful - I've just got to get used to the routine. Thanks.

Raise your pressure already! Just sneaking it up to 6.5 will only prolong your problems and you're just not getting proper therapy. There are people at 15 and higher pressures routinely, and the difference between e.g. 7 and 10 is nothing (at all meaningful). At least give 9 a try - you might surprise yourself.

No need to be "chicken"! You're getting advice from some of the best "experts" on this forum and from what I'm reading you're getting pretty routine recommendations . 10cms seems to be the average pressure that gives a good starting therapy for most people until they find their "sweet spot". My husband was titrated at 13cm and we tried auto settings from 10-15 and finally settled in at straight cpap at 12cms because he was sensitive to the changing auto pressures during the night. It didn't take long before he also turned off ramp as it felt suffocating and Cflex because it didn't match his breathing pattern. All this was done over a period of time with the patient explanations and suggestions of the forum.

OK, OK. But how do you know if you've turned it too high? If you have turned it too low, you have more events and less quality sleep, but if you turned to too high what do you see?

I guess I don't know what I am aiming for when I raise the pressure. Better what?? Thanks.

Your "Pressure" section on your Daily Details sheet tells you that you spend most of the night up there at 9 or 10 cm.

Spending time during the night at pressures below a good therapy pressure for you will not get you good results.

Having the pressure too low means you have to get up to your better pressure ( for you) and that takes awhile if your minimum is too low. You will also wake up (probably not wake right up but partially) as the pressure changes and climbs that often.

Yes, ... I see between 8 and 11. I think it varies a lot because I'm opening my mouth with a nasal mask.

Here is my last night's report ...




It seems that the times where the "leak" is big is probably when I open my mouth and look like something from "The Exorcist". Maybe it's time to grow up into a full face mask? My biggest problem is nasal obstruction. I had my palate, uvula, etc. lasered off years ago - and the sleep Dr. I saw a month ago said it looked good for an "older" laser job.

Would a FF mask help this? I expect that when I raise the pressure I will do more opening of my mouth. Sort of the body's own version of flex.

TRY one - they don't bite and you might feel more relaxed knowing you can breathe however you like without consequences. Of course finding one that fits properly, feels ok and doesn't leak terribly is always fun, but no worse than finding the right nasal mask or having breakfast .

Yes, you do spend most of your time at higher pressures though. You were at 9 and 10 cm most of the night last night.

A full face mask would help with mouth leaking but also getting the right pressure MIGHT. At lower pressures you will be strugging to get therapy (not really getting it) and you may mouth breath to compensate. You did not have any large leaks. I have my machine set at 10.5 cm - 13 cm so it's not really high but up there! My 90% is usually 12 cm and I rarely go to 13 cm. I spend most of the night at 11 and 12 cm.

The alternative to a full face mask (which I cannot seem to deal with myself - have tried many) is taping. I am fortunate and just need a 1" strip of medical paper tape vertically across the middle fo my lips to keep my mouth shut. I also plant my tongue on the roof of my mouth just behind the top front teeth before falling asleep and I have an excellent leak rate. You MIGHT be that lucky too!

It took a bit of practice but my tongue stays there. I find myself putting it there during the day if I am sitting as well. Actually I fell on Monday and my tooth cut my lip so have not worn the tape since then. I just plant the tongue and have the same excellent leak rate and no dry mouth. I think I must have trained myself to keep my mouth closed that way. We'll see as time goes by.

Keep at it!

OK ... well, I will see what more increased pressure will do before I mess around with another mask and/or tape. Maybe I will hit that "right spot". Last night I had worked out really hard - and I usually am energized a bit when I do that much, even though I am tired too. I did toss and turn a lot, so I am not sure whether it is a mouth leak or the mask coming off my face a bit when thrashing around. I had to double my hose length last week because I kept strangling myself with it.

This place is great! Boy, my sleep Dr. doesn't want to bother telling me any of this! She just Rx'd me a machine and told me to come back with results.

But more pressure is far more likely to provoke mouth and/or mask leaks...

jonquiljo wrote:OK ... well, I will see what more increased pressure will do before I mess around with another mask and/or tape. Maybe I will hit that "right spot". Last night I had worked out really hard - and I usually am energized a bit when I do that much, even though I am tired too. I did toss and turn a lot, so I am not sure whether it is a mouth leak or the mask coming off my face a bit when thrashing around. I had to double my hose length last week because I kept strangling myself with it.
This place is great! Boy, my sleep Dr. doesn't want to bother telling me any of this! She just Rx'd me a machine and told me to come back with results.

Another question, what type of hose management are you using so that it's not pulling on your mask and breaking the seal when you twist and turn? That may also account for the VS data. You can do a Search here for hose management and get lots of tips on that. I can assure you your Dr doesn't know any of this unless she's been down in the trenches with us.

You said that last night you had worked out really hard.

I hope you were not exercising within about 2 - 3 hours of bedtime. That will interfer with sleep as will eating or drinking much of anything within about 2 - 3 hours of before bedtime.