Newbie to the Forum

[Better Sleeper]

Hello everyone, I have been reading on this forum for the last 4 months to educate myself on my new BiPAP machine that I received 3 months ago.

I have been on CPAP therapy for about 2 1/2 years. My first machine was a Respironics M Series Plus C-Flex with heated humidifier. I had quite a few problems when I was on this machine. First of all, it would take me a long time to get to sleep on the machine and then I would wake up in the middle of the night and feel like I was not getting enough air when I was exhaling. Also the humidifier would always rainout, even on a setting of one. The most dibilitating problem was when I was using the machine for 2 to 3 days in a row, I would get a bad headache about a hour after I woke up which would last all day. So for the last two years, I have hardly used my CPAP machine.

Fast foward to about 4 months ago. After researching sleep apnea and some of the CPAP/BiPAP machines that were available, I went to my sleep doctor and asked him if a different machine would help. He prescribed me the BiPAP machine listed in equipment section of this post. Wow! What a difference the BiPAP machine made; no more headaches, no more waking up gasping for air, and no more humidifier rainouts.

The only problem I have with this BiPAP machine is that I wake up after only about 3 to 4 hours of sleep and I cannot fall back to sleep for the last 1 or 2 hours of the night. However, I can fall back to sleep when I don't use the machine for the remainder of the night.

Has anyone else had this problem? Could it be my settings?

Listed is a summary of my sleep study.
4 hours in bed total with total sleep time of 2.3 hours
Sleep onset latency: 27 min.
Latency to REM sleep: 174 min.
Overall Sleep Efficency (Calculated): 58%
Sleep Time
Stage 1: 85%
Stage 2: 7%
Stage 3: 0%
Stage 4: 0%
REM Sleep: 7%
Total Arousals: 156
Awakenings: 61
Respiratory Events: 172
Apneas: 21
Longest Apnea: 50 seconds during REM sleep
AHI: 65
RDI (Calculated): 75
Heart Rate: Varied between 41 and 98 beats per minute
PLM Index: 0
Lowest Oxygen Saturation: 75%

CPAP Titration Summary: CPAP 9 through 10 cm appeared optimal including nil snore or respiratory event.

As of today, here is the setup and info of my BiPAP machine.
SETUP
Mode: Auto
Max IPAP: 12.0
Min EPAP: 4.0
Max PS: 8.0
Flex Type: Bi-Flex
Bi-Flex: 3
System One Resistance: X1
Humidifier: 2
INFO
AHI: 7 Day Avg.=1.6; 30 Day Avg.=1.9
90% Pressure: 7 Day Avg.=9.7/6.9; 30 Day Avg.=10.3/7.5
Large Leak: All 0
Periodic Breathing: All 0

[Muse-Inc]

While your machine isn't reporting large leak, is your leak under control? Even small leak messes with sleep. Frequent wakeups plague many of us here & most report being hypersensitive to sensory stimulii, like light, noise, air movement (fan), etc. Sleep hygiene good? Sleeping all in one session with no napping? If not, then sleep consolidation might help.

[Better Sleeper]

Muse-Inc,
I believe my leaks are under control. My machine readout only shows large leaks even when I am in the provider setup. I do not own Encore Viewer 2 software or the Encore Pro 2 software for this machine and I do not know if either would show small leaks. My sleep doctor wrote me a prescription for the Encore Pro 2 software but I cannot find anyone who sells it.
When I wake up using the machine the mask does not feel like it is leaking. I sleep with a fan (for background noise) and it is pitch dark in my room. I even cover all of the humidifier lighting.
I do not take any naps during the day so that should not be the cause.

[torontoCPAPguy]

***************************************ALERT! ALERT! *************************************************************

Anyone notice the oxygen saturation dropping to 75% WITHOUT ANY REM SLEEP?
This, I assume, is a sleep study. Has anyone brought this to your attention? I can tell you that SpO2 of 75% even for a short time during the night, especially in the absence of REM sleep, is an URGENT item that needs to be addressed and investigated immediately. You need to get to an MD ASAP to get that checked out. And if a GP or sleep doc I would ask for a referal to a top pulmonologist that is proactive.

You need to be proactive about this yourself and you need to be as tenacious as a pit bull and avoid "20 minutes are up... next patient please".

If you have been reading the threads on here you will realize that a blood oxygen saturation below 90% at ANY time is considered respiratory distress in medical terms. Paramedics will immediately administer oxygen if your SpO2 is below 90%; the default alarm setting on most SpO2 monitors is 88 or 89%... go below that and all hell breaks loose. THAT I can attest to after a month in critical care last summer. And I can tell you that low SpO2 leads to rapid pulse and skyrocketing blood pressure which leads to "he died peacefully in his sleep" syndrome. When my BP skyrocketed and SpO2 could not be kept up while in hospital (on a respirator and tons of oxygen) they told my family to gather together to say their goodbyes. (The end result is that I was an anomoly. I survived H1N1 and the acute pneumonia that followed but was left with compromised lungs).

The bottom line is that regardless of all the other numbers and efficacy of your treatment for apnea.... if your SpO2 continues to plummet to the 70's you MUST get to medical care as soon as possible. I used to wake up in a sweat at night, was virtually a vegetable during the day, etc. Got CPAP and then APAP and things improved but my SpO2 continued to plummet some nights. Went to the sleep doc, GP, and refered to a pulmonologist (third one was lucky) who ok's 2-3L/M of O2 at night. Now my SpO2 generally sits around 95% (perfect) and during REM sleep, of which I seem to be getting plenty, it may plummet to as low as 88-89% but generally only drops occasionally to 92%. I am sleeping better but still have sleep issues that are being worked on. Much to do with drug interactions (my liver just had a 4 bbl carb installed with the oxygen improvement), sleep hygiene (gotta go to sleep at 11 - 11:30 p.m. every night, cool the room down to 68F, black out all light and sound, set the alarm system, make sure the dog is in the bedroom to wake me in case of intruders (we have had two attempted home invasions and it came awfully close to me taking out two guys with crowbars on the last one.. had they come through my front door) and so on. No caffeine, no smoking, no exercise within two hours of bedtime and nothing to eat after dinner nor anything to drink within a couple of hours of bedtime (I am diabetic so I get to have a bowl of yoghurt before I go to bed... yech). You get the picture. I am finding that each little bit is tending to improve things for me.

BUT, the number one thing that improved things for me? Buying my Contec CMS50E pulse oximeter and recording my SpO2 every night; taking it to the pulmonologist. They did not look at the S9 data but poured over the oximetry.

Not sure if I am making any sense or ranting here but am hoping that you will take the time to read the threads over the past couple of months and ask questions... we all have the T shirt on here and most are willing to share their experience with you. And trust me when I say it is going to be of greater benefit to you than what your MD's will initially provide. YOU need to ask the right questions and keep asking and making appointments. Good luck to you. Get that SpO2 fixed RIGHT AWAY. It kills.

[Better Sleeper]

TorontoCPAPguy,
Thanks for your advice and concern.
Yes this was a split night polysomnography study performed in July 2008, and my doctor is a pulmonologist specializing in sleep disorders. When I saw my doctor after the study he did not even mention my SpO2 rate. I asked him for a copy of the study results. Maybe I should clarify the Oxygen Summary of the study. Here is the exact verbage: "Oxygen saturation while awake on room air was 95%. The low saturation recorded was 75%. The sturation was greater than 90% for 87% of the diagnostic protion of the study.
I did not know that this was that serious. I'm going to consult with my pulmonologist to clarify my study results and to ask him if I should be monitoring my SpO2 rate.

Thanks

[Emilia]

Our host carries the software.... go to this page..... not sure which one you need: https://www.cpap.com/cpap-software/cpap ... ftware.php

[ozij]

Welcome to the forum, Better Sleeper.

I understand that at this point, your main porblem in not being able fall asleep with the mask and machine after waking up during the night.
Could give us more details about that?
What happens when you wake up?
What do you you do? (get up or not? look at a clock? etc).
What are your thoughts? (calculate time left for sleep? thinking about work? etc.)
Is it physical (mask discomfort?)

What makes fallling asleep again different from falling asleep the first time? Is it your thought? Is it re-fitting the mask?

For some of, when we first achieve restful sleep -- as you seem to be achieving now -- our brain wakes us up in amazement after 4-5 hours. It really is a kind of "wow, I'm so rested it must be time to get up". Don't let that waking up rattle you or upset you. If you think that may describe what's going on with you, try to accept this waking up as part of the long term adjustment process. If you're not feeling discomfort that has to be taken care of, try to enjoy that new, relaxed feeling - try even to be happy about this new kind of waking up, greet it with "gee, that sleep was so pleasant! I'd like to get more of it"

O.

[Better Sleeper]

When I first put on the pillow mask and the BiPAP machine starts, I try to slow down my breathing. I noticed that this machine is louder than my old CPAP machine and I can hear it cycling (EPAP to IPAP). My brain seems to want to match my breathing to the machine cycling. I am getting used to this, so I fall to sleep a lot faster than when I first got the machine.

I usually go to bed between 10:45 pm to 4:50 am thats a little over 6 hours. Most of the time I wake up between 3:00 pm and 4:00 pm when I am on the machine. When I wake up I almost feel like I am rested, but then I worry that 4 hours is not enough sleep and worry that I will be tired at work. It varies what I do next. I used to look at the clock and sometimes get up to go to the bathroom. Now I try to go back to sleep on the machine, but I seem to have a lot of random thoughts running through my head. Sometimes I just remove the mask and sleep without the machine.

As for the pillow mask it is not uncomfortable. Before the pillow mask I use now I was on a ResMed Mirage Micro nasal mask which I liked. However, on this BiPAP machine I could really hear it cycling so I switched.

[ozij]

When I first put on the pillow mask and the BiPAP machine starts, I try to slow down my breathing. I noticed that this machine is louder than my old CPAP machine and I can hear it cycling (EPAP to IPAP). My brain seems to want to match my breathing to the machine cycling. I am getting used to this, so I fall to sleep a lot faster than when I first got the machine.

That's good

I usually go to bed between 10:45 pm to 4:50 am thats a little over 6 hours. Most of the time I wake up between 3:00 pm and 4:00 pm when I am on the machine. When I wake up I almost feel like I am rested, but then I worry that 4 hours is not enough sleep and worry that I will be tired at work.

I think this is a perfect place to say "don't worry, be happy" Those 4 hours are giving you so much more rest than the many hours you fought for breath before CPAP,... snuggle into that rested feeling, and forget about work.

It varies what I do next. I used to look at the clock and sometimes get up to go to the bathroom. Now I try to go back to sleep on the machine, but I seem to have a lot of random thoughts running through my head. Sometimes I just remove the mask and sleep without the machine.

Make a deal with yourself that you will not sleep without the mask. And when the urge to remove it and go back to sleep is strong, remind yourself that "its OK to remove the mask, but that means I have to get out of bed - and sleep has been so pleasant with the maks....do I really want to get out of bed now?"

"Sound Mind Sound Sleep" by Dr. Barry Krakow is a very good book for those of us who struggle with thoughts that keep us from sleeping in addition to having OSA.
Sound Sleep, Sound Mind: 7 Keys to Sleeping Through the Night
http://www.amazon.com/Sound-Sleep-Mind- ... 0471650641

[cflame1]

When I first put on the pillow mask and the BiPAP machine starts, I try to slow down my breathing. I noticed that this machine is louder than my old CPAP machine and I can hear it cycling (EPAP to IPAP). My brain seems to want to match my breathing to the machine cycling. I am getting used to this, so I fall to sleep a lot faster than when I first got the machine.

I usually go to bed between 10:45 pm to 4:50 am thats a little over 6 hours. Most of the time I wake up between 3:00 pm and 4:00 pm when I am on the machine. When I wake up I almost feel like I am rested, but then I worry that 4 hours is not enough sleep and worry that I will be tired at work. It varies what I do next. I used to look at the clock and sometimes get up to go to the bathroom. Now I try to go back to sleep on the machine, but I seem to have a lot of random thoughts running through my head. Sometimes I just remove the mask and sleep without the machine.

As for the pillow mask it is not uncomfortable. Before the pillow mask I use now I was on a ResMed Mirage Micro nasal mask which I liked. However, on this BiPAP machine I could really hear it cycling so I switched.

Yes it does take some time to get used to the machine switching between IPAP and EPAP. If you continue to have issues with a wake up and can't go back to sleep... consider that the min EPAP could be too low.