CPAPtalk.com

Pugsy wrote:

James-UK wrote: I'm thinking about increasing my minimum pressure from 4 to 7, does this seem like a good number to start with?

Yes. For 2 reasons.
You likely need more pressure to better prevent the events and the pressure of 4 starting out often is a bit stifling. Just not enough air moving. So partly for comfort and partly because you likely will need a better head start on preventing the events than the 4 cm starting point will give.

Thank you Pugsy, I did think that may be the case but I wanted to double check. I will report back with any changes.

The mask went on perfect last night but I also woke up again and removed it, I can't actually remember why I removed it but I remember thinking that it's okay as there will be more data to look at, it's almost as if I just wanted it off. The time I used the machine is listed as 2hours and 7 minutes, I took roughly 20minutes to fall asleep, I should have mentioned before that this is roughly the time it always takes for me to to fall asleep and not due to the mask/machine.

Changing my minimum pressure has made a massive difference, my AHI for the one hour and forty something minutes of sleep was 3.8 . My average pressure, 90% pressure and leak have all decreased as well.

Here is the data:


I'm going to increase my minimum pressure from 7 to 7.5, I'm hoping that my AHI can be further reduced, if the opposite happens I will revert back to 7.
My priority is making sure I now wear the mask all night, I just wish I could work out why I'm waking up, I normally don't wake up unless I need to use the toilet and strangely the three times I have woken up while using the mask I haven't needed to use the toilet.

Be aware that one night doesn't make a trend. We don't sleep the same each night and sometimes that AHI varies a lot even without any changes being made to anything.
My AHI last night was 1.42...with no Clear Airway events to muddy up the waters.
Last Friday night it was 3.22 with no Clear Airway events..
And I never changed a thing from Friday to now.
So pick a number/setting and be prepared to give it a week or so, unless you have absolutely horrible results, before changing things.

Pugsy wrote:Be aware that one night doesn't make a trend. We don't sleep the same each night and sometimes that AHI varies a lot even without any changes being made to anything.
My AHI last night was 1.42...with no Clear Airway events to muddy up the waters.
Last Friday night it was 3.22 with no Clear Airway events..
And I never changed a thing from Friday to now.
So pick a number/setting and be prepared to give it a week or so, unless you have absolutely horrible results, before changing things.

Thank you for the warning, I will leave it at 7 until I'm able to sleep all night using the mask for a week.
The pressure felt fine last night, I didn't even have to use the ramp feature.

James-UK wrote:I will leave it at 7 until I'm able to sleep all night using the mask for a week.

I think that's a good idea. Now work on using the mask and machine all night....then worry about tweaking the pressures for the AHI if needed.
The brain likes predictability and when we go changing things the brain doesn't have time to get used to one thing before we go changing another. So there is some truth to the "give it some time for the body to adjust to things". Obviously no amount of time is going to fixed horrible therapy from suboptimal pressure or bad leaks but once you find something that is fairly acceptable then I suggest that people try it for a while. Often as the body and brain adjusts then the other stuff falls into line easier.

Right now the most important thing for you to do is use the equipment all night and get more hours of sleep with it.
Gotta get the hours of sleep for you to be able to evaluate them the best.
You will get there...

Pugsy wrote:

James-UK wrote:I will leave it at 7 until I'm able to sleep all night using the mask for a week.

I think that's a good idea. Now work on using the mask and machine all night....then worry about tweaking the pressures for the AHI if needed.
The brain likes predictability and when we go changing things the brain doesn't have time to get used to one thing before we go changing another. So there is some truth to the "give it some time for the body to adjust to things". Obviously no amount of time is going to fixed horrible therapy from suboptimal pressure or bad leaks but once you find something that is fairly acceptable then I suggest that people try it for a while. Often as the body and brain adjusts then the other stuff falls into line easier.

Right now the most important thing for you to do is use the equipment all night and get more hours of sleep with it.
Gotta get the hours of sleep for you to be able to evaluate them the best.
You will get there...

Thank you for the words of encouragement.

I managed to wear the mask for 4hours and 47minutes which is quite a big improvement but still 2hours off a full night, again I can't remember taking the mask off. I was also woken up twice by one of my cats, he decided it was play time at 5am, once he settled I went back to sleep, only to be woken up by him again. After removing him from my room I went back to sleep on my stomach and I'm surprised how comfortable I was, I'm actually impressed by the machine and mask. I don't have a problem using them but for some reason I keep taking the mask off.

My numbers have increased a little, my AHI was 6.9, my 90% pressure was 13.5 and my average pressure was 9.9:



Once I finally manage to keep my mask on all night it may serve as encouragement to those who have a problem keeping their mask on when first starting treatment, so I will continue to update this thread.

I finally wore the mask all night , I did wake up once and I had to remove it due to condensation build up but once I had wiped my face, I put it back on and went to sleep.
I even switched my alarm off this morning and went back to sleep for about 50minutes.

Last night was awful, I woke up at least five times and at one point I woke up feeling like the pressure was too high, as I opened my mouth to inhale my cheeks instantly expanded due to how much air was being blown in, I then inhaled and exhaled a few times hoping something would change but the same thing kept happening. I started exhaling forcible but it didn't make a difference, this morning I realized I should have just used the ramp button.

At this point I thought I had completely removed the mask but looking at the pressure when the mask came off (7) compared to 50 or so minutes before at 17-18 it has to have been at this point the above happened. A little later I woke up and I went to put the mask on only to fall asleep with it around my neck, when I woke up again I then put the mask on correctly.

Hmmm. For some reason your machine did the runaway pressure thing last night. That's pretty much a sure fire way to get woke up.
Yes, if that happens again just use the ramp or turn the machine off and then back on quickly so that it resets to the lower starting pressure.
Looks like it was responding around the time of that cluster of OAs....

I was wanting to see more than a couple of night's reports before suggesting pressure changes but maybe it isn't too soon after all.
The minimum pressure is the most critical setting. Set it optimally and the pressure line normally should stabilize for the most part except for occasional sporadic higher pressure needs.
In other words set the minimum pressure high enough so the machine is in a better prevention mode instead of in "fix it" mode.

I suspect you need more minimum pressure to better prevent the collapse of the airway tissues that end up being those OA clusters.
Maybe related to sleeping position needing more pressure or maybe it is REM stage sleep events needing more pressure...both are quite common.

Look at this thread and you can get a better idea about what I mean when I say with optimal minimal pressure the maximum stabilizes.
viewtopic.php?f=1&t=39869&st=0&sk=t&sd=a

It's hard to say what your optimal minimum might be with such limited data but I suspect around 9 or 10. Usually it falls around the average pressure number.
I wouldn't make that jump all in one night though. I would go up slowly with the minimum for 2 reasons...it's easier to adjust to and we might get lucky and not need as much as originally thought.
I think I would also put a cap on the maximum just to prevent further runaway pressures from happening though this might have been a fluke...still yet it hurts nothing to put a limit on it and prevent that sleep disruption. Should you happen to be one of those people who find that the least little change in pressure is a disturbing factor to sleep then we can use a really tight range if need be.

Your minimum pressure right now is 7 cm..is that correct?
If it were me I think I would try 8 cm starting pressure and give it 3 or 4 nights to see how it does and also limit the max to maybe 13 or 14. If we end up seeing it maxed out often then maybe give it a little more room but I think that if you have a more optimal minimum pressure that the maximum pressure will actually stabilize and become less a factor.

The timing of the clusters of OAs is strongly suspicious for REM stage sleep events needing a little more pressure.
That's something I personally have a good bit of experience with myself.
REM stage sleep normally starts around 90 minutes or so after first sleep onset and then comes on a little more frequently and lasts longer as the night goes on.

Thank you for responding with so much helpful information and for doing it in a away that I'm able to learn, rather than just saying do X because I say so. Part of me is now quite surprised that machines are sold with a wide open pressure range, if it wasn't for all your help and the software I wouldn't have any chance at fixing these little problems.

You are correct about my minimum pressure being at 7, I will change it to 8 and reduce my maximum limit to 14 when I get into bed ( a couple of hours) and you are spot on with there being a rem connection, the sleep technician mentioned this at the end of my report: "The overall pattern suggests a REM-relationship."

Here is the data breakdown from my study and what appears to be a screenshot from the Stardust II software, I doubt it will be of any help but just in case:




I will update this thread tomorrow, thanks again.

Thursday to Friday there wasn't really much data to show, I only wore the mask for 1hour and 5minutes. I don't know why I removed it but I slept straight through (or at least it felt that way) and I had the best nights sleep since starting cpap last Friday. I still felt bad in the morning but not as bad as I do with cpap.



Last night it took me quite long to fall asleep, the first three hypopneas and the first clear airway I'm sure I was awake. I then dozed off for a little bit, the pressure of 8 seemed to be causing air to get trapped between the sides of my gums and cheeks when ever I opened my mouth, it wasn't happening Thursday to Friday so maybe it's due to mask placement. It was still quite annoying so I pushed the ramp button and went back to sleep. A little later I woke up again, then again and I pushed the ramp button, then I woke up again and I removed the mask, then again and I put the mask on but I forgot to push the therapy button:




I hope the FitLife mask suits me better, I don't even feel like this mask is bad but I'm waking up all the time and feel worse using cpap . I'm hoping as the FitLife mask is bigger that the pressure will be better distributed. I am however concerned about my eyes drying out, I already use eye drops for allergies and artificial tears for dry eyes.

I started cpap therapy myself in december of 2012 and i will say that i have experienced much of the same things you have although i am straight cpap with a pressure of 12. here is the thing that i went through often times during that first month i removed my mask while sleeping come to find out that because of the way my face is shaped the mask i was using did not have enough support and would ride up my face untill my mouth was uncovered. i am a mouth breather at night. I can also say that from experience that while you are feeling not good upon waking after using the cpap that will change. The first 2 months that i was using my machine i felt worse than not using the machine at all but once my body got use to having good sleep it really changed how i felt in the morning. after almost a year of using a cpap machine i cant imagine going one night with out it. hell i panic when the power goes out for more than an hour at my house.

Last night I got into bed very late (3am) there wasn't much point in attempting to go asleep earlier as there was a party at a house over the back.

I used the ramp feature straight away and I only remember waking up once, I woke up wondering why I couldn't feel any pressure being blown and when I looked at my machine it was off, I almost started to panic and then I realized I had unplugged the cable from the machine (with my foot I presume). I've now moved the cable so this cannot happen.

After looking at the pressure graph I was happy to see the machine wasn't unplugged very long. AHI is down :

corybodette wrote:I started cpap therapy myself in december of 2012 and i will say that i have experienced much of the same things you have although i am straight cpap with a pressure of 12. here is the thing that i went through often times during that first month i removed my mask while sleeping come to find out that because of the way my face is shaped the mask i was using did not have enough support and would ride up my face untill my mouth was uncovered. i am a mouth breather at night. I can also say that from experience that while you are feeling not good upon waking after using the cpap that will change. The first 2 months that i was using my machine i felt worse than not using the machine at all but once my body got use to having good sleep it really changed how i felt in the morning. after almost a year of using a cpap machine i cant imagine going one night with out it. hell i panic when the power goes out for more than an hour at my house.

Thanks for your post corybodette. It's really good to read that you have overcome all problems and are now feeling good using your machine. I hope I start feeling the benefits soon, if I follow your path I only have 7 weeks more off this lol. I have a Quattro FX and the sizing feels good, if it is the mask at least I should know once my new one is here.

I think one of the things playing a role which I didn't think of before is the weather, I live in London, England and we don't get much hot weather so when it comes I don't deal with it very well, it normally makes sleeping hard and now I have a mask on my face. Last night my room was 32 degree celsius with 55% humidity, that's with my windows open.

I look forward to panicking about not being able to use my machine .