cpap compliant, great data, still waking often

hello, i 1st posted/joined here mid december in regards to my 4 months of struggling with cpap adjustment. This site has been a blessing with some very kind/insightful people. to recap, 47, male, narrow nasal/airway cause of osa, ahi 14, may not be accurate as my sleep study was done in my house as insurance did not approve. no other health issues. i struggled mightily with cpap since august, i have FINALLY fallen asleep (24 days ago was the 1st time) with cpap and swift nasal pillows/chin strap combo, but have woken up every 1-2 hours similar to pre-cpap. i have been cpap compliant 24 straight days, and have fallen asleep easily at night for over 3 weeks. the following is consistent data as per PR S1 auto-cpap for the last 24 days. ahi 0.9-1-8; 90% @ 8.0; leaks 0 (i am a back sleeper and the nasal pillows fit perfectly, also, there has never been a leak during any of my awakenings) 0 periodic breathing; 7+ usage hours each night i went over this data with my sleep doc and he was baffled by my 1-2 hour repeated awakenings and suggested the therapy was working based on data. i asked about possibly incresing pressure but he said no as 90% @ 8.0 indicated it was good. he is trying to get approved an actual sleep study to see what is happening. summary of my settings- auto cpap; 7.0-15 (i don't use ramp), c-flex at 2 (c-flex feels like natural breathing to me) humidifier at 2. i too feel the therapy is working a little as the trainwreck headache i have had for months is a little less, the dense fog my brain has been in is a little less, and my focus/concentration is slightly improved. but no where close to how i should be feeling as i am still so tired. the 1-2 hours of sleep with cpap is certainly better than 1-2 hours without. the repeated wakenings is frustrating, i am not gasping for air, i am not overwhelmed by pressure, not with rapid heartbeat, i am not turning or tangled in tubing, i am just waking up, if that makes sense. i even used quatrro f/x for a few days thinking maybe my mouth was opening a little with chin strap and mouth/air pressure disturbance was cause of waking. i fell right to sleep with f/x, and still woke up like clockwork. i take .5- 1mg klonpoin at night, have done so for 3+ years so increasing that won't help, having full endocrine work up to check/rule out any hormonal imbalance. is this perhaps sometimes normal with cpap adjustment? is data reliable? would sleepyhead data show something else as possible cause for wake-ups? i know it is only 3 weeks of compliance, but is has been a long 22 months of this ( i was undiagnosed for quite some time) the 1st few nights that i fell asleep i was SO happy just to have fallen asleep with cpap/gear. i'm just happy i have adjusted, and hopeful that each night will bring better quality sleep. if anyone has experienced this, or any advice/insight at all, that would be greatly appreciated. thanks

Wow...I am in almost same exact boat...

Went to doc for constant wakening...

Home sleep study...AHI 12...pressure is 10.0...some relief...some ambien...no leaks...AHI < 1.0 since start...use equipment every night for 8 weeks straight now...still waking frequently...

billyc17 wrote:would sleepyhead data show something else as possible cause for wake-ups?

Unknown....but it's a place to start.
Look for obvious easy to fix stuff first...might get lucky.

Unfortunately not all wake ups are tied to something that is related to sleep apnea and the machine doesn't do such a good job fixing stuff unrelated to sleep apnea.

The cpap machine and optimal therapy can't fix bad sleep if the reason for the bad sleep is unrelated to sleep apnea issues.

Sometimes frequent wake ups are just some sort of sleep maintenance insomnia and we have to look for other possible culprits besides what we can see on the cpap software reports.

BUT.....we start with the software reports because sometimes we do get lucky and spot something that is important and fixing it sometimes helps...sure doesn't hurt to look.

billyc17 wrote:hello, i 1st posted/joined here mid december in regards to my 4 months of struggling with cpap adjustment. This site has been a blessing with some very kind/insightful people. to recap, 47, male, narrow nasal/airway cause of osa, ahi 14, may not be accurate as my sleep study was done in my house as insurance did not approve. no other health issues. i struggled mightily with cpap since august, i have FINALLY fallen asleep (24 days ago was the 1st time) with cpap and swift nasal pillows/chin strap combo, but have woken up every 1-2 hours similar to pre-cpap. i have been cpap compliant 24 straight days, and have fallen asleep easily at night for over 3 weeks. the following is consistent data as per PR S1 auto-cpap for the last 24 days. ahi 0.9-1-8; 90% @ 8.0; leaks 0 (i am a back sleeper and the nasal pillows fit perfectly, also, there has never been a leak during any of my awakenings) 0 periodic breathing; 7+ usage hours each night i went over this data with my sleep doc and he was baffled by my 1-2 hour repeated awakenings and suggested the therapy was working based on data. i asked about possibly incresing pressure but he said no as 90% @ 8.0 indicated it was good. he is trying to get approved an actual sleep study to see what is happening. summary of my settings- auto cpap; 7.0-15 (i don't use ramp), c-flex at 2 (c-flex feels like natural breathing to me) humidifier at 2. i too feel the therapy is working a little as the trainwreck headache i have had for months is a little less, the dense fog my brain has been in is a little less, and my focus/concentration is slightly improved. but no where close to how i should be feeling as i am still so tired. the 1-2 hours of sleep with cpap is certainly better than 1-2 hours without. the repeated wakenings is frustrating, i am not gasping for air, i am not overwhelmed by pressure, not with rapid heartbeat, i am not turning or tangled in tubing, i am just waking up, if that makes sense. i even used quatrro f/x for a few days thinking maybe my mouth was opening a little with chin strap and mouth/air pressure disturbance was cause of waking. i fell right to sleep with f/x, and still woke up like clockwork. i take .5- 1mg klonpoin at night, have done so for 3+ years so increasing that won't help, having full endocrine work up to check/rule out any hormonal imbalance. is this perhaps sometimes normal with cpap adjustment? is data reliable? would sleepyhead data show something else as possible cause for wake-ups? i know it is only 3 weeks of compliance, but is has been a long 22 months of this ( i was undiagnosed for quite some time) the 1st few nights that i fell asleep i was SO happy just to have fallen asleep with cpap/gear. i'm just happy i have adjusted, and hopeful that each night will bring better quality sleep. if anyone has experienced this, or any advice/insight at all, that would be greatly appreciated. thanks

In my opinion, from what I'm reading is that the pressure changes in APAP mode is wrecking your sleep. "Good numbers" don't necessarily translate to "good sleep". If your breathing changes as you enter a sleep stage and the machine thinks it needs to increase pressure, you can be bumped out of the sleep stage and disrupt your sleep. You are obviously waking frequently and that makes the pressure changes the suspect. Your scenario is waaaay to common for people who use APAPs in a range of pressures.

You should be able to see from the downloads and reports how many pressure changes you're having during the night and that's where you need to start........scrutinizing your reports.


Den

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I to used to sleep sound with xpap and before, lately I've been sleeping and waking on about a 40 minute cycle all night every night. I wake up just enough to take a sip of water and change position. I go back to sleep in less than 2 minutes. I am using a fixed cpap pressure.

I would prefur waking up didn't happen, but I wont use med's to correct it. Jim

In my opinion, from what I'm reading is that the pressure changes in APAP mode is wrecking your sleep. "Good numbers" don't necessarily translate to "good sleep". If your breathing changes as you enter a sleep stage and the machine thinks it needs to increase pressure, you can be bumped out of the sleep stage and disrupt your sleep. You are obviously waking frequently and that makes the pressure changes the suspect. Your scenario is waaaay to common for people who use APAPs in a range of pressures.

You should be able to see from the downloads and reports how many pressure changes you're having during the night and that's where you need to start........scrutinizing your reports.


Den

.[/quote]
Thanks,- sounds logical to me that having narrow nasal passages and narrow airway, that utilizing nasal pillows one may have these problems when pressure changes/breathing changes. with my settings of 7-15 and a 90% @ 8.0 consistently for over 3 weeks, what would you suggest as a pressure to set it at for? i think i can safely say that if the last 3 weeks are any indicator of my therapy, i will wake up frequesntly tonight, so at least i can break the cycle of insanity of the doing the same thing over and over each night with something new tonight. thanks

billyc17 wrote: Thanks,- sounds logical to me that having narrow nasal passages and narrow airway, that utilizing nasal pillows one may have these problems when pressure changes/breathing changes. with my settings of 7-15 and a 90% @ 8.0 consistently for over 3 weeks, what would you suggest as a pressure to set it at for? i think i can safely say that if the last 3 weeks are any indicator of my therapy, i will wake up frequesntly tonight, so at least i can break the cycle of insanity of the doing the same thing over and over each night with something new tonight. thanks

You would need to scrutinize and monitor your reports, but if your 90% is currently at 8 cm., that may be a good place to start. It kind of depends on the types of events you're having. If there were lots of flow limitations and snores that were driving up the pressures, they're not as critical as apneas. And, keep in mind that NO APAP will raise pressures to attempt to stop an apnea in progress.
You just need to determine what types of events are occurring at what pressures.
As I said, you might try 8 cm. for several nights (three to five) and look at the data. Then, if it looks like that pressure isn't taking care of enough events, you could try 9 cm. for a number of nights.......and so on, until your numbers look good, but also that you're feeling like your sleep quality is better.

It's kind of strange, but sometimes the nights when you sleep more soundly, you MAY have more events. It's not unusual to feel like you've slept good at an AHI of 2.0 and then some nights when you may have an AHI of 0.5 may not be as good. You need to also look at AHI averages over longer periods of time......and see if they're improving or going the other way.
In other words, "a few nights" of good or bad numbers don't give a total picture. This therapy is mostly "averages" and longer term trends.

With fixed pressure (CPAP mode), you need to find the balance between good numbers and good sleep.

I hope I haven't confused you. Please feel free to keep asking questions.


Den

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With the Respironics machines we need APAP mode to be used to get Flow limitation event flags.....so when someone is thinking about trying cpap mode instead of apap mode to see if the pressure changes themselves are a disruptive factor to sleep quality I usually suggest that they still use apap mode but maybe set it so the minimum pressure equals maximum pressure.
That way the variable pressure is eliminated but we don't have to give up flow limitation data (just in case it might be important).

Pugsy wrote:With the Respironics machines we need APAP mode to be used to get Flow limitation event flags.....so when someone is thinking about trying cpap mode instead of apap mode to see if the pressure changes themselves are a disruptive factor to sleep quality I usually suggest that they still use apap mode but maybe set it so the minimum pressure equals maximum pressure.
That way the variable pressure is eliminated but we don't have to give up flow limitation data (just in case it might be important).

That's true, but he could also see those events in his existing reports......with a pressure range.
Either way will work.......APAP mode with minimum pressure and maximum pressure set to the same number or CPAP mode.
For all intents and purposes, "Flow Limitations" don't really matter much with regard to the therapy......they and Snores are what the APAPs use to trigger pressure changes. So, if the machine isn't going to adjust pressure, all you need to see are the snores, hypopneas and apneas.


Den

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Wulfman... wrote:For all intents and purposes, "Flow Limitations" don't really matter much with regard to the therapy......they and Snores are what the APAPs use to trigger pressure changes.

I have to respectfully disagree.
When trying to figure out why a person is waking up (and we can't see any logical reason) I prefer to have all available information at my finger tips...just in case.
The FLs and UARS thing is always a possibility and even if remote....bears keeping one eye open.
After all...there is a reason why the apap mode will respond to a FL.

Pugsy wrote:With the Respironics machines we need APAP mode to be used to get Flow limitation event flags.....so when someone is thinking about trying cpap mode instead of apap mode to see if the pressure changes themselves are a disruptive factor to sleep quality I usually suggest that they still use apap mode but maybe set it so the minimum pressure equals maximum pressure.
That way the variable pressure is eliminated but we don't have to give up flow limitation data (just in case it might be important).

Is this true of resmed as well?

bavinck wrote: Is this true of resmed as well?

No. ResMed S9 users still get their FL data no matter which mode is used so I don't bother telling S9 users about the FL flagging peculiarities that only pertain to Respironics users.

Thanks.

Pugsy wrote:

Wulfman... wrote:For all intents and purposes, "Flow Limitations" don't really matter much with regard to the therapy......they and Snores are what the APAPs use to trigger pressure changes.

I have to respectfully disagree.
When trying to figure out why a person is waking up (and we can't see any logical reason) I prefer to have all available information at my finger tips...just in case.
The FLs and UARS thing is always a possibility and even if remote....bears keeping one eye open.
After all...there is a reason why the apap mode will respond to a FL.

And, in my opinion, the reason is of dubious value. One has to interrogate the reports to see how many FLs turn into Hypopneas, Snores or Apneas. Also, one should look to see how many snores precede apnea events.

Many people have "frank" apneas (without preceding events) and will never get a pressure increase BECAUSE of the lack of preceding events.

Considering that these machines use "air flow" to interpret events, there are many things that a sleeper could do that would NOT be an actual event worth increasing pressure for. Just turning over or repositioning yourself could be interpreted as a flow limitation. The hose rubbing across the edge of the bed could be interpreted as a snore.

But, we were talking about straight pressure for this user and his sleep disturbances. Tracking FLs may be interesting to see how many times the machine didn't have to bump the pressure......but that's about it.
If Flow Limitations were that important, the machines would record them in CPAP mode, too. Yeah, I know, ResMed Elite machines do.......whoopie!

As far as UARS.......???

Upper Airway Resistance Syndrome (UARS) - part of the spectrum of obstructive sleep-related breathing disorders in which repetitive increases in resistance to airflow in the upper airway lead to brief arousals and daytime fatigue. Apneas and hypopneas (see RDI) may be totally absent. Blood oxygen levels can be in the normal range.


Den

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I started CPAP therapy last November and was very disappointed when I found myself still waking up every 1.5 to 2 hours. After doing some reading here and on another board, I became suspicious that the problem may be periodic limb movements (PLMD) which was also noticed during my sleep study. I set up a video camera to see if that was the case and I was amazed at the almost continuous "dancing" my legs do all night! No wonder I can't get any rest! I have an appointment with my neurologist/sleep doctor tomorrow to discuss.

If you have a video camera you can setup it might provide some clues. Of course, if your doctor can get a sleep study approved that would be optimal.