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SleepySheepy
Unread post  Post subject: Thoughts and Advice Requested  |  Posted: Wed Dec 19, 2018 9:05 pm

Joined: Wed Dec 19, 2018 8:12 pm
Posts: 8
Location: Denver, CO
PAP Mask: AirFit P10 Nasal Pillows
PAP Machine: Resmed Airsense 10 Autoset, w/ Climate Tube
Pressure Setting: Experimentation Phase

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Hello All,

I'm new to this but have been reading and learning as much as I can. I've been using my machine for four nights now and have posted below my most recent SleepyHead results. I've been experimenting with the settings throughout my time so far.

https://imgur.com/a/Yfhjz4p

Based on what I currently understand, I'm going to increase my minimum pressure from 5 to 7 tonight in an attempt to clean up some of those hypopnea clusters. I'll go even higher tomorrow night if needed. As you can see, I already have the maximum set to the limit at 20, with my 95% max coming through at 11. Any thoughts on the use of EPR, given my data? And if so - what are thoughts on levels? I believe I read that a correlation between use of EPR and central apneas is not uncommon. I have been going back and forth between "full time" and "ramp only".

For qualitative context, of my nights using the machine so far - last night was the best in the sense of keeping it on the longest (6:48 of the 9 I slept) but the worst in terms of how I felt in the morning/today. Overall, I can remember waking up each night multiple times due to my mouth opening for a moment and the uncomfortable feeling of pressure pulling through (to be clear, I am using nasal pillows). However, this also seemed to be less of an issue last night vs. the nights before and so I'm not too concerned quite yet. But to be honest tho, I'm a bit surprised by how I felt today as it seemed like the discomfort and interruptions while in bed were relatively less, as I remember it. The first few nights I actually did feel a notable improvement in the morning - as I woke up earlier, easier and with more energy. Now, this morning was back to the usual struggle and hitting snooze multiple times.

AHI so far has been - 0.94, 0.50, 6.33, 3.68.
Time with mask on - 4:15, 5:49, 5:13, 6:48

Happy to answer any questions and appreciate any feedback.

Thanks!

https://imgur.com/a/Yfhjz4p


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diamaunt
Unread post  Post subject: Re: Thoughts and Advice Requested  |  Posted: Thu Dec 20, 2018 12:57 am
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Joined: Wed Mar 02, 2016 2:26 am
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Location: Dallas(ish)
PAP Mask: Resmed P10
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Pressure Setting: 18/13-25/19

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You're doing good for 4 days in, and your thoughts on pressure are good.

I think it's too early to worry much about the waking up, or the possible centrals (they're not very high, anyway), it's very possible they're transitional/post arousal, but, like I said, not high enough to do anything about.

Bump the pressure like you planned, and give it a few more nights...you're still getting used to the machine.

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SleepySheepy
Unread post  Post subject: Re: Thoughts and Advice Requested  |  Posted: Sat Dec 22, 2018 7:28 am

Joined: Wed Dec 19, 2018 8:12 pm
Posts: 8
Location: Denver, CO
PAP Mask: AirFit P10 Nasal Pillows
PAP Machine: Resmed Airsense 10 Autoset, w/ Climate Tube
Pressure Setting: Experimentation Phase

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So I turned the pressure up (7-20 cmH20) and it in part led to what was honestly one of the worst physical experiences of my life. Though I had come across it in my reading, experiencing aerophagia first hand is something I wouldn't wish on anyone. This occurred two nights ago. Last night I didn't use my CPAP machine at all and I still feel like there's a knife in my stomach now, though significantly better than yesterday. Yesterday I was shaking, nauseous, cold sweats, lower back pain, headache and short of breath the entire day. The best way I could describe how I felt was pure agony.

Here's the chart:
https://imgur.com/a/C9TFv1r

As you can see I had an RERA, for the first time, and massive air leaks.

I believe that the increase in pressure is partially to blame, as I didn't experience any of this prior. There were several times where I felt pressure building in my mouth and it just sorta "popped" downward (I thought into my lungs). I also know that while I was still drifting to sleep I swallowed several times - how can you not when saliva is continually being produced (honest question)? Lastly, I woke up several times during the night because my mouth came open.

This was absolutely terrible and I'm still not back to normal. However, I'm not giving up. I'm going to order a chinstrap and upon my return from holiday travels will use that in conjunction with a mouth piece to keep my mouth shut. I will also be propping my body up at a 45 degree angle with pillows and backing off the pressure a bit to see if that helps.

I'll keep you all posted.


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diamaunt
Unread post  Post subject: Re: Thoughts and Advice Requested  |  Posted: Sat Dec 22, 2018 1:18 pm
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Joined: Wed Mar 02, 2016 2:26 am
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Location: Dallas(ish)
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Pressure Setting: 18/13-25/19

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SleepySheepy wrote:
As you can see I had an RERA, for the first time, and massive air leaks.

Well, you've had plenty of RERAs, but there were AH flags associated with them, so they weren't 'just' a RERA.
SleepySheepy wrote:
I believe that the increase in pressure is partially to blame, as I didn't experience any of this prior. There were several times where I felt pressure building in my mouth and it just sorta "popped" downward (I thought into my lungs). I also know that while I was still drifting to sleep I swallowed several times - how can you not when saliva is continually being produced (honest question)? Lastly, I woke up several times during the night because my mouth came open.

I know I can't convince you, but I seriously doubt that the 2cm min pressure increase was the reason. You'd had pressure up to 12.14 on the first chart you posted.

I swallow all the time while on pressures that *start* at 13cm.

I know that doesn't help, but I'm not sure at the moment what to suggest other than "keep at it".

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SleepySheepy
Unread post  Post subject: Re: Thoughts and Advice Requested  |  Posted: Sat Dec 22, 2018 1:32 pm

Joined: Wed Dec 19, 2018 8:12 pm
Posts: 8
Location: Denver, CO
PAP Mask: AirFit P10 Nasal Pillows
PAP Machine: Resmed Airsense 10 Autoset, w/ Climate Tube
Pressure Setting: Experimentation Phase

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Right I dont think its solely due to the pressure increase but at the same time even when I was awake I was getting that weird popping feeling which I hadn't experienced previously. Up until last night I never really had problems at all and now I'm honestly scared to try again. Who knows.

Sorry if my message above came across as upset. It's been 1.5 days and I'm still in an awful lot of pain. Really a bummer to be at the airport right now traveling for a Christmas party this evening. I bought some Gas-X earlier, hoping that'll help. Haven't been able to get much food down but I just ate 1/4 a salad and a banana. Anyone have any other suggestions for getting through today?

Thanks in advance.


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SleepySheepy
Unread post  Post subject: Re: Thoughts and Advice Requested  |  Posted: Tue Jan 01, 2019 5:26 am

Joined: Wed Dec 19, 2018 8:12 pm
Posts: 8
Location: Denver, CO
PAP Mask: AirFit P10 Nasal Pillows
PAP Machine: Resmed Airsense 10 Autoset, w/ Climate Tube
Pressure Setting: Experimentation Phase

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Time for an update.

As I was back home for the holidays I took the opportunity to sleep as much as possible; probably around 12 hours/day over 4 days. By the second or third day I was finally able to start eating again and once I did it seemed to move everything through my system. By the end of my trip I felt relatively healthy and pain free.

Looking back I'm still not positive what happened but my best guess is that increasing the pressure opened up my sinuses and allowed years (literally) of chronic congestion to move out of my head and down into my digestive system. My symptoms could best be described as flu-like with terrible pain in my stomach.

I have a deviated septum and have suffered from sinus infections all of my life (side note - I'm 29 years old and appear "fit"). Since using CPAP (2 weeks now) I've noticed that my sinuses feel much less congested and I can breath through my nose easier than I've ever been able to in the past. I'm hoping this incident was actually a positive in that it was a necessary step to get this sinus issue mediated. I've been practicing other therapy for my sinuses for quite some time but this may have been just what was needed to physically alleviate some of what was "trapped", if you will.

Since returning I've added a chinstrap to my therapy and resumed using my machine (going on 6 nights straight). The chinstrap has seemingly eliminated the issue of having my mouth fall open, which has been great. I haven't had any other incidents like this (so thankful!) but I am still working towards getting the settings dialed in and having a full nights sleep. The last few nights have averaged only 2.5-3.5 hours with the machine as I have been waking up and taking it off due to discomfort. I'm hoping this is just a matter of building up tolerance and I'll be able to wear it longer and longer going forward but am open to suggestions.

Here's my graph from last night with an AHI of 2.12:
https://imgur.com/a/DMBbBgZ

Any thoughts on pressure or adjustments to consider? My focus has been on eliminating the ramp, flipping back and forth on EPR (anywhere from 1-3) and keeping min pressure a bit higher. I've noticed that pressure of 8-10 seems to be best for me in terms of not feeling like I'm struggling to catch my breath but then exhaling is difficult/uncomfortable.

Thanks!


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diamaunt
Unread post  Post subject: Re: Thoughts and Advice Requested  |  Posted: Tue Jan 01, 2019 1:49 pm
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Posts: 2419
Location: Dallas(ish)
PAP Mask: Resmed P10
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Pressure Setting: 18/13-25/19

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That's actually pretty good.

There's no reason to change the max.

Finding the right min is the important thing, and that night's result was pretty good.

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SleepySheepy
Unread post  Post subject: Re: Thoughts and Advice Requested  |  Posted: Wed Jan 02, 2019 4:34 am

Joined: Wed Dec 19, 2018 8:12 pm
Posts: 8
Location: Denver, CO
PAP Mask: AirFit P10 Nasal Pillows
PAP Machine: Resmed Airsense 10 Autoset, w/ Climate Tube
Pressure Setting: Experimentation Phase

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Had my first full night with the machine last night (8 hours and 24 minutes). Interestingly, my AHI jumped up a bit to 4.52.

https://imgur.com/a/ulQ0doj

Here's a zoomed in screenshot which shows the pattern developing before a clear airway apnea (actually two of them):

https://imgur.com/a/EnAaIWA

These are what plague me the most and the breathing pattern leading up to it is nearly identical in every instance throughout the night. Just wanted to add in case it's helpful to see.


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Pugsy
Unread post  Post subject: Re: Thoughts and Advice Requested  |  Posted: Wed Jan 02, 2019 7:23 am
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Joined: Wed Aug 02, 2017 8:01 pm
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PAP Mask: Bleep/DreamPort nasal mask
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That rather large gulp in air prior to the CA/central flag looks like arousal breathing to me...you woke up (may or may not remember it) and then there was a little pause in your breathing.
In other words...you weren't asleep fully for some reason or other.
If not asleep...they don't count and in my mind they are a symptom of something causing arousals and less than optimal sleep quality.
They aren't the cause of the less than optimal sleep quality but instead a by product of whatever caused the arousal in the first place.

I see this often myself...I have had nights with the AHI be near 4.0 and every single flagged event was SWJ sleep/wake/junk and either awake breathing related or post arousal related. None were the real deal.
And I get all categories flagged...not limited to CAs/centrals either.
Sometimes not a single event is real.

Now for me I usually know why I had so many arousals...pain.
For you...might not be so easy to isolate the cause.
Even harder to fix it even when we do know the cause...been there and done that myself.

I wouldn't change any settings at this point. Instead I would try to work on the overall sleep quality and try to figure out what might be causing the arousals.
Ignore the CAs/centrals since that seems to be what you are primarily seeing flagged...don't worry about them.
They aren't real for one thing and if something isn't real and you aren't asleep...they simply don't count in the evaluation process except to note that they are evidence of less than optimal sleep quality.
Even if they were real...can't fix them with your machine anyway and you aren't consistently having enough of them if they were real to warrant doing anything about them anyway.


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SleepySheepy
Unread post  Post subject: Re: Thoughts and Advice Requested  |  Posted: Sun Jan 06, 2019 6:50 am

Joined: Wed Dec 19, 2018 8:12 pm
Posts: 8
Location: Denver, CO
PAP Mask: AirFit P10 Nasal Pillows
PAP Machine: Resmed Airsense 10 Autoset, w/ Climate Tube
Pressure Setting: Experimentation Phase

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Pugsy, just wanted to say thank you for your reply. This makes a lot of sense and I meant to respond sooner.

I'm still working through all of this and some nights are better than others (naturally). My best guess is that my arousal are caused by a mix of temperature swings and not being able to sleep comfortably on my back. I've always been a stomach sleeper and this obviously doesn't work with CPAP. If I am actually able to fall asleep on my back then I usually end up waking up later and rolling over to side/stomach... which then involves more tossing and turning throughout the night. Wish me luck, I'm still doing pushing ahead with optimism.


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SleepySheepy
Unread post  Post subject: Re: Thoughts and Advice Requested  |  Posted: Sun Jan 20, 2019 7:03 am

Joined: Wed Dec 19, 2018 8:12 pm
Posts: 8
Location: Denver, CO
PAP Mask: AirFit P10 Nasal Pillows
PAP Machine: Resmed Airsense 10 Autoset, w/ Climate Tube
Pressure Setting: Experimentation Phase

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Curious to know what you all make of this (very zoomed in to a 10 minute span of time). I definitely don't remember waking up but it's possible. Does REM look anything like this?:

https://imgur.com/a/RXhvaXq

The second image is my entire night with CPAP. To be honest, I've been wondering lately if I really do need a machine. I haven't been able to afford a sleep study and embarked on this quest to test for myself. Based on this, and my previous images/posts, what do you think? Not asking for a medical diagnosis here just want to see how you all interpret my results thus far.


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Pugsy
Unread post  Post subject: Re: Thoughts and Advice Requested  |  Posted: Sun Jan 20, 2019 7:59 am
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That zoomed in segment looks like arousal breathing to me.
Not asleep breathing. Just because you don't remember an arousal doesn't mean it didn't happen. We do it all the time.

Need to see what the breathing was right before the start of the ugly cluster of events to best evaluate the cluster. So need to see it zoomed in with the first flagged event on the far right of the graph so that the breathing going on just prior to the first flag can be evaluated.

The cluster isn't REM but what might have happened is you woke up after a REM stage was complete and the cluster is nothing more than post arousal breathing after a REM stage cycle. It's normal to wake after REM cycle. Normally we just roll over and go back to sleep but sometimes we don't.


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SleepySheepy
Unread post  Post subject: Re: Thoughts and Advice Requested  |  Posted: Sun Jan 20, 2019 9:48 am

Joined: Wed Dec 19, 2018 8:12 pm
Posts: 8
Location: Denver, CO
PAP Mask: AirFit P10 Nasal Pillows
PAP Machine: Resmed Airsense 10 Autoset, w/ Climate Tube
Pressure Setting: Experimentation Phase

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Pugsy wrote:
That zoomed in segment looks like arousal breathing to me.
Not asleep breathing. Just because you don't remember an arousal doesn't mean it didn't happen. We do it all the time.

Need to see what the breathing was right before the start of the ugly cluster of events to best evaluate the cluster. So need to see it zoomed in with the first flagged event on the far right of the graph so that the breathing going on just prior to the first flag can be evaluated.

The cluster isn't REM but what might have happened is you woke up after a REM stage was complete and the cluster is nothing more than post arousal breathing after a REM stage cycle. It's normal to wake after REM cycle. Normally we just roll over and go back to sleep but sometimes we don't.


Below is a zoomed in shot with the first flagged event to the far right, per your request. I'm pretty sure I know what you're going to tell me Pugsy :lol:

https://imgur.com/a/jotEdT9

Side note - the last few nights I've dropped the min pressure back down a bit to see if I end up keeping the mask on longer. It's gone well so far. Before, I was bumping it up as I felt that I was struggling to catch my breath but I've found that I just need to relax a bit before putting the mask on as my heart rate was elevated from getting into bed, pulling covers up, etc. Now I'll read for a bit and put the mask on just before I'm about to turn off the lights. Every night remains an experiment.


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Pugsy
Unread post  Post subject: Re: Thoughts and Advice Requested  |  Posted: Sun Jan 20, 2019 10:52 am
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Yep...you probably already realized that you weren't fully asleep right before all those centrals were flagged.
It's all SWJ or post arousal stuff.

Now why the arousal in the first place.....that's the real question.


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