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JamesR
Unread post  Post subject: Marginal better sleep frustrating me  |  Posted: Sat Aug 03, 2019 10:36 pm

Joined: Sat Aug 03, 2019 10:24 pm
Posts: 13
Location: Louisiana
PAP Mask: ResMed Airfit p10
PAP Machine: ResMed AirSense 10 Auto CPAP
Pressure Setting: 7-16

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Hello everyone. I've been using an auto CPAP resmed 10 with p10 mask. It's helped a little but I still wake up once or twice every night. Pressure is 9-16 with epr on 1, Friday a tech adjusted ramp so when I fall asleep it goes to 9 but starts at 7. I have an SD card and software called Oscar and my ahi varies from 3 to 10. It just doesn't feel like I'm getting restful sleep. I have central apnea according to the charts for all nights too. I've been using my CPAP for about 3 weeks. It feels like good rest is out of reach.


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Pugsy
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Sun Aug 04, 2019 6:19 am
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Without seeing the detailed software report to know more details its really difficult to comment on anything.

It's normal to wake after a REM cycle and we normally have several REM cycles during the night. Most of the time we roll over and go back to sleep and don't form a memory .....but to expect lights out and go to sleep and not wake up...unusual for that to happen and an unrealistic expectation.

Some of your central apnea flags may be a symptom of the wake ups.
Go here and watch all the videos and learn to figure out awake/arousal breathing flags from asleep flags.
http://freecpapadvice.com/sleepyhead-free-software

If you determine that the bulk of your central flags are indeed asleep flagged events you might try turning off EPR totally and see if they reduce.

If the bulk of your events are related to arousal/awake breathing then you have to fix whatever is causing you to wake up...and I know it's easier said than done sometimes.

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JamesR
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Sun Aug 04, 2019 11:39 am

Joined: Sat Aug 03, 2019 10:24 pm
Posts: 13
Location: Louisiana
PAP Mask: ResMed Airfit p10
PAP Machine: ResMed AirSense 10 Auto CPAP
Pressure Setting: 7-16

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Ok here is a couple screenshots from last night via OSCAR, I hope its ok to use that here. The changes the tech made along with the EPR setting I turned down seem to have helped. I will also attach a detail of some Central Apnea for review.


Attachments:
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mumin50
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Sun Aug 04, 2019 2:11 pm

Joined: Thu Jul 18, 2019 11:11 am
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PAP Mask: Resmed N30i
PAP Machine: Resmed A10 AutoSense
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Do not give up...

1st...question why to start at 7... it is APAP... i would start on 4 or 5 if you have not enough air. it will allow you to fall asleep easier.
2nd... check epap setting on your is set on 1cm. I'm still experimenting with my settings as i get mine for 2 weeks only, but i see great correlation of epap with centrals. Sometime disabling it is better, sometime making it 3 cm helps with o2 saturation and centrals on higher pressures.

Also your mask i see leeks, similar to me... i also see correlation

Stay positive it works :D


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JamesR
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Sun Aug 04, 2019 2:18 pm

Joined: Sat Aug 03, 2019 10:24 pm
Posts: 13
Location: Louisiana
PAP Mask: ResMed Airfit p10
PAP Machine: ResMed AirSense 10 Auto CPAP
Pressure Setting: 7-16

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mumin50 wrote:
Do not give up...

1st...question why to start at 7... it is APAP... i would start on 4 or 5 if you have not enough air. it will allow you to fall asleep easier.

2nd... check epap setting on your is set on 1cm. I'm still experimenting with my settings as i get mine for 2 weeks only, but i see great correlation of epap with centrals. Sometime disabling it is better, sometime making it 3 cm helps with o2 saturation and centrals on higher pressures.

Also your mask i see leeks, similar to me... i also see correlation

Stay positive it works :D


I had EPR set at 3 from the Dr but I recently got the nerve to turn it down to 2 which didn't make much of a difference.

See above, I turned it down from 3 to 1 a few days ago. I'm thinking about turning it off tonight.


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JamesR
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Mon Aug 05, 2019 8:18 am

Joined: Sat Aug 03, 2019 10:24 pm
Posts: 13
Location: Louisiana
PAP Mask: ResMed Airfit p10
PAP Machine: ResMed AirSense 10 Auto CPAP
Pressure Setting: 7-16

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Pugsy wrote:
Without seeing the detailed software report to know more details its really difficult to comment on anything.

It's normal to wake after a REM cycle and we normally have several REM cycles during the night. Most of the time we roll over and go back to sleep and don't form a memory .....but to expect lights out and go to sleep and not wake up...unusual for that to happen and an unrealistic expectation.

Some of your central apnea flags may be a symptom of the wake ups.
Go here and watch all the videos and learn to figure out awake/arousal breathing flags from asleep flags.
http://freecpapadvice.com/sleepyhead-free-software

If you determine that the bulk of your central flags are indeed asleep flagged events you might try turning off EPR totally and see if they reduce.

If the bulk of your events are related to arousal/awake breathing then you have to fix whatever is causing you to wake up...and I know it's easier said than done sometimes.


I've turned it off but with just one night of data it will take a few I'm sure to know if it's improved, although I feel better from EPR being 1 and now off altogether. I have reports for the last 3 weeks, how many would you like me to screenshot and post to get details?


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Pugsy
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Mon Aug 05, 2019 9:08 am
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Start with most recent detailed report.
I don't really care about a report from 3 weeks ago at this point.
I care about the here and now.

Meaning all I want to see right now is with EPR off.

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I may have to rise but I refuse to shine.


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JamesR
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Mon Aug 05, 2019 12:27 pm

Joined: Sat Aug 03, 2019 10:24 pm
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Location: Louisiana
PAP Mask: ResMed Airfit p10
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Alright, here's the one from last night.


Attachments:
8-4.JPG
8-4.JPG [ 382.35 KiB | Viewed 31957 times ]
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Pugsy
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Mon Aug 05, 2019 4:30 pm
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Why the wake up?

How much time do you think you spent with mask and machine on while awake?

Couple more nights at these settings and if it doesn't change much then how about increasing the minimum to 10 cm?

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I may have to rise but I refuse to shine.


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JamesR
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Tue Aug 06, 2019 4:48 am

Joined: Sat Aug 03, 2019 10:24 pm
Posts: 13
Location: Louisiana
PAP Mask: ResMed Airfit p10
PAP Machine: ResMed AirSense 10 Auto CPAP
Pressure Setting: 7-16

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My best guess is the mask was leaking and it woke me up.

I spent probably 20 minutes awake with mask on. It doesn't take me long to fall asleep once I put the mask on and lay down, normally 5-10 minutes.

Here is the report from last night.


Attachments:
8-5.JPG
8-5.JPG [ 427.4 KiB | Viewed 31918 times ]
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Pugsy
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Tue Aug 06, 2019 6:57 am
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I would be happy with that report from last night if it were me.
7 hours of sleep approx and nice low AHI...
How did you sleep?
How do you feel today?

_________________
I may have to rise but I refuse to shine.


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JamesR
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Tue Aug 06, 2019 7:13 am

Joined: Sat Aug 03, 2019 10:24 pm
Posts: 13
Location: Louisiana
PAP Mask: ResMed Airfit p10
PAP Machine: ResMed AirSense 10 Auto CPAP
Pressure Setting: 7-16

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I'm happy with it but I only got 6 hours of sleep, will shoot for 7 tonight.

I slept pretty good and today I feel somewhat rested. It reminds me of those rare nights when i'd fall asleep and boom next thing I know the alarm goes off.
I woke up around 330 with the mask pushing out a lot of air from the exhaust, is that normal?


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Pugsy
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Tue Aug 06, 2019 8:17 am
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Higher pressures will result in more vented air going out the vent holes... so you are going to experience times where the vented air flow changes in intensity. It's normal and to be expected with variable pressures.
Sometimes you will sleep through it and sometimes you won't.
If you look at your pressure graph you actually weren't at your highest pressure at 3:30. Unless the vented air was bouncing back on you I to wake you up I doubt that the wake up was anything more than a normal post REM wake up and you just happened to notice more air moving out the vent holes.

I don't know about you but I need greater than 7 hours of minimally fragmented sleep to actually notice much change in my overall energy levels for the day. Unfortunately I don't get that much sleep very often because of factors that are totally unrelated to sleep apnea.
6 hours would be a bare minimum for me and even at that I would very likely find my butt dragging by mid afternoon.

Do the best you can with your quantity of sleep as well as the quality (minimize wake ups if at all possible).
Trust me...easier said than done I know.
Accept the fact that when you don't get enough good quality sleep that you aren't going to feel your best. Heck, you wouldn't even if you didn't have sleep apnea.

Accept the fact that you don't sleep the same each night for any number of reasons.
Accept the fact that not all our sleep issues are related to apnea and no amount of tweaking with the settings is going to help fix sleep issues not related to apnea.

At some point you might be curious as to whether or not more minimum pressure will make any difference. Perfectly understandable and it may or may not. Some years back when I was first starting cpap therapy I was pretty much where you are at in terms of AHI and where the pressure was going. So I decided to do a little experiment to see if more pressure did anything for me. I chose to increase the minimum 0.5 cm a week over 6 weeks. Worked my way from 10 cm minimum to 13 minimum.
Nothing changed at all....AHI was still running between 1 and 2 most nights, hours of sleep didn't really change, no real difference in how I felt overall either. So I went back to 10 cm minimum. Back then we didn't have the data available that we have now to evaluate and I suspect the reason my AHI didn't really change was because what I was seeing was SWJ sleep/wake/junk false positives flagged during wake ups or arousals.
The AHI was a symptom of the poor sleep and not a cause of the poor sleep. More pressure won't fix a problem not related to the airway trying to close off.

If you want to take the time to learn about awake vs asleep flagged events
http://freecpapadvice.com/sleepyhead-free-software

Even now 75% of any AHI I might have is going to be SWJ if I take the time to really look closely. I don't always look because I know what I am going to see especially if I have a bad night in terms of pain.

I am at the point where I accept that cpap can't fix problems that I know I have with sleep that are unrelated to apnea. Cold hard fact of life.

This comes with education and time. Your AHI last night...even if every single event was a real asleep event...it is acceptable but I am betting that not every flagged event was a real asleep event.

Work on the sleep quality and quantity the best you can. It's something you never truly win the war on. Sometimes the mask will win the leak war or comfort war. Sometimes other stuff just messes with our sleep and how we feel. It's an ongoing battle that I still fight after over 10 years on cpap. Fixing the apnea part....fairly simple. Fixing the other stuff...not so simple because often we don't even know what needs fixing. To fix any problem we first have to identify the problem and that's not always so easy.

_________________
I may have to rise but I refuse to shine.


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JamesR
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Tue Aug 06, 2019 2:55 pm

Joined: Sat Aug 03, 2019 10:24 pm
Posts: 13
Location: Louisiana
PAP Mask: ResMed Airfit p10
PAP Machine: ResMed AirSense 10 Auto CPAP
Pressure Setting: 7-16

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Pugsy wrote:
Higher pressures will result in more vented air going out the vent holes... so you are going to experience times where the vented air flow changes in intensity. It's normal and to be expected with variable pressures.
Sometimes you will sleep through it and sometimes you won't.
If you look at your pressure graph you actually weren't at your highest pressure at 3:30. Unless the vented air was bouncing back on you I to wake you up I doubt that the wake up was anything more than a normal post REM wake up and you just happened to notice more air moving out the vent holes.

Ah ok it kind of freaked me out but thats good to hear :)

Quote:
I don't know about you but I need greater than 7 hours of minimally fragmented sleep to actually notice much change in my overall energy levels for the day. Unfortunately I don't get that much sleep very often because of factors that are totally unrelated to sleep apnea.
6 hours would be a bare minimum for me and even at that I would very likely find my butt dragging by mid afternoon.

Yeah I try to get 7 but it's tough when you wake up at 430 for work. I'll just have to make sure to be in bed at a certain time, maybe i'll set an alarm haha


Quote:
Do the best you can with your quantity of sleep as well as the quality (minimize wake ups if at all possible).
Trust me...easier said than done I know.
Accept the fact that when you don't get enough good quality sleep that you aren't going to feel your best. Heck, you wouldn't even if you didn't have sleep apnea.
Yeah i've been working at that. Surprisingly a hose cover helps a lot but there are a few more things i can do to help

Quote:
At some point you might be curious as to whether or not more minimum pressure will make any difference. Perfectly understandable and it may or may not. Some years back when I was first starting cpap therapy I was pretty much where you are at in terms of AHI and where the pressure was going. So I decided to do a little experiment to see if more pressure did anything for me. I chose to increase the minimum 0.5 cm a week over 6 weeks. Worked my way from 10 cm minimum to 13 minimum.
Nothing changed at all....AHI was still running between 1 and 2 most nights, hours of sleep didn't really change, no real difference in how I felt overall either. So I went back to 10 cm minimum. Back then we didn't have the data available that we have now to evaluate and I suspect the reason my AHI didn't really change was because what I was seeing was SWJ sleep/wake/junk false positives flagged during wake ups or arousals.
The AHI was a symptom of the poor sleep and not a cause of the poor sleep. More pressure won't fix a problem not related to the airway trying to close off.

Yeah I'm not there yet. I was told by someone at the office if I change the pressure too many times the Dr wont see me anymore. I don't know if that's true but it will be awhile before I test it.

Quote:
If you want to take the time to learn about awake vs asleep flagged events
http://freecpapadvice.com/sleepyhead-free-software

Even now 75% of any AHI I might have is going to be SWJ if I take the time to really look closely. I don't always look because I know what I am going to see especially if I have a bad night in terms of pain.

I am at the point where I accept that cpap can't fix problems that I know I have with sleep that are unrelated to apnea. Cold hard fact of life.

This comes with education and time. Your AHI last night...even if every single event was a real asleep event...it is acceptable but I am betting that not every flagged event was a real asleep event.

Work on the sleep quality and quantity the best you can. It's something you never truly win the war on. Sometimes the mask will win the leak war or comfort war. Sometimes other stuff just messes with our sleep and how we feel. It's an ongoing battle that I still fight after over 10 years on cpap. Fixing the apnea part....fairly simple. Fixing the other stuff...not so simple because often we don't even know what needs fixing. To fix any problem we first have to identify the problem and that's not always so easy.
I can only imagine what I'd feel like with 8. This has put a magnifying glass on my entire sleep schedule and all things sleep. I'm glad I went to the Dr but wish i'd gone sooner. Thank you for all the advice so far, i'll ride with the current for a bit and see how that goes. I was told to keep a close eye on the centrals. I hope they stay in range so I don't to look at an ASV, though I know that's far away.


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Pugsy
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Tue Aug 06, 2019 4:19 pm
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You don't have anywhere near enough centrals to earn yourself a different machine and I don't see it happening even with more pressure.

Centrals can happen at any pressure...doesn't necessarily have to be the higher pressures. I have seen people have a truckload of centrals with as little as 5 cm pressure. On a rare occasion there is a line between where a person might have centrals and when they don't but that's more rare than just any pressure triggering them.

You would need to start seeing at least 5 centrals per hour...every hour...every night...consistently before the doctors even raise an eyebrow.

I have seen pressures upwards of 18 cm....no centrals triggered.

_________________
I may have to rise but I refuse to shine.


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JamesR
Unread post  Post subject: Re: Marginal better sleep frustrating me  |  Posted: Tue Aug 06, 2019 6:20 pm

Joined: Sat Aug 03, 2019 10:24 pm
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Location: Louisiana
PAP Mask: ResMed Airfit p10
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Pressure Setting: 7-16

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Ok that is great news. I have had nights with 8 per hour some 5 and a 6 but that was with EPR on. I still plan to keep an eye on the reports :)


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