First real night with CPAP. Constantly woken by machine.

[SarahB]

Yes, it was only the first night with full face mask (tried nasal mask unsuccesfully once) but it was quite hard work and I woke numerous times, so any hints and tips would be welcome.

The main issue was that when the machine pressure increased it became very uncomfortable and I woke up with the force of air. My cheeks were as full as a hamster's, there was a pressure in my ears and the air was bursting out from under the mask. Whether or not it had succeeded in opening my airway I don't know. I hit the off button, deflated with a sigh of relief and restarted the machine.

Surely I should be able to sleep through these events? Without treatment I was waking up anyway but at least I wasn't conscious of it or uncomfortable. My husband found it more disturbing than my snoring and claims he didn't sleep a wink.

Early days though.

There are other issues I'll have to sort out such as being painfully bloated with air and having a dry mouth and throat but those are details in comparison. I've downloaded SleepyHead and have lots of interesting graphs and statistics which I'm trying to make sense of. AHI was 16.64 which they describe as 'horrible'. I don't know - it's the glass half full/half empty attitude. Untreated it was 45 so as far as I'm concerned it's only a third of what it was which seems great to me.

[Pugsy]

What are your pressure settings?

I wouldn't worry about the AHI right now. I suspect that with the frequent awakenings that you have a lot of what we call SWJ or sleep/wake/junk flagged events that aren't real but instead are awake breathing irregularities getting flagged.
Quite common when we have lots of fragmented sleep or difficulty falling asleep and staying aslelep.

[LSAT]

They are right...AHI 16 is horrible. What are your pressure settings? If you would download sleepyhead software and show some charts of your nights, you will get help. Treated, your AHi should be <5. This is still your first night...hopefully things will get better. Suggest you sit and watch TV with your mask on and machine running to get your body used to the pressure.

[reolhlains]

Welcome Sarah - so nice to see a fellow Scot on here!
Good luck with it all - it's certainly a journey but (generally) a fun one!

[SarahB]

They are right...AHI 16 is horrible. What are your pressure settings? If you would download sleepyhead software and show some charts of your nights, you will get help. Treated, your AHi should be <5. This is still your first night...hopefully things will get better. Suggest you sit and watch TV with your mask on and machine running to get your body used to the pressure.

Which charts should I show? There are loads!

The pressure is 4.0 to 20.0. It looks as if it ranged from 4 to 14.6 during the night.

[LSAT]

They are right...AHI 16 is horrible. What are your pressure settings? If you would download sleepyhead software and show some charts of your nights, you will get help. Treated, your AHi should be <5. This is still your first night...hopefully things will get better. Suggest you sit and watch TV with your mask on and machine running to get your body used to the pressure.

Which charts should I show? There are loads!

The pressure is 4.0 to 20.0. It looks as if it ranged from 4 to 14.6 during the night.

I'll bet your minimum pressure is part of the problem...try increasing it to 6 tonight.
Here is how to post your charts. https://sleep.tnet.com/resources/sleepyhead/shorganize

[Pugsy]

For which charts to post see my thread here post number 2
viewtopic/t158560/How-to-post-images-for-review.html

For how to post images disregard the 3rd post as it was written before we could do attachments here at the forum.
We no longer need to use imgur or a photo hosting site.

[reolhlains]

Hey Sarah - I am defo no expert, but I agree with the guys.
4 - 20 is a massive pressure differential - in my (minimal) experience, you want to start homing that down to a range of like 2-3.
I started on 6 - 16 (I think) - my average was sitting around the 7s/8s, but I knew that wasn't high enough.
As I got more used to it, I squeezed it up - I'm now at 10-12 or something - and it sits in the low tens usually.
There are plenty of posts explaining why this is - basically the machine is responsive - so when you have an event it then ramps up - by the time it gets to the pressure required, you've possibly had your event and semi-woken up. So you want it to be kinda constant.
I can't imagine what 4 would be like - I hear a lot of folk think 4 is like suffocation! I felt like I wasn't getting enough of a breath on 6 - which is why I started pushing it up!
Anyway - good luck, and have a diet Irn Bru for me

[SarahB]

For which charts to post see my thread here post number 2
viewtopic/t158560/How-to-post-images-for-review.html

For how to post images disregard the 3rd post as it was written before we could do attachments here at the forum.
We no longer need to use imgur or a photo hosting site.

Thanks! I have the screenshot but can't work out how to attach. If we don't need to use a photo hosting site how do I get the image into the post?

[SarahB]

Hey Sarah - I am defo no expert, but I agree with the guys.
4 - 20 is a massive pressure differential - in my (minimal) experience, you want to start homing that down to a range of like 2-3.
I started on 6 - 16 (I think) - my average was sitting around the 7s/8s, but I knew that wasn't high enough.
As I got more used to it, I squeezed it up - I'm now at 10-12 or something - and it sits in the low tens usually.
There are plenty of posts explaining why this is - basically the machine is responsive - so when you have an event it then ramps up - by the time it gets to the pressure required, you've possibly had your event and semi-woken up. So you want it to be kinda constant.
I can't imagine what 4 would be like - I hear a lot of folk think 4 is like suffocation! I felt like I wasn't getting enough of a breath on 6 - which is why I started pushing it up!
Anyway - good luck, and have a diet Irn Bru for me

Bleughh! You can have the Irn Bru!

I'm not sure if I'm allowed to alter the pressure settings or even how to do it although I could read the manual! I need to get two weeks of data and send it in to the consultant then go for an appointment to discuss the results. I want to work hard at getting the best out of this treatment before then.

I love 4 as a setting. Very comfortable.

[Pugsy]

When you have the reply to box open look down on the lower left corner for
options and attachments tabs
click on attachment tab
then click on "add files"
then find your screen shot and click on it to attach the file
click preview to see if it shows up
if it does then click on submit for final submission

[SarahB]

When you have the reply to box open look down on the lower left corner for
options and attachments tabs
click on attachment tab
then click on "add files"
then find your screen shot and click on it to attach the file
click preview to see if it shows up
if it does then click on submit for final submission

I don't know how to save the screenshot. I've taken my own and pasted into a document but file extension isn't valid. I've used the Sleepyhead screenshot tool but don't know where it's stored the screenshot.

EDIT: I've found it!

[SarahB]

[Pugsy]

No need to redo this image but next time can you turn off the pie chart?
Preferences/Appearance tab and remove the check mark for "show pie chart".
This will let additional statistics move up into view.
No need to redo this image though...what it might show won't be particularly useful anyway.

This report just shows a crappy night's sleep for probably a number of reasons.
The main reason being simply new everything...new machine/new mask/new to therapy, etc.

I know you like the 4 cm starting point because it is comfortable but it isn't doing you any favors in the therapy department.
It's really impossible to get much of a feel for what pressure you might need as a starting point though because the sleep is so fragmented that the machine never really gets time to settle in.
You are going to need more than 4 minimum but I don't know how much more. Often when the minimum is more optimally set the maximum actually reduces when the machine doesn't have to work so hard to keep the airway open.
I know one woman who thought she was going to need 18 cm all night because of where the max went but once we got her minimum more optimally set the max never went above 11...so it can happen.

I suggest that you use the mask and machine while reading or watching TV for a period of time so that you can get used to the feel of it and see what you have to do to prevent the chipmunk cheeks syndrome.

I realize you are in Scotland and thus part of the NHS and they seem to frown on making changes to anything yourself.
The big range of pressures available along with that 4 cm starting point which means the machine has to travel quite a bit to keep the airway open...compounds poor sleep problems.
You need more solid blocks of actual sleep to be able to evaluate the pressures.
I suspect the bulk of your AHI here is awake breathing flags. The machine doesn't know if you are awake or asleep. It can only measure air flow and awake breathing irregularities can easily fool the machine. With so much fragmented sleep here it's very likely that you have a lot of SWJ flags and they don't count. You have to be asleep for any event to be real.

[D.H.]

Since you report discomfort and you show "Clear Airway" events, I suggest turning the max down to 12 or so. You can always turn it back (part or all of the way) up later. The starting pressure of 4 seems to be agreeable, so I'd leave that alone for now. If your min is 4, the ramp is not active as 4 is the min on most machines anyhow (less would not clear the exhaled carbon dioxide from the mask).

Also, don't worry about the AHI for now. You'll need to worry ultimately, but it's more important to be comfortable with the therapy first.