First month on CPAP and could use some help with dialing in my pressure and settings

Pugsy · Post by **Pugsy** » Sat Mar 23, 2024 8:00 pm

See a doctor about the dizziness....probably ENT....
I speak from LOTS of experience with dizziness or in my case BPPV and it's a bitch for sure but sleep apnea is NOT a known cause for most dizziness especially if you had the dizziness prior to starting cpap therapy.

Alorad13 · Post by **Alorad13** » Sat Mar 23, 2024 8:05 pm

Miss Emerita wrote: ↑
Sat Mar 23, 2024 7:42 pm
About dizziness: I learned by experience that there can be significant benefits from vestibular physical therapy.

I was hoping it would work - spent about 5 months with two different therapists respectively but didn't see a ton of improvement. I'm now increasing my nortriptyline dose slowly and exploring some other issues that could be causing it (my eyes, neck, heart, brain and thyroid!)

Ironically, this all helped me discover apnea. I learned that if I slept nearly sitting up, my symptoms were not nearly as bad. Currently I'm worse in the morning with dizziness and disorientation.

Alorad13 · Post by **Alorad13** » Sat Mar 23, 2024 8:14 pm

Pugsy wrote: ↑
Sat Mar 23, 2024 8:00 pm
See a doctor about the dizziness....probably ENT....
I speak from LOTS of experience with dizziness or in my case BPPV and it's a bitch for sure but sleep apnea is NOT a known cause for most dizziness especially if you had the dizziness prior to starting cpap therapy.

True, only limited studies have found links between apnea and dizziness / vestibular migraines etc. - but I found that when I slept nearly sitting up, my vestibular symptoms were tremendously reduced. It lead me to get a sleep test, so small favors. Now that I've hit my deductible, I'm going to visit a few different specialists to solve this two year issue.

Alorad13 · Post by **Alorad13** » Sun Mar 24, 2024 8:21 am

Pugsy wrote: ↑
Sat Mar 23, 2024 7:55 pm
A word about back sleeping vs side sleeping and the potential impact on OSA and/or pressure needs.

While it is true that back sleeping can worsen OSA and/or cause higher pressures in SOME people it isn't always a given that it happens with everyone. It's always worth trying to sleep on our sides but it doesn't always work out so good for any number of reasons and that's why I don't go down that road immediately with my advice....I save it for later if it is needed critically.

1....when we are new to cpap therapy our sleep quality is usually crap anyway and when we try to change a habit (like sleeping on our back) often we simply can't go to sleep or stay asleep because of trying to force something that we just aren't used to. I don't want to worsen already crappy sleep quality by trying to break a long standing habit.

2...Not everyone will see that their OSA worsens dramatically or significant pressure changes just because of supine sleeping.
I am one of those people....supine sleeping doesn't really do much for worsening my OSA or cause dramatic increases in the pressure needs. Now REM stage sleep...that's a whole different story. My OSA is 5 time worse in REM and I have seen pressure increases up to 8 cm during what I assume is REM. Doesn't matter if I am on my back or on my side (which is my preferred sleep position anyway but I can't always stay on my side due to various old age aches and pains that act up when I lay down. I have done extensive experiments over the years to prove this point plus I had both of my sleep studies (diagnostic and titration) done in a lab with sleep techs in attendance. Supine sleeping wasn't a big deal for me but REM sure was.

3...A correctly and optimally set cpap machine should be able to adequately deliver optimal therapy no matter what sleeping position we end up being in.
This whole thing about sleep can be really fragile and I just don't like trying to retrain sleep position habit and potentially making sleep quality worse just to maybe lower the pressure needs a little. The poor sleep ends up being more of a problem than just letting the machine find the optimal pressure when we change sleeping positions.

Now I do know that for some people supine sleeping is a big deal and sometimes it is worth trying to learn a new habit but I save that advice for down the road when it is proven to be needed. I know someone who needs a pressure of 19 when on their back and 9 when on their side....don't blame them one bit for wanting to learn to be happy on their side.
Now me...I might need 2 cm more when I am on my back but sometimes neither one of my shoulders want me laying on them so I have to get on my back but I don't stay there long because my back/pelvis ends up hurting more than my shoulders so I have to get back on my side.

You were on your back most of the night and the pressure didn't go crazy for most of the night.
Only went a bit crazy when the flow limitations caused the pressure increases.
Makes me wonder what caused the change in FLs later during the night....was it REM??? Maybe but you had one episode with rapid increase in pressure yet you hadn't been asleep long enough to make it to REM...but later in the night the pattern could be REM related.

Again though....a properly and optimally set cpap machine should be able to deal with REM worse OSA pressure needs so I prefer to tweak the settings if needed and let the machine sort it out. It's not like we have any control over REM anyway.

Besides...often once we have that minimum pressure more optimal and the FLs reduced the pressure won't go as high anymore anyway.

So....that's why I do what I do and say sometimes. I don't always have a lot of time to go into the "why" behind my ideas but this time I made a little time to explain my thoughts.
There's always a method to my madness even if I don't always explain it in great detail.

Your sleep is already very fragile...what with the little ones and the newness of cpap....don't go doing anything that makes it harder for you to fall asleep or stay asleep...without sleep none of this stuff matters much does it???

Good morning! Wanted to follow up to let you know I adjusted my base pressure to 7 last night, I'm still reviewing the data, however. I def found it a bit more challenging, like when I was trying to get to sleep after some late night arousals, it would feel like the pressure was filling up my cheeks with air - but overall was able to log a lot of sleep hours. Still determine how I feel today, I had a small bit of coffee which usually sets off my vestibular stuff but I do feel like i have some extra energy

https://sleephq.com/public/f430dc09-3a0 ... 919c0a27a2

Pugsy · Post by **Pugsy** » Sun Mar 24, 2024 8:39 am

Alorad13 wrote: ↑
Sun Mar 24, 2024 8:21 am
it would feel like the pressure was filling up my cheeks with air

We call that "chipmunk cheeks" and it's a common complaint here on the forum with lots of discussion and ideas on how to deal with it. Use the forum search function and start reading.

I scrolled through your last night's report.
All but maybe 2 of the flagged events are arousal related so we have to ignore them except to note that you weren't sound asleep....which means you are still not sleeping soundly. You probably don't remember the awakenings but they are there.
So your real "asleep" AHI is a LOT lower and to be honest I wouldn't worry about your AHI at this time.
Your biggest problem right now is sleep quality. Here's the deal on why sleep quality is so important....when we wake often (even if we don't remember it) then our sleep cycles have to restart all over again and we end up with a short supply of deep sleep or REM sleep and that's where the restorative powers of sleep work their magic.

Stay the course. Your body needs to adjust to the new settings.
If you still have significant problems falling asleep with the new minimum....drop it down to 6 for a few nights and let the body/brain adjust and then maybe try 7 cm minimum again.

Remember...right now your primary goal is fall asleep and stay asleep long enough to get the needed amount of deep sleep and REM sleep...and right now I don't think you are getting it.

Alorad13 · Post by **Alorad13** » Sun Mar 24, 2024 8:47 am

Pugsy wrote: ↑
Sun Mar 24, 2024 8:39 am

Alorad13 wrote: ↑
Sun Mar 24, 2024 8:21 am
it would feel like the pressure was filling up my cheeks with air
We call that "chipmunk cheeks" and it's a common complaint here on the forum with lots of discussion and ideas on how to deal with it. Use the forum search function and start reading.

I scrolled through your last night's report.
All but maybe 2 of the flagged events are arousal related so we have to ignore them except to note that you weren't sound asleep....which means you are still not sleeping soundly. You probably don't remember the awakenings but they are there.
So your real "asleep" AHI is a LOT lower and to be honest I wouldn't worry about your AHI at this time.
Your biggest problem right now is sleep quality. Here's the deal on why sleep quality is so important....when we wake often (even if we don't remember it) then our sleep cycles have to restart all over again and we end up with a short supply of deep sleep or REM sleep and that's where the restorative powers of sleep work their magic.

Stay the course. Your body needs to adjust to the new settings.
If you still have significant problems falling asleep with the new minimum....drop it down to 6 for a few nights and let the body/brain adjust and then maybe try 7 cm minimum again.

Remember...right now your primary goal is fall asleep and stay asleep long enough to get the needed amount of deep sleep and REM sleep...and right now I don't think you are getting it.

Thank you so much for your help! I guess I need to invest in some sleep hygiene practices. Is taking a sleep aide like melatonin safe with a CPAP? Also, would you recommend a device to track REM?

I'm going to try and follow a lot of the items on this list to see if it helps too

https://www.sleepfoundation.org/sleep-h ... sleep-tips

Pugsy · Post by **Pugsy** » Sun Mar 24, 2024 9:11 am

Alorad13 wrote: ↑
Sun Mar 24, 2024 8:47 am
Is taking a sleep aide like melatonin safe with a CPAP?

It is mostly safe and a lot of forum members take it but if you do....read up on the potential side effects (some are a bit nasty and you may not like them...dizziness is one and affecting libido is another. The dizzy thing keeps me from taking it.
Also remember that regular Melatonin (take a very, very small dose because that is what is advised) is mainly for help in falling asleep....it doesn't do a whole lot for staying asleep but they make a long acting sustained release version which may help in that regard.

Also remember that when it comes to new babies in the house we tend to sleep with "one eye open" as we are on high alert when it comes to babies. So don't beat yourself up too much over that fact...it's just part of being a parent.

Also remember the "newness factor" that can affect sleep quality. FWIW it took me over 3 months to get my brain to get over the newness factor and quit waking me up just to tell me "hey, dudette, did you know you have an alien plastered on your nose blowing air up your nose?".

So there is a lot of truth to the "give it time thing".

I am still scratching my head on what it is that might be driving your FLs up a bit which in turn causes the pressure increases.
Maybe it is REM....do you know if your OSA is worse in REM or not? It wouldn't surprise me though...it's common for REM stage sleep to worsen OSA in some people as well as supine sleeping can worsen OSA in some people.

Alorad13 · Post by **Alorad13** » Sun Mar 24, 2024 9:59 am

Thank you again for all your help, you are truly a wonderful human.

Given the little ones, I probably will skip any supplements and just focus on sleep hygiene - and patience! Gotta give this all time.

Also, if I turn off EPR can I lower my base pressure to 6? Are those things interchangeable?

I'm not sure if my OSA if worse during REM, but I can attach some results from my sleep study if that helps determine! Sorry, I'm just so new at all this!

https://ibb.co/pwNB7yd
https://ibb.co/8Mg2L4D
https://ibb.co/BV9msRD

Pugsy · Post by **Pugsy** » Sun Mar 24, 2024 10:10 am

Alorad13 wrote: ↑
Sun Mar 24, 2024 9:59 am
Also, if I turn off EPR can I lower my base pressure to 6? Are those things interchangeable?

I was hoping that adding in EPR would help reduce the FLs which in turn would help reduce the pressure increases.
How about reducing the minimum to 6 but keep EPR at 3 and lets see if you can sleep better at least initially.
Adding in EPR is one way to "maybe" help reduce the FLs (assuming not related to nasal congestion) but it can also be accomplished by just raising the minimum.

Plus I don't know if those FLs are critically important anyway. They may not be impacting your overall sleep quality any but they could be and that's why the machine wants to kill them and why we want to give the machine a chance to go killing them.

Let me go look at those sleep study reports shortly.

Alorad13 · Post by **Alorad13** » Sun Mar 24, 2024 10:12 am

Thanks! I do find myself breathing through my mouth more when wearing the full face mask, not sure if it's a comfort thing - but I def breathed through my nose while sleeping more pre CPAP. It has me looking into a hybrid mask.

Pugsy · Post by **Pugsy** » Sun Mar 24, 2024 10:14 am

Is that it for the home sleep study results?
Did you get anything that showed RDI or AHI during the actual different sleep stages or for that matter sleep position as well?

Alorad13 · Post by **Alorad13** » Sun Mar 24, 2024 10:23 am

Pugsy wrote: ↑
Sun Mar 24, 2024 10:14 am
Is that it for the home sleep study results?
Did you get anything that showed RDI or AHI during the actual different sleep stages or for that matter sleep position as well?

Unfortunately my at home results didn't share that, but I can ask if they have them!

Pugsy · Post by **Pugsy** » Sun Mar 24, 2024 10:33 am

Alorad13 wrote: ↑
Sun Mar 24, 2024 10:23 am

Pugsy wrote: ↑
Sun Mar 24, 2024 10:14 am
Is that it for the home sleep study results?
Did you get anything that showed RDI or AHI during the actual different sleep stages or for that matter sleep position as well?
Unfortunately my at home results didn't share that, but I can ask if they have them!

When you get a chance you might ask them if they have that REM AHI (or RDI) data.
Not that it will change much but it would explain the rather dramatic increase in pressure.
If it is REM related then we know that altering sleep position probably isn't going to help all that much but that doesn't mean we can't at least try it to make sure.

At some point in the future we need to have you sleep on your side to see what the pressure does.
BUT....I don't want you trying anything that causes you to have problems falling asleep and if changing your position routine causes that....lets wait a bit until the newness has worn off and maybe you can sleep a little better.

At some point another experiment to try is drastically limiting the max pressure....and see what happens.

No rush on these experiments though. Rome wasn't built in a day and one night doesn't a trend make. We need several nights with each change for best evaluation. We just don't sleep the same each night. We all have good nights and bad nights and you don't want to be basing setting choices on a "bad" night. You will be chasing your tail forever if you do that.

First month on CPAP and could use some help with dialing in my pressure and settings

Re: First month on CPAP and could use some help with dialing in my pressure and settings

Re: First month on CPAP and could use some help with dialing in my pressure and settings

Re: First month on CPAP and could use some help with dialing in my pressure and settings

Re: First month on CPAP and could use some help with dialing in my pressure and settings

Re: First month on CPAP and could use some help with dialing in my pressure and settings

Re: First month on CPAP and could use some help with dialing in my pressure and settings

Re: First month on CPAP and could use some help with dialing in my pressure and settings

Re: First month on CPAP and could use some help with dialing in my pressure and settings

Re: First month on CPAP and could use some help with dialing in my pressure and settings

Re: First month on CPAP and could use some help with dialing in my pressure and settings

Re: First month on CPAP and could use some help with dialing in my pressure and settings

Re: First month on CPAP and could use some help with dialing in my pressure and settings

Re: First month on CPAP and could use some help with dialing in my pressure and settings