Newbie: first night pressure + leak rate question

First night with a PAP machine last night. I woke up in the early hours of the morning feeling like my face was being blasted off by the air pressure. When I did some research this morning and got Sleepyhead working, the graphs confirm - pressure increases over the night and is really high towards the end. Any idea why that's happening? Will it sort itself out over time or do I need to change something? I ended up taking the mask off around 5 AM because of it.

Also, I tried to fill out my machine details in my profile. I've got a loaner Philips Respironics System One (60 Series) Remstar Auto with A-Flex. The only PR machine listed in the profile options includes humidifier and heated hose, which I don't have.

Thanks!

When you woke up with the air blasting all over your face were you on your back or side or whatever?

Your machine is set to auto so the pressure automatically changes as needed. Your pressure increased because the machine determined that you need more pressure.

I would bump the min. setting to 6 or 7 and see if it helps... 4 is so low!

On my side - I never sleep on my back. I know the pressure's changing automatically, I'm just surprised it's so biased towards the end of the night - I would have expected it to go up and down more evenly through the whole period. It's only one night though so I'm willing to wait and see... just wondered if there was anything obvious to think about.

RaveledSleave wrote: ↑

Sat Mar 10, 2018 8:19 am

On my side - I never sleep on my back. I know the pressure's changing automatically, I'm just surprised it's so biased towards the end of the night - I would have expected it to go up and down more evenly through the whole period. It's only one night though so I'm willing to wait and see... just wondered if there was anything obvious to think about.

It is common to need more pressure during REM, and when on your back.

The end of the night is where a person typically will have more REM and it's common to have our OSA worsen in REM and/or need more pressure in REM.
Since you were on your side we can eliminate supine sleeping as causing the need for more pressure.
That pretty much leaves REM sleep stage as the culprit.
Your OSA is probably worse in REM and you need more pressure in REM. It's quite common. I have it myself. My OSA is 5 times worse in REM and sometimes I need maybe 8 cm more pressure in probable REM than other times.

How did you sleep last night? Spend much time awake with mask on?

Ah, the REM thing sounds likely - now that I think about it I do remember the doctor saying I was getting apnoea during REM specifically. I slept very poorly, felt like I was constantly bobbing up out of sleep, hopefully that will pass as I get used to it. I wasn’t conscious of lying awake for any length of time except an hour or so at the start.

Any thoughts on the profile options? Just wondering if my machine is listed differently from what I’m expecting.

Don't worry about choosing the machine in your profile from the drop down equipment menu.
The link to your machine is broken anyway.
Just add it manually to the comments section .
Doesn't matter about the heated hose or not. We all know it is an option but not everyone uses that option.
Just say PR S1 Auto CPAP ...and if you have a humidifier just say with humidifier and if you don't just say without humidifier.

Later if you get a different machine you can update it at that time. There's a lot of broken links in that drop down menu.
When that happens we just use the comments section.

Great, thank you!

Where are you located?
In the UK perhaps?

Yes, UK. Did my spelling of apnoea give me away?

Nope...wasn't the spelling.
It was the "given a loaner APAP without humidifier" that made me think NHS and UK. That's what they normally do.
Give you the bare bones equipment to get an idea for pressure needs.
They tend to not think of humidifier as being "needed" and for some it isn't but for some it's a critical need.

Ironically, you're right for the wrong reasons. Short version: I didn't get it from the NHS, it's from a private sleep clinic.

Longer version if you have time to kill: I've been diagnosed with chronic fatigue since 2014, but I've been complaining of sleep problems my entire adult life. In 2015 I had an NHS at-home overnight respiratory study (breathing and oxygen levels only, no EEG) which came back with an AHI of 9. But the consultant that I saw in follow-up insisted that such a low score couldn't be causing my symptoms. She said I could try a CPAP machine anyway. They gave me a fixed pressure ResMed machine (WITH humidifier!) and nose mask, and I used it every night for a month. When I went back to the follow up appointment and said I wasn't feeling any better, they said obviously the apnoea wasn't the problem then, and discharged me from the clinic. Nobody told me any of the things I've since learned from this forum and elsewhere, about symptoms varying between individuals regardless of AHI score, and the need to adjust pressure, mask, etc. I also had terrible trouble with the nose mask - they gave me a chin strap but I couldn't stop my mouth falling open no matter what I did.

Since then I've been through a long run of NHS referrals, including a separate at-home polysomnogram and MSLT to look for narcolepsy... when they didn't find that, I was discharged from there as well, even though I was still having sleep problems. I finally bit the bullet at the end of last year and paid to go to a private sleep clinic. They've had me in for a new sleep study, immediately pointed out that the apnoea is waking me up every time I hit REM sleep (and I've got a REM movement disorder going on, where I move around too much when dreaming) and have given me a new machine to try out. I specifically asked for the full face mask this time because of the problems I had with my mouth opening before. The technician said they don't normally give out humidifiers by default, but I could have one if I needed it - I decided against it because dealing with the humidifier was actually one of the things that made it more difficult for me to use the previous machine. But I can get one from them if I'm finding my nose and mouth dry out too much.

So now I'm trying the CPAP again. The fatigue has actually improved significantly over the last few years (I had to stop working, but that helped a lot) and I'm much more able to advocate for myself and to do the extra research now than I was back then. Hence my presence on this forum.

I'm pretty sure myself that the chronic fatigue diagnosis is correct, because I've had several of the hallmark symptoms such as immune involvement and post-exertional malaise. However I feel sure that it was brought on or exacerbated by the stress on my body of being sleep-deprived for so much of my life. I could always tell the difference between fatigue and sleepiness even when the fatigue was extreme, and as time has gone on it's been more and more apparent that my body wants to get better from the fatigue if possible - but I'm constantly running on 10% battery as it were. I'm really hoping that this time I'm going to see some improvement - but I don't dare get my hopes up too much.

Second night, interestingly the pressure didn't go nearly as high at any point. I changed my pillows around slightly to give the mask some clearance, that may have helped. My main question is about the leak rate - why are there two lines and why is one of them higher than the other? Should I be concerned about it? It doesn't feel like the mask is leaking.