Having trouble w waking -- is APAP at 15 cm h20 normal?

Hi folks,

Still having a fair amount of trouble adjusting to therapy. I fall asleep with my mask quite comfortably, but wake every night multiple times having a hard time breathing against the machine. SleepyHead shows the pressure pretty quickly ramps up to my max setting of 15 cm h20 (min is 5).

The pressure at that value is great enough that it's pretty hard for me to exhale against it-- my brain is setting pretty strong "you're suffocating" signals that it's hard to fall back to sleep. Do folks really adjust to that level of pressure, or is something amiss with my setup or my bod?

Thanks!

Are you using the exhale relief that is available on your machine?
If so at which setting?
If you are using constant pressure of 15 that probably means CFlex .

I also have a lot of problems with frequent waking... One thing that I have noticed is that my pressures rise pretty quickly when I fall asleep, then the pressures fall, then I wake up. Here is last night for me:

The places where the pressure stays flat are when I am awake, because I don't have much in the way of flow limitations when I'm awake. There is 45 minutes that started right before midnight, and the hour-and-a-half between 4:00 and 5:30. Between 4:30 and 4:45 I actually got up and read for awhile which made me a little sleepier. Anyway, that the 7:45 "asleep" was really more like 5-1/2...

The high pressures don't seem to bother me -- I started with the machine at 7-20 with a ramp at 4. First I turned the ramp off, and then gradually raised the minimum pressure to 11. Last night -- during the hour and a half I was awake -- I had the idea to turn my EPR back down to zero. I started with 1 (which is the factory default) and raised it to 3, thinking that might help with the awakenings. But last night I realized that the EPR makes my mask pulse on my face with each breath, and maybe THAT is waking me up? I'm going to try turning the EPR off for a couple of nights.

I have developed the habit of reaching over and hitting the STOP button on the cpap each time I wake up, so I get separate sessions generated for each wake up. (I have AUTO-start turned on, so it comes right back on with a new session with the next breath.) Here's the picture that shows the gruesome sleep fragmentation story:


Anyway... I'm in the same boat as you, and am open to any suggestions as to what to try to get better sleep. My AHI is fabulous, and as long as I'm asleep the machine chases snores and flow limitations and keeps the apneas and hypopneas away. It's just that I keep waking up and am frequently having lots of trouble getting back to sleep.

C-flex is set at 3.
Pressure is 5 min, 15 max.

Here's a screenshot of the first segment of my night last night if that's at all helpful. Happy to supply other data as would be helpful. Thanks!

Just do the overall image with no segments so we can get the general idea overall of how the night went.
Be sure to include the AHI bar graphs on the left side.

Are you using APAP mode or CPAP mode? If APAP mode...try AFlex..and try a setting of 2 or 3 and see if it is easier.

cathyf wrote: The high pressures don't seem to bother me --
am open to any suggestions as to what to try to get better sleep. .

higher minimum pressure, your machine has to raise pressure to get your FL under control, then when it backs off, you get them again and wake up.... try to break the cycle.

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Pugsy wrote: If APAP mode...try AFlex..and try a setting of 2 or 3 and see if it is easier.

I'm APAP mode (and pressure do vary throughout the night)-- just changed flex from the original setting of CFlex to AFlex per your suggestion and will see what happens tonight.

Sibbs wrote:C-flex is set at 3.
Pressure is 5 min, 15 max.

Here's a screenshot of the first segment of my night last night if that's at all helpful. Happy to supply other data as would be helpful. Thanks!

That's your problem. You need a higher minimum and maybe a lower maximum. Looking at your report, you appear to have fewer events at around 10 cm. I'd suggest trying to get the machine to optimize your therapy on that pressure.


Den

.

That one report image is just from around 11 PM to shortly after 1 AM...so about a 2 hour segment.
Need to see the entire night to have a better feel for where the pressure wants to go and stay.
You probably need a higher minimum pressure but if you are having trouble exhaling it's going to mess with sleep quality...Also with the starting pressure of 5 cm the full benefit of the exhale feature isn't utilized because the most it can reduce with AFlex is 2 cm (at a setting of 3) so it can only go down to 4 cm.

I am thinking that if you could increase that minimum starting pressure from 5 cm to something a little higher it will help both with ease in exhaling because you can get the full benefit of the exhale relief feature and probably help with overall therapy effectiveness..

I have seen it often...bring up the minimum pressure a little and the maximum pressure will reduce and it's likely that the maximum is the disturbing factor...harder to exhale against that pressure in general.
Bring up the minimum so the machine does a better job preventing the events in the first place and the machine won't have to go so high to fix them.
Don't know just how much more minimum....need to see more than 2 hours of data and the statistics side of the detailed report showing the AHI breakdown and the statistics below the AHI....that's the stuff on the left side of the daily detailed report.

Sibbs wrote:Here's a screenshot of the first segment of my night last night if that's at all helpful.

post the whole screenshot, not a cut and paste, click view, take screenshot.

a bit of a couple charts is like hearing a couple notes out of the song and then being told to guess it