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How to get more APAP sleep?
#1
How to get more APAP sleep?
Brief background: I'm 63, female, morbidly obese, and have probably had obstructive sleep apnea my whole life - my husband sleeps with earplugs because of my snoring and it has even woken myself up! I put up with the daytime sleepiness for years but finally did a sleep study last month. To no one's surprise, I am now formallly diagnosed with OSA, but in order to get a Rx for a machine, I would have had to do ANOTHER miserably uncomfortable study (home options not available in my fairly small town) and I just refused. I am an RN, I know how to do online research, and I quickly found the section here on changing your own pressures. As soon as I read about APAP, I knew that was for me, and I'm a mouth breather so unfortunately nasal pillows were out. I bought a never-used Apex ICH Auto (APAP/CPAP switchable, EPR, built-in-humidifier, data accessible by cable or SD card, small footprint) pretty cheap on ebay and a Quattro FX mask on Amazon. I started with a 4-12 range and didn't feel that was a high enough baseline so I've raised it to 6-12. The mask feels as comfortable as something sitting on my face is going to feel, and I don't feel any leaks. I knew it would take some getting used to, but even after 2 weeks, I'm still barely managing 2 hours/night wearing the APAP. I split sleeping time between my bed (side sleeping) and my recliner. Doesn't matter which one I start in, I have to change whenever I get up to go to the bathroom (1-3 times per night). I have the APAP by my bed and consequently too far away to use it in the recliner. I was hoping I would get used to it and sleep in bed longer but so far that hasn't happened. I wake up after 1-2 hours sleeping while wearing the mask and just HAVE to take it off.

I'm working on getting the machine's data to my computer (SD card didn't work and now I need a longer heavy-duty extension cord to bring the APAP to where it can be connected to the computer) but does anyone have any suggestions or tricks to let me sleep longer in bed wearing the APAP? I have an adjustable bed and tried sleeping on my back but woke up after the usual 2 hours with a backache. I've never in my life been able to sleep on my stomach. After reading some posts here, I'm going to up the max APAP setting to 20 and see if that helps. I know other people must have encountered similar problems but I couldn't find anything - feel free to point me to threads or other sources.  Also feel free to tell me/ask me the obvious. It won't hurt my feelings and I'd rather hear something I do already know than miss something I don't.
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#2
RE: How to get more APAP sleep?
I would up the max pressure only two (2) cm/h20 at a time, but also try each adjusted rated for at least three nights before concluding that it isn't right.

You may have other strongly contributing factors to wakefulness after only two hours of sleep in either the bed or the recliner.  Your physical dimensions and/or body mass, or where the adipose is mostly distributed, may be important factors that are not really controllable in the short term...if at all....?

Sleeping one one's stomach, while a source of bliss for a few of us, is something you must warmly kiss goodbye if using PAP devices and masks.  Promise to write.

Why won't your SD card work?  It should...it MUST.  Are you placing it in the correct type of slot/reader?  If so, SleepyHead should find it and read the data.

If you are large/morbidly obese, tilting up the bed might be an invitation to an uncomfortable sleep. Pillows propped behind your back, keeping you supine, but turned largely to one side, may be the answer to sustained sleep.  Too many covers can be a problem. You should be cool-ish, not cold, and definitely not too warm.

I am 65 and still do not have to rise during the night to go to the bathroom.  My siblings do, and so do my parents.  Not me...and don't ask me why.  But, I make it a practice not to drink anything except a small glass of milk for a late night snack AFTER 1600 hrs.  I have nothing to drink with my late meal.  This means my midnight pee, just prior to bed, is good for at least 8 hours.

I hope you get some meaningful help here, and some good results.
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#3
RE: How to get more APAP sleep?
Other than OSA, Obstructive Sleep Apnea) you say nothing about your Apnea.  It would help if you were to post a copy of your sleep study.  

When I had my original Titration sleep study, I had my BEST night sleep in many, many YEARS. As I had such a difference I forced the system to speed up the process of getting me my CPAP.  To this day a night without my CPAP is pure hell.  Just wanted you to know that while you are still in a strange bed and all wired up, it is MUCH better than the original diagnostic study.

Another possibility is to get a ResMed AutoSet for the bed and the Apex ICH Auto by the recliner.  Anyone who has been using CPAP for a while has a backup machine, usually their old one, but a machine that can use should their primary machine break.  

As I'm sure you realize data is the key to understanding, Sleepyhead (which is not compatible with your CPAP) has the capability to go down to a breath by breath view if needed.  If you could post some similar data for your machine, and I don't mean compliance data it would help.

It is not uncommon to have issues using a CPAP enough initially to have a large impact, just be persistent and the length of time will change.

You can use the CPAP while awake, reading, watching TV , knitting or other pleasurable activity to help get used to it.  Start with a comfortable period and gradually lengthening it.

On the subject of mouth breathing, place your tongue on the roof of your mouth and breath, nasal breathing right? Just practice it.

A lot of good reading in my signature, the Mask Primer has a section on Mouth Breathing. A number of users have found that a loose fitting (We are NOT using it for its intended purpose of immobilizing the neck) soft cervical collar nudges the jaw up enough to stop mouth breathing. Same thing works well for resolving some positional Apneas.

The best advice all hinges on data.

Fred
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#4
RE: How to get more APAP sleep?
You can download the Apex Easy 3.2.1 software free from the Apnea Board private files. http://www.apneaboard.com/forums/Forum-P...-and-Links

With that software, we should be able to at least get a hint of what is going on. I suspect you need a higher minimum pressure than your current 6.0, and would not be surprised to see you use a bilevel machine eventually. If so, we will try to encourage you to get a more mainstream machine like Resmed or Respironics. Anyway, if you can put up a screenshot of relevant data, we can probably help
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#5
RE: How to get more APAP sleep?
Hi, groggygirl, and welcome to the forum (family)!

I'm sad to hear about your struggles, especially these you're having after discovering a path to a better life! You may have already determined from posts on the forum that there are many people here with a wealth of accumulated wisdom who have helped many folks like you and me, yet I will repeat it because you need to understand that you are on the threshold of that better life! Just continue doing what you've been doing: research and application.

You said you're a mouth breather. It's important to elaborate. As you've noted in bonjour's post -- and you will likely hear similar from others -- you will be encouraged to change to nasal breathing so as to maximize the effectiveness of PAP. So please explain if you have obstructions preventing nasal breathing or it's because of comfort/habit or such.

FWIW, I'm obese, was morbidly obese for more than 10 years, and have nasal issues (fleshy nose, small nostrils, and deviated septum) that restrict my breathing, so it isn't easy to breathe through my (handsome) nose. Nevertheless, I endeavor.

I know you are resolved, so I'm not trying to get you to change yet I do want to point out that doing another sleep study would be great because (as you prolly know better than me) titration would provide invaluable information. I guess we could "get by" with the data from your Apex ICH Auto. <sigh>

Hey, as I've "heard" many others around here "say": be assured, you're almost there!
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#6
RE: How to get more APAP sleep?
Thanks for the responses. I don't *have* a copy of my sleep study but I have an appt with my regular doc next week and should be able to get a copy then. (Can you tell I am less than pleased with the local sleep center? Going back for a titration study is going to be a very last option.) I'm not sure why I am a mouth breather but I suspect it's because I have major sinus issues and usually at least one nasal channel has blocked airflow due to sinus.

I did change the max pressure to 20, no difference in the sleep-2-hours-then-can't-use-the-APAP-any-more pattern. I'll try increasing the minimum pressure a little.

I haven't slept through the night since I was pregnant, and my daughter is almost 30. lol So I'm not shooting for the impossible. Also, I have only one kidney, so I'm more concerned about keeping enough fluid in my system to not overwork it than getting up at night. I can usually get right back to sleep, I'm more focused on making my sleep better.

I don't know why the SD card didn't work. The issue was in the APAP, not my computer - I got a WARN 008 error, which is "machine can't read SD card." DH is monkeying with the card now, if we can't get it working I may have to break down and buy a new card. The manual says the card has to be less than 2 GB, which I took to mean 1GB, and formatted to FAT16. We had a hard time finding one in the house that was so small! lol Thanks for the link to the software, I downloaded and installed the files.
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#7
RE: How to get more APAP sleep?
Hi, groggygirl,

At a guess I think you might need a higher lower pressure and if you are as Obese as you say you are, I would not be restricting the max pressure of your machine until you see what pressure it wants to go to.
You might need some EPR to help with breathing out if the pressure get a bit higher.

However, get some data up and see if we can help you a bit more.

Welcome to the Apneaboard forum.
>^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^<
I am NOT a doctor.  I try to help, but do not take what I say as medical advice.

I am just a long term user of c.p.a.p. and therefore I have some experience in using these machines and equipment.

However, I am NOT an expert, so advice given should be taken as given in good faith only and NOT medical advice.

Every journey, however large or small starts with the first step.   Coffee
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#8
RE: How to get more APAP sleep?
Groggygirl, if there is any way you can relate your AHI, and breakdown of OA, CA and H, and the median and 90% pressure you machine is delivering, there is a great deal we can accomplish. Without some information like that, all we can do is pat you on the back and say your supplier screwed you. Let me guess, your sleep clinic, doctor and supplier are all one business?
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#9
RE: How to get more APAP sleep?
Sleep clinic/doctor also wanted to be supplier. Big surprise, right? Refused to give me an Rx so I went hunting for what I could buy without one.

Finally got Easy Compliance running and data copied over from machine. AHI is 10.4/hr, apnea 2.3, hypopnea 8.1. Looks like I had the ICH set to a 4-14 range, I haven't used it since I raised the upper limit to the max 20. Already had EPR enabled and I like it, makes breathing feel much more natural.

Doesn't look like I can just copy the data into a message, and I don't see a breakdown of OA, CA and H, and the median and 90% pressure. Eyeballing trends, snoring was only recorded at lower pressures (5-6), most apneas reported at 10-11, most hypopneas at 10-14 - I bet that will go up when I have some data at higher pressures.

I am impressed with the APAP concept. That this tiny machine can detect problems so quickly and quickly respond is amazing! It adjusts to MY breathing, not vice versa.
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#10
RE: How to get more APAP sleep?
You should obtain a copy of your sleep study. Whether they like it or not, you are entitled to copies of your medical records and test results under HIPAA. We really need to see the numbers and types of events that were recorded in the diagnostic study. I'll assume again, they did not do titration.

I don't know if there is anything illegal about requiring a patient to source their medical equipment from the diagnostic clinic and doctors, but it sure is unethical. If you were prescribed a CPAP or APAP that prescription also falls under HIPAA records. Everyone scheduling a sleep study should read reviews and know to avoid any clinic that fills prescriptions only in-house.

Read here:
https://www.hhs.gov/hipaa/for-individual...index.html
https://www.hhs.gov/hipaa/for-individual...index.html
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