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Sleepless in Seattle
#1
Sad 
Hello all,

I’m new to CPAP having been diagnosed only last month. My Sleep Study AHI was 25.1 during the overnight visit. I have also been diagnosed with a deviated septum by an ENT who suggested that corrective surgery might alleviate some of my difficulties with CPAP. This would be my last choice.

I’m using the Philips Respironics DreamStation Auto CPAP with a Philips Respironics DreamWare nasal cushion mask. I have also tried a full face and nasal only mask with poor results. At this point the mask I’m using seems to work fine and is comfortable.

My initial setting was 5-9 with AFlex-3 and ramp. I quickly figured out that the ramp was of no help and that 5 was just too low as I was starved for air. I upped the min pressure to 6 and turned off the ramp feature. I have set the humidifier to 5 with the heat on 3.

I’ve struggled through about 25 days of therapy with bad to awful results. I’m having a difficult time falling asleep as my nasal passages seem to close up when CPAP is applied. Although, changing the heat and humidity settings have helped. The most troubling problem I’m experiencing is that I wake up each morning between 3:30 - 4:00 AM and am unable to fall back asleep. Eventually after 30 minutes or more I remove the mask and find I can fall asleep again. I’m averaging about 6 hours of use per night with what I would guess to be about 4:30 of actual sleep. Needless to say, I’m more exhausted now than I’ve ever been.

To date I have changed the min setting, turned off ramp, adjusted the humidity and temp and have started using Flonase nasal spray. I am also using a Breathe Right Nasal Strip each night which has actually been one of the better remedies that I have found.

I’m in a profession that will require that I use the CPAP a minimum of 70% of the time for at least 6 hours per night with an AHI < 5 and my doctors sign off that my condition is being managed successfully. Additionally, I have to actually be rested. At this point I’m a bit freaked out to say the least. I can force the usage compliance even if it kills me but actually having the therapy work so that I receive a good night’s sleep is another thing.

I have posted, I hope properly, my last night of SleepyHead data and can post more if it would help.

My main concerns are as follows.

  1. How do I keep my nasal passages sufficiently open so that I’m not starved for air and can fall asleep more naturally? I would like for surgery to be a last resort.
  1. How can I stop this pattern of waking in the early morning hours so that I can receive a full night’s sleep?
  1. What adjustments to my settings might help the above as well as lower my AHI to a more therapeutic level.
As a side note my Sleep Specialist Doctor seems to be of the mindset that continued Sleep “Titration” studies are the answer. I’m not apposed but if the outcome would be minor adjustments to settings I believe this can be accomplished without taking more of time. Additionally, he was verbally upset that I purchased equipment from an online supplier rather than his inhouse representative. That is a red flag to me. Especially since I’m not using insurance for the equipment.
 
Any help or thoughts would be greatly appreciated. Thanks for taking the time to assist with my journey. I’ll make reports and keep this thread current if people believe it might be of assistance to others in the future.

[attachment=3516]

 
GuppyDRV
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#2
Hi GuppyDRV - Welcome

Your chart looks like you may have rolled on your back around 1 AM.  Try to stay on your side if possible.  I think I'd bump your minimum pressure up to 8cm and set the max pressure at 12cm.  The pressure seems to clear your Hypopneas at around 8cm and you plateaued out when you turned on your back. By using the newer pressure range, you should start off in a therapeutic pressure setting and the higher max setting will allow for turning on your back.  Give it a few nights .

I hope this may help. Keep us posted.
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#3
Your minimum pressure of 6 may still be too low. Your AHI is considered treated, but there is room for improvement especially with your comfort level.

Feeling starved for air can be alleviated with a higher pressure. I would move the minimum pressure up to 7cm and the maximum pressure to 12. You may need an even higher minimum pressure.
Also, turn the flex setting to 2.

Try this for a few days and see if it helps.
OpalRose
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#4
Sleepless,

I also have problems with stuffed up sinuses and I found it difficult to breath at lower pressure settings.  If you increase your lower pressure as suggested above, you may find it easier to breath and even fall back asleep in those early morning hours.  You may also find that higher pressure clears your sinuses.  It works well for me especially when I keep my humidity cranked up.
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#5
I have found that the type of mask also has a lot of effect on nasal swelling. RIght now, I seem to do best with a Eson 2 small, or medium, and with a Airfit P10 small. The P10 medium was a total disaster. KI also have to use a chinstrap to reduce mouth breathing and nasal strips to open my nasal passages.

Sleep hours may come along as you gain comfort and belief in xPAP beng healthy and good, but some minds are more stubborn than others.
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#6
Hi GuppyDRV,
WELCOME! to the forum.!
I agree with those who say to raise your minimum pressure, 5 is too low and this could be why you feel air starved.
Good luck to you with CPAP therapy.
trish6hundred
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#7
(05-31-2017, 04:21 PM)OpalRose Wrote: Your minimum pressure of 6 may still be too low.  Your AHI is considered treated, but there is room for improvement especially with your comfort level.  

Feeling starved for air can be alleviated with a higher pressure.  I would move the minimum pressure up to 7cm and the maximum pressure to 12.  You may need an even higher minimum pressure.
Also, turn the flex setting to 2.

Try this for a few days and see if it helps.

I looked at your chart and I was going to recommend exactly what OpalRose recommended.  You need higher pressure, and because your numbers are really very good, only small changes.  The key here is how do you feel?  and the answer is you need improvements.  We need to get you comfortable.  
Please make the suggested changes and let us know how they work out.  We will and can help you

oh, and welcome to the forum.
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#8
(05-31-2017, 07:16 PM)bonjour Wrote:
(05-31-2017, 04:21 PM)OpalRose Wrote: Your minimum pressure of 6 may still be too low.  Your AHI is considered treated, but there is room for improvement especially with your comfort level.  

Feeling starved for air can be alleviated with a higher pressure.  I would move the minimum pressure up to 7cm and the maximum pressure to 12.  You may need an even higher minimum pressure.
Also, turn the flex setting to 2.

Try this for a few days and see if it helps.

I looked at your chart and I was going to recommend exactly what OpalRose recommended.  You need higher pressure, and because your numbers are really very good, only small changes.  The key here is how do you feel?  and the answer is you need improvements.  We need to get you comfortable.  
Please make the suggested changes and let us know how they work out.  We will and can help you

oh, and welcome to the forum.


Thank you everyone for such prompt and thoughtful recommendations. The bump from a min of 5 up to 6 was helpful so it sounds like more of the same might be in order. I'm not one that handles change well so my thoughts are to increase in smaller incriminates. If it sounds reasonable I'll try a min of 7 and max of 10 tonight. I see the recommendation for an Aflex of 2 so I may try this tonight as well. I experimented with the Aflex during the day when I first received my machine so I have a basic understanding of what it does but I'm still not really certain how this effects the therapy. Is there a source where I might learn more about this and other settings?

Again.....thanks for the help. I'll report back with some results.

GuppyDRV
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#9
yes, the most important of the settings I feel is the flex setting from 3 back to 2.  I think this will combat the clutter of H and some CA you are having at some spots.  

generally, the minimum pressure is raised enough to reduce or eliminate OA actual obstructive events and flow limitations.  since you had zero OA and a fairly low flow limitation score, there really might be no need to raise the minimum from 6.

But, 7 to 10 at a flex of 2 is still a fine choice.

be sure to wait several days before another shift to see if the average changes much and in a good direction.  most advise 4 to 7 days.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#10
I thought I would post an update and hopefully solicit some more excellent feedback. I have slowly raised the min pressure up to 7 and the max up to 10. I have experimented with the Aflex starting with a reduction to Aflex2 and last night to Aflex1. I had been having some issues with it at Aflex3 where at the top of each breath the machine would suddenly cut off the airflow leaving me short. I found this very distracting. With Aflex 2 there was a small improvement but not nearly enough. I finally put the Aflex down to Aflex1 last night and found that most of the breathing issues disappeared. I'm not familiar enough with machine theory to understand why but the gain in comfort alone was worth the change.

The screen shot is my Sleepyhead data from last night, so not a real reduction in numbers especially the Hypopnea index. I am sleeping latter into the morning, this is good but still having trouble falling asleep. The 8 hour total from last night probably has 1.5 hours of wake time. I'm also having a bit of bloat and gas, Burps, I think related to the therapy as I have never experienced this before. I have yet to really feel any benefit from using the machine but have to say that I'm not falling behind on sleep as I was the first few weeks of therapy. The small changes suggested and implemented to date have helped.

Any advise on where to go from here would be greatly appreciated.

GuppyDRV


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