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Struggling - How does it look?
#1
Struggling - How does it look?
A very long story short.... I have been diagnosed for several years. First try was not successful. Second try was a bit more successful. This is my third try after having my CPAP machine just sit in my closet.  I would like this try to be even more successful.

I decided about a month ago that I wanted to give this another try.  I was very tired during the day. After I got home to relax, I just couldn't keep myself awake.  Headaches were getting more severe.  I  knew it was time for another go.

I really struggle and get very anxious when I put the mask on. My doctor has prescribed me some meds to help..... both relax me and keep me asleep.  I still wake up multiple times in the night. I struggle putting the mask back on after I wake in the night. (bratty child syndrome). I am claustrophobic and have a very difficult time getting back to sleep. I also love sleeping on my stomach and that is very difficult with a mask.

I think last night was one of the best nights I have had with my CPAP treatment but still don't feel very rested today. I suppose that comes with time.

I just recently installed the software thinking that if I can actually see the data that I am sleeping and know that things are working, I will be more more likely to have a positive attitude about this.  MyAir really doesn't cut it for me.

I hope I followed some good directions and these charts are helpful.


       
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#2
RE: Struggling - How does it look?
Why do you need a full face mask? If claustrophobia is a problem (or just plain comfort and ease) maybe try a different mask? Yes, I am a P10 convert. It made my CPAP journey much easier.

I think comfort is key to long term success. Your description does not sound comfortable, thus is not going to make this easy for you.
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#3
RE: Struggling - How does it look?
Johnboy, turn off the ramp! Look at the snoring during ramp. If you are claustrophobic and don't feel you get enough air, ramp is your enemy. turn it off and just start at your 6.0 starting pressure, or perhaps a little higher. Ramp is causing you to have an air deficit and unrecorded apnea for 45 minutes as you start therapy at an unhelpful pressure, and shortly after ramp ends, you have a big increase in pressure and we can see the OA events not recorded during ramp. It seems to come back to about 8.0, which may be your most appropriate minimum pressure. Once ramp is over, and your pressure stabilizes, your therapy looks pretty good.

Your past usage has shown short therapy times and very fragmented therapy. I think your single biggest problem is ramp. If I was to set you up, it would be Autoset Standard Mode, at 7.0 or 8.0 minimum pressure and 14.0 maximum pressure, EPR Full-time at 3, ramp off. Please consider giving it a shot.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Struggling - How does it look?
Congratulations on returning to treatment!  And it’s excellent you are already using Oscar and posting charts. Your AHI number must be awesome. This is all a good foundation for a path to restful sleep.

Seeing your Flow Limitation chart might help the experts advise you about settings. Next time you post could you include it?  You can make room by scrunching the other charts a little. To do that, grab and move the horizontal grey lines that separate the charts.

I’m with trailrider on the mask problems. Try a P10 during the day and see what you think. If you like it, the next step would be to see how it goes when your asleep. Even people who think of themselves as mouth-breathers can surprise themselves by successfully using a nasal interface. 

A couple of quick additions.  If you use a pillow-type mask, be sure to change the mask setting on your machine.  Often, going one size up on the pillows from what you think is right will make for greater comfort. ResMed has a dopey For Her designation for headsets that are just for smaller heads. And if you like the P10 but have leak problems, let us know. Lots of ways to work on that.
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#5
RE: Struggling - How does it look?
Welcome, we can and will help you.

First, the ramp, it is working against you, not for you.  See how you have heavy snores, but ONLY while the ramp is on?  Turn it off.

Second, a more comfortable setting to start with, Set Pressure Min = 7.  This will be 7 inhale and 4 exhale.  This is a very low setting.

Also, add the Flow Limit chart in, you can make the Snore, Leak Rate, and Flow Limit charts smaller to fit it in. Just grab the gray line between the graphs and move them to fit.

Mask and Claustrophobia:  Change the Mask,  The ResMed P10 is the smallest least obtrusive mask out there, you should even be able to sleep face down with it.  Its problem, it is so small that sometimes the weight of the hose can pull on it causing leaks.  Easy solution, use some hose management,  I use a velcro strap that has a clip on it that you can attach to your pillow or PJs.

Waking up multiple times, sorry, but that's just going to take some time.  You have been in disturbed sleep for quite a while now and your body thinks that being disturbed frequently is just how it is and hasn't fallen into the sleep cycle it needs to.  Just give it time, the frequency will diminish as you conquer this apnea thing and you will once again sleep through the night.


edit: and I see SleepRider has beaten me to the punch with essentially the same recommendations
Ramp = Off
Min Pressure = 7
Max pressure 14 (current setting)
EPR=3 (current setting)
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Struggling - How does it look?
I started my journey with a nasal pillow.  I guess I found out that I sleep with my mouth open. I had that issue where the air would just keep coming out of my mouth... I didn't want to deal with a chin strap. I might be overthinking it, but I feel that a chin strap would be even more claustrophobic.  Might have to do some more thinking on that.

In terms of the ramp. My doctor in the beginning adjusted my ramp settings for me because I was just having difficulty with breathing out against the pressure. I guess that is the ERP. He has adjusted that for me as well.  I don't see where I can change that (ERP) in my settings. I will change the ramp time, but feel I do need some ramp time just to help me relax into it. I have trouble falling right asleep as you can probably see. Maybe I can keep adjusting it as I adjust to the treatment.  It is great to hear that the treatment appears to be working.  

The snoring could be me dealing with congestion. I am dealing with quite a bit of that right now. 

Good to hear the the waking up multiple times in the night might just be that my body isn't used to it. I hear wonderful stories of how folks put on the mask and go to sleep and wake up hours later feeling refreshed. I am jealous.

I have added my flow limitation information to the screenshot.  Maybe that will provide some more insight.

Thanks everyone. I am going to try to stay positive that this will get better and better.

Johnboyinfl


   
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#7
RE: Struggling - How does it look?
If you’re leery of turning ramp off, for now try just shortening the time. But another big recommendation that people are making is not to start ramp at 4. That is the minimum pressure the machine can generate, and while it is nice as an exhale pressure, it is awful as an inhale pressure—makes you feel you can’t get enough air.

So you want to start your ramp at at least 7. That will be your inhale pressure; with the EPR of 3, your exhale pressure will still be 4.

To make this change, you need to go into the clinical menu. Here’s how. Press the round knob to turn on the display. Then press and hold the round knob and the home button simultaneously for several seconds until the menu displays a clinical menu option at the top. Select it, then scroll down to ramp start. Make the change to the pressure, being sure to press the knob after it says 7 to set it. Go back up to the top of the menu to exit.

You’re free to use the clinical menu no matter what, but I note that your doctor said patient access is OK. (That’s on your charts page, on the left.)

Maybe more about the P10 another time.
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#8
RE: Struggling - How does it look?
Thank you. I didn't scroll down far enough the first time to see those settings. I didn't even realize that it said patient access is ok.

I will do some adjusting bit by bit. 

Thanks!
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#9
RE: Struggling - How does it look?
It can be a hard journey! This is not an easy process for many people. But you've got good support here to help you through the bumps.
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#10
RE: Struggling - How does it look?
(06-14-2019, 10:50 PM)johnboyinfl Wrote: Thank you. I didn't scroll down far enough the first time to see those settings. I didn't even realize that it said patient access is ok.

I will do some adjusting bit by bit. 

Thanks!

A good way to wean yourself off ramp is to increase the minimum ramp pressure to 6.0 (you do terribly at 4) and set it to auto.  The machine can automatically detect sleep onset by your breathing patterns and switch from ramp to therapy.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files

How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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