Sudden change in ability to fall asleep

[SleepDub]

Hi All,
I've been using an Autosense 10 since October of 2019 with relatively good results. Wasn't too hard to get used to it, ultimately slept better and was doing ok. I'd have the occasional night where it was harder to fall asleep than others, but nothing too concerning. In my mind, as I was falling asleep, I was kind of letting a slow-moving 'breathing-train' pass below me, and lowering myself on to it. That worked well.

In the last few months, and especially more-so in the last few weeks, I'm really struggling to fall asleep. I feel like I'm actively fighting against the machine and not finding the rhythm I need to drift off. Breathing becomes tough, and I feel like I'm trying to speed up my breaths to the point where I feel like I'm hyperventilating. I wind up shutting the machine off, taking a break, catching my breath, settling down, and trying again when I feel like it may work. There are times I go through that cycle multiple times, fail, and get out bed to wander the house before trying again. Now, I'm at the point where I'm nervous to go to bed because of the high-potential for frustration and lack of sleep.

I posted my current settings as an attachment, and if it helps, last night's Oscar data where you can see a couple cycles of start/stop/regroup/repeat. I've tried multiple variations of increasing EPR, turning it off altogether, turning off ramp, etc, but can't get my groove back. I'm ultimately back to where I was when things were working, but still having problems. BTW, I'm thinking any of the increased Leak Rate numbers early in the night are me opening my mouth to let air flow that way while I catch my breath, and not an actual leak. I'm generally don't have issues once asleep with leaks or breathing only through my nose.

A part of me wonders if something might be wrong with my machine. How would someone go about confirming that? Or, the more likely cause is something changing with me and my CPAP needs, in which case I'm hoping someone here might point me in the right direction. 

Thanks in advance for any guidance.

               

[Ockrocket]

Perhaps before putting your mask on do a breathing routine.

I've found a breathe in hold and count 1 to 5, breathe out hold and count 6 to 10, in and hold for count 11 to 15. etc.. 
I do this until I reach the count of 40 - mask up and asleep within a minute or two ( I tried counting 1 to 5 six or seven times, but lost track of how many "sets" I had done ).

[staceyburke]

Your flow limits are high, the machine raises pressure when it has flow limits. Flow limits are apnea but are not at least 10 seconds long. And are not counted In the AHI.

To control flow limits we use EPR. you have epr set as 2 but your min is to low for it to work. 

EPR(exhale pressure relief) subtracts from the min for your exhale pressure. 

I would suggest you try the following changes. 

EPR 3 FULL TIME
min 7

This would make your inhale at 7 exhale at 4 (4is the absolute lowest any pap machine can go)

[OpalRose]

I agree with Stacy. Your minimum pressure is too low for EPR to be effective, and you need EPR to tackle the Flow Limitation.
Plus what you describe is probably a feeling of being "air starved."

Try:
Minimum 7cm
Maximum 12cm
EPR 3 Full Time

Also, turn off the ramp setting. This is only useful if you are using high pressures.

One more thing: When posting a chart, use the F12 button to take a screenshot.
Use the Attachment Feature to post your chart here. There's a link in my signature line to guide you.

[SleepDub]

Thanks all. I was going to try and ease into new settings last night, and continued to have trouble falling asleep. I think I only increased min to 7 and EPR to 3. Continued to have problems. Around 2am, I disabled ramp and increased max to 11, gave it another try, and fell asleep much quicker. Also stayed asleep a lot longer, which I definitely needed.

At this point, I'm at min 7, max 11, ramp off, EPR 3, and increased humidity to 4 as I had been feeling pretty dried out.  Not sure if that was the ticket or if I was just finally so exhausted I fell asleep, but it was ultimately a good night, so I'll take it. I guess big test will be trying to sleep tonight with all the changes in place.

Also, I made the changes in Oscar to get better screenshots, so thanks for the tips on that as well.

Here's last night's data.

   

[SleepDub]

Hi again. I wanted to check in and ask for additional review. I made changes in settings to where I'm now at min 7, max 10, EPR 3 (full-time). I wound up leaving ramp on, but for only 5 minutes just while I settle in.

I'm still having problems staying asleep. I'm falling asleep ok, but I wake up multiple times through the night, feeling as if the machine pressure is very high, and I'm working against it. Other times, I have that air-starvation sensation. 

I'm attaching my chart from last night. You can see the times where I wound up getting up or trying to restart, but there is also a big cluster of Hypopnea events starting a little before midnight and going til about 12:15. Not sure what those were, and I managed to sleep through that whole series.

Thanks in advance for any further advice or guidance on how I can better stay asleep and not feel like I'm working against the machine. I had a pretty long string of good luck where things were working well. I'm anxious to get back to that.

   

[SleepyTeacher]

I am running into similar problems. First few days I slept like baby, no wake ups. Then it started to wake me up all the time. Any updates?

[WarmHoney3650]

Is OPs flow limits really that bad? I have similar flow limits but ppl tell me it's not that bad

[Crimson Nape]

SleepDub  -  The concentration of hypopneas and resulting flow limits in mainly one area would indicate that you're chin-tucking, thus restricting your airway.   The normal recommendation is  to use a Soft Cervical Collar, referred to around here as "SCC".  They can be obtained from your local pharmacy or online.  Another method to try would be to wedge a corner of your pillow under your chin.  Of course, this only works if you sleep on your side.

This is the link to the Wiki on the Soft Cervical Collar, to help in a better understanding of the SCC and its use.

- Red

[SleepDub]

Thanks all. I'm a stomach sleeper for the most part. I've tried to force myself to at least side-sleep, but almost always revert to my stomach. I have other sleeping issues related to hypo/hyperthyroidism, so sleeping is somewhat of a challenge anyway these days. I think I'm getting closer to dialed in on that front though, so I'm trying to rely less on sleep aids, etc. I'm sure my stomach sleeping, especially with the way I curl my arms up below my head, is contributing to the chin-tucking behavior that Red mentions.

Anyway, as an update, things have been somewhat better lately. I've been better able to fall asleep and get my breathing under control by letting myself breathe through my mouth, even with the pillows on, just to get my breathing into a rhythm. From there, I ease back into breathing through my nose and ultimately drift off.

My apnea is really related to my weight, and at least in the past, when I got below a certain weight, the apnea really diminishes. My current struggle is getting back to that weight, especially with my thyroid challenges lately. I'm still optimistic I'll get there, but I've seen an uptick in my weight again just recently, which I think is contributing to all of the above issues even more.

I really appreciate all the feedback and help here. This board has been a great resource.

Thanks.