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[Treatment] Waking reflexes, cannot fall asleep
#1
Question 
Waking reflexes, cannot fall asleep
Hello,

I am new here and have been trying to get used to the APAP therapy I have been prescribed for a few days. I was diagnosed with obstructive sleep apnea with 50 breathing pauses per hour. I was prescribed APAP, pressure range: 5 to 9.4 mbar.

Now that I have been trying to get used to the therapy for a while, I think I have found comfortable settings for mask and device. Nevertheless, I have not yet succeeded in falling asleep with the device, so that I have always taken the mask off after about 1 hour.

In the beginning, I still had the impression of not getting enough air during the sleep phase. I woke up immediately with a strong reflex to take a breath.

After I deactivated the ramp for a short time in order to have the pressure quickly in the therapy range, the wake-up reflex when falling asleep has eased. Last night I also used a deswelling nasal spray so that I could breathe easily through my nose. Nevertheless, I was not able to fall asleep. A slight waking reflex remains, although everything feels comfortable so far.

Can you give me any tips? Attached is the data from my SD card in case an evaluation is useful.

Thank you in advance for your tips.

I am 40 years old and male.


Norbert


PS: I have tryied to attached SD card Data from my ResMed AirSense 10 AUTOSET. But the Forum does not accept the 1.5 MB ZIP file. Thinking-about
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#2
RE: Waking reflexes, cannot fall asleep
hi norbert,

First, download the free OSCAR software.  Flllow the directions given and set up a profile.

Then place your SD card in your computer or laptop and import the data.

For posting your data here for analysis, follow the instructions in this link.  
http://www.apneaboard.com/wiki/index.php...ganization

All we need to see is a screenshot of the Daily Page in OSCAR.  The link will guide you on how to take a screenshot and organize the graph.  We don't need to see all the graphs, just the following:  Events, Flow Rate,
Pressure, Leak Rate and Flow Limitation.

Include the left sidebar minus the pie chart and calendar.  That will enable us to see all the statistics on the chart.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


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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#3
RE: Waking reflexes, cannot fall asleep
I second OpalRose's recommendation. With a screenshot of Daily Page, we'll be able to see a wealth of information about your treatment and may be able to recommend some changes to your settings that will improve your experience.

In the meantime, try setting your machine up outside your bedroom during the day or evening -- in a place where you can use the machine for an hour or two while you read, watch RV, or do some other mildly pleasant and diverting thing. This will help to accelerate your adaptation to the new sensations.
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#4
RE: Waking reflexes, cannot fall asleep
I'm not one of the experts, but I know that most adults find a beginning pressure of 5 too low. Hopefully someone will chime in with more advice so that you can sleep better tonight.
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#5
RE: Waking reflexes, cannot fall asleep
5 could very well be too low, and agreed for most it is. Even so there's a few contrarian folk out there that may be fine at 5 min. A ResMed will be better at letting folk get away with lower pressure, so the OP has that as a positive.

Show the OSCAR to be sure. It will very shortly answer a lot for the therapy status and efficiency.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Waking reflexes, cannot fall asleep
Hello,

thank you very much for the support. I have already installed OSCAR yesterday. Enclosed you will find a screenshot.
I notice that the device regulates early to the upper APAP pressure limit (9.4 hpa).  Is this an indication that this limit is set too low for me?

I look forward to your comments and advice. In the meantime, I will also use the device in the early evening, as suggested, with the goal of getting more used to it.

Norbert

PS: I wish you all the best in the new year.
PPS: How can I edit my profile in this forum?

   
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#7
RE: Waking reflexes, cannot fall asleep
The Airsense 10 reacts to flow limitation, and yours is extremely high at .04, .34 and 0.50 (median, 95% and maximum). The algorithm is designed to increase pressure for flow limitation to reduce the inspiratory flow resistance or obstruction. If you look very closely at the flow rate graph, you will see very distorted and flattened peaks. This happens because as inspiration progresses, resistance becomes higher and the flow rate slows. Normally with an unobstructed airway, the flow rate to the point where flow slows ahead of expiration because the lungs are full.

The best way to treat this with your machine is to turn on EPR (exhale pressure relief) and increase maximum pressure. The settings should be minimum pressure 7.0, maximum pressure 12.0 or higher with EPR on full-time at 3. This will result in bilevel pressure with inhale/exhale pressure of 7.0/4.0 to 12.0/9.0. The use of bilevel pressure supports inspiratory effort and reduces flow limitation.

Your chart shows a lot of central or clear-airway apnea events in the second half. I suspect these events are false, or when you are awake. EPR may make that worse, however, it is worth trying to see what happens. If EPR does increase CA events, you will likely need a different form of therapy. Did you have any central apnea in your diagnostic study?

To change your profile just click on the UserCP in the upper right corner of this page http://www.apneaboard.com/forums/usercp.php
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#8
RE: Waking reflexes, cannot fall asleep
Hello Sleeprider,

Thank you very much for your insightful explanation.

I will gladly try the suggested settings.

> Did you have any central apnea in your diagnostic study?

This is a very interesting question for me. I will explain why in the following. First of all I want to mention again that the recordings contain only waking phases, because I woke up again and again directly while trying to fall asleep.

The sleep laboratory, in which I was recently and already 2 years ago, diagnosed both times a purely obstructive apnea. (Single, central events would be normal, according to the doctor).

However, I was once in another sleep lab about 15 years ago. There, interestingly, a purely central apnea was diagnosed. Accordingly, I was also surprised that I should now have a (purely) obstructive apnea.

But it is also possible that I have changed in the last years. I remember that a few years ago I often woke up because I had forgotten to breathe. I was really gasping for breath at that time. This phenomenon has decreased. However, I sometimes have situations during the day when, for example, while working at my desk, I realize that I have forgotten to breathe.

But there have also been wake-up events in the recent past where I woke up with a loud snore or grunt. Big Grin

So my personal guess is that I have a complex apnea. However, there is no such diagnosis. There is only the earlier purely central diagnosis and the newer purely obstrusive diagnoses. Dont-know


Norbert
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#9
RE: Waking reflexes, cannot fall asleep
I hope the use of EPR will clarify what you are dealing with. If you do have complex apnea, there are very effective positive air pressure devices to treat that. Doctors seem reluctant to make central apnea diagnoses, and it's not unusual to see someone with many central events diagnosed with obstructive sleep apnea. Here in the U.S. nearly all sleep disordered breathing is treated with CPAP initially, then more advanced devices may be considered if problems continue. This trial with EPR should tell us a lot.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
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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#10
RE: Waking reflexes, cannot fall asleep
Just to be sure we understand: you were not asleep during the periods of time shown on the Oscar chart? It'll be good to see what happens with the revised settings Sleeprider has recommended. When you post the next chart, could you indicate the periods of time, if any, during which you were asleep?
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