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frustrated with vpap auto
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me50 Offline

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Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
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Post: #11
RE: frustrated with vpap auto
vpap settings per sleepy head

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02-06-2014 09:39 AM
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robysue Online
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Machine: PR Dreamstation BiPAP Auto
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CPAP Pressure: min EPAP = 4; max IPAP = 9;
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Other Comments: Papping since September 2010

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Location: Buffalo, NY

Post: #12
RE: frustrated with vpap auto
me50,

I'm going to split my response up into several shorter posts.

(02-05-2014 08:25 PM)me50 Wrote:  [quote='robysue' pid='58083' dateline='1391611251']
And PAP does not fix bad sleep; PAP only fixes sleep disordered breathing, regardless of whether it's CPAP, APAP, bi-level (VPAP-S) or auto bi-level So if there are any other causes for the bad sleep, those other causes have to be addressed before the overall quality of the sleep improves.

UNLESS THE FRAGMENTED SLEEP IS CAUSED BY NOT TOLERATING THE PRESSURE, LEAKS, ETC.
In that case, the VPAP is clearly not fixing the bad sleep; the VPAP is causing the bad sleep.

Or more technically, PAP is contributing to the bad sleep in spite of fixing the sleep disordered breathing.

For what it's worth, I understand all too well how PAP can cause bad sleep by triggering an excessive number of wakes or severe bedtime insomnia or both. I've dealt with some serious CPAP-induced insomnia off and on for the last three and a half years. And it's not fun, to say the least, to be sleeping with a machine that is supposed to fix your sleep by fixing the sleep disordered breathing part of the problem, only to have your sleep remain bad sleep because of an excessive number of wakes tied to problems tolerating the pressure, dealing with leaks, and other sensory stimuli that either wake you up or keep you from getting to sleep in the first place.

Since you have good reason to believe that the VPAP itself is leading to fragmented sleep, you need to do some sleuthing to figure out how the VPAP is contributing to the fragmented sleep. Because the only way to fix bad sleep caused by VPAP intolerance is to figure out how to make the VPAP more tolerable.

Questions for you to ponder:

1) If the AHI is not consistently below 5.0, then the question to ask is: Is the pressure setting sufficient to fix the sleep disordered breathing? Because if the VPAP is NOT fixing the sleep disordered breathing, then the VPAP is NOT fixing the fragmented sleep that is being caused by too many sleep disordered breathing arousals and wakes. The therapy itself must be effective in terms of reducing the AHI (or RDI for UARS patients) before there's any hope for getting high quality, non-fragmented sleep. So what does the data say about the efficacy of your therapy?

2) If you think the fragmented sleep is due to pressure intolerance, what's going on that's leading you to that conclusion? How uncomfortable are you when you're trying to get to sleep? How uncomfortable are you when you first wake up in the middle of the night? And exactly what is "uncomfortable"? Is there air in your stomach? Is your nose and throat dried out? Do your sinuses hurt? Do you ears hurt? Is there air getting into your eyes from inside the tear ducts? Or is the problem that you feel suffocated because there's not enough air coming through the mask to inhale comfortably, and that leads to a wee bit of panic, which leads to fragmented sleep?

3) If you think leaks are contributing to the fragmented sleep, are the leaks large unintentional leaks that show up in the data? Or are they small annoying, but persistent leaks that don't show up in the data? Is the intentional exhaust flow from the mask disturbing you? Are you willing to consider other masks? (and why or why not?) And what have you done to try to solve the leak problem and how successful was it?

4) Are other mask issues contributing to the fragmented sleep? Do you have to adjust the headgear so tight that it hurts by the end of the night? Does part of the frame or part of the headgear lie right on top of a sensitive place in your face or head? (Straps going directly over a painful TMJ, for example, can lead to additional TMJ pain and that can lead to fragmented sleep.) Does the mask prevent you from sleeping in your favorite pre-CPAP sleeping position? Are you willing to consider other masks? (and why or why not?)

5) Are other VPAP-related comfort issues contributing to the fragmented sleep? Is the air coming through the tube too cold? too hot? too dry? too humid? Are there noise issues that tend to wake you up or keep you awake? Does the hose get in the way of moving around in bed with a minimal amount of effort?

If you can identify some of the ways the VPAP therapy is contributing to or causing your fragmented sleep, then you've got a target to start working on. But it's up to you to figure out how the VPAP therapy is leading to the fragmented sleep in the first place.
02-07-2014 03:32 PM
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robysue Online
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Posts: 1,216
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #13
RE: frustrated with vpap auto
(02-05-2014 08:25 PM)me50 Wrote:  
robysue Wrote:1) What does your overall sleep hygiene look like?

SEEMS FINE
Can you be a bit more specific?

Have you got a regular wake up time on all seven days of the week? Or is wake up time on your days off much later than wake up time during the work week?

Have you got a regular bedtime on all seven days of the week, or do you go to bed much later on days off?

When you find that you are awake in the middle of the night, what do you do? Stare at the clock and start worrying about the fact that you are awake and it's the middle of the night? Or turn over and go back to sleep without giving the wake much thought?

When you can't get to sleep or you can't get back to sleep what do you do? Lie in bed and stare at the clock and start worrying about the fact that you can't seem to get to sleep? Lie in bed while relaxing and not worrying knowing that you'll eventually doze off? Give yourself a bit of time to get back to sleep and then get up if you're still not sleepy after 20 or 30 minutes?

How much caffeine do you consume during the day? And how close to bedtime is the last of the caffeine?

How much alcohol do you consume during the afternoon and evening? And how close to bedtime is the last drink?

How close to bedtime do you eat supper? Any evening snacking? If so, how close to bedtime is the last snack?

How close to bedtime do you watch TV, web browse, or spend time texting with friends?

How much exercise do you get on a regular basis?

All these things are part of sleep hygiene and even if you're very good in all but one of them, the one you're weak on can play havoc with the quality of your sleep.

In my case, the big sleep hygiene issues are regular wake up times---I hate having to get up at my work week time on my days off. And a close second is regular bedtimes---if I don't maintain a regular wake up time seven days a week, then my bedtimes get very, very ragged because I'm not "sleepy" at bedtime on the days I sleep in.
02-07-2014 04:04 PM
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robysue Online
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Advisory Members

Posts: 1,216
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #14
RE: frustrated with vpap auto
Quote:
Quote:6) What are your expectations? In other words, what are you trying to achieve? Unrealistic expectations about what "decent" or "good enough" sleep is can lead to additional stress caused by worrying about the bad sleep, which can make the sleep get even worse. As hard as it sounds, sometimes it helps to simply not worry about the sleep for a few weeks.

SLEEP FOR 7 OR 8 HOURS WITHOUT WAKING UP 5 TIMES PER NIGHT.
Are you aware that normal people---those without OSA and those without any insomnia or "fragmented sleep" issues---usually wake up several times a night?

The wakes in the normal population are usually post-REM. And we typically have a REM cycle about every 90 minutes or so. Hence if we get 7-8 hours of sleep, it's very likely that we'll go through 3-5 REM cycles during the night, and so a person with normal sleep may very well have 3-5 wakes per night, but these wakes are usually so brief that once morning comes, the person does not remember any of them.

One important difference between the normal population and the people who complain that their sleep is fragmented, is the person's response these post-REM wakes. A person with normal sleep does not prolong the wake by trying to figure out why they're awake. Instead, a normal person quickly assesses that there's nothing significantly "wrong" that needs their attention (like a crying baby or a leaky roof), then they quickly assess their comfort and make any necessary adjustments (such as turning over in bed or kicking the covers off if they're too warm) and then they go back to sleep. And all this happens in less than 5 minutes. And most people don't remember any wakes that are less than 5 minutes long.

But people who describe their sleep as "fragmented" or who describe themselves as an "insominac" typically reacts to the wake in ways that maximize the chances that the wake will last at least 5 minutes, and hence that they'll remember the wake the next morning. And, of course, the longer the wake, the more disruptive it feels in terms of overall sleep quality.

And what do these people who describe their sleep as fragmented do to prolong the length of each wake? The most common behavior pattern is that they first look at the clock and then start calculating how much (or little) sleep they've gotten since the last wake and how much (or little) time remains before the alarm clock goes off in the morning. Calculating the "sleep numbers" tends to increase the anxiety about being awake, which in turn makes it harder to fall back asleep. Folks who are worried about their fragmented sleep also tend to start trying to second guess why they are awake in the first place and that in turn tends to make it more difficult to return to sleep.


Quote:
Quote:2) How fragmented is the sleep? How many wakes do you typically have during the night? How long are you typically awake during the night? How much total sleep would you say you get on a typical night?

3 TO 5 TIMES PER NIGHT (ONCE OR TWICE THERE WERE 8)
I don't mean to sound glib, but if you are only having 3-5 wakes per night on a regular basis and you're getting around 7-8 hours of sleep, there's a high probability that most or all of those wakes are simply post-REM wakes, which are actually normal.

So the solution to your fragmented sleep problem may like in figuring out a way to NOT react to those (normal) wakes and prolong them to the point where you remember them in the morning.

In other words, a part of fixing your fragmented sleep problem may be unlearning the behavior patterns you have that currently maximize the length of each wake and lead to you remembering every single wake during the night. In other words, if you could train yourself to not respond to the post-REM wakes by staying awake long enough to start worrying about them, you might get back to sleep fast enough for the 3-5 wakes to not really matter in terms of your overall sleep quality.

And how does one go about training yourself to NOT respond to the post-REM wakes by prolonging them? That's a tough question, but it's one that you need to be asking.

You can start with self-help measures. A great book about how to sleep more soundly by training your body to NOT respond to nightime wakefulness in inappropriate ways is Sound Sleep, Sound Mind by Dr. Barry Krakow.

Sometimes all it takes is learning to not look at the clock when you wake up.

Sometimes it helps to use a sleep restricted schedule, but that can be extremely difficult for a lot of people to do. (This was a critical tool for me in getting over the worst of my fragmented sleep issues that stared during my first 6 months of PAPing).
02-07-2014 04:27 PM
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JIII Offline

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Post: #15
RE: frustrated with vpap auto
Vitamin D deficiency can correspond to a low testosterone condition. If you are feeling tired/crappy/foggy all day, but are getting decent enough sleep time, I would look into it. Requires your GP or an Endocrinologist to do a blood test for LH, Estradiol, Free Testosterone, and total Testosterone. The blood draw is done in the morning (highest T time). You want to be in the top 20 percentile. If you are in the bottom 10 percentile (some would say bottom 40 percentile), your issues may well be T related.

It is rare for doctors to check for low t...even when they do thyroid tests.
02-17-2014 12:38 PM
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trish6hundred Offline

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Machine: Resmed S9 AutoSet for Her
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Post: #16
RE: frustrated with vpap auto
Hi JIII, WELCOME! to the forum.!

trish6hundred
02-17-2014 05:51 PM
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eviltim Offline

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Post: #17
RE: frustrated with vpap auto
me50, I had (and still have to a much lesser degree) the same problem. When you say your sleep hygiene is good, have you eliminated all sources of light, particularly blue light during bedtime? Turning off electronic devices, using blackout shades, etc. The two things that really improved my sleep and made me need to sleep less to be well-rested were blacking everything out and not looking at the clock at night. I still wake up during the night but I don't worry about it, go back to sleep, and I find that I am well rested on a little over 8 hours of sleep nowadays.
02-17-2014 11:27 PM
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me50 Offline

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Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #18
RE: frustrated with vpap auto
(02-17-2014 11:27 PM)eviltim Wrote:  me50, I had (and still have to a much lesser degree) the same problem. When you say your sleep hygiene is good, have you eliminated all sources of light, particularly blue light during bedtime? Turning off electronic devices, using blackout shades, etc. The two things that really improved my sleep and made me need to sleep less to be well-rested were blacking everything out and not looking at the clock at night. I still wake up during the night but I don't worry about it, go back to sleep, and I find that I am well rested on a little over 8 hours of sleep nowadays.

yep to all of the above. no clock in the bedroom. no radio, no tv on at night in the bedroom. only thing on at night is the ceiling fan, heat pump, vpap machine.

thanks for your thoughts.
02-17-2014 11:29 PM
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