New CPAP User Struggling With Getting a Full Night's Sleep

[benlandrail]

Hi,

I'm a 35M, thin (179 cm, 60 kg), relatively physically active. Two months ago I did a home sleep study with a Watchpat-300 and was diagnosed with OSA. 

Here are the study results:

• WP: 8.2
  
• RDI: 22.8
  
• REM-dependent
  
• saturation avg. 94%, min. 89%
  
• deep sleep snoring 23%
  

In addition to that, an ENT discovered that I have vasomotor rhinitis, due to which one of my nostrils gets blocked when I sleep on the side. However, it's rather mild and doesn't really affect my throughout the day or when sleeping on the back. 

After fruitlessly trying various alternative methods, I bought an AirSense S10 Autoset machine with an F20 full-face mask. I slept well the first night, but after that it has been hit and miss — but mostly miss. I started using the machine about three weeks ago. 

The main problems are that a) it takes a long time to fall asleep and b) I wake up for some reason 2 or 3 hours into the night, take the mask off and go back to sleep. Needless to say, I'm not sleeping particularly well. 

Part of the reason may be that I'm a very sensitive sleeper: can't fall asleep without earplugs, when it's too hot or bright etc. On the other hand, I don't find the mask uncomfortable at all when going to sleep. I just can't get back to sleep while wearing it after waking up at night. 

My current settings are: APAP mode, pressure 5-15, no EPR, soft response, everything else on auto. Comfort-wise, I feel that they are okay,  
My current results are attached to this post. 

What could be causing my early awakenings and trouble getting through the night with the machine? Should I change some settings? 

Any input will be much appreciated!

   

[Deborah K.]

Did you have a lot of CAs in your sleep study?  If you don't know, post a redacted copy of the study.  Ask your doctor's office for a copy if you don't have one.  By US law they must provide it if you ask.

Raise your start pressure to 7.2.  That will provide better therapy.

Change your response from soft to standard.  That is better for most, especially men.  

Turn EPR on full-time, set at 3.  This will make your breathing more comfortable, and keep your flow limits low.  It will probably raise your AHI, but do it anyway until we find what is happening with your CAs.

Make those changes and post again so we can see how you are doing and how to advise next.

Again, welcome, and best wishes for achieving great therapy and comfort!  

[mesenteria]

Deborah, his EPR is currently off, but those CAs are bugging me, especially their clustering.  Would you see some EPR added just for giggles?

[jdougc]

Deborah K. is correct , your minimum pressure is too low for an adult, your median pressure is 7.2, so that is a good starting pressure. 

The CAs could be treatment emergent, or you could be holding your breath as your move around during the deep/rem sleep episodes in those clusters.

Can you change the Y-axis of the Flow rate graph from default to over ride and change the values to  -60 and 60? Right click on the right side of the graph to get that menu. That would show more detail. After you change the Y-axis range of the Flow rate graph, please post zoomed in charts of the CA clusters around midnight and 1 am.
[attachment=76703]

[benlandrail]

Deborah K., thank you for the welcome and the recommendations, will try them out tonight. I'm seeing the doctor in ten days, will make sure to get the sleep study results.

jdougc, thanks for the interest, here are the screenshots. 

   
   

[jdougc]

You can see the breathing  pattern clearly now,  you had big breathes after something aroused you and looks like you held your breath a few times as you moved/rolled over. You might not have been fully awake.

The 2nd one shows a gasp and a couple of breath holds and rough/junk breathing . Neither seem to be true Central Apneas, where the brain says no breath is needed, imo...

Your Flow Limits are causing your pressure to increase. Those swings would wake me up and maybe you are sensitive to these swings also.
Can you  try cpap mode with a fixed pressure of 9cm or 10. EPR 3 Full time. Standard mode response , not soft.
Ramp pressure of 7cm for 5 minutes if needed for comfort.
Consider using the cpap as you read or watch tv to get used to it.

[benlandrail]

Thank you, will adjust the settings and see how it goes.

[benlandrail]

Went to the doctor. She recommended the following settings: 

• Pressure: Min 6, Max 11
  
• Ramp: Auto
  
• EPR: 3, Full Time
  
• Soft Response
  

These didn't work. I would still wake up 40 to 90 minutes into the night, feeling out of breath. My AHI and the number of OAs, Hs and CAs actually went up.

I tried out jdougc's recommendations and they didn't work as well — the pressure was too high for me to fall asleep. 

After some slow and careful tweaking, I have arrived at the following settings:

• Pressure: Min 7, Max 11
  
• Ramp: Auto
  
• EPR: 1, Full Time
  
• Soft Response
  
• Humidity 2 (solved the wet mask problem)
  
• Temp 26° (solved the warm air problem)
  

Comfort-wise, these are working quite well. However, I still wake up 1.5-2 hours into the night and take the mask off.

So the question is: is it simply a matter of getting used to sleeping with the mask? Or should I make further changes to the settings? 
How do the stats and the graphs look?

Thanks in advance. 

(Screenshots of my daily view, CA and OA events are attached below).

           

[benlandrail]

After spending more time with the same settings, I have finally slept my first 6-hour night with the mask. 
However, the sleep quality was still bad, as I kept waking up several times during the night.

Here's the latest graph. Should I be worried about anything? Should I try to change settings further?

Any input will be much appreciated.