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New to cpap therapy, having trouble falling asleep
#1
New to cpap therapy, having trouble falling asleep
Started having maintenance insomnia issues last December, and sometimes onset. Stopped being able to sleep for more than 4 hours at a time. Did a sleep study and was told I have mild (10 events/hour) sleep apnea. I got my cpap machine 2 weeks ago and have been struggling being able to sleep with it. I'm trying to learn to breath with the machine as my default breathing pattern while using it is too deep/fast. Inhaling is easy, but exhaling is difficult automatically, which sometimes keeps me from getting into that sleepy transition state. When I do get into that state, mind wandering and whatnot, I catch myself not breathing and wake up/jolt from that and am awake for at least another hour until I can "try again". I've not had this issue before using cpap, just waking up multiple times throughout the night/not sleeping at all.

I got an sd card, downloaded oscar and attached one of my nights this week showing a lot of central airway events happening at what appears to be sleep transition. Is there anything I can do about this? My cpap is set to constant 8 with epr 1.


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#2
RE: New to cpap therapy, having trouble falling asleep
I'm no help with settings, but let's address some of your other issues:

After another advisor suggests new settings, implement those, and try this:

—use your unit and mask (the whole getup) during the day while you're watching TV or reading. Steady and relaxed. The only goal is to get used to breathing with the machine on. Your body needs to get used to it as well. Your whole organism has to learn this new way of doing things.
—spend an hour or so every day doing this.
—while you're doing this, learn about how to detect leaks and how to adjust for them. These are transferable skills you can use while asleep. The more readily you can execute these at night, the more likely you are to stay in sleep mode.
—adjust the humidifier and temperature so they're comfy and relaxing.
—I find if I work at exhaling, the pressure is likely incorrect, and/or I'm sabotaging success. Just let the exhale happen, in other words (provided the setting number is correct).
—if you post Oscars while you do awake experiments, be sure to indicate you're awake, otherwise sleep analysis will get skewed.
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#3
RE: New to cpap therapy, having trouble falling asleep
Welcome

I see a few changes that should help.  

1.  Turn off ramp.  You don't get real therapy during ramp.
2.  Raise your EPR to 3.  Your flow limits are too high.  This will also make breathing more comfortable.
3.  I suggest that you switch from Cpap to Apap, and set a range of 7-15.  In this way, you will see what pressure you actually need.  It may be more or less than you are now using.  Some like fixed pressure, but I think a range is good because our needs can change during the night.  That will be up to you, but do the range for now to see what you need.

Also, did you have a lot of CAs in your sleep study? Post a redacted copy of your sleep study if you can. That will help us understand what to do about the tremendous number of CAs on your chart.
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution
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#4
RE: New to cpap therapy, having trouble falling asleep
I'll ask for it on Monday and redact/post it as soon as I can. All I was told was I had 10 events per hour. It's something afaik only happens when using cpap and has been happening multiple times nightly since being on it. Don't believe I've experienced(knowingly) the sensation before therapy started, and if I have cpap has exacerbated it.

Thanks for the suggestions. My system is locked down so while I can turn off ramp, epr can only be set on/off but I can call and ask to get it changed. Not sure if they'll let me try apap given my prescription is 8cm but once again can ask.

I do need be better at sleep hygiene. I've been getting used to the machine while on the couch watching TV and getting pretty sleepy/falling asleep(first stretch of Oscar data) but then when I get up to go to bed the sleepiness disappears. I might try reading for an hour while in bed wearing the machine to see if that makes a difference
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#5
RE: New to cpap therapy, having trouble falling asleep
You can easily change any settings you want yourself. Some doctors don't like it, but it isn't their therapy, it's yours. I think most of them just want people to come in frequently so they can charge them for an office visit. We'll help you make your changes if you want. It's remarkably easy to do.
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution
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#6
RE: New to cpap therapy, having trouble falling asleep
Your system is not actually "locked". They just like to tell you it is. If you get your AHI super low with help from here and use it every night, I hardly think they'll complain: it's how they make their $$$.

Great that you're getting used to it all while AWAKE as well as trialling the sleep. Try adjusting the humidifier and temp and see if it calms you down for the night.
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#7
RE: New to cpap therapy, having trouble falling asleep
I made the requested adjustments. It looks like I fell asleep for 20 minutes or so at the beginning, starting with the first burst of ca events. I thought I was awake until after midnight but not sure now thinking about it and looking at how i was breathing from 11 to 1:30. I think I woke up around 7 so the last bit of ca's are most likely false positives or i was on the brink of falling back to sleep and don't remember.

The 7 pressure moved up to 7.30 while I was awake, and it definitely felt more comfortable than the 8 I was using before. The epr adjustment also made me feel like I could more naturally breathe, with some adjustments. One thing that was different was my mouth was extremely dry when I woke up. I think I need to try taping my mouth. Also think I get mask leaks on my side when my nasal mask touches the pillow and pulls a little.

I felt pretty bad waking up, but I stayed asleep more than I usually do. If I can fall asleep early I almost always wake up 1-3 hours later and then it takes a while to go back to sleep. I do feel more like a zombie today than I normally do(sometimes on 3 hours of sleep I can be oddly alert for the day).

Is there a way to label certain events to remove them from the stats to make it more accurate? Or clip the data so it starts later and ends earlier?


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#8
RE: New to cpap therapy, having trouble falling asleep
Your leaks and flow limits are both a lot better.  As to the dry mouth, you can tape if you want, but with last night's 2.79% leaks, you probably don't need to. I tape my mouth but still get dry mouth. We like Xylimelts for that. Amazon carries them.  

Most folks have fewer leaks with pillows mask, maybe because they are considerably narrower, and don't get jostled around as much.  I prefer those for lots of reasons.  I now use Bleep DreamPorts, but before then I liked the P30i pillows quite well.  Lots here like the P10s a lot.  Just throwing out ideas.  Smile
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution
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#9
RE: New to cpap therapy, having trouble falling asleep
Left settings the same. I'm definitely leaking through my mouth more. I think I see two instances that I woke up due to it. Going to try mouth taping tonight as last nights sleep was terrible.

I do wonder if its worth trying out a bigger mask that covers my face. With the 7-15 apap mode I don't feel like I'm suffocating(with 8 cpap I wanted to use my mouth to get air) but the dry mouth has been more frequent. I know that while I primarily breathe with my nose, I sometimes switch to my mouth, which may be what's happening at night, I'm not sure.


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#10
RE: New to cpap therapy, having trouble falling asleep
I use an F40, which is a hybrid: a nasal pillows with mouth coverage. It might be worth a try if you don't want to tape or firmly need to mouth-breathe, but I will say, it doesn't eliminate dry mouth completely. I use a loose neck support to ease this: it keeps the jaw from sliding back during sleep.
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