Waking Up to High Pressure

[CatNapCA]

A huge thank you in advance to all the people who have taken their time to support others in this forum.  While this may be my first post, I feel like I have already learned some very valuable information just from reading the forum.

Diagnosed with OSA in April 2017.  My at home test had an AHI of 38.1.  

Been using a ResMed APAP AirSense 10 AutoSet since May 2nd - 6.0 to 16.0 range with AutoRamp turned off and humidity set to 6.  Struggled at first with F&P Brevida Nasal Pillows as I could not get comfortable. (side sleeper) Switched to Respironics DreamWear under nose mask about a week ago and have felt very comfortable with low leak rates and what I think are good AHI scores ranging from 0.55 to 6.02  

My issue is that when I am having an event and my pressure goes up toward the top end of my range it is waking me up.  Normally it's with a feeling similar to being at high altitude, able to breath okay, but seem like I'm working much harder to do so.  O2 Sat has been good around 95.   

Going back to sleep is anything from 5 minutes to well over an hour.  Obviously the longer that I am awake the worse I feel the next day - still waiting for a night since May 2 when I sleep all the way through the night and hopeful that will come some day and the tired run down feeling will slowly start to go away.   You can spot the times that I wake up in my SleepyHead graphs as they are right after the pressure spikes from my average of about 7.5 up to about 12 and you can see the leak rates increase as I roll around trying to get comfortable and go back to sleep.   I would love to post graphs for review but received a message that I cannot do so without 4 posts first. 

I know I am still a very new user.  Is this something "normal" that I will adjust to?  Is there anything that I should be doing differently, or just waiting to get past this.  

Thanks

[CatNapCA]

I should now be able to post my graphs and original test results.

[Marillion]

Are you currently using EPR? If so, I would recommend turning it off. That could contribute to your occasional CA events as they do for me. Or it may not. Likely worth a try.

Although your numbers are not terrible by any means on a couple of days I can see where there could be some room for improvement. Most of your obstructive events seem to happen in clusters. This would indicate there is some chin tucking going on at certain times contributing to the events. What kind of pillow do you use? If it is a soft and thick pillow, that may be what is causing you to tuck your chin as well as interfere with your mask when you lay on your side causing leaks.

My recommendations would be to change your pillow to either a firmer lower loft memory foam pillow or a buckwheat chaff pillow. Some have had good success with a soft cervical collar (the $10-14 kind) that can serve the dual purpose of aligning your airway preventing obstructions and also prevent you opening your mouth. I would also (after turning off EPR or at least setting it to 1 for now if you absolutely need it) up your minimum pressure to 7. But Sleeprider may recommend leaving it as is until you change your pillow and/or get a cervical collar to possibly mitigate these obstructive events. I would leave your maximum as is.

You are doing great and things can only get better for you with some more time and a little bit of tweaking.

[trish6hundred]

Hi CatNapCA,
WELCOME! to the forum.!
Hang in there for more suggestions and answers to your questions and good luck to you with CPAP therapy.

[CatNapCA]

I hadn't thought about the pillow. It is rather soft. I do have a memory foam pillow and will swap out for that and report back. Next step would be to try the ERP at 1 {it's at 3 now} 

Thanks

[Marillion]

Whenever my ERP setting was at 3, I always had a multitude of CA events. When I started turning off my EPR gradually my CA events reduced. Once I turned off EPR entirely my CA events were almost eliminated (most nights now I don't even have any CA events.) When I tried turning EPR back on, they came back. Needless to say I don't use EPR anymore. If your EPR was at 3 and your minimum pressure was at 6 your effective lower exhale pressure was down to 4 (the minimum possible.) No wonder you are working so hard to breathe!!

[CatNapCA]

Would you recommend that I start slowly and go to 2 or should I just see if 1 is better 

Thanks

[Marillion]

Because the EPR setting is more for comfort rather than a pressure setting, I would recommend you go to 1.

Odds are you will get more benefit out of greatly reducing or eliminating it. But if you need it for comfort then there is always that option. I found it pretty easy to get used to not having it on at all.

[quiescence at last]

looking at your charts, it seems you already have EPR=2, so going to EPR=1 is not much of a shift.  that would be alright.

I just wonder if you are in a different position during those times you got higher events and higher pressure.  Your sleep study does show a distinct difference when you are on your back versus on your right side.  Could you be shifting to side sleeping during those 'hard' times?

another reason I say this may be when you are on your side is the sudden appearance of higher leakage levels, like you are resting your mask against something (like sinking into your softy pillow while you are nodding off.)

QAL

[CatNapCA]

There is a distinct possibility that these events are related to a shift from side to back. I think I remember waking up while on my back. I'll see what happens tonight