[CPAP] 5-6 Weeks into CPAP Therapy, Sleep Getting Worse of Late

[SleepyLP]

TechieHippie: Thanks very much for your help with this.  Last night I had the leaks under control using a cervical collar so, for the time being, I'm going to stick with the Dreamwear nasal mask.  Cervical collar isn't ideal but it's working for now.  I will note the name of the tape you recommended in case it comes to it.  

In case anyone is willing to offer some input on my latest data, the last three nights have gone a bit better as I've tried bumping pressure up to 7.6 to accommodate using EPR (I realize that my best overall AHI was when I had pressure at 7 and EPR at 1; I read, however, that someone advised me that pressure should be increased by same amount as EPR at the same time because failing to do so would allow EPAP to drop below the 7 cmH20 prescribed at my original study).  Looking at last night's data, I was actually awake for a chunk of time (from around 2:45 am until sometime after 4 - any advice for falling back to sleep???) and most of my events took place during that period, especially CAs.  

I see that during my initial sleep period, from around 10:45 pm to 2:45 am, my breathing looked very regular, I had fewer events, and flow limitations were generally lower. When I woke up and paused my machine, it reported an AHI of only 2.4 at that time.  

However, once I finally got myself back to sleep after 4 am, things were somewhat rockier, particularly with a lot more hypopneas and more flow limitations.  

Questions:
1) is there a way to exclude the awoken period from the overall calculations to get a clearer sense of how I’m breathing while actually asleep?

2) any thoughts on why the second period of sleep (after 4 am) saw more volatility?

I’ll plan to stick with the same settings once more tonight and see how we do. Thanks again for any insight you can offer.

[Deborah K.]

No, you cannot set anything to not see what is happening while awake.  Also, your flow limits are still not good.  You need to raise the EPR to 3 to improve that.

[SleepyLP]

Thanks, Deborah.  I plan to gradually increase the EPR over the next week to see how it goes but I don't want to make too many adjustments before I have a few days of data to go off of.

[TechieHippie]

I am curious also what it means to have events when I'm awake. I'm not sure about discounting them, because I have an oxygen monitor and it also notices the drops. I think I stop breathing when awake, too.

However, if you want to see the data without them, the trick I have thought about trying is (assuming ramp is off) stopping the machine briefly right before I fall back asleep and then restarting it, so that a new session is created, and then can be excluded from the data set in Oscar. But, some machines might not start a new session within a short window, and doing this might wake me up too much to make it worth it....

Regarding changing the EPR, If you increase the minimum pressure at the same time by 1, you will effectively be keeping the same pressure for inhale and isolating the exhale pressure, at least that's my understanding.

[DancesWithCats]

I can say that a ResMed AirSense AutoSet 10 will, IME, start a new session any time it's stopped and started. 

The trick with "Turning it off when you're awake" is then "Turning it back on when you go to sleep" if the reason you are awake is that you can't fall asleep and are trying to.

If the reason you are awake is more pragmatic and involves getting up and turning the machine off, then getting back in bed and turning the machine on and going back to sleep, it's pretty simple.

[SleepyLP]

DancesWithCats - you mean that the machine must be completely turned off (i.e. holding the power button down for 3 seconds) and then turned back on to start a new session, right?

[SleepyLP]

This is also my understanding of how EPR works.  I increased pressure to 8 last night and kept EPR at 1, giving me an EPAP of 7 (my prescribed pressure based off of my titration sleep study).  This was a big step in the right direction for me as my flow limitations decreased considerably and my AHI dropped to around 2.6 (where it's been around 6-7 in the last few days since I got leaks under better control but hadn't made this most recent pressure change).  I plan to stay with these settings for 1-2 more nights and then, assuming stability, will probably try pressure of 9 with EPR of 2 to see how it goes.

[DancesWithCats]

No. That's putting it in sleep mode. The only way to power it off is to pull the plug, but you don't need to do either one.

Simply stopping it (short press power button) and starting it (same) makes a new session. Note that all sessions for a given day will load in Oscar, but you can select only certain ones to view. Also note that if you're playing with it, Oscar will ignore any day (split at noon) it has sessions already loaded for. Not generally a problem for normal use.

Look at the bottom of the left-hand panel in Oscar, under the setting info, when in daily view. It's cut off in your screen shots. I don't sleep through the night, so I usually have 3 or 4 sessions for any given night. I know for a fact that even a single minute will make a session; got back into bed, heard something I needed to deal with, got up and dealt with it, that minute was a session unto itself the next morning. I suspect even seconds will.