Is it Working?

[ajack]

You must have diaphragm muscles like an Olympic weight lifter. I also bounced around 20, Add me to the "get a bilevel' list. titration guidelines would suggest anything over 15. Ask your doctor if he is aware of this.
page 33
https://www.resmed.com/us/dam/documents/...lo_eng.pdf

[trish6hundred]

Hi shinkdavid,
WELCOME! to the forum.!
I agree with those who suggested that you talk to your doc about the problems you are having.
I wish you good luck with CPAP therapy and getting a different machine.

[shinkdavid]

Thanks for the advice. I also take Klonopin which does exacerbate sleep apnea. My sleep doc wanted me off of it and my psychiatrist wanted me to stay on it. Problem with the medical community is they all live and work in silos and don't understand much outside of their respective fields. Of course, there are exceptions but not many.

[shinkdavid]

Here is my data from last night. 

[Spy Car]

Shrinkdavid, at 5 years you are due for a new machine in any case, yes?

You've got some good people on the case, but to analogize the situation. It looks like you are driving a four-banger that has the capacity to hit top-speeds of 100 mph, and then driving that car at the maximum speed of 100 in one gear full-time pedal-to-the-metal right at the red-line full time.

It seems like a Bi-level, especially one with an auto mode would be more suitable. That way you could hit 125 mph if you ever required it, but you could also drop back to 75 (following the analogy) when you don't need that much speed.

I'm pretty sensitive to high pressure (more than most perhaps), so full-time pressures of 20 sound very uncomfortable to me.

Even if you IPAP (inhalation pressure) remained high a Bi-level would give an option to reduce the exhalation (EPAP) pressures, which should be more comfortable.

The current machine is obviously "working" in terms of reducing events, but if you are not sleeping well it looks like there is a more appropriate machine option.

One question, what is happening in those long nightly breaks?

Bill

[shinkdavid]

Shrinkdavid, at 5 years you are due for a new machine in any case, yes?

You've got some good people on the case, but to analogize the situation. It looks like you are driving a four-banger that has the capacity to hit top-speeds of 100 mph, and then driving that car at the maximum speed of 100 in one gear full-time pedal-to-the-metal right at the red-line full time.

It seems like a Bi-level, especially one with an auto mode would be more suitable. That way you could hit 125 mph if you ever required it, but you could also drop back to 75 (following the analogy) when you don't need that much speed.

I'm pretty sensitive to high pressure (more than most perhaps), so full-time pressures of 20 sound very uncomfortable to me.

Even if you IPAP (inhalation pressure) remained high a Bi-level would give an option to reduce the exhalation (EPAP) pressures, which should be more comfortable.

The current machine is obviously "working" in terms of reducing events, but if you are not sleeping well it looks like there is a more appropriate machine option.

One question, what is happening in those long nightly breaks?

Bill

I just got a new CPAP. 

Where are you seeing long nightly breaks? If you are referring to the breaks in between sleep those are because I have been sick and sleeping a lot. I have been sleeping, getting up for a couple of hours and then going back to bed. When I nap I always use my CPAP so it can look like I have long breaks but it is related to poor sleep patterns on my part. I am not good and going to bed and waking up at the same time every day and due to medication I take, I get sleepy pretty easily and tend to sleep a lot.

[shinkdavid]

Also, my tiredness and not sleeping well may not be related to the apnea or the machine. I take Klonopin which isn't good for sleep. It makes me tired but makes it hard to get deep sleep. I don't feel the machine needs to be switched to a BIPAP. I don't notice the pressure at all. Sometimes I wonder if it is really doing anything but I think I have gotten used to it over the years. It was initially set at 18 and I switched it to 20 about a year ago. The doc kept it there saying if it works, no reason to mess with it. I don't find the pressure uncomfortable, in fact, there is something almost soothing about using the CPAP. I think I went too many years snoring and and not breathing well that the CPAP helps my body work easier. It is also great for colds. It almost makes it more difficult to wake up as it keeps me in a half sleep state. If I don't take it off when the alarm goes off I tend to fall back asleep. One of the most frustrating aspects of the pressure is all the air that ends up in my stomach.

[Spy Car]

Shrinkdavid, at 5 years you are due for a new machine in any case, yes?

You've got some good people on the case, but to analogize the situation. It looks like you are driving a four-banger that has the capacity to hit top-speeds of 100 mph, and then driving that car at the maximum speed of 100 in one gear full-time pedal-to-the-metal right at the red-line full time.

It seems like a Bi-level, especially one with an auto mode would be more suitable. That way you could hit 125 mph if you ever required it, but you could also drop back to 75 (following the analogy) when you don't need that much speed.

I'm pretty sensitive to high pressure (more than most perhaps), so full-time pressures of 20 sound very uncomfortable to me.

Even if you IPAP (inhalation pressure) remained high a Bi-level would give an option to reduce the exhalation (EPAP) pressures, which should be more comfortable.

The current machine is obviously "working" in terms of reducing events, but if you are not sleeping well it looks like there is a more appropriate machine option.

One question, what is happening in those long nightly breaks?

Bill

I just got a new CPAP. 

Where are you seeing long nightly breaks? If you are referring to the breaks in between sleep those are because I have been sick and sleeping a lot. I have been sleeping, getting up for a couple of hours and then going back to bed. When I nap I always use my CPAP so it can look like I have long breaks but it is related to poor sleep patterns on my part. I am not good and going to bed and waking up at the same time every day and due to medication I take, I get sleepy pretty easily and tend to sleep a lot.

Yes, I am referring to the hours where you get up during the night and the naps.

As to the machine, are you within a window where you could swap? 

Those here who are more expert than I seem to have reached the same conclusion I would have alone, that you'd be better served with a Bi-level machine and one with auto features that would open more options.

I'm very surprised that your sleep doctor would have recommended an AirSence 10 Elite in your case.

Bill

[shinkdavid]

He did say we could go to one and asked if I am snoring at all during the night. I said no and he didn't seem to think I needed it. I can put in a call and see what they say. Insurance already approved this so I am worried they may not go for it but it is worth a shot.

[Spy Car]

Also, my tiredness and not sleeping well may not be related to the apnea or the machine. I take Klonopin which isn't good for sleep. It makes me tired but makes it hard to get deep sleep. I don't feel the machine needs to be switched to a BIPAP. I don't notice the pressure at all. Sometimes I wonder if it is really doing anything but I think I have gotten used to it over the years. It was initially set at 18 and I switched it to 20 about a year ago. The doc kept it there saying if it works, no reason to mess with it. I don't find the pressure uncomfortable, in fact, there is something almost soothing about using the CPAP. I think I went too many years snoring and and not breathing well that the CPAP helps my body work easier. It is also great for colds. It almost makes it more difficult to wake up as it keeps me in a half sleep state. If I don't take it off when the alarm goes off I tend to fall back asleep. One of the most frustrating aspects of the pressure is all the air that ends up in my stomach.

Only you know what is comfortable for you. For me, it is those times of "half-sleep" (if not the times of pure insomnia) that I worry about, because half-sleep leaves me feeling unrefreshed.

I also know that a new machine doesn't fix everything going wrong in the man, as I've recently begun therapy with an advanced machine (ASV) that helps those of us with mixed apnea (CAs and Obstructive). So far I've had beautiful restorative sleep on a few nights, a night of pure insomnia, and some unrefreshing nights with a lot of half-sleep.

But those refreshing nights give me hope that I'm on the right track (and are something I have not felt in a very long time). For me, it is worth maximizing the possibility of restorative sleep by having the most appropriate machine available to me to treat my type of apneas.

On paper, you are getting amazingly successful therapy from a fixed pressure machine. Amazing. But you are also here complaining of tiredness and fatigue. If I were in your case I'd want to see how I did using a device that was designed for optimal treatment of people like yourself who require high pressures. 

If you said you were feeling great it would be a "head-scratcher," but since you feel tired and sick I'd consider other options.

Bill