New user trying to figure out Dreamstation & OSCAR

[spacewrench]

I'm only a few days into CPAP treatment with a Philips Dreamstation.  It's been a mixed bag so far: the equipment is pretty comfortable, but I tend to wake up around 2:00 and 4:00 sort of confused and having forgotten how to breathe.

My OSCAR data seems to match up: I'll have 30-45 minute periods with lots of events, and they match up timewise to what I remember as "I'm breathing OK!  Why is the machine trying to inflate my lungs like a balloon?!"

Subjectively, it feels like my inspiration time is much longer than expiration (and it's a lot noisier too), with the result that I inhale more and more until it feels like my lungs are full.  (This is not what is actually happening, though; although it's hard to breathe, and feels like I'm not exhaling enough to balance the inhale, I think I'm actually just normal: could exhale a little more at the bottom, and could inhale a little more at the top.)

The problem is, I don't understand what's going on at the time, and don't know what to do to get back to normal breathing and sleep.  So I often take off the machine and wander around the house for 5-10 minutes.

Is this a common problem?  Do you just get used to it, or is there something I can do to get over these episodes faster?

Thanks!

[Sleeprider]

Not so good! I think you should set the minimum pressure to 6.0 and limit Flex to 1 and see what happens. Your events are very clustered and might be the result of chin-tucking, but time will tell. for the short-term, lets try a minimum pressure of 6.0 and Flex at 1 or 2 and let's see where that takes you.

[spacewrench]

... lets try a minimum pressure of 6.0 and Flex at 1 or 2 and let's see where that takes you.

I had a fight with my mask (ended up switching to the M nosepiece) and it took 90 minutes to fall asleep, with me breathing somehow "wrong" the whole time, but once I was out, things got better.  I woke up around 3:00, I guess, and dozed until 6:00, but didn't have trouble breathing and was surprised to see that the machine had gone to 7, when I'd had such trouble falling asleep at 6.

I guess I need to learn how to breathe better with the machine on.  When I'm having trouble, it's really noisy on inhalation, really hard to exhale, and tiring to the point that I keep stopping, thinking "I'll just take a little rest now, and then start breathing again in a sec."  (Yeah, I know, that doesn't make much sense!)

Thanks much for the suggestion; I probably would have avoided increasing pressure for much longer, since I thought the high-pressure=hard-to-breathe thing was the problem.
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[Matt00926]

To make sure you are comfortable from this point I would increase the minimum pressure by 1 each night since you are headed in the right direction with a dramatic decrease in your total AHI

[Sleeprider]

The higher minimum pressure nearly eliminated OA events and cut hypopnea in half. CA events are even reduced with this change, so I'm going to double down and suggest you increase minimum pressure to 7.0. An AHI of 11 is not what I would consider a success, but it is less than half of where we started. Let's titrate upward and see where it goes.

[spacewrench]

At minimum pressure = 7, I had a terrible time falling asleep (not sure that the pressure had much to do with it).  I wasted 2.5 hours of miserable breathing (minimal if any sleep, overall AHI 15.85) in the attempt.
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But if you just look at the 4.5 hours I was actually asleep, things are better at AHI 9.88.
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I need more practice falling asleep (which is a weird thought!)  Earplugs helped last night; I'll try them again.

[spacewrench]

Grr, worser and worser.  If I can manage to get to sleep, things are pretty good, but the last two days have been worthless for that.  You can tell when I'm awake: it's nothing but hypopnea & clear-airway events.  I've moved my pressures back to 5.5~8.5 since that worked well on an earlier day (8/27, mostly 6.0~7.0), whereas higher pressures didn't get me any improvements, and I kept waking up with the machine at whatever the current max was set at.
       
If I'm reading/understanding correctly, I don't really have Obstructive Apnea events.  It's all Hypopnea, and if the flow rate corresponds to breathing (as I believe), then what happens is while I'm awake, I breathe shallower and shallower until I stop completely, then start again after 5-10 seconds.

This matches up to what I remember: the whole time I'm trying to go to sleep, I can't think about anything except breathing.  Am I still breathing?  Is it a rib-cage breath or a stomach breath?  Have I inhaled enough, so it's time to start exhaling?  Have I exhaled completely?  Should I start inhaling now?  Am I dizzy from hyperventilating, or from hypoventilating?  Etc.  The noise of breathing (and the machine) was also keeping me up, but earplugs mostly eliminated that problem, so now it's just that my breathing never switches over to automatic / autonomic when I'm on the ventilator.

Eventually, I give up trying to sleep and go do something else for an hour or two before trying (and failing) to fall asleep again.

I ran across an interesting paper while I was up Thursday night, discussing CPAP-treatment-emergent central sleep apnea.  Authors mention a possible mechanism being interrupting the standard breathing triggers (CO2 levels, stretch receptors in lungs, maybe some other stuff).  That sounds relevant to me: it seems hard to go to sleep because I keep concentrating on breathing (and if I slack off, I stop breathing!)

Links to related stuff I may want to be able to find again:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3700705/
http://www. a DME-owned forum .com/view...hp?p=22702
Ventilation is unstable during drowsiness before sleep onset

[sheepless]

the conventional wisdom is to ignore waking events but what you describe is central apnea. the only trouble I had adjusting to asv was for the first week when the machine would nudge me to breathe when I paused too long. the only time I'd notice this was when not fully asleep. but it was clear airway cessation of breathing even if I was wakeful.

this personal experience leads me to believe there is a difference between the holding of breath we all sometimes do when awake and some sleep wake ca that really is treatable ca.

you need to titrate your existing machine to avoid ca so you can fall asleep. if ca is pressure induced it'll pass in time. did you have ca in your sleep test? if not pressure induced, you need a different machine.

meanwhile, I'd start over with the lowest fixed lowish pressure you can tolerate, moving it up incrementally over time to determine the best balance between oa and ca.

many of your events are clustered. a soft cervical collar can help reduce them, even if they're sleep wake events, again, perhaps helping you to fall asleep.

[spacewrench]

meanwhile, I'd start over with the lowest fixed lowish pressure you can tolerate, moving it up incrementally over time to determine the best balance between oa and ca. 

That seems like a good plan -- even the low pressures when I was just starting out seemed to help, so if I can just get over the hump to sleep, I can start getting better "while actually asleep" data.

Maybe I can use the ramp feature to start with a really low pressure while I'm awake, and extend the ramp time to long enough that I'm completely out before the machine comes up to regular pressure.

Thanks!

[sheepless]

I would say your situation is exactly what ramp is for.

edit for an afterthought: do you notice this breathing pattern if you try to sleep without the machine, like dozing for a nap?