One month with PR Dreamstation: high pressure wakes me up

[spacewrench]

I've sort of made it through my first month with CPAP, and although my AHI isn't great at ~8-12 mostly, ~4.8 best; it's better than the terrible start-up nights with AHI > 40, 2-hour insomnia and such-like.

The pressure range I can tolerate and sleep is still low and narrow, at 5-6.5.  I've been trying to raise the high end, but even at 7.0, it wakes me up and I can't get back to sleep.  (I expect part of that is psychological; I'll be fine 3-4 days at 6.5, so I'll try sleeping with it at 7, get woken up, and set it back to 6.5.  Realistically, it shouldn't be that much different.)

Last night, I tried at 7 again, and woke up completely alert at 3.  Couldn't sleep again, and felt like I hadn't slept before then (I'm guessing that's just how I feel when I spend time in the lighter stages of sleep, without some rounds of deeper / REM?)

My machine is reporting more random stuff: Hypopnea, PP, RERA, CA, etc., very few OA.  During my start-up fight, it was mostly hypopnea, but absolutely constant, and I'm pretty sure I was awake or mostly awake for the whole time.  Then when I settled in at 5-6.5, I would get a spate of hypopnea while trying to fall asleep, and some noisy events early in the morning (maybe during REM?), but at least long periods of no events after falling asleep.

Now, especially when I try to raise the high pressure, I get more junk, and more constantly through the night, even if the AHI isn't altogether that high (8-10).

So I'm at a loss what to try next.  I can just keep on at 5-6.5 and live with AHI around 10.  Or try to fight through getting used to higher pressure?  I feel a little bit better than before CPAP, but I was exhausted around 7:00 yesterday evening, as bad as anything before, yet I couldn't finish out the night at 7.0 and was awake after 3:00AM.  That's not helping enough to justify the expense and hassle of dependence on the machine.

[mesenteria]

We'll gladly do what we can to help you with some guidance.  However, we gotta see hard facts.  We need data.  Would you please look at the top black marquee and find 'OSCAR'?  Read there, download the software if you're so inclined, and then post a couple or three sample nights' worth of charts. 

Please...do take the time to organize your data-rendering per 'organizing your charts'.  That way, we get rid of stuff we can't really use, and we get a standardized view that most all other people supply us.

[Sleeprider]

Spacewrench, it would help to see a chart. Very rarely is raising the maximum pressure the best soluion. Instead, with the Philips Dreamstation, it is the minimum pressure that need increased to avoid excessive pressure swings, and to prevent apnea and hypopnea. If pressure changes disturb your sleep, and you need something higher, it may be better to just start at a pressure of 6.5 and adapt to that without the increases and decreases of pressure that disrupt your sleep. The point is to use a fixed pressure you can tolerate, then adjust that up if and when your tolerate it. You will achieve better results and sleep at fixed pressure in your circumstances. I would also advise a Flex setting of 1 or 2 and to avoid Flex at 3.

You indicate most events are H and CA with RERA and I'm unfamiliar with PP. Again, a chart would be very helpful.

[spacewrench]

Thanks, I'll post some charts this evening.  [PP is Pressure Pulse, which I think is the machine checking whether my airway is obstructed.]  I could definitely raise the minimum to 6.5, altho from what I recall, the first few hours after I fall asleep are pretty uneventful with pressure at 5.  The machine advances to 6.5 every few minutes, for no apparent reason, but then drops back.  Later in the night, I either enter a different phase of sleep or wake up, and after that it's many more events and pressure usually at 6.5.

[Sleeprider]

The Philips pressure pulse, was something that never bothered me, but it is a fairly strong pulse of air that tests for a clear or obstructed airway. I guess I do know what it is. I don't think there is any way to disable the pressure pulse on your machine, but fewer events will result in fewer pulses. Hopefully we get you to a place where there are very few apnea and therefore few pulses through the night. Philips and Resmed both might be advised to consider a control that turns off PP and FOT respectively, for those individuals sensitive to the pulses.

[spacewrench]

Here are charts over the past month or so.  The Overview shows that my AHI is sort of declining, and I'm managing to stay asleep for most/all of the night.
   
This is a bad night when I'd recently started (AHI 39.19); high pressure was 8.5 for part of the night, reduced to 6.5 for the last session.
   
My best night (AHI 4.41), from a few days ago; note the period from about 00:00 to 02:30 where pressure was low and events were almost absent.
   
An average night looks more like this (AHI 7.53) (still a quiet, low-pressure period shortly after I fall asleep):
   
And last night (AHI 9.16), where I tried to increase the high pressure to 7, but ended up inflated, fully oxygenated and completely awake at by 03:00:
   

I'm concerned that I'm chasing low AHI (but not catching it), and that my events profile is changing from "mostly hypopnea while trying to fall asleep" to "random stuff that might be noise or measurement error, and not something that will improve my sleep even if I can get it cleaned up."  I think I have the Flex set to 2.

[Gideon]

Looking at your charts I'd like to see a min pressure of between 6 and 7 with a flex of 1 or 2. In short I'm agreeing with SleepRider.

[Sleeprider]

You don't have much tolerance for pressure, and your events are primarily hypopnea. I know you can't swap machines, but a Resmed Airsense 10 would probably resolve this with its EPR which acts more like bilevel. What I see here is that you need a higher pressure, and you'd be better off with fixed pressure. I find fairly few people that do well below 8-cm which is a modest pressure. If you zoom in on your flow rate, I suspect you will see a lot of flat-topped inspiration, which is flow limitation. It's common, and is much easier and comfortable to treat with a lower exhale pressure and higher inhale pressure that your machine does not offer. I don't know what to say to encourage you. There is a solution, but the Dreamstation imay not be the best answer.

[mesenteria]

You also have some substantial leaking going on, and an increase in pressure is just going to raise that rate.  So, while you're fiddling with settings to get the best AHI next morning, you might want to figure out why, and where, you are getting leaks.  These are not so bad that your report says 'large leaks' with a number there other than '00'.  But your chart for leakage says you're getting quite a bit of it at times. 

Maybe you need a different fit, maybe a different mask, maybe have to adjust the way you use them when sleeping.  Pillows sometimes cause problems, but so can forearms and wrists folded up under the chin when side-sleeping or around the mask.

[Sleeprider]

You also have some substantial leaking going on, and an increase in pressure is just going to raise that rate.  So, while you're fiddling with settings to get the best AHI next morning, you might want to figure out why, and where, you are getting leaks.  These are not so bad that your report says 'large leaks' with a number there other than '00'.  But your chart for leakage says you're getting quite a bit of it at times. 

Maybe you need a different fit, maybe a different mask, maybe have to adjust the way you use them when sleeping.  Pillows sometimes cause problems, but so can forearms and wrists folded up under the chin when side-sleeping or around the mask.

This is incorrect, and an easy mistake to make without the chart. The user has a Dreamstation which reports the full leak rate (Resmed reports the net leak rate).  A leak rate of 24-26 L/min in that machine is essentially zero, and even the 95% leak rate is below the large leak threshold.  It would help to include the leak chart with the graphs for events, flow rate, pressure, snore, leaks.