Still wake up using CPAP

[urachan]

Hi,

I've been on a CPAP for 7 months now and have yet to experience a full night's sleep. Although I can fall asleep pretty fast (less than 5 minutes), I always inevitably wake up 1 to 2 hours later and it's very hard to go back to sleep with the CPAP then, as my body feels wide awake.

Any idea what's going on? I assume this shouldn't happen if my apnea was under control.

To give you some quick context, I was diagnosed with OSA with a 33 AHI, and the physical act of lying down (not even sleeping) makes it hard for me to breathe and makes me wheeze. CPAP suppresses that feeling, though, yet I can not comprehend why I can't stay asleep with the CPAP if SA is all there is to it. As you'll see in the screenshots below, it doesn't even look like the CPAP flags any event.. yet I always wake up after 1-2 hours of sleep.

Attached to this post is today's sleep data (I gave up on the CPAP after waking up the first time, then eventually put it back on which is why there's a huge gap in the middle). Thank you in advance for your guidance!

[Deborah K.]

I don't know if would cause you to wake up, but your flow limits are high and your pressure is very limited.  I suggest that you raise your lower-pressure limit to 7 and use apap instead of cpap, setting your higher-pressure limit to 11.  Also change your EPR setting to 3.  Allowing more pressure and changing  your EPR should help you sleep more comfortably and improve your therapy.  Can't hurt to try it.  Good luck!

[urachan]

Thank you Deborah! Can't hurt to try indeed.

I initially had set the pressure to a fixed 4 or 5 (sometimes more as I try different settings) because of aerophagia issues, but since I don't have this problem anymore it could be worth a try. I'm struggling to understand what Flow Limit is though, any chance someone could help me understand?

[urachan]

So I tried upping the minimum pressure to 7 and EPR to 3, but it looks like more pressure (or EPR?) seems to create more apneas, and I wasn't able to sleep more than 1 hour. It's consistent with what happened in the past when I tried to do the same thing (which is why I haven't bumped the pressure range to more than that as per recommended - I was afraid this would cause this scenario.) I tried to go back to sleep at around 6am but couldn't.. my body was "wide awake", although I managed to fall back asleep after taking off the CPAP..

Here is today's chart, along with a zoomed in picture of the events:

[Sammy21]

Have you had any luck with this? I've been on my BiPap and have the same issue, I believe its been like 5-6 months now. I only sleep for like 1-2 hour, then it comes off.

[Phaleronic]

EPR @ 3 only really works for high pressure, it causes more issues than it remediates when the pressure is below 14cm, also your original chart had only 3 hours of sleep recorded, so don't use EPR 3 please, raise your pressure in cpap mode to 9cm and keep EPR on @ 1, but try it for 30 to 50 minutes before bed tonight to see how you feel Sammy21. You were also at zero ahi so I'm not sure why the drastic change in settings was advised.

[staceyburke]

I completely agree with Debora.  Your flow limits can be better controlled with EPR 3.  And I too would say you should run min 7 max 10.

Flow Limits are apnea also just like O and H events.  The difference is mainly the length of the apnea and the amount of obstruction.  Because apnea is considered to last at least 10 seconds to count in the AHI, flow limits are not counted when calculating the AHI.  But they STOP you from getting into deep sleep and sometimes will wake you up.


The apnea you had was right at the beginning of your sleep (3 central or clear airway events) and may have only been you holding your breath as you turned over in bed.  We really don't count those as a problem when they are right at the start of sleep or at the very end of the sleep cycle.

[Sammy21]

So you would just recommend 7 Min and 11 Max. However just easybreathe on, which I believe is just EPR 3, with ResMed 11 with the S Mode BiPap. I only have EPR when using the CPAP mode which I cannot use since I have treatment-emergent central apneas. Also should it be 4 apart so 6 Min and 10 Max? Heres a recent nights of sleep.

[Phaleronic]

No, please set mode back to cpap raise your pressure in cpap mode to 10cm and keep EPR on @ 1, and that data is a tiny segment of only 40 minutes.

[staceyburke]

You have quite a few flow limits, they are apnea just like O and H events but they are of shorter duration and are not counted in the AHI.

We help to eliminate flow limits with EPR.  You are using EPR but it can go up more.

I suggest the following setting

 Min 7
EPR set to full time (I think it is now)
EPR 3
using autoset

see how that feels...   post tomorrow.