Why CPAP

[RNeil]

I don't know what kind of apneas I have. I know I am tired. Increasing the low pressure seemed to make it worse. Tonight I will try 4 cm for the low and 11 for the maximum.

[Gideon]

I don't know what kind of apneas I have. I know I am tired. Increasing the low pressure seemed to make it worse. Tonight I will try 4 cm for the low and 11 for the maximum.

That is why we are asking for more data.

The Rule of thumb is

Increase Pressure for Obstructive Apnea
Decrease Pressure for Central Apnea on CPAP
Increase the pressure difference between EPAP and IPAP for Hypopnea (Pressure Support on BiPAP, Manipulating pressures and flex/epr on CPAP)

Not knowing the types of apnea leave it all up to guesses and experimentation.

[RNeil]

I think I am making progress. I have used the machine all night 11 nights in a row, a record for me. In the past I would be non-functional after 4 nights. I have found from this forum that an older version of Sleepyhead, v0.9.8, works with the F&P Icon+. I have attached some data.

[zzzlessinMS]

I started CPAP 20 years ago and had a simple brick (Sullivan V) with passover humidifier (no heat).  Pressure set at 10.  My sleep study at that time showed an AHI of 25.  When I returned to sleep doctor at 6 weeks, I was still having excessive daytime sleepiness and felt no improvement.  My "idiot" doc said, "Then you don't have OSA".   With AHI of 25 on sleep study, that was ridiculous statement.  But without any data, we had no way to know whether the pressure was anywhere near where it needed to be.  Even though he said I didn't need to use CPAP because no improvement after 6 weeks, I stayed on it.  And my daytime sleepiness went away after about 3 months on CPAP.

I stayed on that old Sullivan V at pressure 10 for 12 YEARS without any checkup with doc.  Then my excessive daytime sleepiness returned.  I went to new sleep doc and had new sleep study.  My AHI was 75.  Over those 12 years of using CPAP at 10 without any data, my OSA was much worse.  The tech started titration at 4 even though we already knew pressure at 10 wasn't working anymore.  So by morning they had only been able to get pressure from 4 to 14 and I was still have OAs.  I got new CPAP machine with data and was started on pressure of 15 due to inadequate titration on split night study.  I gradually got better but had to increase my pressure up to 19 (CPAP max is 20) over one year.  I returned to doctor with my data and was prescribed a Bilevel machine with settings at 21/17.  I did well on that for 6 years with occasional adjustments.    The bilevel I used for 6 years had almost 18,000 usage hours so it was time to get a new machine.  

I took in graphs of my data to a new sleep doc.  Although my AHI on 21/17 was always below 2, those averages were hiding the fact that I had 3 hours of no events, then 2 hours of constant OAs with AHI up to 20, then another 3 hours of no events.  So clearly the pressure setting I was using was adequate for 75% of the night but not high enough for 25% when I was apparently in REM sleep and/or sleeping on my back.

I just got new prescription for a Auto Bilevel machine.  This should keep me at lowest pressure needed for 75% of my sleep but will adjust automatically to whatever pressure is needed to prevent those ugly OA clusters.

The bottom line of my long story on my CPAP experience is that you really can't expect to feel much improvement right away.  It takes time to gradually feel better.  You probably have been suffering with interrupted sleep for some time due to OSA and insomnia.  You have been chronically sleep derived.  CPAP doesn't fix that overnight or even over 6 weeks.  Don't be looking at your data and changing your settings frequently.  Let your body adjust to the CPAP at the same setting for at least 2-3 weeks.  It is premature to be tweaking settings just eleven days into treatment.  Then you can look at your data and try tweaking your settings, adjusting only after a week or two at the new setting.  Changing settings daily based on the results the night before will make adjusting more difficult.  No two nights will ever be the same so by adjusting settings before you have even adjusted to CPAP is counterproductive.  Take it easy and make changes slowly overtime.

[Gideon]

First, per your chart, your numbers appear OK (<5 AHI) but you are at 4 cmw for most of the night and it is not uncommon for to feel to low for most people, so how do you feel?

I would like you to work your pressure up slowly, 1 cmw every couple of days and see how that works out.  I would start setting the min pressure at 5 cmw initially targetting something between 6 and 8 but possibly higher.  This is to provide a comfortable band but give your CPAP a headstart when events occur.


Again since your numbers are good so how do you feel?

Fred

[Melman]

I agree with Bonjour's recommendations. zzzlessinMS is correct  that you don't want to change pressure settings by too much too quickly but an initial increase to 5 is very conservative as is the recommended 1cm increase every few days based on review of Sleepyhead data.

[RNeil]

I feel tired, but I am functional. In the past, I would not be functional after 3 or 4 days on CPAP. I now meet the 70% in 30 days insurance criteria. Today I can't see the benefit, but nor can I say that I am better without it. I will push on.

I did try increasing the minimum pressure to 5 cmw, but it seemed to make it harder to sleep and the senseawake measure increased.

[Fats Drywaller]

I feel tired, but I am functional. In the past, I would not be functional after 3 or 4 days on CPAP. I now meet the 70% in 30 days insurance criteria. Today I can't see the benefit, but nor can I say that I am better without it. I will push on.

Yes, do keep on keepin' on. Sorry to bear bad news to someone who is having a difficult time, but the insurance requirement for CPAP compliance is conservative and is not a threshold at which you're getting the full physiological benefits of the therapy. The insurance thing is just a rule that some paper-shuffler somewhere came up with because it sounded good (and presumably because it turned out to be tolerable for most new patients). Once you're able to put up with using the mask & machine full time while sleeping, and continue that for some number of nights consistently, you should see some dramatic improvement.

And one answer to the thread title is "To get to the other side."

[RNeil]

I had a bad night. I could not get to sleep and took the mask off at about 1 AM. I am wearing it now as I type this to help me sort it out. I also increased the minimum pressure to 4.5 cmw.

[Fats Drywaller]

I had a bad night. I could not get to sleep and took the mask off at about 1 AM. I am wearing it now as I type this to help me sort it out.

This is no help, just anecdotal, but at the risk of sounding smug I'll mention something for you to look forward to once you have got everything sorted out (which can happen, so keep pushin' on with it): Since getting back to normal with regard to sleeping, thanks entirely to the good old machine, I've been keeping much earlier hours, like sleeping 10 to 6 or often even 9 to 5, and tonight I (sort of bizarrely) went to sleep so early that I slept for 6 hours, woke up in the middle of the night feeling normally rested, couldn't get back to sleep, so said "What the hell" and got up. No adverse effects! It's almost like being young again. (Har! Yeah, right.)

"Early to rise and early to bed / Makes a man healthy, wealthy, and dead." (James Thurber)