recent problems with sleep disturbance

[sleepybones]

Looking for a bit of help/guidance. 

i started using a Resmed Autoset10 last may following self diagnosis. With the data obtained i managed to convince the NHS i have mild sleep apnoea.
i struggled with masks, and eventually came across the new Resmed Airtouch memory foam mask in November, and until mid february have been having good success.
i have struggled over the past 3-4 weeks with increased nighttime wakenings. 
the number average around 7-10 per night - wihch has interrupted my deep sleep periods so i am now feeling rubbish again.


i thought the wakeups was caused through an itchy nose - as i was removing the hose, to get my finger through the mask to itch my nose. 
i then waxed my nose to ensure no stray hairs causing a tickle. 
over the past 2 weeks i've not noticed the tickle, but the sleep tracker i use (Resmed S+) still indicates the 7-10 wakeups per night.

i'm waiting to hear from my NHS sleep clinic for thier view. Last time i saw them i had to wait 4 months to see the consultant. starting to get worried as i am starting to feel tired and fatiqued again, even though my AHI's are low - which i assume is due to the disturbed sleep.

i spoke with a private GP through a phone consultation yesterday - i wanted to know if it was possible to get a mild seditive to keep me in continous sleep throughout the night so i didn;t awake. She suggested nytol short term, but i need to try to see my consultant. i was nervous, as i heard a seditive can make apnoea worse due to relaxed muscle. i tried 1 x 25mg nytol last night and it was worse - so i won't be trying that again. 

i've attached a couple of screen prints for the past 2 nights, along with the data from the Resmed S+. Resmed own statement on awakenings is: On the other hand, if you’re feeling tired during the day, then it’s possible you may have sleep issues related to un-remembered awakenings. You may be experiencing what sleep scientists call “micro-arousals.” Micro-arousals are very short awakenings, lasting less than two seconds. But they often occur many times within a brief period of even five minutes. Micro-arousals can be disruptive to sleep, and are often (but not always) symptoms of larger sleep issues like Restless Leg Syndrome (RLS) and Periodic Limb Movement Disorder(PLMD). Both of these disorders are frequently accompanied by fractured sleep and by many un-remembered awakenings. The likelihood of experiencing RLS and PLMS increases with age. Research indicates that 34 percent of adults in their 60s have some symptoms of PLMS.


any helps, advice or suggestions would be hugely welcome. 

   
   
   
   
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[Walla Walla]

You might want to try setting your machine for a fixed rate of 8cm and see if that helps you sleep better. Sometimes pressure changes can cause sleep disturbance.

[Sleep2Snore]

Hi Sleepybones,

I see your machine is set at a low pressure of 4, this is far to low for you and the machine is having to go from 4 to (can't see the data now) I think around 10 or higher.
First thing I would do is to set the lower pressure to around 8 to 9 and I would raise the higher to 15, not that it matters as I don't think it is getting to that pressure, however, it will allow it to if it needs to.  You can even leave it full open at 20 if you want, it is not going to get anywhere near it.  It will only go high in pressure if it needs to, so far on the charts you have posted it is no where near a high pressure.
I would raise the lower to 8, if things improve I would put it to 9, but try it at 8 to start with, this will stop most events from ever happening, though the last chart you put up suggested you might need it slightly higher, but try 8 to start with and we will see how it goes.
I would allow the high pressure to go at least to 15.  you can adjust it in the clinicians menu.
Press and hold the button on the right and the bottom oblong one, though you should have a manual with the machine.
If not you can get it from here or google it and it will come up as a .pdf from ResMed.

Give it a week to see how things go.

[Gideon]

Your numbers are good, extremely good.  The target is comfort which is what you have asked about.  

Try raising your minimum to 6 initially, try for about a week because a single day does not make a trend.

Eventually MAYBE to 8.

[sleepybones]

ladies and gents. thank you so much for your comments. i'll increase the lower to 8 and the upper to 15, and see what that does.
regarding the comfort settings. they are currently at:
Ramp Time - auto
Start pressure - currently 4 - shall i increase a bit?
EPR - on
EPR Type - Full time
EPR level - 2
Climate Control - Auto
Tube Temp - 27'c

thank you again for taking the time to review these.

[Sleep2Snore]

Good luck, let us know how you get on.  

[Sleeprider]

ladies and gents. thank you so much for your comments. i'll increase the lower to 8 and the upper to 15, and see what that does.
regarding the comfort settings. they are currently at:
Ramp Time - auto
Start pressure - currently 4 - shall i increase a bit?
EPR - on
EPR Type - Full time
EPR level - 2
Climate Control - Auto
Tube Temp - 27'c

thank you again for taking the time to review these.m

Remember at a pressure of 4, that is the minimum pressure of the machine, therefore when at minimum pressure, there is no EPR.  This means as your machine increases pressure, you get both a maximum pressure change and in increase of EPR until the machine reaches 6 cm.  I'm sure that is why Bonjour suggested a minimum pressure of 6 with EPR at 2.  I'm certain you will find this comfortable and much less disruptive.  We're not concerned with optimizing therapy since your results are nearly perfect, but stabilizing pressure is important to good rest.

[sleepybones]

thank you for the above advice. this really is a flipping science to master. and the most depressing thing is that each night i go to bed i long for a decent sleep and when its not perfect, it then feels that i have to wait an age for another chance to have a go.

i thought that my mild OSA would require light pressure, but have learnt that the pressure has no direct relation to the number of AHI, so although my AHI is very low - (for which i am extremely grateful, and do not know how you guys n girls manage when its in the 10-20's) i've now learnt about the "comfort" to minimise the disturbances and wakeups which you've mentioned.

i've tried running at a minimum of 8, which didn't change the number of AHI. Increase to 9 and it reduced to 0.1 AHI and only 2 nighttime wakeups, but i struggled with the higher pressure to enter a decent deep sleep.

I've tweaked it down to 8.6 and it increased to 0.2 AHI with 7 wakeups.

i'm now aware that i need to tweak it up/down until i get the magic comination of low AHI and crucially the low nighttime disturbances.

i've reduced the EPR from 2 to 1. I initially set it at 2 as initially struggled with the outbreath on CPAP when i first got the machine. Its now more bearable so reduced this to minimise pressure changes. i've also upped the startup pressure to 7 with a ramp of 45 mins so i don't get disturbed as much when it ramps up.

thank you for the tips to increase the minimum pressure - i'll continue working around the mid 8's to mid 9's to keep AHI low, and hopefully over the next week i'll get used to the pressure with less wakeups.

[Sleeprider]

I think your approach to trial and error, with a focus on comfort and sleep quality is a very good one. Keeping adjustments within a small range and evaluating them for efficacy and best quality of sleep will take you to a place that you suddenly realize, further adjustments just don't make a difference. Well done!

[sleepybones]

just a quick update on this.
i have set the minimum pressure on the machine to 10.6 and maximum to 11.8.
this seems to have reduced my mid-night disturbances. i assume i was disturbed when the machine went from the lower set figures up to the levels needed to prevent/reduce the apnea. i've got used to the higher pressure. the resmed f20 airtouch mask i use floats on the face and doesn't appear to leak as much as it did previously, when i had the lower set pressure which increased/reduced as needed.
thank you for the advice on here. i'm feeling much more refreshed. i'm still waiting for a reply from my Sleep Nurse when i asked them for help back in March..