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Oh dear, what have I gotten myself into...

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Roonie +0 points · about 2 years ago Original Poster

Hi all.

48-year-old male. 95kgs. I'm four days into a one-month CPAP trial with a ResMed device. I use the gym regularly, however, my BMI has always put me in the obese range. Some of it's genetic, but most of it is environmental (stress, IBS, eating habits). At my lowest weight I looked fit but, much to my chagrin, people generally can't tell that I use the gym. I also am a lycra-wearing cyclist and try to get a good ride in once a week.

Some time ago, I was informed by my dear wife that I had stopped breathing during my sleep that night. I thought she was over-reacting or mistaken so I ignored her (like who stops breathing in their sleep, right? seriously). Some time later, she reported the same again. I didn't take her seriously that time either.

I eventually did listen to her, and got myself to a doctor who ordered a sleep study suspecting sleep apnoea. I attended a sleep clinic where they wired me up. Couldn't fall asleep due to the discomfort of not being able to move freely. Sensors fell off my face and head a few times during the night, forcing the technician to come into my room to fix it. I must have fallen asleep eventually towards the early hours of the morning. When I awoke, I felt heavy-headed, but lumbered on and got myself to work. I was certain that I had botched up the sleep study due to being unable to actually sleep that night, but you can imagine my surprise when the doctor got the report back weeks later and confirmed I had sleep apnoea, but only mildly (AHI 7.0).

The doctor suggested that I retake the test in my own bed but, as has been a regular bad habit of mine, I chose to ignore the advice.

A year later, with my weight now having gone up by quite a bit, I went to the doctor again. He said the same thing as before and booked me in to have a sleep study done at home. On the night, I wired myself up per the instructions and proceeded to sleep. Tossed and turned for a few hours, but eventually fell asleep. An overall better result than the first study, but still I had the feeling that I might have botched it up. Results came back again confirming mild sleep apnoea (AHI 7.5). This time, as I was also emailed a copy of the results, I was able to also see that my SPO2 had gone down to 75% for several minutes during the night. Reading this in the report triggered a memory from many years earlier when, lying in recovery after surgery to remove my gallbladder, the anaesthetist had told me that my SPO2 had fallen dangerously low (80's) during the operation. He wanted to know if I had any OSA or any other condition that I had failed to report to them. I told him I had never ever heard of the terms he was using and that I had not hidden anything from him. He couldn't explain why my SP02 had dropped, and asked me to see my GP about this issue. Me being me, I forgot all about it, as I was now dealing with changing my entire lifestyle due to the missing gallbladder.

Long story short, after two sleep studies confirming sleep apnoea, I have been put on a CPAP trial for a month. I received a ResMed AirSense 10 Autoset four nights ago. I can say without hesitation that the past four nights have been downright awful and rather than feel better I feel worse. The first night I couldn't fall asleep until the wee hours of the morning. I went to work feeling like a zombie and resorted to coffee and vitamins to get me through the day. The second night was barely better, again went to work with a foggy/heavy feeling in my head. The third night was better than the second, and I initially woke up feeling "fresh", but after breakfast that freshness started deteriorating quite quickly and by mid-morning I again felt zombie-like. In fact, it felt like I was oxygen starved. Last night was the fourth night and it was no different than the third night, and I woke up this morning feeling quite unideal. I have still managed to drag myself to the gym each of these four days, but have not been able to work out to the intensity that I'm meant to be. Been on two medium-length bike rides with the boys over these four days, but have stayed at the back of the pack where the workload is less. Can't bring myself to actually exert myself physically.

I've been looking at my ResMed device to see if I can understand more about it. Found an SD card inside it, which I removed. Read on this forum about the Sleepyhead software, which I downloaded, and can see the data on the SD card. I also signed up to the ResMed myAir app on my phone, thinking it would help me. The sign-up process asked me to enter in details from the back of the ResMed device (serial number and device code), and it tells me that the device is actually a "for her" model, but there's nothing written on the device itself or within the menus that suggests "for her".

Sleepyhead tells me that my machine is running in APAP mode, not CPAP. My min and max pressures are set to 6 and 20 respectively. I find 6 to be quite comfortable, but could probably tolerate a higher setting. I have no issues tolerating the air being forced into my lungs. To me it actually feels quite nice.

Sleepyhead tells me that over the past four nights my average AHI has been around ~2.5. Apparently I've had several Clear Airway events, several Obstructive and Hypopnea events, but no Unclassified Apnoea events. One or two Large Leaks were also detected. Total Time in Apnoea over the past 4 days has been 3.5 mins, 1.25 mins, 37 seconds, and 2.75 mins respectively. I personally felt that last night was the best night so far, but from these results, it appears that it was just marginally better than the first night.

Also, my Fitbit Versa tells me that I've been getting almost no REM sleep at all since starting on CPAP (but slow wave/deep sleep has gone up), but I understand fully that it's not a medically rated device and that I need to interpret the information it presents with a grain of salt. However, that said, I know from prior to starting the CPAP trial that whenever my Fitbit told me I was low on REM I was usually able to correlate that to how I felt. On days where I'd wake up feeling quite good, my Fitbit would be able to confirm this by telling me that I had received a good deal of REM sleep that night (I would check the Fitbit later in the day) and on days when I would wake up feeling "unideal" the Fitbit would again be able to correlate this with a fair amount of accuracy to having little to no REM.

So, I'm about to start day five on the CPAP and I am literally dreading it. I have another cycling session with the boys in the morning and I'm concerned that I may not be able to join them if I again have that "unideal" feeling waking up. From what I'm reading on this forum, it appears there are CPAP users out there who literally have never improved using CPAP and have always woken up feeling tired and bleh.

I've read quite a few posts here, and the advice is quite clear and obvious that one needs to give the device a chance to work, but I'm only on a one-month trial with this machine and I fear that one month just isn't enough to allow me to stabilise. Will things improve, and generally how long does it take to improve?

I honestly feel far worse with CPAP than without it. On two of the past four days, as mentioned above, I has woken up feeling initially quite "fresh", but that feeling didn't last for more than a few hours into the morning, and has in fact been a bit of a deception. By evening I've been feeling quite headachy and tired, which was never the case before starting with CPAP and life generally felt more liveable. In fact, one of the reasons I was able to ignore my wife and doctor is that, generally, I didn't feel so bad waking up despite experiencing the aforementioned issues with brain fog and memory, etc.

I'm eager to receive any type of guidance from forum members, including whether I may have been given the wrong machine ("for her" vs. regular version), or whether maybe the settings are not ideal for me.

Lastly, I'm also battling the feeling that maybe the sleep apnoea diagnosis is being over-prescribed by the medical community, and that maybe it's the current flavour of the month. I was told that I needed at least 8 hours of sleep to get a good sleep study result, and know for sure that for one of the studies I must have had about 2 hours of sleep and the other probably 6 hours. I'm really quite surprised that they were able to extract a conclusive diagnosis of sleep apnoea from what, to me, seems like insufficient data.

Thanks in advance, and I appreciate your patience in reading my lengthy post.

Regards

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Biguglygremlin +0 points · about 2 years ago Sleep Enthusiast

Hi Roonie,

I understand the dread and for some of us it doesn't really get much better but unfortunately the conditions that cause Apnea usually get worse.

If I was able to wind the clock back a decade or two I would still not get a machine till a lot later in the piece than where you are atm (I was very severe [50+] when I finally ventured down this road) but I would have tried every form of surgery and mouth device and been more serious about exercise to fight the disorder than what I was and I would have tried to negate the cumulative effect of poor sleep on other systems like reandron and melatonin production because I believe they escalate each other.

It seems that the whole sleep disorder industry is struggling with credibility and legitimacy issues but it has gained real power through compliance which makes for a dangerous combination.

Having said that I get the impression that any number over 20 is likely to be dangerous in the long term so total avoidance is not much of a protection.

You seem adept at managing the machine and although 4 nights might seem like an eternity it is not long enough to be making drastic decisions.

There are others here who might be more encouraging and helpful when it comes to making the machine really work for you.

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Sierra +0 points · about 2 years ago Sleep Patron

Welcome to the forum,

Some thoughts on your issues. First, an AHI of 7.5 is not real high. On the surface one could question how much benefit one could get from reducing the AHI from 7.5 to 2.5. Some, but not a lot. Then there is the issue of the discomfort in getting used to the machine and especially the mask. There is definitely an irritation factor that does not improve sleep, until you get used to it, and maximize the comfort of the machine. You seem to have had some fairly serious oxygen desaturation events, so it is possible that your AHI is underestimating your apnea. AHI is based on the number of events, but not the length of them. Perhaps you are not having many events, but the events you are having are longer in duration. SleepyHead should help you with that. Just beside the Details tap is the Events tab. You can then click on the type of event, and it will show you how long each one is. Mine seem to range from 10 seconds (the minimum to be called an event) to 14 seconds. I was a reluctant user of the machine (I have the AirSense 10 AutoSet too), but over 6 months I have gotten quite used to it, and I am at the point where I can say it really does improve my sleep. It takes time, and a lot of fine tuning with both the machine, and the mask type.

On your question about the type of machine it is, the colour is the give away. Your SleepyHead may identify it as well. The standard machines are black except for the humidifier reservoir. The For Her machine is a cream color with a floral or leaves graphic on it. The For Her version in my opinion is the better machine. The For Her mode is selectable and you can run the machine in either standard mode or For Her mode. It is part of the setup. The For Her mode can be more suitable for someone using lower pressures and having more flow limitation issues than apnea events. It is not so good if you have obstructive events that require more than 12 cm pressure. The good news is you can try both modes and see which one works the best for you. Here is a link to a manual that shows you how to switch the mode. It is worthwhile to download the PDF so you have it for reference. It also has a good explanation on how the machine works.

AirSense Technical Manual

This machine has some good features that improve comfort especially when going to sleep. Here is how I set my machine up for comfort in the order they appear in the manual:

  • Ramp Time: Auto
  • Start Pressure: I have mine at 9 but since you are using a lower minimum I would suggest 6 cm
  • EPR: On
  • EPR Type: Ramp Only
  • EPR Level: 3 cm

What this will do, if it is not already set up this way is start you out with a fixed 6 cm pressure on inhale and then the EPR will reduce it to 4 cm (machine minimum) on exhale to make breathing easier. When you fall asleep the EPR pressure reduction on exhale will stop, and the pressure will be put in automatic control mode to adjust to your events. I also use the ClimateLine heated hose and put it in auto too. For me this results in a pretty comfortable setup to go to sleep. Having EPR off when in the treatment mode generally lets the machine use less pressure to control events. Less pressure makes it easier for the mask to seal, and should also be more comfortable.

If you want to do a screen capture of the your daily report and post it here, I would be happy to comment on what I see. I am not a medical professional but do support myself with my machine as I have not sleep doctor to count on. I'm on my 30th version of machine setup, and I think I am pretty much there in what works for me. To capture the screen in SleepyHead just press F12 (on a PC). Then in file explorer just left click on the image file captured and drag it into the body of your post. You can tell a lot from where the pressure goes during the night and when the events occur.

What type of mask are you using? Generally most of the discomfort comes from the mask more than the machine settings. Are you having any issues with the mask?

Hope that helps some,

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Biguglygremlin +0 points · about 2 years ago Sleep Enthusiast

It's four in the morning and once more ......... :( If I had the "for her" machine it could do untold damage ..... to my diminished pride, but as long as it doesn't have FOR HER! blazoned across the top of it in hot pink I could probably live with it because as far as I understand it is just the macho one with a few extra options. :)

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Sierra +0 points · about 2 years ago Sleep Patron

No Hot pink! Fairly innocuous looking...

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EasygoingAquamarineMagpie7538 +0 points · about 2 years ago

I have been on the RedMed for 1.5 yrs now. It's not the miracle cure I had hoped but took my AHI from 75 to an average of about 1.2. It didn't really turn out to be what I wished it would be but I have to breathe when I sleep so not much choice. Leaks are what bother me most, I sleep with my mouth open so my chin sinks lower and creates a leak unless I have the mask pretty tight. Some nights I feel like I am a fighter pilot going into battle (full face mask). I can say that it does get better. Cherish you lower pressures!

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