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Startling awake, need help

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SeaNurse -1 point · 2 months ago Original Poster

Hi. I've been on CPAP for about 5 weeks, using the nasal pillows. It took at least a week for me to even be able to fall asleep with the mask on, and after an hour or two I would take it off in frustration, so I could get some "real" sleep. Anyway, once I was able to start falling asleep with the mask, I then would startle awake, every time I drifted off to sleep. This happens over and over again, no matter if I'm on my left side, right side, or on my back. It's disturbing and upsetting. I then end up removing my mask so I can get some sleep. I'm averaging 1 to 2 hours usage a night, although most of that is not asleep. I'm either totally awake and trying to fall asleep, or I'm in the "startling awake" pattern. I get up for work very early, and I'm a nurse, so my job is already tiring. I'm chronically sleep deprived at this point, and quite frustrating. I also feel guilty that I've been unable to get through one night wearing the mask. I've changed the settings, changed pillows, tried sleeping pills, and Afrin. My current settings are 8.4 minimum and 9.4 maximum. I turned the ramp feature off as I felt air-starved with lower pressure. When I go higher than 8.4, I feel discomfort in my chest. My max AHI I've had on the machine is 13. I'm 5'6" and 135lb. My original sleep study only showed an AHI of 5. Before CPAP I was chronically tired and having frequent migraines, so my sleep doc though trying CPAP might help. I feel like it's making things worse at this point, so not sure what to try next. I won't be able to have a follow up appointment with my doc for another 2 weeks. Any help would be greatly appreciated!

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Sierra +0 points · 2 months ago Sleep Innovater

First, what make and model of a machine are you using? Do you know what your breakdown of central and obstructive apnea events that make up your total AHI?

If you have a PC or Mac with an SD card reader, you may want to consider downloading SleepyHead. It will give you a better picture of what is happening during the night, and possibly some clues as to why you are waking up.

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SeaNurse +0 points · 2 months ago Original Poster

I have the ResMed, AirSense10, Autoset for Her. Looks like the majority of events are obstructive, but a few central. I haven't downloaded the SleepyHead app yet, but I can try that.

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Sierra +0 points · 2 months ago Sleep Innovater

You have a good machine. My first suggestions would be to set the comfort settings as follows:

  • Set Ramp Time to Auto
  • Set Start Pressure to 8 cm
  • Set EPR to On
  • Set EPR Type to Ramp Only
  • Set EPR Level to 3 cm

This will give you 8 cm of pressure as soon as the machine starts. It will hold there until you go to sleep. The EPR at 3 will make it comfortable to get to sleep because it will reduce exhale pressure to 5 cm. And having the EPR on ramp only will give you full 8.4 (minimum) pressure while you are asleep. That alone may reduce your obstructive apnea frequency.

You can leave your minimum and maximum pressures at 8.4 and 9.4 but after you get SleepyHead installed, you may find that the 9.4 is too low. If you do a F12 (with a PC) you can save a screenshot of the Daily report. If you drag it to a message here it will be very informative as to what is going on.

I think you have a good outlook to improve your AHI. If you said your AHI was primarily central the outlook would not be as good...

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SeaNurse +0 points · 2 months ago Original Poster

Thank you I will try those settings tonight!

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SeaNurse +0 points · 2 months ago Original Poster

Just an update - I still only wore the mask for a little under two hours, but had only .6 apnea events with the new settings you suggested. But, I did have a sort of breakthrough with figuring out what is waking me up. I'm getting a lot of air in my stomach, and when that air wants to come back up (like a mini-belch), that wakes me up, or partially wakes me up. So not all the startling is apnea related. I may turn down the minimum pressure to in the 7.4 range tonight and see if I get less air in my stomach. I think I turned the max up to 9.8 or 10. Not sure if that is contributing to the air stomach or not. My goal is to try 4 hours tonight, no matter what. I don't have to work tmrw, so less pressure to get good sleep.

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Sierra +0 points · 2 months ago Sleep Innovater

As bonjour suggests it is generally the high pressure that cause the air swallowing. And again in general, many that have the issue get over it. So you could limit pressure for a while and accept a little higher AHI, and then increase it over time.

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bonjour +0 points · 2 months ago Sleep Commentator

try lowering the max to a bit lower than your 95% pressure. Then ease it lower to minimize your aerophagia. Lowering your min will have little impact because the algorithm will increase pressure to eliminate events.

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SeaNurse +0 points · 2 months ago Original Poster

Ok, thank you, I can try that tonight. I'm so new to this, what do you mean by "a bit lower than your 95% pressure"?

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Sierra +0 points · 2 months ago Sleep Innovater

If you use SleepyHead it will report your 95% Pressure. However, since you have your minimum set at 8.4 cm, and maximum at 9.4 cm that is a very tight range, and most likely your 95% pressure will be reported at 9.4 cm. So, what you might want to do is set the minimum at 7.4 and max at 8.4 to see if that gives you some relief without affecting the AHI too much. It is best to download SleepyHead though so you can see what is really happening.

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SeaNurse +0 points · 2 months ago Original Poster

Ok thank you. I did pretty well last night and kept it on 4.5 hrs, with NO apnea events. Still some air in my stomach but better. I think I'm at 7.2 and 8.4 for settings. I will download the sleepyhead this weekend. I haven't had a chance to do much else this week due to work being busy.

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