Nic 2010-05-22 07:00:07
I was recently diagnosed with sleep apnea (about 50/70 apneas per hour).
Then I did a second sleep study for the CPAP titration : the machine
used was Resmed Autoset Spirit with Ultra Mirage Nasal mask.After this
night, results showed that sleep apnea numbers dropped to 10 but I
haven’t felt any improvement at all (during that night I had lots of
difficulties to fall asleep and I woke up several times, so it may be
possible that I haven’t slept a lot). The machine I received is the
Resmed Autoset Spirit + Ultra Mirage Mask with pressure been set to 6-
It has now been 10 nights since I am on CPAP and I still haven’t felt
any improvement, I have well verified that the mask is set correctly (to
avoid leaks). Also, whenever I check(from the machine) the number of
sleep apneas I did from previous night, result is usually between 8 and
10 which is quite a good number compared to 50/70 (without machine) so I
really don’t understand why I haven’t started to feel better.Regarding
the average daily pressure displayed from the machine , it is usually
about 10-11 , so I guess the initial pressure settings(6-12) don’t need
I have to mention that I still have lots of difficulties to fall alsleep
(maybe a bit of insomnia and also that it is not that easy to sleep with
a mask) and that I will wake up few times during night , therefore I
guess that my total hours of sleep must be around few hours.
So , I would like to know how long does it usually take before feeling
any improvement. What do you think about my case ?
I would appreciate if you could speak about your own experience when you
started CPAP treatment (how long did it take before feeling improvement,
did you take any sleeping pills….) , if you have any advice that could
help me , thanks.
David ruether 2010-05-22 07:00:25
I’ve been on a CPAP machine for about seven weeks now.
I never felt tired before (or since), though I regularly went
to sleep in the evening while watching TV (this stopped for
a while with the use of the CPAP machine, but has returned).
I was desperately tired the day after the sleep-test (almost
no sleep) and the day after that (no sleep the night before), so
I pressed matters to get the CPAP gear on the second day
after the sleep test. Before, I slept about 9 hours/day, but
with the machine, I slept only about 5.5-6.5 hours/day
(I go to sleep easily with the CPAP gear, but wake early).
I use the CPAP gear “religiously” when sleeping. Why?
‘Cuz my blood-oxygen saturation level now doesn’t drop
much below 90% during the night (62% before), and I now
can reach REM sleep and dream again. Many recent
neurological problems that led me to a neurologist and then
on to a sleep test have not lessened, but an enlarged heart,
heart-arrhythmia, and the belief that my father died of
complications from OSA keep me going with it. Some have
reported that it can take years to see some benefits; others
report almost immediate relief in some areas – but you have
just started – and it can take a while to get used to the gear
and to find a good mask for you and to get the mask to
fit properly (not simple…).
Andy hall 2010-05-22 07:00:32
This can be deceptive. From my own experience, prior to treatment
there were nights when I didn’t feel that I had slept at all, but
according to my wife I had been asleep and snoring.
Opinions differ between doctors about what is an acceptable level for
apnoeas and hypopnoeas, but the most often mentioned figures are
5-10/hour for the apnoea hypopnoea index (AHI)
I have one of these, although with a different ResMed mask. The
pressure range is set to a minimum of 6 and the default maximum of 20cm.
This does seem to vary from person to person. Some people experience
an immediate effect. For others it takes longer and you will find
the expression “sleep debt” mentioned. Basically this is something
that for some reason for some people has to be “repaid”.
Some people find that they have compatibility problems to begin with –
as you say wearing a mask is a bit unnatural; while yet others do OK
to begin with and the perceived improvement declines (a bit like a honeymoon effect ).
It is possible for leaks to be OK when you first put on the mask but
to become worse as you change position during the night.
I’m not sure about that. If the clinic has enabled the patient menu
for you, as it sounds they have, then you should be able to see a
median or average pressure as well as a 95th percentile – a higher
figure which represents a statistically determined value close to the
peak. You should also be able to see the figures for the last night
and then cumulative numbers for the last week, the last month etc.
It is typical for the pressure levels required to vary based on
sleeping position (more pressure is often needed when people sleep on
their back), whether one has drunk any alcohol and from night to
night. This may not happen to everybody, it does for me, and as far
as I know is quite common. I find that for me the 95th percentile
pressure is typically 11-14cm, while the median is around 8.
If your average pressure is 10-11 and the machine is limited to 12,
then it is possible that a higher setting is needed, although that is
not immediately suggested by the AHI figure. However, please do not
attempt to change the settings yourself because for some people, a
higher pressure can create central apnoea events and you don’t want
that as it can be dangerous.
I would suggest that you contact the clinic and arrange with them to
take the machine with you. They should have the AutoScan software
and be able to download the machine. This will provide them with
detailed data of what has been happening for the last five nights
concerning pressure, leak and AHI. They should be able to
determine whether the machine settings are correct and whether there
is mask leak, and from the usage profile may even be able to see
information about sleep behaviour.
They might give you a recording oximeter to take home to record the
oxygen levels in your blood during the night. This gives another
set of information about how effective the treatment is and works with
a small probe on the finger – it doesn’t hurt 🙂
Sleep apnoea results in other problems apart from poor sleep. The
various effects of reduced oxygen in the blood are more serious in the longer term.
THis may be an issue of how you are managing with the equipment, bu it
may be that there are other factors influencing your sleep.
Sometimes people have obstructive sleep apnoea and other conditions at
the same time, and treating OSA does not help sleep very much.
It does vary from person to person, so I am not sure how useful
comparison to other people’s experiences actually is.
I do think that returning to the clinic with the machine and asking
them to check is the next thing, along with talking to them about what
you are finding.
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Richard evans 2010-05-22 07:00:35
With me, improvement was instant and complete. The first night.
Unfortunately, that improvement lasted only about six months, at which
time insomnia entered the mix and I’ve not had a really good night’s
sleep in over ten years. You may have the misfortune of the insomnia
interfering right from the start.
Andy hall 2010-05-22 07:00:43
Do you think that you slept solidly for 9 hrs before, or did the
neurologist check what the sleep pattern was?
I found that prior to treatment, I would sleep poorly but for more
hours if I had the opportunity.
Now the number of hours tend to be less but of better quality.
Has the arrhythmia started to improve at all?
AIUI, heart enlargement can begin to reduce with CPAP treatment but
that is not going to be an overnight thing.
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David ruether 2010-05-22 07:00:50
Yes, that is what I meant. And the greater amount of “bad”
sleep likely did more damage than less would have done…
I had only the one episode, that I know of (symptoms are
slight, but potentially dangerous). It took the “big zap” to
regularize the rhythm after a sonogram to make sure there
were no clots in the heart chambers following three days on
anti-coagulants after I got to a hospital…
Yes. But this should improve things over time, and reduce
the need for heart-rhythm regulation medication, I suspect.
I’ve also begun to lose weight, which should also help things…
Charles perrin 2010-05-22 07:00:57
I knew my titration worked when I woke up from being titrated.
Richard evans 2010-05-22 07:01:08
Yes, that was the “first night” I meant. One minute I was in the lab
and they were hooking up the CPAP, the next minute it was morning. It
was literally the first time in memory that I had slept straight
through the night without being conscious of the passage of time.
Nic 2010-05-22 07:01:19
Ok , thanks for your message.
Nic 2010-05-22 07:01:23
The menu I have access is somehow restricted , I mean I can only set
mask type,language and other basic stuff. Thanks to the little trick, I
also have access to the “clinical menu” which allows me to change/see
more stuff , the following data(weekly data) is what I can see from the
“efficacy menu” :
Pressure : 9.8
Leak : 0.14L/sec
AHI : 8.5
AI : 1.2
HI : 7.4
So , the average pressure is 9.8 , I try to look for 95th percentile but
haven’t found that data , maybe it is in another menu ?
Regarding the pressure , I know I can change it by myself ,but like you
said : it is better that only my doctor does the change if needed
About the recording oximeter , I was having one during the cpap
titration and the oxygen level was quite ok (with cpap) , without cpap
it dropped at 84% sometimes.
I am about to see my doctor in 3 weeks normally
Thanks again for your explanations
Nic 2010-05-22 07:01:26
Ok , thanks for your message , it seems we all react differently.
Nic 2010-05-22 07:01:30
Well, for myself , titration also worked since AHI dropped to 10
(initially at 50/70) , but unfortunately there is not any improvement at
Martin basil 2010-05-22 07:01:33
In my case the improvement was immediate when I used CPAP from the sleep
trial on as with most people who have OSA I understand.
Andy hall 2010-05-22 07:01:40
The daily numbers are 95th percentile values, and those calculated
over a range of dates are medians calculated by taking the 95th
percentile values for the period in question (e.g. 7 for a week) and
sorting them into order. The median is the middle value (e.g. the
4th in a set of 7).
If you write down the daily values for a week you will see a variation
in each of them. You might find a spreadsheet useful for this.
Gradually over a period of time the numbers average out. I find
that occasionally I will have a night where there is higher than
normal pressure and that is generally if I have slept on my back for
most of the night.
For last week, I had (median)
Pressure = 7.8
Leak = 0.3
AHI = 7.0
AI = 0.3
HI = 6.8
Over a month, the figures are similar
Resmed recommends that the leak value should be less than 0.4 L/sec,
and you seem to be doing well with that.
OK, so certainly something positive is happening.
If you are feeling concerned about the lack of sleep issue in the
meantime, then you could make a phone call to the doctor and discuss
it. I would certainly take the machine when you go for the
appointment so that they can look at the data.
You are very welcome.
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John 2010-05-22 07:01:44
It varies from person to person. It took me around 10 weeks then the
improvement was sudden and dramatic. This was because I had difficulty
adjusting to sleeping with the mask on and failed to use it enough to get
much benefit. Once I overcame that hurdle, it was plain sailing from then
on. So, my advice is, keep using the mask every night and you will gradually
get accustomed to it and will sleep for longer and longer periods.
It will also take some time to re-establish new sleep patterns since your
sleep will no longer be fragmented due to apneas.
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Rob 2010-05-22 07:02:31
are using is a computer auto cpap. It has a software program that can use
change pressure ranges. There is a computer software program that allows
this adjustment and it can print out sleep data reports. You should be
provided this information on a frequent basis. Some one must explain the
information to you Best wishes