Can't Handle the Pressure!!

[TiredMominCanada]

Hello all!
Had my titration study last night and my visit to the DME today to get my machine. Two things:

1 My new prescription is 15cm (have been on a trial of 9 for the last 3 weeks)

2 The loaner machine that they gave me (S9 Autoset), I cannot have - long storty short - script is for CPAP only, to get an auto I would have to pay completely out of pocket. So I'm stuck with straight CPAP which I'll have to deal with ( I got the S9 Elite).

So the sleep tech said ("I had the pressure lower and it stopped your events, but couldn't stop your snoring until I put it at 15") Frankly I don't give a crap if I'm snoring as long as I'm breathing!

I tried my machine with 15cm pressure and I couldn't take it! It was like my lungs were filling up and it couldn't get rid of the air (even with the EPR on). Soooo, I figured I'm going to set the machine at a lower pressure (like 11 or 12) and see what my AHI is. I figure if it is under 5, I feel rested and I can handle the pressure it's good enough.

Thoughts???

[123.Shawn T.W.]

I'd go with 10, and set your ramp to start at 7 and run for 5-10 min, give it a few day then increase...

Do you have software to monitor you results?

[Xney]

Can you turn on C-Flex / EPR? Try setting it to 2 or 3.

however, I should note that 15 is kind of the range where people start considering Bi-Level instead of CPAP. I've been okay up to about 15cm with cpap, but then it started to get too much.

The reason the techs want to eliminate snoring is that it's a precursor (often) to obstructive events. However, you may want to take the tact that you'll watch out for events happening rather than trying to eliminate them, rather than suffering at that pressure level. I think that's reasonable if you have the ability to look at your data.

[greatunclebill]

keep returning to the doc. tell him over abnd over you are trying but you absolutely can't breathe against the pressure. he'll have no choice but to prescribe an automatic machine. even if you have to pay out of pocket, they are not that expensive, new, on line and even cheaper lightly used. whatever you do, do not stop treatment.

[Todzo]

Hello all!
Had my titration study last night and my visit to the DME today to get my machine. Two things:

1 My new prescription is 15cm (have been on a trial of 9 for the last 3 weeks)

2 The loaner machine that they gave me (S9 Autoset), I cannot have - long storty short - script is for CPAP only, to get an auto I would have to pay completely out of pocket. So I'm stuck with straight CPAP which I'll have to deal with ( I got the S9 Elite).

So the sleep tech said ("I had the pressure lower and it stopped your events, but couldn't stop your snoring until I put it at 15") Frankly I don't give a crap if I'm snoring as long as I'm breathing!

I tried my machine with 15cm pressure and I couldn't take it! It was like my lungs were filling up and it couldn't get rid of the air (even with the EPR on). Soooo, I figured I'm going to set the machine at a lower pressure (like 11 or 12) and see what my AHI is. I figure if it is under 5, I feel rested and I can handle the pressure it's good enough.

Thoughts???

Hi TiredMominCanada!

In my experiance it helps to spend quality time with the machine and/or new setting during the day. The change may be little in terms of absolute pressure but is hugh in terms of the changes that need to take place in our breathing reflexes to handle it.

Part of the time should be in bed learning to breath quietly with the machine. For me it helps a lot to put a pause between the breath out - - breath in. Think two slow easly counts in, two counts out, two counts pause.

With the practice in bed then with a book, music, or light TV. Some kind of distraction.

I think I would set aside a half hour each for a couple of days and the half for the distraction time (or full hour for a full TV program) to complete a week.

When you start to use the CPAP at night, use the practice to breath quietly.

Rigging to use CPAP data is strongly advised.

Have a great week, and may you find good sleep!

Todzo

[LSAT]

If your insurance will pay for the Elite...they should pay for the Autoset. They have the same insurance code. It may be the DME that is refusing to give you the more expensive unit. See if you can get your doctor to specify on the prescription that you need an auto titrating unit. There is nothing wrong with the Elite ...it is a good machine that gives you data.

[Pugsy]

A jump from 9 to 15 is huge for some people even with EPR maxed at 3. It will take some time and gradual adjustment but it can be done.
In the meantime start with the 11 or 12 if you can tolerate that well. Then give it a week or so then try a little more (like 0.4) and give that a little while. All the time watching your software reports. Keep inching upwards with the pressure but go at it in small increments and you can get a lot closer to 15 that way. Plus it will be much easier on you getting there.

[Slartybartfast]

If your insurance will pay for the Elite...they should pay for the Autoset. They have the same insurance code. It may be the DME that is refusing to give you the more expensive unit. See if you can get your doctor to specify on the prescription that you need an auto titrating unit. There is nothing wrong with the Elite ...it is a good machine that gives you data.

She's in Canadia, not the U.S.

[Xney]

It's a big jump.

When I started, 8cm seemed crazy. I got CPAP all the way up to 15cm by going up bit by bit. You actually can get used to higher pressures, though everybody reaches their own personal point of too much.

I would definitely consider self-titrating up (in consultation with your doctor) slowly or an auto machine!

It's funny but now like 13cm or 14cm is no big deal to me.

[archangle]

If it were me, and I'd been using 9, I'd set it at 9 or something comfortable, then creep it up a little each night.

Most of us find that we can exhale against any pressure after a little adjustment.

The medical mafia may treat you like some sort of heretic if they find out you changed the pressure on your own. They may sic the CPope on you.

The AutoSet is better, but if you are willing to look at the data and tinker wisely, you can probably get pretty good therapy with the Elite.

[TiredMominCanada]

I set the pressure to 11.6cm last night (EPR at 3), Ramp from 9cm for 20 minutes, seemed okay (although I had a dream that I was filling up with air!!). My AHI was 4.4 this morning so a big improvement. I will keep it at this pressure for a few days and keep an eye on the number and inch up slowly if I need to. Thanks so much for all of the advice and support!!

[TedVPAP]

I do not use the ramp. I like to make sure I have a good seal and comfortable/relaxed breathing before I fall asleep.

[Denial Dave]

I feel your pain

during my sleep study I thought 4 was unbearable....

I was prescribed with bi-pap of 21 /15.......!!


Good Luck

[KEQ5]

Ramp is tool. Sometimes it's useful, sometimes not. When I started CPAP in August, I used the ramp with a 5 minute setting. Then I ran without it for a while, now that I've upped my pressures again, I'm using it at 5 minutes again for a bit.

However, I think that when using the ramp feature, you should set the "start" pressure for something not much lower then your prescribed pressure. So if your pressure is set to 12, starting the ramp at 4 is too much. You might not leak at 4 but start leaking at 8 or 9 on the way to 12. In which case, a starting pressure of 8 or 9, then a ramp up to 12 over 5 or 10 minutes would make more sense as you'd be more likely to have a good mask fit.

[archangle]

Getting rid of the ramp, gradually if necessary may be a good next step. Either do without or try increasing the ramp pressure until you don't need it.