My CPAP Treatment Journey

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Heart Jumping
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My CPAP Treatment Journey

Post by Heart Jumping » Wed Nov 18, 2015 12:06 pm

I'm going to use this single thread for most of my ongoing questions as I precede with my treatment. First my sleep study diagnosis, so you know the starting point:
Severe obstructive sleep apnea, with it being worst on my back.
AHI: 37
Lowest oxygen baseline of 86%.
And FWIW I'm positive that was a good night.

Last night was my first night of treatment. I'm going to start using Sleepyhead but for now here's what the front panel tells me:
Pressure: 11.2 (range is set to 7 - 13)
AHI: 6.1
Total AI: 6.0
Central AI: 2.9
Leak: 2L/min

Other than leak rate which I don't yet know anything about, based on my beginner knowledge these all look very good?

Thank You

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: DreamWear Nasal CPAP Mask with Headgear - Fit Pack (All Cushions Included with Medium Frame)
Additional Comments: AirFit F10 Full Face Mask is my backup mask for when congested.
Last edited by Heart Jumping on Thu Nov 19, 2015 11:11 am, edited 1 time in total.

fj62
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Re: My CPAP Treatment Questions

Post by fj62 » Wed Nov 18, 2015 12:30 pm

I would say you are doing well considering how high you started. Download Sleephead for detailed information. My numbers are terrible with AHI of 11 being my best number. To compare my wife's numbers run 0.40 to 0.78 AHI so my numbers are terrible. Hopefully your numbers will go down.
Pittsburgh, PA
ResMed Air Sense Auto 10

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ChicagoGranny
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Re: My CPAP Treatment Questions

Post by ChicagoGranny » Wed Nov 18, 2015 12:39 pm

Heart Jumping wrote:Last night was my first night of treatment. I'm going to start using Sleepyhead but for now here's what the front panel tells me:
Pressure: 11.2 (range is set to 7 - 13)
AHI: 6.1
Total AI: 6.0
Central AI: 2.9
Leak: 2L/min
From that limited amount of information, and the fact that your aren't ****ing and moaning about your first night, it looks like you did well. Congratulations.

On a subjective basis, how well do you think you slept? How energetic do you feel today? Any excess sleepiness?

Now, I think you need to become a Sleepyhead user to make some improvements in your therapy.

Without seeing more data (Sleepyhead), I will hazard a guess that raising your minimum pressure will improve your AHI. But I would like to see more data before putting a value to the min pressure.

In recognition of your first night results and your can-do attitude -->

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Heart Jumping
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Re: My CPAP Treatment Questions

Post by Heart Jumping » Wed Nov 18, 2015 1:35 pm

ChicagoGranny wrote:On a subjective basis, how well do you think you slept? How energetic do you feel today? Any excess sleepiness?

In recognition of your first night results and your can-do attitude -->
Thanks! As far as your questions you beat me to the punch of my next post.

So here's my subjective experience that I need input on. Looking at the big picture I'm very happy with my first night of treatment, I didn't sleep well but I didn't expect to plug in my machine and suddenly sleep like a baby, I expect this is going to take some acclimating to and getting right. Here's what happened:

1. First the positive, in the morning I always have nasal congestion. For as many years as I can remember. Except for this morning! I could breathe clearly through both nostrils!

2. I slept quite poorly for 6 hours using the Airfit P10. Subjectively it seemed as though there was little to no leaking. The single challenge that kept me from sleeping well was the amount of pressure I experienced as I was exhaling, I felt like I was pushing against the machine on every exhale. I have expiratory pressure relief set to #3 which equals least resistance.

3. I then switched to the additional mask I bought, the ResMed Mirage SoftGel mask and slept with that for 2 hours (and changed machine setting to nasal mask). This mask was physically less comfortable, and also seemed to leak more easily when I wasn't situated perfectly. But, exhaling was much easier with a more comfortable level of resistance (even though the machine resistance setting was the same) so it was easier for me to relax and fall asleep with it on, in spite of the extra bulk and sometimes distracting noise.

If I could experience the Airfit P10 with the sensation of exhaling I got from the Mirage SoftGel that would be ideal. But unless someone has some magic they can suggest tonight I am going to use the Mirage SoftGel and see how that works for an entire night.

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Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: DreamWear Nasal CPAP Mask with Headgear - Fit Pack (All Cushions Included with Medium Frame)
Additional Comments: AirFit F10 Full Face Mask is my backup mask for when congested.

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Pugsy
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Re: My CPAP Treatment Questions

Post by Pugsy » Wed Nov 18, 2015 2:05 pm

What size nasal pillow were you trying to use? If you can move up a size you might find that exhaling is easier.
The P10 nasal pillows seem to run a tiny bit smaller when compared to the various other nasal pillow masks I have used over the years and sometimes a little larger nasal pillow will allow for easier air movement which could help with exhaling.
Also I don't remember if you said you were using the ramp feature or not but if you were and it starts out at 4 cm the magic of EPR can't help since that is as low as the machine will go anyway.
If you were using ramp you might try turning it off and see if that helps the exhale issues.

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Heart Jumping
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Re: My CPAP Treatment Questions

Post by Heart Jumping » Wed Nov 18, 2015 2:23 pm

Pugsy wrote:What size nasal pillow were you trying to use? If you can move up a size you might find that exhaling is easier.
I wore medium during the night. I tried large but it didn't fit quite as well and resistance didn't seem to get any easier. But maybe I'll sit down tonight and try large for a little longer period of time.
Also I don't remember if you said you were using the ramp feature or not but if you were and it starts out at 4 cm the magic of EPR can't help since that is as low as the machine will go anyway.
If you were using ramp you might try turning it off and see if that helps the exhale issues.
Ramp Time: 20 Minutes
Start Pressure: 4.0
EPR: On
EPR Type: Full Time
EPR Level: 3

I don't understand your points. When I set EPR Level to 3, it is massively easier for me to exhale than with it set at 2 or 1 or off. Doesn't that mean it is doing some of its magic? Could you elaborate on what the relationship is to the start pressure and EPR? Why might turning off ramp make exhaling easier? I thought the point of ramp was to make it easier, because it moves up slowly in intensity instead of just starting at whatever your prescribed range (7 - 13 for me) is.

Thanks

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: DreamWear Nasal CPAP Mask with Headgear - Fit Pack (All Cushions Included with Medium Frame)
Additional Comments: AirFit F10 Full Face Mask is my backup mask for when congested.

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ChicagoGranny
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Re: My CPAP Treatment Questions

Post by ChicagoGranny » Wed Nov 18, 2015 2:26 pm

Heart Jumping wrote:I felt like I was pushing against the machine on every exhale.
Here is my POV on that very common sensation. Now know that I am a small elderly lady and not at all a physically strong person due to my age. My min pressure is 12 and max is 20. No exhalation relief. Most nights the pressure hits 16 and some nights 18 or 20. But still I have no problem exhaling against it.

How to explain this when younger, stronger men have problems exhaling against lower pressures?

I think it is a matter of the mind and not the lungs or muscles used in breathing. Newbies in particular tend to focus their thinking on breathing and attempt to "follow" or "breath with" the CPAP. This is unnatural and causes the sensation you describe.

If you can distract your mind from breathing and let the breathing autonomous function take over, you should be able to breathe easily while using CPAP. That may be easier said than done, but I hope you quickly make it.

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Pugsy
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Re: My CPAP Treatment Questions

Post by Pugsy » Wed Nov 18, 2015 2:42 pm

With a starting pressure of 4 cm (that's where your ramp starts) EPR isn't working at all because the machine can't drop the pressure below 4 cm.
4 cm is as low as it will go...so EPR can't do anything (work its magic) until the pressure starts climbing above 4 cm and you can't get the full 3cm until you hit 7 cm (end of ramp time).
When the pressure is climbing and is at 5.0 you are only getting 1 cm EPR relief...at 5.5 you are getting 1.5 cm reduction via EPR...and so on.

When you are using ramp and it starts at 4 cm...you are getting 4 cm on exhale and inhale until the pressure starts to go upwards and when it does you are getting only a partial reduction (down to 4 cm because it can't go any lower) or partial benefit to that EPR.

If you can't exhale against 4 cm without difficulty...then the first suspect is the air volume available in the nasal pillow and the opening to that little inner cone...hence the suggestion to try larger size nasal pillow.
Also make sure the nasal pillow is able to fully inflate so that the air can move....if the pillows are too tightly squished into the nostrils they can't inflate properly.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

Heart Jumping
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Re: My CPAP Treatment Questions

Post by Heart Jumping » Wed Nov 18, 2015 2:48 pm

Thanks Chicago Granny and Pugsy. Your info helps and gives me more to work with tonight.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: DreamWear Nasal CPAP Mask with Headgear - Fit Pack (All Cushions Included with Medium Frame)
Additional Comments: AirFit F10 Full Face Mask is my backup mask for when congested.

WindCpap
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Re: My CPAP Treatment Questions

Post by WindCpap » Wed Nov 18, 2015 5:29 pm

Like I said in my earlier post, autoramp is definitely a worth-while feature on the Airsense 10. The ramp is faster (2 minutes), but it really doesn't happen until you go to sleep. Also, start your ramp at at least 7 if you are using EPR on it. The drop in pressure will make your exhaling seem like more air is coming out. I personally found that a 7/EPR 3 was the best combination so that the pillows would feel like natural breathing. Also, try not to use EPR beyond the ramp time. If you are sleeping, you won't notice the difference. If you are not, just reset the ramp, and the resistance goes back down.

In this way, I am in complete agreement with Chicago Granny except that I find it easiest to set the autoramp for the most natural non-sleeping breathing, and let my sleeping self manage the sleeping rhythmic. When I first wake up, I don't notice the exhale pressure until I get out of bed, and come back.

Also, with nose pillows, if you are temporarily having a sensation of not getting enough air, you can temporarily breath through your mouth to catch your breath and convince your brain that you are not suffocating. After, you will find that the breathing is easier because your brain is not grasping for air.

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IDontSnoreISwear
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Re: My CPAP Treatment Questions

Post by IDontSnoreISwear » Wed Nov 18, 2015 10:03 pm

About exhaling against pressure: My settings are APAP 13-18. When I first started my therapy, my sides actually got sore. The good news is, that sensation goes away after a few days.

You're doing great. Stick with it!

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Heart Jumping
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Re: My CPAP Treatment Questions

Post by Heart Jumping » Wed Nov 18, 2015 10:44 pm

Thanks Windcpap and IDontSnore. Even though I'm already committed these words of encouragement are truly helpful. I find that knowing what I'll encounter ahead of time is really helpful, and in this case knowing the sensation will get better is especially helpful.

Since my last post I've figured out 3 things.

1. Since this sensation should go away instead of trying the Mirage tonight I'm going to force myself to keep using the AirFit P10 and adapt to it. Because it is so lightweight and comfortable, with what seems like no leaking, that if I can get it to work, that is the way to go.

2. And this is the big one. I think at first CPAP may make new users more aware of your breathing, plus the sensation of having air blown into you, that you start to exhale the minute you've finished inhaling. At that moment the machine is still blowing against you. That's what I was doing all last night. I just noticed that if when I have fully inhaled I pause only a moment, that the machine stops blowing and it becomes much easier to exhale.

3. I moved to the larger nose piece size and am angling it at more of a straight up angle.

But I think 2 is the big one. I just laid in bed testing it and wow, just a brief pause after inhaling and suddenly exhaling become much easier.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: DreamWear Nasal CPAP Mask with Headgear - Fit Pack (All Cushions Included with Medium Frame)
Additional Comments: AirFit F10 Full Face Mask is my backup mask for when congested.

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zoocrewphoto
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Re: My CPAP Treatment Questions

Post by zoocrewphoto » Thu Nov 19, 2015 3:06 am

Heart Jumping wrote:Thanks Windcpap and IDontSnore. Even though I'm already committed these words of encouragement are truly helpful. I find that knowing what I'll encounter ahead of time is really helpful, and in this case knowing the sensation will get better is especially helpful.

Since my last post I've figured out 3 things.

1. Since this sensation should go away instead of trying the Mirage tonight I'm going to force myself to keep using the AirFit P10 and adapt to it. Because it is so lightweight and comfortable, with what seems like no leaking, that if I can get it to work, that is the way to go.

2. And this is the big one. I think at first CPAP may make new users more aware of your breathing, plus the sensation of having air blown into you, that you start to exhale the minute you've finished inhaling. At that moment the machine is still blowing against you. That's what I was doing all last night. I just noticed that if when I have fully inhaled I pause only a moment, that the machine stops blowing and it becomes much easier to exhale.

3. I moved to the larger nose piece size and am angling it at more of a straight up angle.

But I think 2 is the big one. I just laid in bed testing it and wow, just a brief pause after inhaling and suddenly exhaling become much easier.
Your number 2 is a good point. When I started, I felt like I was rushing to keep up. I had to keep reminding myself that it was supposed to work for me. Once I relaxed and slowed down, I felt much more comfortable. I think it is normal to be very aware of the breathing, and kinda hard to relax and just breath normally.

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Mask: Quattro™ FX Full Face CPAP Mask with Headgear
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Who would have thought it would be this challenging to sleep and breathe at the same time?

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ChicagoGranny
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Re: My CPAP Treatment Questions

Post by ChicagoGranny » Thu Nov 19, 2015 7:08 am

Heart Jumping wrote: I think at first CPAP may make new users more aware of your breathing, plus the sensation of having air blown into you, that you start to exhale the minute you've finished inhaling. At that moment the machine is still blowing against you. That's what I was doing all last night. I just noticed that if when I have fully inhaled I pause only a moment, that the machine stops blowing and it becomes much easier to exhale.
Another thing to think about, when we are asleep, there is no effort to time our breaths with the CPAP pressure. Our autonomous breathing function just has us breathing naturally and comfortably.
I just noticed that if when I have fully inhaled I pause only a moment, that the machine stops blowing and it becomes much easier to exhale.
I wonder how long it took you to fall asleep? At some point you had to discontinue the conscious effort of breathing or you would not have fallen asleep.

WindCpap
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Re: My CPAP Treatment Questions

Post by WindCpap » Thu Nov 19, 2015 7:24 am

I think scuba divers definitely have the advantage here.

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