New to CPAP Treatment - a bit lost

[Weej]

Hi all,

I went for a sleep study in a hospital that involved me wear a huge watch-like device with sensors on my chest and finger. The report showed that my AHI was 88, and i heard it was super high. (perhaps I was not used to hospital settings or the big watch device) And so the doctor recommended me to get the CPAP machine, and recommended APAP since it can auto adjust.

Buying it local cost 30-40% higher than online, so I got a brand new Resmed S9 Autoset with Humidifier, and a AirFit F10 (L) mask.

As I am new to this, here was my Setting:
Autoset Pressure 4 - 20
20 mins Ramp
EPR Full time level 0
27 degrees celcius
Humidity at 4.0

Mask: Sat upright, fitted the mask, Maskfit test OK. Laid down and start feeling some leaks at nose bridge area, adjust mask and tightened abit, still minimal leak.

Day 1: Woke up after 2 hrs feeling the leak at nose bridge and super dry mouth. Adjusted humidity to 4.5 and attempted to go back to sleep. Woke up again after 3 hrs, felt the leak at nose bridge and general discomfort. decided to stop machine. Reading: Mask fit failed, leak rate 66 L/min, 5.2. hours used AHI 8.0

Day 2: Fitted my mask, adjusted while lying down. Pressure: 4 -18, 30 mins ramp, 28 Degrees, 5.0 humidity. Woke up 2 hours later by the high pressure air flow, leaking at nose bridge. pressure got higher while i was awake, air was leaking at the bottom of mask. air was gushing into my mouth, blowing up my cheeks, gushing out of mask. Uncontrollable, hence stopped machine and removed mask to sleep. Reading: Mask fit Passed, leak rate 61L/min, 2.3 hours used, AHI 2.5

I have frequent sinus problems so i breathe through my mouth. Is it that the max pressure is too high? Perhaps i need to check on the data from SD card.

Is this treatment right for me?

[Julie]

Hi, the problem is more likely that the low setting needs raising... the high setting is far less relevant and you can either leave it as it is or lower it a bit, but it's not important at the moment... the lower one is. And turn the ramp off unless you're ultra sensitive to any air blowing at you when starting up even for a minute. Twenty minutes of ramping up from 4 (the default low machine set) to e.g. 6 or 7 is fairly ludicrous and you won't be fully treated for all that time. If at some time in future your low setting is much higher through prescription or otherwise, you might want to try ramp again for e.g. 5 mins, but otherwise most here wouldn't bother at all.

You might set the EPR however, at 2 or 3 which will help with exhalation and hopefully the 'gushing'. Something else you need to experiment with yourself.

You've also discovered what trying on a FF mask sitting up does - much better to try them lying down! But there are very many out there at diff. sizes, and you can look at them on Cpap.com where they have graphics, reviews, lots of info on all, and will let you try them for 30 days at a small return fee.

And btw, while 88 is nothing to sneeze at, many have had much higher results. Don't confuse the 'severity' of those however, with the level of pressure needed to keep your individual airway open - no connection there as you could have very mild apnea but need a high pressure to open your throat.

Good luck, for now try to stick to this thread to we can follow things and be able to help with any questions. Welcome!

[jim22]

Hi weej,
It sounds like you do need to use your machine. Over the long term, sleep apnea can make you very sick it also sounds like you have a good machine. You have come to the right place for help! Please try to fill in your equipment in your profile as it will help us help you. As you are experiencing, the mask fit can be the toughest part. You may need to try several masks to find one that works for you. There are fitting videos online that may help. It may be helpful to see a local DME supplier where they can show you several and help you find one that works for you. If at all possible, a nasal pillow type may have fewer fitting issues,but only if you can breath through your nose and keep your mouth closed while you sleep. Others will respond soon with more suggestions. The pressure settings you are at now are wide open to allow the machine to figure out what pressure you need. If you feel like you can't get enough air, you can raise the starting pressure to 8 or 9. During the ramp time, you are not being treated effectively, so you may want to raise the ramp starting pressure and reduce the ramp time to 5 or 10 minutes. Many experienced users don't actually use the ramp. The EPR helps by reducing the pressure you exhale against. You can try the different settings to see what is comfortable for you.
Welcome!
Jim

[grayghost4]

Yes it would be good for you to install Sleepyhead and look at the data form your machine .

If you are ready to take control of your therapy .... I think it is important to get accustom to the mask and pressure and sleep through the night..

I would set the lower pressure at a comfortable level and the upper pressure 2 or 3 cm higher something like 6 and 8 cm and epr set to 3 for comfort and no ramp …and get the mask fit under control at that pressure and sleep through the night. Then look at the data for Sleepyhead and make adjustment from there.

[Mudrock63]

I found that once I got used to wearing a full-face mask, I could incrementally tighten the fit and it didn't bother me. You don't want it so tight that it is uncomfortable and interferes with your sleep, but it needs to be snug enough to stay sealed to your face. Especially if you move around in your sleep. Good luck and welcome!

[Julie]

It needs to be loose enough so the cushion can inflate properly. You can always use Padacheek.com liners to help seal things and discourage strap marks.

[Weej]

Hi all,

Thanks for your replies!
I changed my settings to Pressure min 6.6, max 11

Day 3: Wore my mask only to watch a movie at home, attempting to get used to the mask. Had a hard time getting to sleep with mask and machine on. Woke up several times in the night by either leaks or huge change in pressure. Here is my data:
AHI: 37.72
Large Leak 25.52%
Clear Airway 0.83
Obstructive 28.91
Unclassified Apnea 4.98
Hypopnea 2.99

I have ordered a M size mask in hopping for a better fitting. I think tonight I will be setting max pressure of 20 to see if there are any improvements.

thanks folks for your helpful advices!

[Julie]

If you do have large leaks (or ongoing ones) your mask may likely be the wrong size, badly fitted or just not the right one for you, but higher pressure if leaks exist will only make them worse, not help your AHI to be lower.

[Weej]

Hi all,

Finally after the festive seasons, my new mask came. It was a M size instead of L size. When I first wore it, I felt that it was a much better fit, almost no leakage in my opinion.

I was having problems trying to fall asleep. I am not sure what is causing the problem, perhaps the mask, the 'deliberate' breathing, the air flow speed etc. Just when i was about to doze off, I got awaken but the sudden huge pressure of airflow. After a while I woke up thought that I had at least 3 hours on the machine, and its not really helping, hence I removed the mask and fell asleep immediately.

I took a look at the sleep report, shocked to see that only 1.4 hours used, leakage is 87L/min, mask fit was POOR. AHI was 30

So now I have a bigger problem of not being able to fall asleep with the mask on... then the problem of leakage which I did not feel any..

I will try again tonight..

[Julie]

Couple of things - first of all don't breathe deliberately in any way - the machine must adjust to you, and not the other way around, or it won't be able to evaluate the treatment you need from your natural breathing vs 'deliberate'.

Second thing - there are a zillion masks out there in many sizes and configurations - you need to try any on lying down (when your face changes a lot) but you can make choices that suit you, not the dealer, etc. Cpap.com will let you try masks x 30 days for a small return fee, and if you can talk a local DME into trying on a few (lying down) you might get lucky. Very few of us end up with the 1st or 2nd or even 3rd one we try, so instead of messing around with one, try others.

[Sleeprider]

You are using a full face mask because you say you have sinus problems, and breathe through your mouth. You may actually find nasal pillows can clear your sinuses and that nasal therapy will work. It's worth a try. Even a FFM does not really work well with mouth breathing as you are finding out.

Mask fit and leaks are your main problems to solve right now. It might be worth using a local supplier for the mask to get some support and assistance in fitting and using the mask. It should not matter that you bought your machine from another source. Proper fit, strap adjustment and possibly using liners could solve most of your problems. You may need some professional support to find a mask that works for you.

[otrpu]

When I have trouble keeping a seal with my regular FFM I switch to my RespCARE Hybrid FFM. The kit comes with three sizes of cushions & nasal pillows. It also has a chin flap, so no chin strap is required. Link in my equip list below. Might want to take a look at it.
Cheers,
otrpu

[Weej]

Hi all,

thank you so much for your advices. I have been trying to use the machine every night even though it does not allow me to fall asleep easily. I adjusted my mask and it felt good, until half way through the very high pressure pushed through and flabbing and whistling noises could be heard. Also i was awaken by the sudden high pressure. I am beginning to wonder if CPAP is the correct therapy to what I am suffering...

[Weej]

zoomed in on the high event parts, and last picture the zero event parts

[Sleeprider]

Your pressure range of 9-18 cmH2O is high enough that you may benefit from a true bilevel machine. The pressure is almost immediately moving to the high end of your settings, and still not stopping obstructive apnea. Your leak rates are very high, and that is interfering with therapy. It's time to consider the mask fit a failure and try something else.

The obstructive apnea you are having, even where large leaks are not present, are very long-lasting (over a minute), and you clearly need to control this problem. I suspect a lot of your problem is positional apnea from sleeping on your back. In addition to resolving the leak situation, you're going to have to get off your back until you can find a pressure range that works to keep your airway open.

You need a mask change, and you need to get off your back. Do you have any support from a DME, or are you on your own?