At Wits' End

[Pugsy]

OK, I have the AirSense 10 Autoset Machine and the AirFit P10 nasal pillows by ResMed.

This is NOT a "basic" machine and is actually a very good machine and it does indeed have EPR (exhale pressure relief) available on it.

Read this clinical manual...it will explain how to find EPR and your settings, etc.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

I don't have any idea why it worked well for 9 days and then things changed unless someone changed something in the settings.
DMEs can do it remotely so maybe they changed something.

[TedVPAP]

It is not clear to me that you understand that your machine is auto-pap. So the pressure will change automatically within the settings (5 to 20 in your case) as the machine does its best to prevent apnea. It is possible that your pressure needs have changed and that is why you are noticing higher pressure sleeping on your back). You have exhalation relief turned on if the pressure decreases every time you exhale. You can hear the change as the machine noise will change.

Read your manual so you become more familiar with your machine. I don't have your machine but you should be able to check the settings.
At some point you may want to get the clinician manual (on line) so you can learn how to make changes to the settings. And then there is learning how to use the data to optimize your treatment. An educated patient has the best outcome.

I am new to this. I am still learning which is why I found you guys. Obviously, I read the manual(s) cover-to-cover (more than once, in fact) before I ever came online in search of assistance. As I said above, the manual gives very little information. From a patient's point of view, it's very, very limited. I'm a very good researcher but at times there is too much information online and some of it has been contradictory.

When I open my mouth and exhale (as I did last night), there was no pressure drop. There was just a rush of air out of my mouth. I am a side-sleeper.

I prefer not to do the doctor's job (re the clinician manual), and if it comes to that, I would consult my doctor first. I come from the school of not messing with stuff if I don't understand it first. I'd have to be a lot more experienced to mess with stuff like that.

I figured you guys have been through some of this stuff and perhaps what was happening to me was common or at least easy to fix. At this point, I've done everything (or will with tonight's session) to fix the problem. If that fails, and hopefully it will not, I will be on the horn to my doctor and/or the people that gave me this contraption for advice. I'm a little irked that they gave me this with so little support other than how to do the basic stuff (turning it on, and cleaning it).

And that is why this forum provides such great support.
Does your machine have an SD card? If so, the 3 links below will show you how to see and share your data - the settings, the summary statistics, and every breath. Then you will better understand what is going on. Do this in parallel with pursuing support from your doctor and DME provider.

[Julie]

The doctors may understand the science of apnea, but they tend to know very little about individual equipment beyond the very basic 'this machine does that' with no knowledge of adjusting things in anything like the detail experienced people have here. They either just don't have the time, or the understanding that time is needed to learn about things and leave so much to the dealers, who unfortunately, most of the time, know even less except for pricing. I believe too that one should consult a doctor when you're sick, etc., but there are instances when you must take control of your therapy (as diabetics are taught to do even when young) and not be left to 'fail' Cpap because of ignorant providers who don't or can't provide.

Take advice here from the knowledgable members (not, unfortunately, ones who sound authoritative but are mostly dangerous in their need for attention vs helping) and try changes when suggested, in small increments - these are not suggested if there is any chance at all that they would harm you... and keep in mind that even if sometimes you feel lousy or untreated, the basic process is just one of applying a little (very little compared to even blowing up a balloon) pressure to facilitate air - not 'oxygen' (therapy) going into your airway properly rather than being blocked by anatomical or other issues. It's air, nothing more serious.

[poppi2]

Since you are using the P10 nasal pillows mask, you cannot open your mouth to exhale. When you do that, you lose the pressure keeping your airway open. The blast of air from your mouth is the machine trying desperately to maintain pressure.

EPR is to help you exhale against the pressure in the tube. You just can’t break the seal and lose air. Your mask has vents to exhaust (intentionally leak) your CO2. But you need to minimize any unintentional leaks (e.g., via mouth).

I have to go to extreme measures to prevent mouth leaking.

Good luck. Most of us have succeeded with the help here. Earl

[AMK]

Getting to know the clinician's menu is important. People on this board have taught me about things like turning on "Smart start," which means that if I put my mask on and start breathing the machine will automatically start. This saves wear on the on button and if my power flickers and turns the machine off it will turn itself back on. I would be surprised if there was a sleep doctor out there anywhere who would take the time to turn that on. That's just one example of a change you can make that probably nobody is going to make for you. BTW, EPR is wonderful and worth the effort to figure out.

[nicholasjh1]

A few things,

1. With the airsense I believe you press the rotating button and the home screen button at the same time for 5 seconds and you can go to "clinician" mode where you can adjust all your settings. Highly reccomended as you get more experience... For instance if I'm having a cold or allergies I set my starting pressure higher because I know I will need a higher pressure - You will never be able to do this by prescription, and ramping isn't good enough in my opnion.

2. as others have indicated many people have an issue with 5 as a starting pressure. I can't stand less then 7 or it feels like I have to work to hard to breathe

3. as others have indicated there should be no mouth hurricane... there are a few solutions chin strap if it is shooting out of your mouth (I found a simple stretchy head band to be better than apnea chin straps, at least initially before I was used to all the head gear), other solutions are a hybrid mask (tends to keep the mouth closed) or a full face mask (though many have fitting issues here).

4. I agree with Julie, no Doctor will have very good insight except maybe one that already has apnea. living with it daily you are far more likely to become better at treating yourself... but only if you actually try.

5. I don't personally like exhalation relief, but as others have indicated this should be a setting on your model... I believe the airsense calls it EPR, you may have to go to the clinicians menu to turn it on, I can't remember, but there's absolutely no reason to ask your doctors permission to turn it on.

[Sleeping Ugly]

That is a symptom of untreated sleep apnea.

I've heard that in the past few days (reading others' posts) but for me, it's a symptom of a middle-aged woman who has had 3 children bounce on her bladder for nine months. I don't know many older women who don't have to get up in the middle of the night for at least 1 trip to the bathroom.

I have treated sleep apnea and my numbers are almost always perfect and I still make at least one trip in the middle of the night to the rest room. I am 61. So, yeah, that. I hear ya.

[DonO]

I agree with checking with your doc, but at the same time, you are responsible for your treatment as well. The manual you have is more than likely the user manual which is very sparse. The clinician manual and settings show a full host of features that you do not see (both of which you should be able to find online). I'm guessing the reason the manufacturers do that is so that those who do not have the desire, will or intelligence to go deeper can remain ignorant or it prevents them from messing something up. It really is very simple to get into clinician mode and adjust your pressure. If I had not done that myself, I probably would not be compliant but waited until my next doctor appointment.

There are a ton of YouTube videos on how to adjust the machine. I prefer to use my doc and DME as resources and partners in my care, but I'm the one in charge. It is my health and my care. I need to understand the issues and participate in treatment. Therefore, I prefer to avoid the time (and cost) associated with unnecessary office visits for something I can fix by researching the issues myself and reaching out to folks who have a lot of experience (this forum).

Hope it works out for you. Once you get adapted to the machine, it can be life changing. I know it was for me.

[Bertha deBlues]

That is a symptom of untreated sleep apnea.

I've heard that in the past few days (reading others' posts) but for me, it's a symptom of a middle-aged woman who has had 3 children bounce on her bladder for nine months. I don't know many older women who don't have to get up in the middle of the night for at least 1 trip to the bathroom.

I have treated sleep apnea and my numbers are almost always perfect and I still make at least one trip in the middle of the night to the rest room. I am 61. So, yeah, that. I hear ya.

Mid 60s here, and usually one trip per night, sometimes (okay, rarely) none.

[TBonzie]

Well, I had a much better night last night. I didn't get quite enough mask time, but my husband left his cellphone in the room and of course, it rang and woke me up! Never fails.

But things went well. I was able (while still awake) to breathe out. At least, at this point in time, for me, "ramp up" did the trick.

I will look at what you guys provided since I last posted. Knowledge is power.

Definitely feeling more positive about things after one good night. Now if I could get to sleep quicker. It still takes 30-45 minutes. Without a mask - anywhere from immediately to 15 minutes.

[Bertha deBlues]

Definitely feeling more positive about things after one good night. Now if I could get to sleep quicker. It still takes 30-45 minutes. Without a mask - anywhere from immediately to 15 minutes.

Ah, there's the rub. I also went to sleep very quickly pre-CPAP. The problem was staying asleep. It took awhile to get used to falling asleep masked up, but now I'm back to (mostly) falling asleep very quickly. The difference is that now I stay asleep, except for the bathroom trip in the wee hours.

[Janknitz]

Almost 60 menopausal woman here. I had 2 babies bounce on my bladder and have stress incontinence to show for it. I DO wake at least once per night, I almost NEVER need to relieve said bladder during that waking time.

Glad you had a better night. As you say, "knowledge is power". If you take some time to learn more about your machine and your apnea, you will feel much more in control. If you want to try instead to see your doctor (who probably knows very little about the particular machine you are using and will refer you back to the "distributor" (DME) to change the settings and charge you for it, then be our guest. But if you truly want to have some control over your treatment, we can help you understand and know how to adjust settings when necessary.

For example, there is--as others have tried to tell you--a setting for "exhalation pressure relief" or EPR which may relieve that awful feeling of not being able to exhale against the pressure. That setting is entirely there for your comfort, and if it's not on at all or it's too low, changing it can only make you more comfortable. That's not affecting your treatment at all it's not something you need a doctor or DME for.

It's up to you how much you want to be involved in your treatment. Those of us here who stick around are usually highly involved in our treatment, which makes for a high degree of success. Better sleep may make a profound difference in your fibro symptoms and your life in general. So it may be worth sticking around, learning all you can, and being fully engaged in your treatment.

But ultimately it's your call. Let us know if you want help, but please don't ask for help and then reject it if it requires a little learning on your part (saying with understanding that none of us think very well when we are sleep deprived as you were after those two bad nights when you said that you didn't want to have to read the clinical manual).

If you make your goal being able to simply put your mask on and fall right to sleep, it's a very achievable goal, it just may take some time and effort to get there. Don't give up! It will be worth it.

[Soothest Sleep]

That is a symptom of untreated sleep apnea.

I've heard that in the past few days (reading others' posts) but for me, it's a symptom of a middle-aged woman who has had 3 children bounce on her bladder for nine months. I don't know many older women who don't have to get up in the middle of the night for at least 1 trip to the bathroom.

I have treated sleep apnea and my numbers are almost always perfect and I still make at least one trip in the middle of the night to the rest room. I am 61. So, yeah, that. I hear ya.

Mid 60s here, and usually one trip per night, sometimes (okay, rarely) none.

I'm in this club, too.

Jean

[TBonzie]

Update:

Well, I downloaded the clinician's manual and then went upstairs to look at things.

I'm still struggling at times. I'll have a few good nights (scoring 99/100) and then a night like last night, where I felt I was suffocating all night and couldn't stick the mask for even an hour. It's the same problem - breathing out. Last night, when I felt the worst, I had a quick look at the pressure and it was at 10 (I hadn't yet fallen asleep - this was 45 minutes after putting the mask off and trying to sleep (and yes, I was very tired!)

Anyhow over time, I've tried the CPAP with ramp, auto ramp, and ramp turned off. No difference. The exhalation thing ranges between 1-3 on my machine (if memory serves) and it came set to 2.

I have a call in to my pulmonologist I've had zero medical support since getting this thing.

I don't mind the mask/hose. I'm used to that. Just need to get the breathing solved.

[Janknitz]

Keep in mind you are going to have good nights and bad nights. Once I had my first good night (not until about 3 months in, so you're way ahead there) I knew I wanted more. My goal was first to have more good nights than bad nights, and eventually to have mostly good nights.

I still have the occasional bad night with CPAP 6 years in. Sometimes things are just not right--the mask is leaky, I can't get comfortable with the mask, etc. But 99% of my nights are good, at least as far as CPAP goes. So I'm OK with that.