WARNING: Do you know the minimum pressure for your mask?

SelfSeeker · Post by **SelfSeeker** » Fri Sep 29, 2006 2:35 pm

I did not know that mask have a minimum pressure that they can be used at.

I am including what I found for the Comfort Curve at the Respironics site, in the user guide as an example. I am glad that Respironics has the user guide on line.

I know that we do not have a user guide until we get a mask, I think I would be pissed, if I bought a mask online/DME just to find out I could not use it because of low pressure issues once I read the user guide.

I know I have read posts where people are using low pressures such as 4 or 5.

I cannot remember which posts I read the low pressure in, so I am putting out a general warning for everyone to get as much info before ordering their mask.

Look at the user manual check for yourself and be safe.

I do not know if there is a maximum pressure for most masks.

The complete assembly has an enclosed volume of approximately 110 ml. This volume
may not be suitable for some patients.
Explanation of warning: At low pressures (< 6 cm), the airflow through the exhalation
port may not be enough to clear all of the exhaled gas (CO2) from the mask. You may
breathe in some of the air that you have exhaled.

Snoredog · Post by **Snoredog** » Fri Sep 29, 2006 2:40 pm

any doctor that would send a patient out the door with a cpap pressure of 4cm to 5cm should have his/her license re-evaluated by the state board of exams.

oldgearhead · Post by **oldgearhead** » Fri Sep 29, 2006 2:58 pm

any doctor that would send a patient out the door with a cpap pressure of 4cm to 5cm should have his/her license re-evaluated by the state board of exams

Strong statement. However, I would agree if the treatments is for "normal"
OSA. In addition to the CO2 issue, most full-face masks have a "check valve"
that requires pressure above a certain level to keep it closed.

I think mistakes are made in this area when an APAP is issued without the
prescribed pressures. Of course this problem can easily be corrected if the
"blower" makers would ship all APAPs with a minimum pressure of 6 cm/H2O,
instead of 4 cm/H2O as they do now.

sleepyinsunnyvale · Post by **sleepyinsunnyvale** » Fri Sep 29, 2006 3:46 pm

I was never titrated just given an APAP and sent on my way. (5 years ago)
Never had any problems with compliance from day 1. Once I got the SW I found that my pressure is <6 for 96% of the time and my AHI is <2.5 consistently.
Average around 4.8.

I use a Comfort Gel mask with no issues. I have an Activa but haven't used it yet. I was also wondering if my pressure is too low for it to establish a reliable seal.

DME Police · Post by **DME Police** » Fri Sep 29, 2006 7:21 pm

Most machines have ramp pressures at 4 cm or even less.

I think Respironics is keeping a lawyer happy with this disclaimer.

NightHawkeye · Post by **NightHawkeye** » Fri Sep 29, 2006 10:04 pm

I feel compelled to point out that there are many of us for whom 4 cm CPAP pressure is quite comfortable and also some for whom rebreathing a little CO2 is probably beneficial. CO2 thresholds vary from person to person - part of the normal distribution.

It seems to me that CO2 clearance is just another comfort issue with masks, rather than something to get overly alarmed about. If you try on a mask at your therapeutic pressure, then you should know whether it's comfortable for you or not. (By the time you've tried several masks, you may very well know whether or not you need a mask with good CO2 clearance.)

Regards,
Bill

Snoredog · Post by **Snoredog** » Sat Sep 30, 2006 1:44 am

[quote="sleepyinsunnyvale"]I was never titrated just given an APAP and sent on my way. (5 years ago)
Never had any problems with compliance from day 1. Once I got the SW I found that my pressure is <6 for 96% of the time and my AHI is <2.5 consistently.
Average around 4.8.

I use a Comfort Gel mask with no issues. I have an Activa but haven't used it yet. I was also wondering if my pressure is too low for it to establish a reliable seal.

SelfSeeker · Post by **SelfSeeker** » Sat Sep 30, 2006 5:30 am

sleepyinsunnyvale - did you have an initial sleep study that indicated you have sleep apnea.

NightHawkeye - How would you know you need a good clearance mask of CO2 by trying them on?

jshuler43 · Post by **jshuler43** » Sat Sep 30, 2006 6:12 am

I was just diagnosed with OSAHS with Significant Hypoxemia 77% and a low heart rate of 26. When I went back for the test with the CPAP I was told it wasn't a good test because I only was able to sleep for about 4 1/2 hours and didn't get any significant REM sleep. They said I only went up to a 6. But they are recommending that I get a CPAP anyway and told me to continue to use it and I should slowly work up to where it will be helpful. Does this make sense? I never saw a sleep doctor just a therapist.

SelfSeeker · Post by **SelfSeeker** » Sat Sep 30, 2006 6:29 am

Hello jshuler,

What does the HS stand for in OSAHS?

From what I understand a Dr has to write the script for a CPAP, if you did not see a doctor who would write the script?

I do not know about your data to comment.

jshuler43 wrote:I was just diagnosed with OSAHS with Significant Hypoxemia 77% and a low heart rate of 26. When I went back for the test with the CPAP I was told it wasn't a good test because I only was able to sleep for about 4 1/2 hours and didn't get any significant REM sleep. They said I only went up to a 6. But they are recommending that I get a CPAP anyway and told me to continue to use it and I should slowly work up to where it will be helpful. Does this make sense? I never saw a sleep doctor just a therapist.

ozij · Post by **ozij** » Sat Sep 30, 2006 7:01 am

Osbtructive Sleep Apnea Hypopnea Syndrome.

jshuler43, with those results you must be feeling terrible, and your health is
being harmed every night too. It makes a lot of sense for you to be:

1. Starting with cpap immediately and not waiting for another titration study
2. Finding out the proper pressure in you own bed at home as you go along.

Many of us have been doing this "self titration" procedure, and research has shown people can do it.
http://www.sleep-solutions.com/clinical ... n_CPAP.pdf

You'll find some people here positively hysterical at the fact that the pressure you were give is "only" 6. Disregard that. There are people who need lower pressures, others who need higher pressures. Start out at 6, build up gradually to more if you find it necessary. For some of us its almost like weight lifting: even if you aim is high, you have to start out at something lower.

The major question is what kind of equipment you have. Some machines have the capacity to report breathing disturbances, thus making self-titration easier. Others don't.

Give us all your equipment details (machine, mask,humidifier) and we might be able to help.

Ask as much as you need to - its your life we're talking about.

Good luck and welcome to the forum.

O.

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, CPAP, Hypopnea

sleepyinsunnyvale · Post by **sleepyinsunnyvale** » Sat Sep 30, 2006 8:43 am

By way of clarification. I had an initial sleep study done in Nov 2000. I went to the ENT because my snoring was peeling the paint off the walls and my wife was threatening me with great bodily harm. She actually suspected I had OSA but I had no other symptoms. No daytime sleepiness, BMI = 26, etc. I went to the ENT for a referral for Somnoplasty. He didn't think I was a candidate and neither did the sleep doc he referred me to.
The study showed AHI of 38 with O2 desat down to about 80% as I remember.
At the time I knew nothing about OSA so when the sleep doc Rx'd an APAP and the DME gave me a half hour of instruction I thought that was normal.
I had no problem with treatment. Compliance 100% with an occasional mask removal during the night at the beginning. Snoring stopped immediately.
About a year later I became aware of the SW (Respironics) and started to monitor my results. AHI <2.5. Pressure <6 with ave 4.8. I keep thinking maybe I should have another sleep study done. Maybe some day I will.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): DME, AHI, APAP

jshuler43 · Post by **jshuler43** » Sat Sep 30, 2006 9:46 am

ozij wrote:
The major question is what kind of equipment you have. Some machines have the capacity to report breathing disturbances, thus making self-titration easier. Others don't.

Give us all your equipment details (machine, mask,humidifier) and we might be able to help.

Ask as much as you need to - its your life we're talking about.

Good luck and welcome to the forum.

O.

_________________

Thanks for the post with all the helpful advise! Yes, I do feel pretty bad! I haven't ordered my equipment yet. After reading a lot of the posts I think I will get the RemStar Auto C-Flex as many have this and seem happy with it. I figure I can get a lot of support from this board if I have any problems. This machine seems to do most everything. Do you know if it does the self-titration? Frankly, all the terms are still pretty foreign to me. I am ordering the heated humidifier with it. As far as the mask, I'm not sure. My internist sent me for the sleep study and she wrote me an RX for the CPAP last week. My doctor is a dear, but is so busy I really didn't get any info except the RX. If I had not found this board I probably would have dismissed getting a CPAP out of hand. After reading so many people say how helpful their CPAP it, I knew I had to try.

ozij · Post by **ozij** » Sat Sep 30, 2006 10:31 am

Great that you have a script, and your thinking about the machine seems right to me.

Sorry for the jargon.

Titration, in cpap therapy, is the process of fiddling around with the pressure, adding a small amount of pressure at a time, observing the results, and deciding how to continue.

Any automatic machine can give you the info you need for self titration.

You don't need a script for a mask - so you are all set to buy and... try.

Mile High Sleeper, a member of this forum created this blog with lots of info for beginners. http://smart-sleep-apnea.blogspot.com/ including info about masks.

Masks are a very personal thing. I can tell you two things about masks and myself: The first time I saw a picture of a person using the Breeze I thought I would never, ever in my life use a nasal pillows mask (pillows masks have pillows straight in your nostrils)

I tried about three Comfort somethings nasal masks (nasals are masks that cover your nose, without entering your nostrils), and then was given a nasals pillows mask - the Swift that I couldn't stand, and then the Breeze -which - surprise surprise - I could sleep with, and grew to like.

And I now rarely use the Breeze, because I've got another favorite: The Aieomed Headrest, usually referred to on this forum as the Aura, it's original name. And that is also a nasal pillows mask.

Which is not to say that either of those is the best for you, just to tell you not to listen to your preconceptions (if you have any ).

And the Swift, which I couldn't stand is one of the perennial favorites of many others, actually better tolerated than the breeze.

Keep us posted.

O.

jshuler43 · Post by **jshuler43** » Sat Sep 30, 2006 11:19 am

ozij wrote: Mile High Sleeper, a member of this forum created this blog with lots of info for beginners. http://smart-sleep-apnea.blogspot.com/ including info about masks.

Masks are a very personal thing. I can tell you two things about masks and myself: The first time I saw a picture of a person using the Breeze I thought I would never, ever in my life use a nasal pillows mask (pillows masks have pillows straight in your nostrils)
I tried about three Comfort somethings nasal masks (nasals are masks that cover your nose, without entering your nostrils), and then was given a nasals pillows mask - the Swift that I couldn't stand, and then the Breeze -which - surprise surprise - I could sleep with, and grew to like.

Keep us posted.

O.

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Thanks for the link for beginners! It looks really helpful. Thanks also for your input on the masks. I can see that they are a very individual choice. I'm planning on buying my equipment from billyourinsurance.com but it would be nice to have a DME just to help with the masks. I told my doctor I had found the online site and asked her if she recommended anyone, but she didn't really say.

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