Intro and Question

Hello! I've been lurking for a little over a month at this time, however I decided to finally post.

Several months ago I had a physical, which included blood work; the blood work came back showing that I had become a type 2 diabetic (just barely!) and that I had a severe vitamin D deficiency. Through hard work and exercise, I've lost 20lbs, stablized my blood sugar, and am no longer vitamin D deficient. Great! Right? However upon a check up on everything I had stated that I was still very tired despite everything, so a sleep study was scheduled. I had 27 episodes once I finally fell asleep; I realize that's not as high as many others however it still shocked me.

The evening of my study I was awoken and a cpap machine placed on me, as it is my practitioner's norm to put a patient on the cpap if they experience 20 or more episodes during their study. Afterwards, I slept.... too bad it was only a couple of hours before it was "over" and I had to go home. Long story short, shortly thereafter I was called and scheduled an appointment with the DME department for a cpap. After the appointment I walked out with a ResMed Airsense 10, and all the fixings if you will.

I have had my machine just over three weeks now, and my occurances are an average of less than one per hour. Great!! I think I've been very very lucky in this sense. That being said, it's now becoming a bit more difficult to breathe when I put my mask on. I have read that I should up my pressure (currently set at 4 with auto ramp ~9 - 14) however I'm at a loss as to how to do so. I've played and played with the machine and cannot figure out where to fix it. I'm sure I'm missing something...

Secondly, I've noticed that I'm having great issue falling asleep now. My mind races and races and races, and about nothing important or nonsensical. I'm not sure if I simply didn't notice so much before because of the difficulty I had staying asleep, or if this is new. I'm not a stressed person really, I have a great husband who's super supportive, my kids are amazing, work is great, etc. Melatonin, sleep teas, lavender, etc... I've tried it. I'm sleepy, but my mind prevents me from falling asleep. Is this normal once being acclimated to your machine, has it been like this all along but I was too sleepy to notice, or is this brand new and happening because I'm now getting sleep?

In any case, thanks for your help! I'll continue to read even if unable to respond terribly much.

This is a sleep hygiene issue and stems from you not developing the habit of:
I'm in bed,
I'm masked up,
I'm going to sleep.

It will help if you don't read in bed or do other intellectually stimulating things. Over time, this will pass as you become habituated to the use of the machine.
As to how to make the change in pressure, post a request for the Airsense Clinical manual and you'll get a pointer to get the manual and how to make the changes.

Just found this:

To access the Clinical Menu:
 Press and hold the dial and the Home button for three seconds.
The Home screen is displayed with an unlock icon in the top right corner of the screen.

Hi, and welcome.

The first thing I'll suggest as you seem to be doing alright in terms of using the machine/mask (vs freaking out, big time claustrophobia, etc) is to turn off the ramp feature. What's happening is that you're prolonging the time needed for the machine to reach your scripted pressure (from 4) and you're not being fully treated during that time. It would be one thing if you could not accept any pressure at all when starting out each night, if you were 80, etc... and had to use the ramp, but I don't think that's the case, plus 4 is the machine default low setting... not therapeutic in itself and very difficult to breathe at for most of us, but at least you can not make it worse by using the ramp and allowing the machine to jump to the pressure that will address your apneas as they occur rather than waiting for the ramp to be done with. Most of us stopped using it within the first week or so.

You might want to download read and save the manual for your machine. It explains how to go about changing those minimum settings and/or that auto ramp so that you are more comfortable breathing.
It's not unusual to have a bit of problem at those low settings. While we won't suffocate it sure can feel like it and add to your already busy brain issues.
While some people are okay with those 4 or 5 cm starting points...most people seem to do better with a little more air movement and to get that you may need 6 cm starting point for whatever ramp you want to use or maybe don't even use ramp at all.

https://sleep.tnet.com/home/files/resme ... -guide.pdf

Pugsy wrote:You might want to download read and save the manual for your machine. It explains how to go about changing those minimum settings and/or that auto ramp so that you are more comfortable breathing.
It's not unusual to have a bit of problem at those low settings. While we won't suffocate it sure can feel like it and add to your already busy brain issues.
While some people are okay with those 4 or 5 cm starting points...most people seem to do better with a little more air movement and to get that you may need 6 cm starting point for whatever ramp you want to use or maybe don't even use ramp at all.

https://sleep.tnet.com/home/files/resme ... -guide.pdf

Thanks for the link!! I must have had the 'dumbed down' version, as I read nothing about accessing the clinical menu. That would explain why I could not find a setting to change the starting pressure!

Many of us experience not being able to shut down or thoughts at night, life gets in our way.

What I do is not recommended, I have a t.v. series recorded so that it plays 8 hours, no commercials. I play that nonstop, over and over. Two problems, if it stops, I wake up.

Another thing I have used, I made a recording of nature sounds, rain, storms wind, looped, for years I worked nights and ran a noisy electric motor to make background noise. As the night wears on my ears plug up with XPAP use, I still wake up if the sound shuts down.

Try not to watch anything that will disturb you before bed, that's hard and it's difficult to shut out life. Congrats on your sensible adaptation to XPAP.

RAMP OFF! Training wheel not needed, just steer around the trees. Jim

Goofproof wrote:Many of us experience not being able to shut down or thoughts at night, life gets in our way.

What I do is not recommended, I have a t.v. series recorded so that it plays 8 hours, no commercials. I play that nonstop, over and over. Two problems, if it stops, I wake up.

Another thing I have used, I made a recording of nature sounds, rain, storms wind, looped, for years I worked nights and ran a noisy electric motor to make background noise. As the night wears on my ears plug up with XPAP use, I still wake up if the sound shuts down.

Try not to watch anything that will disturb you before bed, that's hard and it's difficult to shut out life. Congrats on your sensible adaptation to XPAP.

RAMP OFF! Training wheel not needed, just steer around the trees. Jim

Well put, sir.

I upped my pressure to start off at 5.8 last night, and it seemed helpful. I did something I never do, which is watch tv in bed... though I sat up with my mask on and machine running for an hour before laying down. I fell asleep a little faster than I have been, so I'll call that a success.

Thanks for everyone's kind words and suggestions! I would have had a solid 7hrs in if my big fat cat hadn't woken me up at 4am for food.... Lesson learned!

Kinda frustrated to hear turn the ramp off and training wheels. Well I use the auto ramp and love it. I personally have a problem falling asleep at my min pressure and IMHO this is exactly what the auto ramp is designed for.

Why would someone not use something that they find useful? Everyone here on plain old CPAP constant pressure? Some find it nice to have reduced pressure during exhale? Is this also training wheels?

"RAMP OFF! Training wheel not needed" seriously? I take it you have a standard CPAP machine and no humidity or anything else to add comfort using CPAP?
" turn off the ramp feature" "you're not being fully treated " My system starts to ramp in less than 15 minutes and is at full pressure 1.5 minutes later. Is this amount of time not at full pressure significant?
"It would be one thing if you could not accept any pressure at all when starting out each night" are we sure of this yet?
"not make it worse by using the ramp" Funny how a fully certified manufacturer thinks that this is just fine

I really don't understand where this type of advice is coming from. I honestly don't see the difference between this and telling someone not to use APAP or BPAP, just use CPAP and tough it out. When set up correctly, Auto ramp works just fine and can be useful and just because you personally don't like or use it does not mean that it is not therapeutic.

As I read the OP, I see nothing that would cause me to think they are suffering from the first 15 minutes (or any time) not at full pressure. Or that not being at full pressure is preventing them from falling asleep. They simply asked how to increase the pressure pre-ramp and not how to turn it off.

PoolQ wrote:"RAMP OFF! Training wheel not needed" ...
" turn off the ramp feature" "you're not being fully treated " ... I really don't understand where this type of advice is coming from. I honestly don't see the difference between this and telling someone not to use APAP or BPAP, just use CPAP and tough it out. When set up correctly, Auto ramp works just fine and can be useful and just because you personally don't like or use it does not mean that it is not therapeutic.

come back when you've got some more experience and tell us if you feel the same way, or if you too have ditched the training wheels.

apap, bilevel, both provide extra *TREATMENT* effectiveness. humidity can be for some a huge difference, ALL NIGHT LONG.

ramp does none of those things, it just gets you started, like training wheels, and, like training wheels, restricts your experience. training wheels keep you from doing anything other than wobbling along mostly upright, instead of going faster and leaning into turns. many auto machines won't react to apneas during ramp, so you're restricting your THERAPY.

like training wheels, MANY, if not most people decide, after they have some experience on the hose, that THEY don't need it. a select few continue to use it.

ranting against the prevailing advice doesn't help anybody, do what you like doing.

I didn't realize is was ranting, sorry. I did say I was kinda frustrated and that I really don't understand. I just copied and pasted what I did not understand. I did not add caps or punctuation.

" provide extra *TREATMENT* effectiveness. humidity can be for some a huge difference, ALL NIGHT LONG" of course, my point exactly. These are not treatment, but increase the probability that the patient will use the machine and therefore get the treatment they need. I see this as VERY valuable.

All three of these features, exhale relief, humidity, and start up pressure, came about the same way. The manufacturers saw that "some" number of patients were having issues using the machines because they were sensitive to specific conditions and so the manufacturer introduced these features to address them. None of them are therapeutic in themselves, but allow the patient to tolerate treatment more successfully. Any or all of these features will be helpful or unhelpful to some and not to others.

Auto ramp is just one more feature that is intended to address "some" patients that have a problem with falling asleep at the minimum pressure required for treatment. For the patient that has an issue with this, the auto ramp will offer a solution just as humidity does for others. Personally I turn humidity off as it is not an issue for me and I don't consider it "training wheels" for those that do find it important.

"training wheels" seems like a way to say that someone is being a child regarding their treatment. It belittles someone that finds a particular feature important for their treatment.

PoolQ wrote:All three of these features, exhale relief, humidity, and start up pressure, ... "training wheels" seems like a way to say that someone is being a child regarding their treatment. It belittles someone that finds a particular feature important for their treatment.

you're more than welcome to your opinion, no matter how many people share, or don't share it.

ramp is NOT a treatment enhancement, it's only in action for at most 45 minutes, (depending on machine and setting) and actually DELAYS treatment for that period.

if it helps you get to sleep, fine. use it.

and, like I said, after you've got some experience, revisit the issue and see if you've decided you don't need it anymore.

you're new to this, and you're arguing against what people with years of experience, have experienced. many new people like the ramp, especially if they're told "hey, use this".. many experienced people have decided that it's not worth bothering with, and they'd rather have active treatment right away.

what would you PREFER to call something that is primarily for beginners, since you find the prevailing label offensive. btw, you're the first person I remember railing against the term. maybe you should try to be a little less thin skinned? people are too damn easily offended these days.

palerider wrote:you're the first person I remember railing against the term.

I don't like the term either...never have. I just long ago decided it wasn't worth fighting over.
I also don't like it when people say that humidity has no therapy value and is just for "comfort"...well, hell, if I am not comfortable I sure as hell am not going to get good sleep and good sleep is paramount to good therapy...but that just my opinion.
I feel like it is a slap in the face and someone is saying that I am a baby because I need lots of moisture just because they don't happen to need the added moisture.
Now I know that is not what is likely meant...but it still feels like I have been talked down to...and we both know what that does to my mindset.

I understand that using ramp has its limitations and negative side but if it helps someone get to sleep who otherwise wouldn't get to sleep....who cares. Gotta get the sleep first.

So I don't like it either but given the way people are talking to each other now....I won't be railing for a change because it simply won't happen and I have no need to go pounding my head against that wall.
It is demeaning though and that's why I have never used the term "training wheels".
Seems like demeaning has become the new norm here and it makes me very sad that we make fun of people like that.

Okay, I give up. Uncle! I sure hope this post does not get labeled as arguing or railing against something from someone with no experience.

I was truly just trying to understand. The current accepted status must not be even questioned nor understood, just accept and come back in a couple years. Good one. Another brick in the wall.

"ramp is NOT a treatment enhancement" okay, please tell me how humidity increases the effectiveness of CPAP pressure which is the only treatment going on.
If you answer that humidity improves the ability of the patient to tolerate CPAP. I agree.
Now tell me how if auto ramp improves my ability to tolerate CPAP, that this is not treatment enhancement just because it happens right before the pressure ramps up?

This is my last try and then I have better things to do, as I am sure you do also. I am not saying that anyone should use any of these, I am saying that I see little difference behind the reason for any of these features being used; tolerance to using CPAP.

Pugsy: I just tried to post the above and saw that you had responded. Nice to hear from someone that "gets it". Quite simple really. Yep after this post I am giving up also. It's not just on this forum, it's everyplace, people have found the way it works for them and some tend to like to discount anything that is different, they have found the one and only way. It sure seems like our generation started out questioning everything and has ended up just like the last generation by discounting any and all questioning. Just seems sad to me, but perhaps just human and our parents weren't so bad after all.

Peace

Oh and by the way, there is nothing wrong with being comfortable while using a medical device suffering through medical treatment went out of style long ago.

PoolQ wrote:Okay, I give up. Uncle! I sure hope this post does not get labeled as arguing or railing against something from someone with no experience.

I was truly just trying to understand. The current accepted status must not be even questioned nor understood, just accept and come back in a couple years. Good one. Another brick in the wall.

"ramp is NOT a treatment enhancement" okay, please tell me how humidity increases the effectiveness of CPAP pressure which is the only treatment going on.

I never said not to use ramp, just that many people decide they don't need it after a while. I have said each time, use it if it helps you, and pointed out that you have very little experience in which to argue the long term effectiveness of the pre-treatment option.

it's completely different from humidity in that ramp is used before treatment, humidity is used DURING treatment.