2 day user, mask or machine issue?

My equipment is a REMstar Auto A-Flex and a ResMed Mirage Quattro which I've only been using for 2 days so far and have not had a complete nights sleep. The issue is hard to explain but it seems as if the pressure in the mask is not being regulated at times and the mask feels as if I'm sucking it in. This issue happens whether I have the machine ramp up or start on full pressure which for me is 19. When this happens I feel no leaks or any air "blow out" as the mask moves. I've readjusted the mask numerous times and sometimes it will happen right away and others it's a few minutes into use. It also does not seem to matter if I'm exhaling or breathing in.

My 24-72 hour follow up call was worthless as I explained to the therapist what was happening and got no information, probably due to it being past her time to get off on a Friday night. Since they are closed for the weekend I've been searching the internet for something that may explain my problem and have ended up here. I'm hoping another user has experienced this and can shed some light.

Thanks,
Mike

When you say it feels like pressure is not being regulated, do you mean it changes widely over short periods?

It would help so much if you had software and a card reader so we could see what's actually going on. The name you gave for your machine is very generic, not specific - and the actual model number, age of the machine, etc. would be helpful in finding out what software's available (lots of it here for free depending on your machine). If you use a humidifier, make sure to empty the water or detach it altogether, then turn the main machine over and see if there's more info, model #, etc. underneath. Your pressure setting of 19 is high for a 'regular' Cpap, and though you say it's an auto, are you sure it's not a Bipap? Is there a high setting as well, as there normally would be with an auto machine?

It says Philips Respironics and System One on the top of the machine. This is the bottom When I say the pressure isn't being regulated, I mean the mask tends to suck in towards my face like I have taken a huge breath which is more than the pressure being fed into the mask.

You have a model 560 machine.
The machine you have chosen in your profile is a 550 machine and humidifier.
This would be your correct equipment choices.
Machine....PR System One 60 Series Auto CPAP
Humidifier....PR System One 60 Series Heated tube humidifier with heated tube (even if you don't have the optional heated tube yet).
Don't forget to click on "submit" so that the changes will stick.

This machine is a full efficacy data collecting machine. You can use SleepyHead software or Encore software.
Send me a private message if you want Respironics Encore software and check out Jedimark's thread on the forum's main page for information about SleepyHead if you have Windows OS as a new version was just released.
There's also a Mac version available.

Are you using the Flex exhale relief? If so at what setting? If not...I would suggest playing with the various settings to see if one feels better than another. It might help...and won't hurt to try.

Once you get the software and the reports...let's see what's happening when you are experiencing the breathing difficulties.
How to post images of your reports so we can see what you are seeing is discussed here.
Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779

If your pressure is indeed 19 cm....you would likely do better with a BiPap machine as it has settings available that would make the pressure delivery more comfortable.

How come you are using a full face mask? Do you have significant nasal congestion issues that can't be cleared up so that you can breathe only through your nose?

Ok, what you need to do - and let us know if you need help doing it - is download SleepyHead (works with Macs too) from the link in small blue letters below the large note from Pugsy re SleepyHead at the top of the main forum page, then read thru her note about how it all works, and then post a graph of a night's results here using e.g. Photobucket and a link to that here (in this same thread please). If it's all too much, write again and tell us, but doing the above will give us info to work with.

Still don't know tho' if you're actually set up to use the auto mode, or just straight Cpap...??

Most of what you wrote could have been in Japanese as it makes no sense to me at this time. I have the equipment that the sleep place gave me. It was in a bag ready to go based on my sleep study results I assume. I am unsure why I have a full mask but am wanting to get rid of it. I am a nose breather so the full mask didn't make sense to me. I have not done anything with the settings of the machine. I will look into the software you referenced and try to figure it out.

They probably gave you a full face mask because of the high pressure needs.
There are some DMEs who think that people using pressures in the teens can't successfully use a nasal only mask.
That's an old wives tale. People use nasal pillows and nasal cushion masks all the time with pressures exceeding 20 cm....I see over 20 cm every night and never know it until I see the report.
It can be a bit of a challenge but it's not like a full face mask has no challenges..

Don't worry about not understanding what I said...keep reading and it will clear up.

I wanted to see the report so that I could have an idea what your pressure is actually doing and to find out which mode of operation you actually are using....straight cpap at 19 or auto adjusting up to 19 and figure out if you are having lots of pressure changes with it.

Flex relief
http://aflex.respironics.com/

It may not even be turned on and made available to you.
Give me a couple of minutes and I will send you a pdf copy of the clinical manual so that you can understand how to get into the clinical setup menu to check settings for your mode/pressure and even turn on AFlex.
So look for a private message from me shortly.

If you need different screens from SH let me know. I appreciate all the help so far.

Holy crap. Those are some ugly reports.

How was your sleep quality last night? Did you wake often? I see a couple of for certain breaks in therapy...any idea why?

Can you please show the leak line graph?
Also turn off the PieChart and that will let the upper statistics numbers come into view. Preferences ...forget which tab but you can remove the check mark from "show pie chart".
The calendar can also be hidden

Last nights sleep was horrendous I think. I'm exhausted today. First break was to use the bathroom and the short ones were me trying to get the mask to stop "sucking" in like I described. Finally got up and did some things for a bit and then laid back down.

Leak rate is well within acceptable limits for your mask at your pressure...so we can't blame leaks for less than optimal therapy.

I have a sneaking suspicion that you are going to need pressures in excess of 20 cm to deal with the obstructive component of your OSA (those OAs and hyponeas).
I don't know what to make of the Clear Airway events (centrals) as they seem to be reducing in numbers. Maybe those are related to awake/post arousal centrals.

When is your follow up scheduled for the sleep doc...not the DME?
You likely need a different machine that will go above 20cm.
You might consider making yourself a mask liner to see if it helps with whatever the mask is doing at those pressures that's waking you up and being annoying.

Do you know about mask liners? People who need high pressures (you aren't alone) swear by them.
You can buy them designed for multiple (months) use or make your own out of an old T shirt.

As to exactly what the mask is doing that is so annoying...I have no idea what it might be. I have never used a full face mask so I don't know how much "give" or inflating/deflating is normal. With using a fixed single pressure I wouldn't think there should not be much give though....I would think.
Perhaps other forum members who use a full face mask at these high pressures will have some sort of idea.
AFlex/CFlex exhale relief can cause a drop in pressure during exhale only up to 2 cm. I wouldn't think it would be that noticeable.
If you are using AFlex or CFlex you might try turning it off and see what happens.

I've never used a full face mask, but used a nasal mask for a short time. I think I know what you mean by it feeling like it's "sucking in" and I would say you might have the straps too tight so the cushions are not able to inflate.

Never heard of the problem with FF masks where it feels like the mask is being sucked in - no more than I've heard of it with any other mask... something else is going on, whether it's a pressure issue, a just plain 'wrong' mask for you, or other physical problems.

Thanks for all the comments. I'm going to try a different mask. I do not have a sleep doc, just my general practitioner and do not have a follow up appointment. If you are talking about the people who did my sleep study, again I do not have a follow up appointment. I'm not really sure who is in charge of this other than who sent in my script. I'll take a look at my data from last night later today to see how many events I had.

Okay. GP is managing the OSA.
Let's see what happens after a couple of more days/nights...the data seems to be improving a little.
Let's see what happens with a different mask.
With someone reporting lots of awakenings and fiddling with the mask it makes it difficult to figure out if a good bit of the ugliness on the reports are a from awake/semi awake stuff getting flagged by mistake.

Are you using the Flex exhale option? If so...at what setting? It's not showing on the images of your reports. Easier to just ask the question.

Can you normally breathe through your mouth just fine or do you have significant nasal congestion issues that you can't clear up so that you can easily breathe through your nose?
The reason I ask is that if you could use a nasal pillow mask you might have a little more/better OSA prevention at your current pressure because a lot of the time people using nasal pillows can get by with a little less pressure. In your case a backwards way to give you the more pressure you appear to need.

Don't let people tell you that you can't use nasal pillows at your pressure...people do it every day.
You need to be able to breathe through your nose though.