CPAP pressure and airflow timing

Hello, I'm newly diagnosed and have been prescribed a CPAP. I'm having a lot of trouble adapting to it.

When I start inhaling through my nose the airflow does not always increase fast enough. That makes the beginning of each breath difficult requiring more effort.

When I'm almost finished exhaling the pressure will suddenly increase. This makes exhaling more difficult at the end of each breath.

The result as far as I can tell is that each breath is shorter and less complete. Breathing while awake on this machine is challenging and very distracting.

This results in me having to "fight" the CPAP. Gradually after about 2 to 5 minutes I'll begin to feel out of breath and I have to turn off the machine or disconnect the mask to breathe through my mouth (mouth breathing is very uncomfortable with the machine on and connected).

Initially I only had a problem breathing out so my respiratory therapist lowered the pressure from 6 cm to help me adapt. When she did this she said that I'll probably need a bipap. A few attempts later I called and explained my current issue. She said that a bipap is for people who need higher pressure and would not be good for me. I've got an appointment with my specialist doctor on the 29th because she said that there was nothing she could do but raise and lower the pressure.

My questions are as follows:
Is my CPAP working correctly?
If so, are there any that might be better for my needs?
Is there anything I should be doing differently?
Have you encountered any problems like this before?

I'm using a Philips Respironics REMstar Auto A-Flex.

What is the full name and model of your machine? What mask are you using? What are your pressure settings? Do you use the ramp feature? Do you have any software? Without any of those, we'd love to help but have nothing to go on...

Nardella -- It sounds like you just need to make some adjustments to the comfort settings and possibly the pressure setting(s). At least for now it does not sound like you need a different machine, nor is there a reason to suspect your machine is malfunctioning.

We can help you troubleshoot but it would be most helpful if you register on the forum and post all your equipment info like most of us have in our signature boxes. To get the exact make and model of your machine, look for a label (on the blower unit not the humidifier) -- there should be a number like 550 or 560 and begin with DS or REF. Also, double check your pressure settings and let us know that info as well. When we have all this info we can start going through all the possible tweaks to make breathing with your machine feel more natural and comfortable.

I have a link below in my signature box to a short video tutorial on the RemStar machines (last video on the page). It shows how to access the clinical menu to see your pressure settings.

I have updated my signature with the information I could collect. Unfortunately I can't seem to find more detailed information. I am going to try to access the settings you spoke of but the link in your signature lead to a 404 page.

Nardella wrote:I have updated my signature with the information I could collect. Unfortunately I can't seem to find more detailed information. I am going to try to access the settings you spoke of but the link in your signature lead to a 404 page.

Whoa, that's unexpected! Let me see what I can find for you, not sure why it's a 404 page now.

Looks like the videos are being moved. I found your machine here: https://vimeo.com/41393273

Glad you registered. You have a good machine and it's fully data capable. This means you can use SleepyHead software (free to download) and we can take a close look at what is going on throughout the night with pressures, leaks, etc.

Re your discomfort breathing -- might be the A-flex settings need tweaking, and/or the min pressure might be too low for your comfort. Many people struggle with low pressure and end up increasing the min a bit.

Welcome to the forum.

Nardella guest wrote:When I start inhaling through my nose the airflow does not always increase fast enough. That makes the beginning of each breath difficult requiring more effort.

When I'm almost finished exhaling the pressure will suddenly increase. This makes exhaling more difficult at the end of each breath.

The result as far as I can tell is that each breath is shorter and less complete. Breathing while awake on this machine is challenging and very distracting.

This results in me having to "fight" the CPAP.

Nardella,

This is a very frequent problem for newbies. It's common when starting out to instinctively feel that there is a timing to the CPAP and a necessity to breathe in time with the machine. I had some problems with this at first.

But it is not the case that you have to breathe in time with the machine. The problem is that you are highly aware of your breathing and are concentrating on your breathing. You consciously control each breath. On the other hand, if you fall asleep, the autonomic system takes control of breathing and you are unaware of the pressure from the CPAP and you breathe normally and relaxed.

What to do until you fall asleep? Try to distract your mind from breathing. Think of some calm, pleasant activity that is a favorite of yours. For me it is imagining I am sitting in a beach chair under an umbrella with gentle surf before me and white sand around me while a gentle breeze blows the warm air.

Be confident that once you fall asleep your breathing will work fine with the CPAP.

Good luck,

I'm quite confident that once I fall asleep I will be fine, that's what the doctor said and it makes sense to me!

I just increased the flex setting from 2 to 3. That and the humidity is the only setting that I have access to. I wonder why my respiratory therapist didn't mention that setting when I consulted with them!

Nardella wrote:I'm quite confident that once I fall asleep I will be fine, that's what the doctor said and it makes sense to me!

I just increased the flex setting from 2 to 3. That and the humidity is the only setting that I have access to. I wonder why my respiratory therapist didn't mention that setting when I consulted with them!

You have access to all the settings on your machine. I just watched the video tutorial for the 60 Series machines (yours) and to learn how to get to the clinical menu (where pressure and other settings are), they refer you to their earlier video on the 50 series because the navigation is the same: https://vimeo.com/24175022

Even if you don't feel inclined to change anything in the clinical menu at this time, it's always good to be familiar with where everything is.

I misunderstood how to get to the clinical settings, my rt said that they were locked (appears that she was lying when she said that).

Anyway I've been using the following settings:
Mode auto
Auto max 16
Auto min 4
Opti start off
Flex type a-flex
A-flex 2
Tubing type 15
System one resistance 0

ChicagoGranny wrote: This is a very frequent problem for newbies. It's common when starting out to instinctively feel that there is a timing to the CPAP and a necessity to breathe in time with the machine. I had some problems with this at first.

I feel like I'm not being understood. I'm unable to make my breathing automatic because before that can happen the machine changes the airflow at the wrong time in my breathing cycle.

Nardella wrote:I misunderstood how to get to the clinical settings, my rt said that they were locked (appears that she was lying when she said that).

Anyway I've been using the following settings:
Mode auto
Auto max 16
Auto min 4
Opti start off
Flex type a-flex
A-flex 2
Tubing type 15
System one resistance 0

Yep, she was lying. Happens every day and all the time.

Almost everyone feels very uncomfortable with a Min of 4 -- just feels like not enough air coming in. That low Min also means your machine has a long way to go to reach the Max pressure of 16 when it needs to. And during that time obstructive events can slip through the defenses.

If you have a little rebel in you you could try some awake breathing with the min pressure set to say, 6 and varying the flex settings to see what suits you best. You say you've mostly been awake while using the machine -- the machine always starts at the min pressure and generally stays there as long as you're awake because you don't need more pressure until you're asleep and having obstructed breathing. So what you're really struggling with is breathing at a pressure of 4. Very common.

Then, if/when you find a min pressure and a flex setting that you're comfortable with, consider turning off Ramp (if it's on) and just start out the night with the settings you found worked best for you. Leave the max pressure alone for now.

Nardella wrote:I feel like I'm not being understood. I'm unable to make my breathing automatic because before that can happen the machine changes the airflow at the wrong time in my breathing cycle.

You posted this while I was typing my previous post. I think you are actually dealing with two challenges: First, your current A-flex setting isn't feeling right to you -- the timing of the inhale-exhale transitions are not compatible with your own breathing rhythm. You may feel better with A-flex at 1 or even turned off altogether. The less you feel the A-flex kicking in, the easier it will be for you.

Second, I believe you are also having a problem because of the min pressure being so low. "Feel out of breath" is exactly how people describe trying to breathe at a min pressure of 4. I know you're attributing that feeling to the A-flex setting but I would not be at all surprised if the low min pressure is contributing to your difficulty.

This is a visual (on the cpap.com website) of what A-flex is doing in the transitions between inhale and exhale -- since you're sensitive to how it feels, you might want to reduce the setting or see what it feels like to turn it completely off.

A-Flex Easy Breathing Technology Visual Graph

kaiasgram wrote:You may feel better with A-flex at 1 or even turned off altogether. The less you feel the A-flex kicking in, the easier it will be for you.

Second, I believe you are also having a problem because of the min pressure being so low. "Feel out of breath" is exactly how people describe trying to breathe at a min pressure of 4. I know you're attributing that feeling to the A-flex setting but I would not be at all surprised if the low min pressure is contributing to your difficulty.

Agreed.

I don't like the A-Flex setting and kept it off when I was using a Respironics machine.