Changed Settings. New comments and questions.

Thank you for your referral to this site for instructions on how to change my settings:

http://www.apneaboard.com/adjust-cpap-p ... tup-manual

A few comments: with DreamStation, menu has to be on "My Info". Then hold down the two buttons shown on the instructions for usually more than 5 seconds (sometimes 10) for the screen to change to clinical settings.



Ok. So I changed my bottom pressure from 5 to 6.5 because I felt I wasn't getting enough air when falling into deep sleep. This could be because I'm a shallow breather and snore. So would rising that bottom only help? Because I also feel as though exhalation is difficult. Is there a setting to ease that too?

Ramp is at 4.5. Flex is at 3. Tried it while awake just now and boy, one tiny mask leak and my mouth is blowing up and I feel the gas in my stomach. Feels like lungs are being pushed to new limits too a little bit. Not terribly uncomfortable, but is this right?

I'm ordering a size small mask today and will get some mask liners. Any thoughts about the above are welcome. Thanks.

Raising the maximum pressure won't help your exhale difficulties because the maximum is just somewhere you could go if the machine thought you needed it and you would have to be asleep for the machine to think you needed to go there. So it's where the machine could go but that doesn't mean that it will for sure go there.

Did you play with the Flex settings at all or just stick with the setting of 3?

Did you use the ramp to start with at 4.5 or use full starting pressure of 6.5?

Flex won't engage or kick in when you are using the ramp until you reach 6.0....so it is zero help initially if you are using the ramp.

Hi Pugsy,
I was swallowing so much air and getting gas-like feelings in my chest at 6.5 that I lowered it to 5.5. I'll try that or 6.0 tonight. I also ordered a smaller mask and need liners because at a higher pressure I feel leaks.

Should my cheeks be puffing out at the top of an inhale? It's doing that at even 5.5. I'm okay with it as long as it's not causing harm to ears or chest/stomach that I'm unaware of right now.

I have ramp at 4.5 and remember you saying it won't kick in unless at 6.0.
I'm playing with FLEX and have it at 2 right now. But what do you think of trying bipap for exhalation relief?
And what do you think of this comment someone made on the other site:

"One more note on pressure. Your machine allows you to enable OptiStart. This starts the pressure at the 90% pressure of your previous session. Obviously, this will likely be a much higher minimum pressure than you currently have selected, but the 90% pressure is widely considered the optimum "therapeutic pressure".

The new Philips machines have what is called SmarRamp that works with OptiStart to set the starting pressure in Auto mode to the minimum set pressure. So, try Optistart with SmartRamp, and you should get pretty good results. I have an older machine, so can't vouch for this, but it looks pretty good."

"

90% pressure may or may not be an "optimal pressure" when using cpap mode.
Sometimes it is and sometimes it isn't. I posted about this just in the last few days. When it is used it needs to be a long term average and not short term.

I don't know anything about the Smart Ramp thing on the new Respironics machines. Sorry.

The chipmunk cheek thing is because the air going up the nose and down the airway tries to exit the mouth instead of proceeding down the airway to hold it open. So the air enters the mouth and the lips are closed so the air can't do anything except cause the cheeks to expand or balloon out. Annoying but won't hurt you.
The trick to prevent this happening is to position the tongue so that the tongue blocks the air from ever entering the mouth in the first place.

If you can't exhale against pressures as low as 4 to 5 to 6 then you need to be talking to your doctor and making sure that some other lung issues aren't going on. Bilevel might help because there is an actual difference between inhale and exhale that can be set at the lower pressures which you can't really feel the difference now because your machine doesn't allow for any reduction until 6 cm.
Bilevel would also help with the tendency for the air to get into the gut (aerophagia).

Alternately...you might have done better with a ResMed machine because its EPR exhale relief feature works like a poor man's bilevel machine. Meaning you could set it to have 6 cm inhale and exhale of 4 cm and actually get the full 2 cm drop which should be a lot easier.

Pugsy wrote:Raising the maximum pressure won't help your exhale difficulties because the maximum is just somewhere you could go if the machine thought you needed it and you would have to be asleep for the machine to think you needed to go there. So it's where the machine could go but that doesn't mean that it will for sure go there.mp.

Just noticed this response, Pugsy...I am actually wondering if it will help to raise the minimum pressure - not the maximum. If anyone can answer that'd be great thx

(Again the issue is when I fall into shallow breathing/snoring I feel I'm not getting enough air during inhalations.

Then in the other end I feel I'm not exhaling enough either. Still wondering if that is what CPAP has to feel like. Thx

Pugsy wrote:90% pressure may or may not be an "optimal pressure" when using cpap mode.
Sometimes it is and sometimes it isn't. I posted about this just in the last few days. When it is used it needs to be a long term average and not short term.

I don't know anything about the Smart Ramp thing on the new Respironics machines. Sorry.

The chipmunk cheek thing is because the air going up the nose and down the airway tries to exit the mouth instead of proceeding down the airway to hold it open. So the air enters the mouth and the lips are closed so the air can't do anything except cause the cheeks to expand or balloon out. Annoying but won't hurt you.
The trick to prevent this happening is to position the tongue so that the tongue blocks the air from ever entering the mouth in the first place.

If you can't exhale against pressures as low as 4 to 5 to 6 then you need to be talking to your doctor and making sure that some other lung issues aren't going on. Bilevel might help because there is an actual difference between inhale and exhale that can be set at the lower pressures which you can't really feel the difference now because your machine doesn't allow for any reduction until 6 cm.
Bilevel would also help with the tendency for the air to get into the gut (aerophagia).

Alternately...you might have done better with a ResMed machine because its EPR exhale relief feature works like a poor man's bilevel machine. Meaning you could set it to have 6 cm inhale and exhale of 4 cm and actually get the full 2 cm drop which should be a lot easier.

Great thanks. So my machine has no way to set the exhale separate from the inhale? I'll ask on the other forum too

I'll ask doc about lungs and talk to him about exhale relief or other machines. That's if they ever call me back

I am having a hard time understanding if your issues are just difficulty in exhaling or if you are feeling air starved.
I thought you tried increasing the minimum a little but didn't do well with it.

Difficulty exhaling is not the same thing as being air starved and feeling like you are suffocating.
Sometimes people have a hard time distinguishing or explaining exactly what they are feeling.

It's common for people to feel air starved at lower pressures...both inhale and exhale can be difficult and not satisfying. While we won't/can't suffocate at those lower pressures (like 4 to 5) it sure feels like we are suffocating.

Difficulty exhaling is just a problem with exhaling against whatever pressure we are using but we don't feel air starved usually.

Maybe you are experiencing one or the other or maybe even a little of both.

Hopefullady wrote:So my machine has no way to set the exhale separate from the inhale?

No, not by separate settings. All you can do is utilize what reduction the Flex option offers but if you are using less than 6 cm at all then you aren't able to utilize that reduction for relief.
You need to at least set the machine to 6.0 cm and set Flex to 3 and not use the ramp and try 6 cm and see how it feels.

I have been unable to ascertain if you tried 6.0 with flex at 3 from what you have talked about.
I saw a maybe 6.5 trial that didn't work so great but don't know what Flex was used or how long you tried it.
And I saw some ramp time using less than 6 but Flex isn't able to help unless you use 6.
If you can't exhale using 6 and Flex then you need to be talking with the doctor if the issue is exhale only.
Being air starved is a different problem.

Pugsy wrote:I am having a hard time understanding if your issues are just difficulty in exhaling or if you are feeling air starved.
I thought you tried increasing the minimum a little but didn't do well with it.

Difficulty exhaling is not the same thing as being air starved and feeling like you are suffocating.
Sometimes people have a hard time distinguishing or explaining exactly what they are feeling.

It's common for people to feel air starved at lower pressures...both inhale and exhale can be difficult and not satisfying. While we won't/can't suffocate at those lower pressures (like 4 to 5) it sure feels like we are suffocating.

Difficulty exhaling is just a problem with exhaling against whatever pressure we are using but we don't feel air starved usually.

Maybe you are experiencing one or the other or maybe even a little of both.

Hopefullady wrote:So my machine has no way to set the exhale separate from the inhale?

No, not by separate settings. All you can do is utilize what reduction the Flex option offers but if you are using less than 6 cm at all then you aren't able to utilize that reduction for relief.
You need to at least set the machine to 6.0 cm and set Flex to 3 and not use the ramp and try 6 cm and see how it feels.

I have been unable to ascertain if you tried 6.0 with flex at 3 from what you have talked about.
I saw a maybe 6.5 trial that didn't work so great but don't know what Flex was used or how long you tried it.
And I saw some ramp time using less than 6 but Flex isn't able to help unless you use 6.
If you can't exhale using 6 and Flex then you need to be talking with the doctor if the issue is exhale only.
Being air starved is a different problem.

Ah. Got it. Sorry for my lack of understanding and frustration...I'm afraid I am very tired and I need to keep hearing things and was confused. Thanks for not giving up on me.

I'm having both problems - not enough air - and - need exhalation relief.

Ok. So what I've done is set machine at 6.0. Flex is at 3. SmartRamp is on. When you say I should turn the ramp off, do you mean SmartRamp? Other ramp features under "Comfort" menu are: Ramp Time (this is at :15) and Ramp Start (this is at 4.5).

Thank you!

When I say turn the ramp off I mean don't use it...not unless the settings on the ramp starting point are a lot higher.
Turn it off or don't push the ramp button if that is all you have to do to not turn the ramp on.
I know with the System One machines the ramp could be on in the menu but unless I actually pushed the ramp button it never would engage the ramp.
I don't know how Smart Ramp thing works but anything that lowers your pressure is going to make the air starved feeling worse.

So whatever it takes for any ramp to not be used...turned off in the menu or don't push the button.