100+ AHI and New to CPAP

Hi everyone, I've been perusing these boards for a while but now I'm getting around to posting because I've began my own therapy on a ResMed AutoSense 10 w/ a nasal mask. I'm just about done with my first week. I'm heavier set with a small windpipe so my AHI has consistently been over 100 and as high as 131 on average. According to many people I've spoken with thus far on this journey, this is insanely bad.

I could write a novel for you but the long story short is this has been a difficult therapy to adjust to. My sleep doc has the thing set at 20cm with a 14cm ramp up. I seem to tolerate 20cm fairly well when I'm actually asleep but if I wake up with the mask on suddenly for whatever reason the feeling is intense and most often times I end up throwing the mask off like I just woke up to an axe murderer in my room. I'm also experiencing aerophagia to some extent about every other night. Overall the entire experience has been one of love and hate because even for the relatively small amount of time I've managed to keep the mask on nightly(2-4 hrs) I have been feeling less drowsy during the day for it .

I'm posting now to ask if maybe I'm missing something about the therapy? Should I be doing something different? Or are these sorts of pains part of the adapting process with regards to the therapy?

Your description of your machine is confusing.
With your pressure needs and aerophagia, you should be using an AirCURVE machine,

In the sleep study I seemed to tolerate the mask and pressure fairly well so they just went with it. I haven't had a whole lot of choice in this entire process. They've just been handing me things and telling me to go with it lol.

Please specify exactly the model of your machine...Airsense 10 can be several models. It would say on the bottom right on the front of the machine.

Sorry I got the name mixed up. It's an AirSense 10 AutoSet w/ HumidAir

I agree with CF. At that pressure, your machine is maxed out all night long. An AirCurve 10, which has a max pressure of 25, would be better suited for your needs.

I think it's more likely the OP is a bit mixed up, it's more likely set to a range of 14-20.

I wish I was mixed up but it's true. I have ramp time set to auto and the ramp itself is set to 14 while the actual pressure setting is 20.

I can sleep through the 20 but the second I wake up, like I said earlier, the feeling is intense. I can believe I need a better machine, having looked at the AirCurve now but that thing is $1,800! Yikes!

You are (or are likely to be) mixed up re settings... With an auto machine there are two prescription pressure settings - the lowest (machine default actually) possible LOW setting would be 4, and the highest HIGH setting 20 (again, machine default high). Possibly the majority of us have the low set at somewhere from 6 (4 is just too hard to breathe at - not enough air coming thru) to 12 or so - and it is that LOW setting that really matters in terms of therapy - and the HIGH setting which is often just left at 20 or possibly in the high teens.

The Ramp, which most of us actually stop using altogether very early on, is a facilitator (not 'therapy' in itself) for those for whom turning on the machine at a relatively high LOW prescription setting (e.g. 6, 8, 12, as above) of something north of 10 or 15 is too much pressure to handle in one (relative) blast, so set the machine to 'ramp' up to the LOW pressure of e.g. 7, 11, 14) over an arbitrary period of 5 mins, 15 mins, etc. until it reaches our low pressure setting... during which time, of course, we're not fully treated and may feel the effects of that - as I said most don't bother with the ramp at all after a week! Does this help anything? Maybe draw a line on paper representing pressure settings - the lowest (or line beginning) called '4', and the end of the line '20'. Your prescription low setting is likely to be closer to 4 (though not necessarily) and the high left at 20 or somewhat lower. The ramp is a whole other thing entirely... doesn't enter onto the line of prescription settings but has its OWN settings and can be used or discarded altogether.

Rasz: I am also a fellow newbie. I have known I had an issue for years (due to scaring the you know what out of my girlfriends)...diagnosed via a home sleep study at the first of this month. I had around 85 AHI during the 3 night home sleep study. It was insane and the doctor literally called me in the day they got the results (versus waiting on the next appointment a few weeks away). I was immediately put on a CPAP...starting pressure of "6". After the first night my AHI dropped from 85 to 10. The nurse called me the next day to check on night one, and advised we move the start from 6 to 8. That immediately dropped my AHI another 5 points and since it's only lowered to where I am now under 1 every night.

I felt (and still feel) your pain concerning waking to the high pressures. I am going from 8 to around 15 at anytime in the evening...and waking up at 15 is a shock! I'm still having trouble keeping my mask on all night, so having some disruptive sleep for sure, but still, good quality sleep with the mask on.

So keep at it...I know in my mind, I just say take it day by day and don't stress about how much sleep you are getting, etc...it progressively seems to get better.

I will also say be sure you are comfortable with your mask. I started with a full mask and after 4 days moved to a nasal mask and it's been a blessing.

Good luck!

Thanks for the words of encouragement Lowspark, it seems we are in a somewhat similar situation.

I turned off the ramp on my machine to test the theory on this and it goes straight to 20cm and stays there. The pressure is somewhat tolerable but I find that when I'm falling asleep that my mouth is kind of "blown open" by the pressure. Perhaps a chin strap would remedy this? I'm not terribly psyched about adding even more headgear to the already pretty annoying bit I already have.

Any advice would help at this point in managing what is a pretty unfortunate first week on CPAP. The first night I managed 3.5 hrs, now I'm down to 2.5 per night and having a hard time falling asleep consistently. I need to master this somehow, whether it be via mask change, machine change or whatever needs to be done.