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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
RosPap
 
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Noob here: so how is this suppose to... feel?

Postby RosPap on Mon Dec 04, 2017 5:30 pm

I’m currently wearing the Wisp mask with the Phillips DreamMapper. The person who delivered the CPAP initially had me using a medium nose mask but I realized the first night that it was pinching my nostrils shut, so I moved up to the large mask.

At some positions, there is definite pressure and no air movement inside the mask. Exhaling out of my nose into the mask is difficult and tends to feel very suffocating — to the point where I sometimes have to release the mask to catch a proper breath.

Other times, when the mask is in a different position, the air inside the mask is “turbulent” (in a good way) and it feels like a small fan is running inside the mask and pushing air in and out of my nose.

Between these 2 sensations, what is suppose to be happening? Should I be aiming for that still, suffocating pressure or shift the mask into the more “turbulent” position?

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LSAT
 
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Re: Noob here: so how is this suppose to... feel?

Postby LSAT on Mon Dec 04, 2017 6:36 pm

What are your pressure settings?

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RosPap
 
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Re: Noob here: so how is this suppose to... feel?

Postby RosPap on Mon Dec 04, 2017 6:41 pm

Pressure setting are set to auto ramp. It starts off at 5 and goes up to 20.

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Re: Noob here: so how is this suppose to... feel?

Postby Pugsy on Mon Dec 04, 2017 7:39 pm

Exactly which model DreamStation machine are you using? DreamMapper is the name of the online software web site stuff that can be used to see the data gathered by the machine.
Sounds like the DreamStation Auto CPAP model DSX500xxx (the x's don't matter).

Do you know if you are using the Flex exhale relief and if so at what setting?....but I don't think even if it is turned on that it kicks in until your pressure is at least 6 cm.

How about we try to resolve the suffocation like feeling first and see what's left?

Can you try setting the machine to 6 cm...and turn Flex exhale relief on and set it to 2...and then see how things feel in general.
Do this while awake and not under the gun to try to get to sleep.

If you don't know how to get to the clinical menu area where you can set the pressures and turn Flex on or off go here and request the provider/clinical manual for your machine. Instruction for how to request the pdf of the manual is about 2/3 the way down the page.

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

Now there is a quick setup version available for quick viewing but I strongly suggest that you get the clinical manual as well because it has a lot of information in it that isn't included in the typical user manual.

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RosPap
 
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Re: Noob here: so how is this suppose to... feel?

Postby RosPap on Mon Dec 04, 2017 9:04 pm

You are indeed correct. The machine is Philips-Respironics DreamStation Auto CPAP

I just received the clinical manual (and turned on Mask Fit test that was previously turned off for some reason). I can’t seem to locate anything called “Flex Exhale Relief” — is it just called “Flex” perhaps? The Flex is currently set to
Flex: A-Flex (Options are: C-Flex, A-Flex, Off)
Flex: 2 (Options are: 1,2,3)

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Pugsy
 
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Re: Noob here: so how is this suppose to... feel?

Postby Pugsy on Tue Dec 05, 2017 5:55 am

Yes, the on screen menu simply says Flex...and that's the exhale relief.

When you use exhale relief it creates a small bilevel situation where there are 2 pressures and it can be more comfortable for some people.
Makes them able to breathe easier and less chance of the "suffocation" feeling. We won't suffocate at 4 or 5 cm but it can sure feel like it.
To be able to make use of the Flex relief though the machine has to be able to change between inhale and exhale a little.
At 5 cm there's no real room for change because the machine can only go down to 4 cm so Respironics won't even have Flex kick in until the machine is doing 6 cm.
By setting it at 6 cm starting pressure the machine can do 6 on inhale and 4 on exhale and move the air a little better so it can help with that suffocation feeling.

Give it a try...you might even want to try 6.5 and see how it feels to you.

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RosPap
 
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Re: Noob here: so how is this suppose to... feel?

Postby RosPap on Tue Dec 05, 2017 4:28 pm

Where am I making that 6.5 adjustment though? If it’s the Flex adjustment l, mine only shows options as 1,2 or 3

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Re: Noob here: so how is this suppose to... feel?

Postby Pugsy on Tue Dec 05, 2017 4:33 pm

Flex is only a 1, 2 or 3 choice.

The 6.5 is the minimum pressure.

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RosPap
 
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Re: Noob here: so how is this suppose to... feel?

Postby RosPap on Tue Dec 05, 2017 6:10 pm

Ah. I think I understand now. You are saying I should set the main minimum pressure on my machine to 6.5 so that Flex will kick on. This means that when I turn the machine on, it will start at 6.5 (instead of the default 5) and ramp up from there, correct?

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Re: Noob here: so how is this suppose to... feel?

Postby Julie on Tue Dec 05, 2017 6:14 pm

It will rise if events call for it to do so. The ramp and its settings is a separate feature to the prescribed pressure settings based on your testing/titration results. The ramp can be turned off altogether (which most of us seem to do early on unless our min. pressure setting's very high (and yours isn't).

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Re: Noob here: so how is this suppose to... feel?

Postby Pugsy on Tue Dec 05, 2017 8:19 pm

RosPap wrote:Ah. I think I understand now. You are saying I should set the main minimum pressure on my machine to 6.5 so that Flex will kick on. This means that when I turn the machine on, it will start at 6.5 (instead of the default 5) and ramp up from there, correct?


Correct.

It will start at 6.5 unless you happen to push the separate button for the ramp and if you do the machine will start at 4 cm and potentially that is too low for your comfort so I wouldn't push the button to engage the ramp. If you don't push it then it won't start.
Respironics machines have a separate ramp button that has to be pushed. If you were using a ResMed machine ramp would be in the clinical setup area and be turned off in that area.

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RosPap
 
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Re: Noob here: so how is this suppose to... feel?

Postby RosPap on Tue Dec 05, 2017 8:56 pm

I am likely confusing the definitions of all of this but I thought my machine does “ramp” up to 20 while I sleep?

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Re: Noob here: so how is this suppose to... feel?

Postby Pugsy on Tue Dec 05, 2017 9:08 pm

Yes, it will increase the pressure from the starting minimum as it senses the need.

The term ramp is really mainly for the predetermined time frame where the "ramp" starts at a lower pressure and the works up to the starting minimum pressure.

I prefer to keep "ramp" meaning that time at lower pressures prior to getting up to the minimum starting pressure
and not what happens from the starting pressure up to where the machine wants to go...like say it wanted to go to 10.
I prefer to say "increase" the pressure instead of "ramp up" the pressure when talking about what it does after the minimum pressure is being used.
Less confusing for people.

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Machine: AirSense™ 10 AutoSet™ For Her CPAP Machine with HumidAir™ Heated Humidifier
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RosPap
 
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Re: Noob here: so how is this suppose to... feel?

Postby RosPap on Tue Dec 05, 2017 9:19 pm

Ah. Ok. I sense you have a teaching background because this is all beginning to make more sense to me. :)

Given your definition, it seems that in the “true ramp”, as it works up to the minimum starting pressure, it won’t use the assistive Flex at all? That would explain why, when I press the ramp-icon button, the pressure is lower but I don’t find it necessarily easier to breathe.

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Re: Noob here: so how is this suppose to... feel?

Postby Julie on Tue Dec 05, 2017 9:35 pm

It's harder, because you're not getting the benefit of the 'full' setting, even if it's a low one. The ramp feature (as I call it) is something to gradually acclimate you to the air coming in - for some it can be at a high rate if their min. setting is high - until you reach your low/min. setting, and if that's low to begin with you will feel air-starved, which is why we so often recommend bumping the low setting by 1-2 cms if it's only at 4 or 5 and in fact many end up with that closer to 8 or 10 over time, ramp or no ramp.

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