Advice on handling 20/16 pressure

[ejy2]

Hello everyone,

This is my first post on this forum. I was recently diagnosed with moderate sleep apnea at the Stanford Sleep Clinic (RDI 26). I just got outfitted with a VPAP 25 Auto and an Activa nasal mask.

After an overnight study, they found that they could not stop my respiratory problems even with bilevel 18/14 (altho my RDI reduced to about 6 at that level), so they prescribed 20/16.

I find the high pressures quite difficult to handle, mainly because I find it hard to fall asleep when I'm breathing in so hard. I feel like I am forced to inhale extremely deeply, which it agitates me a bit. It's not terribly painful, but I find it hard to relax enough to go to sleep.

I also sense that I breath through my mouth at times. I tried taping my mouth once, but noticed that my mouth occasionally fills with air like a balloon. I've been trying a head strap, but I must admit, all that layering (mask and headstrap) gets a bit painful.

I've only been at this for a week, so I likely have a lot to learn. I would welcome any tips and thoughts from the forum regarding how to overcome these problems, whether one gets used to the pressures over time, whether you can relate etc. Also, any stories about experiences with oral appliances would be welcome too. Thank you for your help.

[Bluebonnet_Gal]

Welcome!

My current pressure on the VPAP Auto 25 is 17/25, so I can relate. My biggest challenge is eliminating leaks at the high pressure. I didn't have a problem getting used to it, but I started with a ResMed Vantage Auto at lower pressures and worked my way up. Perhaps that is what you need to do to get used to the pressure?

I've found at the high pressure, I like the Activa best. I haven't tried taping, but I do use Poligrip strips. If the pressure gets to be too much or if I need to cough or open my mouth for some reason, it's fairly easy to do so, but the strips are just enough to help me keep it closed while I'm asleep. Many on here with mouth leaking problems find a full face mask works best for them. Didn't work well for me, but everyone is different.

I suggest you register, fill out your profile showing what equipment you have (text, not icons) so it's easy for everyone to tell at a glance what equipment you have.

Also, if you haen't done so already, check out the Where A CPAP Newbie Should Start - second thread from the top and the "Our Wisdom" "Lightbulb" at the top.

Come back here with any questions!

[ejy2]

Thanks so much, bluebonnet gal. I'll take your advice to heart and will fill out a profile soon.

[Gerryk]

EJY2 if your not already registered why not do that. You are going to be here with us for a while aren't you?
I am ay 21/17 was at 20/16 I found it hard at first and I used the ramp button. I have found that after using it for a while sometimes I don't need to ramp but that is if I am realy tired. I put my mask on begin to lay down while I hit the on button and I am asleep after a couple breaths if not I hit the ramp button.

Good luck.

[ejy2]

Thank you both. I've finally registered. It's nice to have such a supportive community here.

I will try the advice from both of you -- working my way through higher and higher pressures, as well as using the ramp.

I was wondering: does anyone have any thoughts on a good way to work through higher and higher pressures? Should I start at, for example, 10/6 or 13/9 or whatever feels decent, keeping doing it until I feel comfortable, then move upward?

Also, any advice on using my machine (Resmed VPAP 25 Auto Bilevel) in general and its diagnostic routines in particular would be great. I heard that some machines can almost act like a mini overnight sleep study. Is this true? Can I, for example, view detailed data on a PC? It would be nice if I could analyze my progress with various pressures. The information I can see right now on the machine itself seems very limited (altho I may be missing something) -- I can see info re leaks, AHI, but with no sense as to how I'm breathing, how long I'm in each stage of sleep, when exactly breathing/leak problems occurred, etc.

Thanks again for your help!

[Bluebonnet_Gal]

I'm not a medical professional, so I hate to recommend pressures for you. It might be best to first try the ramp. Also, talk to your physician or RT about the problems you're having with your pressure. They might recommend a lower starting pressure and steps to increase the pressure.

Here's an example of the info provided by the software with card reader. I have version 3.7:

http://www.box.net/shared/y87qj10rys

Hope this helps!

Gail

[GumbyCT]

Get your mask adjusted and sealed at the highest pressure you will use then either use ramp or learn to set your machine for a lower max. pressure. A search here for your machine will turn up the info you need.

Yes, in time your body will adjust to the higher pressure, then you can raise it.

You won't get the full benefit until you get up to your titrated pressure and you will see more info if you get the software and card reader.

Sorry, I don't have a Resmed so I can't help you more.
But yea spend some time reading as suggested - there is no learning pill for CPAP.

[ejy2]

Thanks for all of your comments. Bluebonnet, I noticed that you use the same machine (Resmed VPAP 25 Bilevel) as me, and your diagnostic sample from your software was impressive. I presume for me to reproduce that, I need the software and card reader. I checked cpap.com, and they only list a Resmed Smartcard Reader for S8 machines. Is that compatible with the Resmed VPAP 25?

Also, any thoughts or general comments on how useful or helpful these diagnostic programs are would be welcome. It'd be nice to hear those before I shell out the money. Thanks!

[Bluebonnet_Gal]

Yes, the card reader for the S8 will work. I find it very helpful to see the graphs. You can check the numbers on the display, and for some, that's all they need/want. For me, it really helps to see the graphs, to see when events happen, if they happen in clusters or are spread out through the night, see if the machine responded by going to a higher pressure, see if leaks correspond to events, etc.

A couple of forum members use something called Reslink. Apparently it's quite expensive but gives more info. I don't have it and doubt that I can afford it, so I haven't checked into it too much, but if you're interested, just search the forum for "reslink". Some have a usb attachment that attaches the machine directly to your computer rather than a card reader. I don't know if this provides more information or if it just enables transfer of more than 2 days detail data. For me, the card reader is only storing 2 days of detail data. So far, that's not an issue for me as I download to my computer and view my results daily. At some point when I'm satisfied that I've tweaked to a level where I can't improve my therapy anymore, I may not download daily. I don't know if the absence of every day's detail data will be a problem or not.

Hope this helps. Also, check your PMs.

[FoxNewsFan]

Ejy2,

You come across as an intelligent person who wants to spend the time and energy to get the best results possible out of your therapy. If I'm right, you're my kind of person.

You've gotten some good advice so far and if you keep asking questions, I'm sure you will get a lot more.

If you can possibly afford it, get the software. Each time you look at it you will gain a better understanding of what is going on and you will be able to constantly make adjustments. Go for the oximeter too, if you can.

My sleep study prescribed I 24, E 18. My doc prescribed a nasal mask. Totally screwed up. Thanks to many good people on this forum and my data, I am now down to I 11, and E 10 with a full face mask and 0 apneas. I have so much energy, I'm like a wind up bunny. One yr. ago I was taking 3-5 short naps a day and was still tired.

I'm hoping you can get great results also.

Take care,

Ed

(Bluebonnet gal, thanks for telling us about box.net I'm signing up today)

[FoxNewsFan]

A couple of forum members use something called Reslink. Apparently it's quite expensive but gives more info. .

FYI I paid less than $200 for my ResLink.

Ed

[Bluebonnet_Gal]

A couple of forum members use something called Reslink. Apparently it's quite expensive but gives more info. .

FYI I paid less than $200 for my ResLink.

Ed

Where did you get it? Any tips on how/where to get one at a price that's not too expensive?

[FoxNewsFan]

Gail,
PM me.
Ed

[ejy2]

FoxNewsFan, Bluebonnet, and others, thank you for your kind comments, I really appreciate them. I'm also going to post another thread, describing my sleep disorder in a bit more detail; hopefully I can gather stories from people with similar difficulties and learn from their experiences.

[ejy2]

Well, I've been working with my 20/16 pressure for a couple days now. It seems to be getting easier to handle the high pressure, altho I find that it's still somewhat difficult to get to sleep. Even when I do fall asleep, I wake up twice or so a night, and getting back to bed at that point is particularly difficult.

I am disappointed that I don't stay asleep when I finally fall asleep at 20/16. Isn't that the point of PAP therapy -- to crush the apneas so that you don't keep waking up? Unfortunately, I am waking up about 2-3 times a night. It does appear I am leaking somewhat (based on my machine readout), so it seems my chin strap may not be keeping my mouth shut. What's even more disappointing is that I feel at least as or more tired now than I did when I wasn't using PAP at all. Have other people had similar experiences? Does it just take time (I've been at this for about a week)?

FoxNewsFan, you were sharing about how you had an initial prescribed pressure similar to my own, and that you eventually found a much lower pressure and a different mask to do the trick. I'd be interested in hearing about the details of that journey. Perhaps I can draw lessons from your history. Thank you.