CPAP Altered - Causing sleepiness?

[Dormeus]

Yesterday, my RT altered my CPAP so that the pressure would "back off" a little when I exhale, and last night I had the worst night of sleep I had in a long time. Is that related? There is a lot of expertise here; has anyone had the same experience?

[Babette]

Sounds like your RT put you into Cflex or Aflex mode.

We need to know more information before we can help you diagnose this:

#1 - What is your machine name, model, style, etc?

#2 - What are your pressure settings?

#3 - Can you read off your LED screen to answer some of our questions?

#4 - Why did your RT adjust your machine this way? What problems were you having that prompted him/her to make this change.

If you can answer some of these, we can help you better. It also helps if you will actually register as a member of the forum, and fill in your equipment profile.

Good luck!
Barbara

[Dormeus]

Sounds like your RT put you into Cflex or Aflex mode.

We need to know more information before we can help you diagnose this:

#1 - What is your machine name, model, style, etc?

#2 - What are your pressure settings?

#3 - Can you read off your LED screen to answer some of our questions?

#4 - Why did your RT adjust your machine this way? What problems were you having that prompted him/her to make this change.

If you can answer some of these, we can help you better. It also helps if you will actually register as a member of the forum, and fill in your equipment profile.

Good luck!
Barbara

Thanks Barbara,

My pressure setting is 12, and I was having some trouble exhaling against the pressurized air, so my RT made the change. I am new to CPAP - 4 weeks - and I don't know what machine I have. When I get home tonight, I'll send in my CPAP information. BTW, how do I register as a member of the forum?

Dormeus

[Babette]

Hmmmm..... Well, depending on what setting they set the relief to, that could be a problem for you. It might take a few nights to adjust to the new setting, or you might need to re-adjust that setting.

You can register to be a member of the forum up at the top of the forum's main page. I think there's a link that says "Register" or "Log in" in the upper right hand corner. Or something like that. Being a member and logged in, I can't see that link.

Do write down everything you can figure out about your machine and let us know.

Cheers,
Barbara

[john_dozer]

It may be possible the change in behavior in your machine is triggering centrals. I know the first night I started at home, I had countless central events that passed in a couple of days.

Seems to me other people described problems when making significant changes. If there was a way you may want to ramp into the new settings in small increments.

[Dormeus]

John - What are 'Centrals"?

Dormeus

[Guest]

Centrals? Hmmmm....just please don't listen to some people on here who endorse patients changing their own pressure. Please don't listen to them.

[AuntieNae]

No, I do believe that they are trying to determine if the C-Flex or A-Flex or EPR has been turned on. These features provide relief upon exhale but do cause problems if not set correctly. My C-Flex was turned on at 3 and it was way too much - the only way we figured that out was I ASKED here and went back to my DME.

[ozij]

It is illegal for RT's to make pressure changes, unless instructed to do so by a doctor.
Therefore, either your RT was doing illegal things on your machine - or else s/he was changing a comfort feature that you too can control
On Respironics machine, C-Flex or A-Flex can be varied to give different kinds and levels of relief
On ResMed machines that feature is called EPR.

If your RT changed your pressure without a change in your Rx, I suggest you should report him/her ASAP to the doctor and to licensing authorities, since there is no knowing how much harm this irresponsible person has been causing other people by his illegal behavior which is contrary to all he/she was taught.

If you tell us what change he/she made, we will tell you how to change things back.
If you take care to track you own data, you can get info that will let the doctor and you know the effects changes have.
If your machine does not trach therapy effects, you really should get one that does.

I change the settings on my machine based on the data I have, which I track in a spreadsheet.

Welcome to the forum, and good luck
O.

[rested gal]

Dormeus, is your machine made by Respironics or by ResMed?

The full name of the machine will be written across the top of the machine.

If it's a ResMed machine with "EPR", I have a layperson's opinion about why sleep might be worse after exhalation relief is turned on (and the prescribed pressure is not raised) ....

viewtopic/t35923/viewtopic.php?p=310021#p310021

[Dormeus]

Thank you all for your help. I have a REMstar M series...

Dormeus

[ozij]

Which if the M series machines is it?
O.

[Dormeus]

Which if the M series machines is it?
O.

I don't know - I think I have a big learning curve ahead of me. I'm at work, battling a HUGE case of sleepiness, and feeling a bit desperate about keeping awake for the next 7 hours. I'll take a look at it when I get home, and email the info. I appreciate your help.

D.

[rested gal]

Since it's a Respironics machine set for a pressure of 12, it's most likely the M series Plus (maybe the Pro) and the DME turned on "C-Flex" for you. You can see the full name of the machine written on the top surface of the machine. Do please let us know what the full name is.

I like using C-Flex, but some people do not respond well to C-Flex.

C-Flex drops the pressure down some when you first start to exhale. C-Flex is designed to let the regular pressure come back in (in your case, the pressure of 12) before the person finishes exhaling. So, probably at the midpoint or near the end of breathing out, you might be feeling the pressure of 12 coming back at you. That can be disconcerting to some people and can cause them to start trying to get their breathing in synch with what the machine is doing. It can make the person try to start inhaling before they normally would...trying to match what the machine is doing.

You can never "get in synch" with C-Flex. You aren't supposed to. It will always bring the pressure back in when it senses the force of the exhalation is starting to dwindle. You aren't supposed to try to start inhaling just because you feel the machine pushing more air at you again, with C-Flex. You just have to ignore that feeling and breathe the way you want to...not the way the machine feels like it's doing.

For some people, the feeling of pressure coming back in before they've finished exhaling causes them to try to breathe faster and faster...trying to keep up with what the machine is doing. It's a race that can't be won because C-Flex will always let the pressure back in before the person starts to inhale. It's designed to do that so that the airway is being held well and truly open before the person is ready to take another breath. That keeps the airway from collapsing. If the airway collapsed with a sudden apnea (at the lower pressure C-Flex used) the person would not be able to inhale again.

Anyway, here's the problem some can experience if they (or their airway reflexes) can't relax enough to ignore what C-flex is doing and simply breathe normally. They might start breathing faster and faster... "breath stacking":
viewtopic/t808/viewtopic.php?p=4257#p4257

I'm not a doctor, but I'd suggest trying the various C-Flex settings to see which one feels better, smoother to you:

C-Flex 1 - gives just a little drop in pressure at the beginning of an exhalation.
C-Flex 2 - gives more drop.
C-Flex 3 - gives the most drop in pressure.

The user can adjust the degree of C-Flex to 1, 2, or 3.

If none of those let you breathe naturally,you might want to turn C-Flex off. To turn it completely off, you have to go into the "therapy setup" menu. To go into that menu (like the DME did, when she turned C-Flex on) you have to know how to access that "hidden" menu:
http://www.cpap-supply.com/Articles.asp?ID=130

Or, go back to the DME and tell her C-Flex is not getting the job done for you.
Perhaps she has a ResMed machine with EPR that she can let you try there in the office or for a night or two, to see if the way ResMed's EPR handles breathing out suits you better. EPR can have its own set of issues:
viewtopic/t35923/viewtopic.php?p=310021#p310021

I personally didn't much like EPR when I used it -- EPR doesn't have much "give" to it when you first start each exhalation. Felt like hitting a brick wall to me. EPR does its pressure drop for breathing out as the exhalation progresses. But EPR keeps the pressure down until the person starts to breathe in again (or until x number of seconds have gone by) so that might feel better to you.

Also ask the DME if she'll help you make a case with your doctor for "CPAP intolerance." Then the doctor might be willing to switch you from straight CPAP to a BILEVEL machine. A bilevel machine lets two separate pressures -- the lower exhaling pressure stays low until you start to inhale again -- can give the best pressure relief for exhaling.

Some insurance policies will not pay for a bilevel machine until the person has tried "CPAP" and has proven to be intolerant to it. Not being able to exhale well against the prescribed pressure should qualify as "intolerant to CPAP" and earn you a switch to a bilevel machine. To me, the most natural breathing feeling is with a true bilevel machine. Feels like breathing out into an empty hose almost.

Good luck, Dormeus!

[ozij]

The beginning of cpap therapy can be tough - take care on your drive home!
When you feel better, try to tell us what made the RT change your pressure in the first place (did something bother you?).

If you don't have a user's manual for your machine, you'll find them here:

M Series Auto
M Series Remstar

O.