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Even though I wasn't able to deal with the CPAP machine during my sleep study my doctor has apparently ordered me a CPAP machine. I'm going to try to get some wiggle to pick the device that I want, based on how hard it is for me to deal with exhalation resistance.

So what I'm wanting to know is.. Which device has the best exhalation relief? Most sensitive to exhalation, lowest pressure during exhalation, etc. Any information you have on the differences between the exhalation relief in different models would also be immensely valuable.

Most newer machines have some feature that will help, so once you accept that, you can concentrate on the other issues that matter - such as making sure you have a machine (and software) that gives you all the information you want to keep track of your own progress (and not just a doctor who reads the card every six months to see if you're compliant for the insurance co., plus that you do get an Apap vs plain Cpap (Apap's can be run in Cpap mode, but cpap's only do cpap). I'm sure others can tell you about the fine points of exhalation relief though...

It's much more important to get a machine that records full data.

Do not accept a Philips DS150 or Plus machine. Get a "PRO" or Auto model.

For ResMed, avoid Escape or Escape Auto. Get an S9 Elite or S9 AutoSet.

All of the recommended machines have exhale relief. I'm not sure there's a lot of difference in how well they work.

You'll probably find the pressure won't be a problem pretty quickly even without exhale relief. If you can't adjust to the pressure, bilevel machines provide even more exhale relief, but cost a lot more and usually require you to "qualify" by "failing" CPAP to get insurance coverage. BiPAP and VPAP are brand names for bilevel.

Don't let the doctor force you to buy the CPAP through his supplier buddy. You can buy from any DME you want to. Be sure to find out which DMEs are "in network" for your insurance. You often get more choice if you call up a DME and say "I'll switch my prescription to you if you sell me the model I want."

CraigDC wrote:So what I'm wanting to know is.. Which device has the best exhalation relief? Most sensitive to exhalation, lowest pressure during exhalation, etc. Any information you have on the differences between the exhalation relief in different models would also be immensely valuable.

Hi,

What is important to know is what your prescription is for, specifically, what pressure levels. As is mentioned above, most modern machines have FLEX or EPR (exhale pressure relief). These machines will drop the exhale pressure by up to 3 centimeters. So, if you are running at a pressure of 10, it will drop to 7 on exhale. Most folks fall in the 7 to 13 pressure range. Above 15, you will probably want a BiPAP machine rather than a CPAP or APAP. With BiPAP, you can get a much larger drop in exhale pressure, but it also depends on what pressures you need for treatment. For example, I run at a pressure of 20, but I have a 7 centimeter drop on exhale, so my exhale pressure is only 13.

When I first tried CPAP, I was blown away by the pressure. I thought it would be impossible, zero chance of using it. Once I got a BiPAP machine that was set up right, I could at least tolerate the system, but I was far from happy. Later, I got a nasal pillow mask. Within 10 days of starting on the nasal pillow mask, I could no longer even feel the pressure. In fact, I have to check my machine to make sure it is working because I have no sense of pressure at all. Other folks here have reported something similar.

Bottom line is that you first reaction might be kind of scary, but once you learn to trust the machine and get a little experience, you will probably adapt to the pressure. This is not to minimize what you felt during the study, but rather, to let you know that if you hang in there the first few days, it will get easier.

-john-

archangle wrote: You'll probably find the pressure won't be a problem pretty quickly even without exhale relief. If you can't adjust to the pressure, bilevel machines provide even more exhale relief, but cost a lot more and usually require you to "qualify" by "failing" CPAP to get insurance coverage. BiPAP and VPAP are brand names for bilevel.

I think its pretty safe to say that I "failed" the CPAP because I was unable to get to sleep at all with the panicky feelings the CPAP machine was giving me during my sleep study.

jweeks wrote:

CraigDC wrote: When I first tried CPAP, I was blown away by the pressure. I thought it would be impossible, zero chance of using it. Once I got a BiPAP machine that was set up right, I could at least tolerate the system, but I was far from happy. Later, I got a nasal pillow mask. Within 10 days of starting on the nasal pillow mask, I could no longer even feel the pressure. In fact, I have to check my machine to make sure it is working because I have no sense of pressure at all. Other folks here have reported something similar.

That is interesting. So using a nasal pillow mask instead of a full around the mouth mask made it easier for you to tolerate the pressure? Are you a mouth breather in any way, or use a chin strap to keep your mouth shut? When I tried the nasal masks it seemed the pressure would just blow out my mouth!

Craig, I am a mouth breather by day and at night I breathe through my nose. My nose is constricted and I have trouble getting enough air in when I am awake. I trained myself to breathe through my nose using a nose pillow mask by watching a lot of football on tv while using my machine. It took me a few weeks to accomplish. During that time I used my FF mask to sleep with while trying to only breathe through my nose. After a while I tried the nasal pillows at night and it was successful. The pressure from my machine helps me get enough air through my nose. Make sure you get one of the data capable machines mentioned in above posts. It is the only way to know how well your therapy is working.

deerhound wrote:Craig, I am a mouth breather by day and at night I breathe through my nose. My nose is constricted and I have trouble getting enough air in when I am awake. I trained myself to breathe through my nose using a nose pillow mask by watching a lot of football on tv while using my machine. It took me a few weeks to accomplish. During that time I used my FF mask to sleep with while trying to only breathe through my nose. After a while I tried the nasal pillows at night and it was successful. The pressure from my machine helps me get enough air through my nose. Make sure you get one of the data capable machines mentioned in above posts. It is the only way to know how well your therapy is working.

Do you find it easy to 'switch modes' between nose and mouth breathing? Do you use a chin strap to keep your mouth closed? Did you have any problems with the pressure just blowing out your mouth?

I think its pretty safe to say that I "failed" the CPAP because I was unable to get to sleep at all with the panicky feelings the CPAP machine was giving me during my sleep study.

You can't judge how you're going to do by one very stressful night in a very artificial environment of the sleep lab. You have the rest of your life to get used to CPAP, and it can be done. If, after trying very hard for a reasonable period of time, you still cannot, then it's time to consider other options.

Some people think they are mouth breathers because they have always had to open their mouth to get enough air in because of apnea. You may find that you do just fine breathing only through your nose, and if you have mild congestion, the right humidifier setting and pressure will actually help you breathe through the nose only.

You can start practicing right now as you read this. Plant your tongue on the roof of your mouth, right on that ridge behind the top teeth and keep it here every waking moment unless you are eating or talking. One or two days of conscious effort is enough to train your brain, and then you will probably be able to do it all night, too. Even if you have a full face mask this is helpful. If you allow yourself to breathe through your mouth in a full face mask, you are more likely to have aerophagia and experience a dry mouth and throat--both are very uncomfortable.

You may not need a chin strap, but if you do, they are available.

I don't use a chinstrap or any other aid. I just spent hours in the chair watching something on TV practicing nose breathing with my mask and machine. I has become second nature when I put on my mask. Funny thing, I hold my tongue to the top of my mouth just behind my front teeth to stop leaks into my mouth. I have been doing it so long now that floss goes between my two front teeth very easily now, whereas before they were too tight together to even get floss between them. I've got a small gap between them now. I must have pushed them out a little with my tongue.

Dale

Guest wrote:

archangle wrote: You'll probably find the pressure won't be a problem pretty quickly even without exhale relief. If you can't adjust to the pressure, bilevel machines provide even more exhale relief, but cost a lot more and usually require you to "qualify" by "failing" CPAP to get insurance coverage. BiPAP and VPAP are brand names for bilevel.

I think its pretty safe to say that I "failed" the CPAP because I was unable to get to sleep at all with the panicky feelings the CPAP machine was giving me during my sleep study.

I don't know if insurance will accept one night of not sleeping as "failing." They may take the stand that you have to try harder than that.

However, I don't know what they do in the case of a patient who can't sleep in the sleep test.

I wish all doctors would prescribe a sleeping pill for all sleep tests to be taken if the patient can't sleep, but most of them don't. I guess they want to be "pure" and not have results affected by medication, but without a pill, they may get data not affected by sleep.

archangle wrote:[
I don't know if insurance will accept one night of not sleeping as "failing." They may take the stand that you have to try harder than that.

It wasn't simply a problem of falling asleep; I can fall asleep almost anywhere. The problem was the panicky feeling of the CPAP made it impossible to sleep.

Turns out my doctor put in a script for 6 cm. I then talked to the DME he sent my script to and they said they won't give me a BiPAP or Auto CPAP because he only gave one level, so now I have to call him back and get him to change the script to a bilevel one.

Tedious.

CraigDC wrote:Turns out my doctor put in a script for 6 cm. I then talked to the DME he sent my script to and they said they won't give me a BiPAP or Auto CPAP because he only gave one level, so now I have to call him back and get him to change the script to a bilevel one.

Tedious.

Good for your doctor. Don't be afraid to shop around for a DME who will give you the machine you want. They CAN give you an auto CPAP with a manual CPAP prescription. They just have to set it manual pressure. The probably can't dispense a bilevel machine.

Whatever you get, be sure it's one of the data capable machines.

Be careful. The insurance may deny the claim because you don't have a sleep study showing an AHI of 5, even though the doctor wrote a prescription.

I've been doing this for about 2 months now. I have had three machines in that timeframe.

My insurance company rents for the first three months so that made switching machines in the first few months a lot easier. I made sure each machine I got had full data so I could track what was going on in Sleepyhead software. I communicated what was happening in my therapy with my doc and she had the DME get me the machine I asked for each time. I did use her preferred DME and they will do just about anything she asks to keep her happy.

My machines were:
Respironics PR System One Pro with AutoIQ (the fixed pressure didn't fix all my problems)
Respironics PR System One Auto (this one irritated my airway)
Resmed S9 Autoset (this one is working great and much quieter than the Respironics)

All my machines felt about the same when it came to pressure relief for exhale. I am finding that I want less pressure relief the longer I am on therapy. My initial pressure was 8 and now I am running a 95% pressure between 9.5 and 10.5 depending on the night with my auto.

The therapist at the DME listened to me and given my horrible experience with the mask and pressure during my sleep study, she recommended the Swift FX Nasal Pillow. It made a HUGE difference. I was concerned because I thought I was a mouth breather because I have problems breathing through my nose, but this mask made it easy to breathe. This mask made therapy feel completely different from what I experienced in my study. My sleep study was ended two hours early because I wasn't sleeping with the mask on and I took the mask off several times to breathe.

I thought I had to have the best machine right up front and was upset when I didn't get it, but it actually helped me learn more about my therapy and get better therapy. I'm sure the DME thinks I'm a pain in the butt, but I'm the patient. Now, I have the machine I need with the settings that are making therapy much more effective and comfortable.

When my rental period is up, i'll be buying this machine.

Just thought I would share my experience, since my sleep study was troublesome like yours.

Mike