First night, lots of questions

zzzaoem · Post by **zzzaoem** » Sat Aug 19, 2006 7:33 am

Just had my first night (Resmed Autoset Spirit, Activa mask). Things did not go well. I had difficulty falling asleep. After I did, I woke up within an hour with a terribly dry mouth. I increased the humidity setting to 4, but soon wound up with a mask filled with water. Moreover, I found the higher humidity setting very uncomfortable. After a total of about 4 hours, I gave up for the night. Any advice on how to improve comfort?

Also, any advice on how to access stats? The only thing that I see is the number of hours that the machine was on (4), nothing on the pressure the APAP used, let alone AHI (I don't have software yet but the pressure should be accessible on the LCD).

My final worry here is that the settings just aren't right. I couldn't sleep during the titration study either (earlier diagnostic study went fine), so the doc prescribed APAP at the lowest range (4-8cm). When I woke up, the pressure seemed to be higher than early on.

Thanks!!!!

tomjax · Post by **tomjax** » Sat Aug 19, 2006 7:45 am

I am wondering how the doc determined that 4-8 was appropriate.

This is likely the problem and I hope others will help with this.

I would think 4/8 would be used as diagnostic, and not good at that

If it is eventually determined that a pressure of 12 is your 90 pct pressure, then your apnea will probably NEVER be controlled at this setting.

IMHO, a lower setting of 4 is totally inadequate for more than 95 pcxt of patients.
Your problem is your DOCTOR, not your machine.

IMHO, a setting of 4 should never be used beyond the first night when a realistic level can be determined and changed.

Sleepless in St. Louis · Post by **Sleepless in St. Louis** » Sat Aug 19, 2006 7:47 am

so the doc prescribed APAP at the lowest range (4-8cm). When I woke up, the pressure seemed to be higher than early on.

Man, those are some low pressure settings. Many people struggle with pressures that low often feeling like they are starving for air. Was that the case with you. Sounds like your doc was basically taking a shot in the dark about your pressures. If it were me, I'd work with him to increase them especially that low of 4. I would not be able to breathe at 4. For a beginner that had not been properly titrated I would think that you'd want to be a little less conservative on the pressures. Something more like 7-12? Let the auto do its thing but 4 is way low. You will probably find that finding the right mask for you will be the next big hurdle once you get your apap operating within the pressure range you need.

Knightfall · Post by **Knightfall** » Sat Aug 19, 2006 8:23 am

zzzaoem wrote:
Also, any advice on how to access stats? The only thing that I see is the number of hours that the machine was on (4), nothing on the pressure the APAP used, let alone AHI (I don't have software yet but the pressure should be accessible on the LCD).

While accessing stats shouldn't be your top priority at this point (dry mouth; maybe mouthbreathing?), eventually you will want to be able to access this data. You and I have similiar machines (mine is the Elite, straight CPAP). For me to access the "Results Menu", I press and hold the left and right buttons simultaneously for at least three seconds. This should bring up a message displaying "Efficacy Data". Hit "Enter" and you can scroll through your pressure, leak, ahi, ai and hi data. You can actually view data for the present day, week, month, last 6 months and year also. One thing I learned the hard way is at 12:00 noon everday the system resets to start a new sleep session. If you don't get your data by then (assuming you're strictly using the LCD), you will get a "No Data" message for that day.

If another member is more familiar with the Resmed APAPs, please feel free to correct any misinformation given here.
Best of luck, Ken

Guest · Post by **Guest** » Sat Aug 19, 2006 10:05 am

just as an aside, the feelings of suffocation or inablility to breathe are a lot of time purely subjective to the circumstances. the restrictive impression a mask and air blowing into your nose can be immense to a new user. scuba instuctors experience the same effects. Pleural pressure is usually measured in cm of H2O and flow is L/s (liters per second). In a young subject, pleural pressure tends to peak at about 16 cm H2O and a flow of about 4+L/s. As we age, those numbers can change to about 8 cm H2O and 2 L/s. remember, these are peaks. normal inspiration is much less.

zzzaoem · Post by **zzzaoem** » Sat Aug 19, 2006 12:02 pm

Thanks. I did not realize that the low pressure could contribute to my breathing problems. I am really worried that the mask keeps me awake AND that the machine doesn't really help when I am asleep given the low pressure. I was diagnosed with moderate apnea (25 episodes per hour) and am really motivated to do something about it. Is there a way to increase the range yourself or do you need a doctor to do this?

snoregirl · Post by **snoregirl** » Sat Aug 19, 2006 12:12 pm

I may be wrong but here is my opinion.

4 - 8 is barely enough for most people to breath. I can't tollerate anything less than 7.5.

You don't say if you had a sleep study or if your doc is just titrating you with the auto.

If you had a sleep study what is your pressure?, if not (and I personally don't have a problem with this approach) 4-8 is not a good place to start.

I would try 7-14 and maybe go up or down from there

You mention very dry mouth. I believe (though I have never used the Activa) that it is a nasal mask. You may have mouth leaks. I suggest tape and maybe even also some sort of chin strap. Doesn't need to be store bought chinstrap. I have been using for a month now an ace bandage gently stretched. Seems better than what I was doing with tying a panty hose leg around. I disliked the commercial chin straps. More secure and doesn't slip around.

Lots of info on this forum on taping procedures (turning under ends to be able to remove quickly) and controversy over possibility of vomiting with mouth taped shut.. But you can search and read all that.

See if you still have a dry mouth problem after eliminating mouth leaks then look further.

snoregirl · Post by **snoregirl** » Sat Aug 19, 2006 12:14 pm

I just saw your note. You are supposed to have a new prescription to change the range.

Doesn't mean you can't do it yourself physically.

I have Remstar soI don't kow how and can't help but if you search this forum you should be able to find some info, or someone might even post it here again.

snoregirl · Post by **snoregirl** » Sat Aug 19, 2006 12:18 pm

I just looked back and found this in a previous post maybe it will help if you try it

"I'm not familiar with the S6, but on the S8 you press and hold the "Down" and "Right" buttons simultaneously to get you into Clinicians Menu."

On my Remstar, you just scroll though the menus and change what you want, I would assume it is similar on the Resmed machines, but I can't be certain.

snoregirl · Post by **snoregirl** » Sat Aug 19, 2006 12:29 pm

I deleted this post since it was the wrong machine. Sorry

zzzaoem · Post by **zzzaoem** » Sat Aug 19, 2006 12:34 pm

Thanks. My first titration study failed as I got virtually no sleep, partially due to a REALLY bad sleep lab experience (they didn't even have a pillow!). Rescheduling takes at least 2 months here (I am at GW hospital in DC) and I don't want to wait for that. Perhaps I'll try to get the machine set at a slightly higher range tonight, see if that helps.

snoregirl · Post by **snoregirl** » Sat Aug 19, 2006 12:43 pm

I am just really curious. Your sleep test failed, yet you were given a machine. Not the usual, but in your case lucky. Maybe your doc did it because of the long 2 month wait??

Good luck

snoregirl · Post by **snoregirl** » Sat Aug 19, 2006 12:45 pm

Ignore that second LONG post I copied. It is for Remstar (even though I was searching for Resmed.

My mistake Sorry

zzzaoem · Post by **zzzaoem** » Sat Aug 19, 2006 1:02 pm

"I am just really curious. Your sleep test failed, yet you were given a machine. Not the usual, but in your case lucky. Maybe your doc did it because of the long 2 month wait?? "

I did a diagnostic study that went well (25 p.h. obstructive apneas). I had to wait two months for a titration study after that. When that failed, the doc gave me an APAP.

zzzaoem · Post by **zzzaoem** » Sun Aug 20, 2006 8:52 am

Setting the higher pressure (7-14) made breathing a lot easier. I still had trouble falling asleep and kept waking up shortly after I dozed off. While that may be a matter of getting used to sleeping with the mask on, more disconcerting is that my apnea seems not to be treated: AHI was 26.5 according to the data, which is pretty much where it was in my sleep study. Could mouth breathing be the reason here?

First night, lots of questions

First night, lots of questions

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Re: First night, lots of questions