Just got my diagnosis and machine, having some questions!

[Flex Plexico]

SYNOPSIS & DIAGNOSIS:

Some of you may recall I posted a thread about how I've been tired and having major health problems for months in this thread https://www.cpaptalk.com/viewtopic.php?t=173657 - I had done my sleep study and was minutes away from buying an APAP online out of my own pocket when the guidance of some helpful forum users convinced me to wait another two weeks for the results.

Well, yesterday I FINALLY received my results - AIH of 22.4, 27.3 during REM, and many hypopneas with some centrals that were determined to be benign. Oxygen desaturations were only down to 87% with no motion disturbance, but I did wake up a total of 16 times during 6 hours of sleeping (only one that I remember). I'm excited to be on the road to recovery because I have literally been debilitated to the point of not being able to work from the fatigue for months now.

FIRST NIGHT AND QUESTIONS:

They set me up with a Dreamstation APAP with an initial prescription of 6-12 and a Dreamwear mask with two types of nasal accessories to try (the one that is just flat with the single opening, and the type with two tubes that go directly into your nostrils. I do have some questions:

1) I had a pretty typical experience of someone that had a lot of trouble adjusting to the machine. The nasal accessories were irritating on the bottom of my nose (I did just recover from a sinus cold though), and I woke up after about 30 minutes feeling suffocated. I often felt like I was breathing through a straw. I tried the nasal accessory that has tubes going into your nose and that one was very noisy and felt like I wasn't able to get enough airflow (like breathing through a straw). The other one with just the slot in front allowed for more airflow, but still seems obstructive. When I try and breath through them without the Dreamwear attached, they do still seem to restrict my airflow.. would a triangle style nasal mask be better?

2) This one may be Dreamstation specific, but - I feel like when I am breathing in, the machine only gives me half a breath before it reduces the pressure for the exhale. Like, I will be breathing in and the machine will support me nicely with little resistance, but before I reach the top of my breath it will reduce the pressure and make me feel suffocated and I have to force the rest of the breath before exhale. I tried playing with the flex (Setting it to 3 and 1) but that behaviour still continues... I think this is my primary concern as I feel like I have to conform my breathing to the machine and it feels incredibly unnatural. Any Dreamstation experts have any ideas about how to adjust this? I also tried adjusting my base pressure to 7.5 which feels better, but still doesn't stop this from happening.

I only got about 1-2 hours of sleep last night, and it may be a placebo, but I am feeling more refreshed today. I can't wait to be able to do a full night with this thing. Thanks everyone for all your help

Paul

[Pugsy]

Did you try to use the ramp last night?
If you did...don't. The lower pressure during start of ramp could be a big factor in the "not getting enough air" feeling.

If you didn't...we can maybe come up with alternative to help you out depending on the answer to this question.
Also...what size of nasal cushion and/or pillow did you try to use?

[Flex Plexico]

Did you try to use the ramp last night?
If you did...don't. The lower pressure during start of ramp could be a big factor in the "not getting enough air" feeling.

If you didn't...we can maybe come up with alternative to help you out depending on the answer to this question.
Also...what size of nasal cushion and/or pillow did you try to use?

I didn't use the ramp as that made the feeling of suffocating worse. Honestly, the feeling of pressure doesn't bother me - I like it and it is extremely easy to breathe with the pressure. The problem is when the machine releases the pressure - I think it thinks I'm exhaling when i'm still inhaling. In terms of size, they measured my nose at the clinic - I'm not exactly sure. I think it may be the smaller size.

[Pugsy]

Sounds like more of a timing issue with the transition from inhale to exhale.

Play with the Flex exhale relief settings again...try them all ...even off. Pay special attention to how it matches your own natural breathing rhythm.
Do it while awake...under no stress to sleep. Try each setting for about 5 minutes if you can. There should be a Demo available to make it a quick change between the various settings. Don't forget to try it OFF...you might like it better.

I didn't like CFlex at all...just felt weird at all settings.
I found I liked AFlex at 2 the best. Pretty much matched my respiration rate to a tee. YMMV...everyone breathes differently.
With Respironics exhale relief the settings reflect more of a timing issue than an actual drop in pressure because it bases the actual drop more on the force of your own breathing.

If no settings are comfortable...and make sure you are using at least the setting of 6 cm when you try them because Flex doesn't engage at all if the pressure setting isn't at least 6...that's why I asked about ramp...ramp starts at 4 cm.
If no help...change the minimum pressure to 7 cm...and/or try a size larger in the cushion or pillow if you can.

Do your experiments while awake and under no stress to sleep. You need to be stress free so you can best evaluate how it feels.