When I exhale my throat closes, is Cpap right for me?

golfcrazy · Post by **golfcrazy** » Tue Aug 28, 2007 3:00 am

Hi folks, I picked up my cpap machine yesterday for a 2 week trial. I have just had my first night with it and I dont feel what I hoped I would but I do understand this treatment takes a lot of tweaking. I firstly woke up after 4 hrs because I could either hear or feel the pressure, it was at 12.5 when I awoke (i'm using a REMstar auto with comfort gel mask) I turned off the machine , went for a drink and came back and tried again, this time the pressure started at 4 so I found I was able to get back to sleep. When I did wake up again 2 hrs later I noticed a slight headache and my throat really dry (cpap machine doesnt have humidifier yet) I'm 31 m and I was told I have severe apnea with 40 events per hour. What I'm wondering just after having experinced cpap is, my apneas seem to occur when I exhale as my throat just basically closes up, am I usuing the right treatment with cpap as I believe the pressure is only increased when i inhale and the machine has c flex? Do you think I might have to turn off or reduce c flex function and if so how do I do this?( I didnt get instructions as a 2 week trial) Any help appreciated!

mindy · Post by **mindy** » Tue Aug 28, 2007 3:51 am

Hi Golfcrazy,

Since you just picked up your rental machine yesterday, I would guess you're dealing with a DME. Asking your DME's respiratory therapist or your sleep doc would be a good start.

I'm no expert but can relate to feeling of throat feeling like it's closing on exhale: possibly pressure drop sensation? Mine disappeared after a couple of nights.

I've generally heard that it's best to avoid tweaking too soon or too often (unless bad effects) but I'm sure other more experienced "hoseheads" will chime in to help you with this. I'm just beginning to feel a bit better after almost 3 weeks. My first few nights were a bit rocky and I don't have severe apnea. I didn't sleep through the night until late in first week.

Good luck!
Mindy

MRH · Post by **MRH** » Tue Aug 28, 2007 7:16 am

Are you using a chin strap? I was using one and when it was hooked up farther back on my chin I had the same trouble, causing me to breathe thru my mouth when it happened. Now I use a full face mask so no more chin strap.

Mark

mindy · Post by **mindy** » Tue Aug 28, 2007 7:30 am

Ah yes, chin strap .... my sleep doc asked me if I woke up with a dry mouth and when I said "yes", she prescribed a chin strap. That was before I first started.

My C-flex was set at 2 and for me that's sufficient relief on exhale. You noted that your machine starts at a pressure of 4 ... that seems kinda low for severe sleep apnea. I've heard that they like to set the low pressure a little bit below your titrated pressure and then ramp start to a little below that. My ramp start is at 5.

Mindy

cflame1 · Post by **cflame1** » Tue Aug 28, 2007 8:13 am

Or maybe golfcrazy hasn't had a titration study... appears like that might be the case.

Guest · Post by **Guest** » Tue Aug 28, 2007 9:17 am

Yeah I've not had a titration study yet, this 2 week trial with auto cpap I guess is my study aswell, as the sleep clinic will look at the smart card on machine when i take it back. Thnx for everyones advice. Yeah 4 does feel low for me to start with, when i last woke up the pressure was at 15. When i woke up after the first 4 hrs of use then went back on it it started at 4 again? I guess as its an auto maybe that is what start pressure they set me as, although I do feel more comfortable when the pressure is higher as I felt I was getting decent sleep.

AdmiralCougar · Post by **AdmiralCougar** » Tue Aug 28, 2007 4:52 pm

Golfcrazy. Don't have anything to add, but I hope that you find a setup that will be compatible with you fairly quickly

Christy

cflame1 · Post by **cflame1** » Tue Aug 28, 2007 4:57 pm

golfcrazy... your minimum is probably set to 4... that means that when you either shut off the machine or press the ramp button it's going to start at 4 again (provided that is where your ramp is setup if it's setup at all, if it's not setup it'll start at your minimum).

Goofproof · Post by **Goofproof** » Tue Aug 28, 2007 5:30 pm

It sounds like two problems with the same cause:

1. The DME has your machine set for failure mode 4cm to 20 cm.

2. You are a mouthbreather, and they gave you a nasal mask instead of a FF mask.

It's usually three strikes you are out, but in the case of a DME, two strikes are enough to put you out.

Unless the DME also used a ramp of 4 cm, if so he covered all three bases, and got everything wrong.

mindy · Post by **mindy** » Tue Aug 28, 2007 7:10 pm

Golfcrazy,

A few more thoughts .... if you didn't have a sleep study, how do they know you are having 40 events per hour? Or did you have a sleep study but no pressure titration?

I've read about some docs that are using the A-flex machines in order to titrate pressure. IMHO, if they do that, they should tell you to call/come in to have the pressure range checked/adjusted after the first few days or a week so they can start narrowing in on the range. I've heard of problems with a too-wide pressure range.

Mindy

golfcrazy · Post by **golfcrazy** » Wed Aug 29, 2007 7:05 am

Thnx again guys and gals for your help. I did have 2 sleep studys but no pressure titration. I believe the machine minimum is set to 4 and maximum 20 as last night I was wakened by a mask leak and the pressure was 20. Also I've been pretty stupid as I realised that the filter cap was still on at the back of the machine! I take it this should be removed so that its just the foam showing? I was never told to remove this at the sleep centre Anyway when i removed this and tried to get to sleep I think the machine worked alot better. Would I be right in thinking that with the filter cap off the machine could deliver the pressure needed to me without possibly going as high as 20? I'm still pretty tired as did not sleep well at all last 2 nights but up for the challenge again 2nite!

mindy · Post by **mindy** » Wed Aug 29, 2007 7:35 am

Golfcrazy,

Sorry to hear you are having trouble. Hang in there ... it takes time to "get it right".

I don't know what would happen if filter cover was on.

The machine is set at the factory for the maximum range (4 - 20) but the sleep docs usually specify a smaller range to be set in the machine (i.e. mine is 7-12 with ramp starting at 5) - I have mild sleep apnea.

If I had to *guess*, in order to use the machine to titrate , the range probably needs to be set wider than usual. However, in my strictly amateur opinion, if you've got severe sleep apnea, a somewhat higher starting point might work better.

Can you get in to have them read the card and see what's happening?

Mindy

ozij · Post by **ozij** » Wed Aug 29, 2007 10:21 am

mindy wrote:Golfcrazy,

Sorry to hear you are having trouble. Hang in there ... it takes time to "get it right".

I don't know what would happen if filter cover was on.

The machine is set at the factory for the maximum range (4 - 20) but the sleep docs usually specify a smaller range to be set in the machine (i.e. mine is 7-12 with ramp starting at 5) - I have mild sleep apnea.

If I had to *guess*, in order to use the machine to titrate , the range probably needs to be set wider than usual. However, in my strictly amateur opinion, if you've got severe sleep apnea, a somewhat higher starting point might work better.

Can you get in to have them read the card and see what's happening?

Mindy

The number of apneas per hour, and the amount of pressure needed to keep the airway open don't necessarily go together - the severity is defined by the number of apneas per hour - our well know apnea index.

I guess they started you on 4-20 to get an indication of what to narrow the range to. When I had an auto for home titration they started at 4-16 (they new I didn't need higher) and a week later narrowed in to about 6, then 7.5 (on a PB). 7.5 was too much for me at the beginning, and my RX says 4-8. I raised from 4 when I got used to it (and saw the AHI drop concomitantly)/

O.

mindy · Post by **mindy** » Wed Aug 29, 2007 10:27 am

ozij wrote:
mindy wrote:Golfcrazy,

Sorry to hear you are having trouble. Hang in there ... it takes time to "get it right".

I don't know what would happen if filter cover was on.

The machine is set at the factory for the maximum range (4 - 20) but the sleep docs usually specify a smaller range to be set in the machine (i.e. mine is 7-12 with ramp starting at 5) - I have mild sleep apnea.

If I had to *guess*, in order to use the machine to titrate , the range probably needs to be set wider than usual. However, in my strictly amateur opinion, if you've got severe sleep apnea, a somewhat higher starting point might work better.

Can you get in to have them read the card and see what's happening?

Mindy
The number of apneas per hour, and the amount of pressure needed to keep the airway open don't necessarily go together - the severity is defined by the number of apneas per hour - our well know apnea index.

I guess they started you on 4-20 to get an indication of what to narrow the range to. When I had an auto for home titration they started at 4-16 (they new I didn't need higher) and a week later narrowed in to about 6, then 7.5 (on a PB). 7.5 was too much for me at the beginning, and my RX says 4-8. I raised from 4 when I got used to it (and saw the AHI drop concomitantly)/

O.