New to CPAP with questions

bigt4187 · Post by **bigt4187** » Sat May 10, 2008 8:36 am

Hello everyone. First a little history ….

I have had one sleep study and a follow up with my doctor. I have “moderate” sleep apnea. My doctor prescribed CPAP as therapy. Yesterday I picked up my CPAP machine and nasal pillow mask (see my profile, although my machine is a REMStar Plus with C-Flex. This site didn’t have that machine as an option). Since at my first sleep study the technician didn’t use a CPAP device on me, my doctor estimated my machine setting at 10 until I can get another sleep study to determine the exact setting I need. The earliest I can get in for the second sleep study is June 17th.

Now on to my problem .....

Last night I set up the machine and humidifier and put on my mask and started it up. My machine has a “ramp” setting which starts the machine at a lower setting (4 I think) and then gradually ramps up to my setting. I ran into one problem. It felt like I couldn’t exhale as the air was being pumped into my nose. This forced me to open my mouth to try and exhale and take some deep breaths. It felt like I was fighting the machine. I could not get to sleep. I tried for about 2.5 hours before I finally took the mask off. I know that wasn’t a good thing to do, but I was frustrated.

This morning I did some research on my machine. When I picked up the machine yesterday, the therapist told me that the C-Flex would allow me to exhale easier than a machine without C-Flex. This morning I downloaded the user manual for the machine. According to the manual there are three different levels of C-Flex. My machine was set on the default of setting “1” which is the most pressure. I lowered it to “3” which is the least pressure. I put my mask on and tried it and it was a lot easier to exhale. My fear is that by changing the setting I won’t be getting the full effect of treatment. Does anyone have any thoughts on that?

I will be giving the machine another shot tonight, and pledge to stick with it. I also will be calling my therapist to request a face mask that covers my mouth as well as my nose. I think I am a “mouth breather”.

Any suggestions or advice would be greatly appreciated. I hope to check this forum regularly for advice as well as one day offer my suggestions for new users.

Thanks,
Tony

thimarine · Post by **thimarine** » Sat May 10, 2008 8:50 am

Welcome to the forum and to cpap. This is a great place to get answers.

As to C-Flex, it is a matter of personal comfort. I set mine at 2. That is where I am most comfortable. I personally never use the remp as I don't get enough air at 4 cm. I set my machine at 2 cm's lower than what my avg. 90% pressure is. That way, when the machine senses an event it doesn't have to go from 4 or whatever your lowest setting is, to what you need. In my case, around 11. I set my lowest pressure at 9 and have had great success. C-Flex is designed to help upon exhalation. Experiment with the different levels until you feel the most comfortable.

For what it's worth, many people don't even last an hour the first night of cpap. I only made it for 1/2 hour my first night. Also, mask choice is important to proper therapy. Chin straps are an option with nasal pillows but ineffective for me. I am a mouth taper. Information on taping can be found under the collective wisdom section of this forum. Just click on the yellow light bulb. It's a good place to start.

I wish you luck. There are many good people on this forum. Don't be afraid to ask questions.

yardbird · Post by **yardbird** » Sat May 10, 2008 9:00 am

Changing the c-flex won't hurt your therapy. Getting used to exhaling against pressure can be a bit odd and can take a little while. I know last night was frustrating for you, but believe me when I tell you that you really do get used to the mask and the pressure.

I will also say that if your doctor is GUESSING at a pressure of 10, he's an idiot. If you weren't titrated, you should have been given an auto-adjusting machine that can deliver the CORRECT pressure according to your needs. I just thought I'd throw that in there. Totally my opinion

I do not suggest messing with pressure settings (other than c-flex which is more of a comfort setting), but I would definitely see about getting an auto machine while you're waiting for the titration study.

Again... my opinion.

pjwalman · Post by **pjwalman** » Sat May 10, 2008 9:00 am

Welcome! I am fairly new to CPAP also, so hopefully others will chime in here, but I wanted to answer your question about whether using a C-Flex setting of 3 will in some way lessen your therapy. The answer is no, as far as I'm concerned anyway. The therapy isn't on the exhale to my understanding; it would be on the inhale. The C-Flex (and on other machines EPR) is a useful tool for many of us who can't stand fighting that strong force when exhaling. So use it at 3 with no worries.

The other thing that may be keeping you from falling asleep easily is that 4 is awfully low for a lot of people, even on their ramp. I don't know how long your ramp is or if you're hitting it again and again as you're trying to tolerate the pressure you described. For me, having the ramp on 4 was what made me fight the machine, because it felt like I was just sucking my own air back in, like I wasn't getting enough oxygen. I tried 5 then, which was better, but ultimately 6 was the lowest I could tolerate for my ramp start as far as my own "oxygen needs" or however you want to phrase it.

The ramp is something you can change on your machine easily, and you can also change the length of the ramp. If you find tonight you're still fighting the machine even with the C-Flex on 3, then my suggestion would be that you try starting your ramp at a higher pressure to see if you can tolerate that better.

You know, it just occurred to me that you said you're using a nasal mask, and all I've used are full face masks, so I don't know if the phenomenon is the same about feeling like you're breathing back your own air. Hopefully someone else will add their two cents.

Good luck tonight!! I think you'll find great advantage to using that 3, and I'll betcha this night will be easier than the last. Honestly, it does take a few days to get used to sleeping with the danged thing anyway, so it may be partly just that you're consciously thinking about your breathing and getting your mind too engaged to relax enough, but you'll get there.

Take care!

Peggy

Sholankord · Post by **Sholankord** » Sat May 10, 2008 12:20 pm

I have recently been tested and set up with a Cpap machine. I was issued a Fisher Paykel CPAP 600 Series machine, and hev only had it for 2 days.

My pressure is set to 16, and I haven't set the humidifier to any prferance yet, (trying 1.5 the first night 2 the second).

Anyway, the first night with it at home, I experianced a solid night of sleep, never "waking up"... Then last night, I "woke up" twice, noticing a significant drop in my air pressure... the unit is set by a tech to it's level, and I can't change it at all... The pressure drop felt like the Ramp button had been pressed. I turned the machine off and switched it back on, and got full pressure again...

I'm worried that it may be malfunctioning, but my wife thinks I had just gotten used to the pressure... What do you think?

Being the weekend, I can't call the clinic, and I haven't had any luck asking my co-worker (who is also on cpap) because he is off today.

ozij · Post by **ozij** » Sat May 10, 2008 12:26 pm

Many of us were suprised to discover we had to place the back of our hands in front of the mask's vent in order to find out it the cpap was working. Yes, you do get used to the pressure, that's a reasonable assumption.

However, if you felt a pressure drop "like the ramp" and then more pressure when you turned the machine on - then I suggest you make sure the elelctrical connections on both machine and wall were plugged in firmly.

O.

ReedRichards · Post by **ReedRichards** » Sat May 10, 2008 3:56 pm

I have the same machine you have. It took some time to get use to. I have mild/moderate sleep apnea (17 AHI per hour) I have it started at 4 cm to get it up 7cm. Whether you are at 7 cm or 15 cm, it takes some time to get use to. Once you get use to it. The oxygen feels great.

ReedRichards · Post by **ReedRichards** » Sat May 10, 2008 3:58 pm

I have been on it a week. It's getting better and better.

bigt4187 · Post by **bigt4187** » Sun May 11, 2008 5:36 am

Thanks to everyone for your encouragement and advice. Last night was A LOT better than the first night. I actually was able to sleep! Lowering the C-FLEX to setting 3 certainly helped a lot.

Now I have another question. On my mask there is a "vent" area under the nasal pillows. Is air supposed to come out of that all the time?

ozij · Post by **ozij** » Sun May 11, 2008 5:41 am

[quote="bigt4187"] On my mask there is a "vent" area under the nasal pillows. Is air supposed to come out of that all the time?

alnhwrd · Post by **alnhwrd** » Sun May 11, 2008 6:14 am

But air is NOT supposed to come out of your mouth, so while you wait for your full face mask, get some paper tape and tape your mouth shut at night.

Can you get your nightly data from your machine? If so, start checking your nightly AHI, AI, HI and Leak Rate. If you cannot, then get a machine that will let you. It is very important that you know if the changes you make, such as different masks, different C-Flex settings are helping or not, and nightly data access is the best way of finding out. Best of luck!

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New to CPAP with questions

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