New to Apnea, CPAP and the forum.

[DepDave]

Hello, as the title says, I am a newbie (sigh....). I got my CPAP machine today and I could swear I wasn't that uncomfortable when I had my sleep test done (I took an hour nap with it on today). I'm already fighting the back pressure on a 14 setting. Any advice for me? BTW, I really like the forum, everyone seems helpful and informative. Thanks!

Dave

[Slinky]

Welcome to the forum, Dave. What brand and model xPAP do you have? Which mask are you using?

You might want to go into your User Control Panel to your Profile and add the brand and model xPAP you are using, plus the humidifier and mask so you don't have to keep answering this question as we try to figure out how to help or advise you.

[Volcanomom]

Welcome Dave. I'm a newbie myself, and have found wonderfully nice and helpful people here! It's a great resource and you'll be glad you've found it

[jsmythe]

What kind of mask did you use in your Study? Do you have the same thing now or a different one? As the others suggested, fill in your Profile with your equipment listed, as Text, that will be a big help for us to help you. It might be that your mask is causing you problems with getting used to the air. I have a pressure prescribed at 17, with the nasal mask, I can not feel the air. Does your machine have a comfort setting with cflex or EPR? Those are a big help too.

[DepDave]

Well, I edited my profile and hopefully the equipment info will pop up now. But in case it doesn't, I have a GoodKnight 420G and a FlexiFit 431 full face mask. My machine is on a ramp setting (starts out at 6 and goes to 14 in a bout 10 min). I believe it is the same mask as I used in the study, but I'm not sure.

[Slinky]

Bump. How about you Puritan Bennett users helping DepDave out?

[echo]

whoops missed this one! (Thanks slinky!)

Depdave, you might try with a ramp set to a longer time - 10 min seems too short for a jump from 6 to 14!

It looks like you need to go into the clinical menu to set the ramp time. You should be able to change the starting ramp pressure without going into the clinical menu.

To get into the clinical menu: Find the hidden button under the first three letters of the "Goodknight 420G" just above the LCD screen. Press the hidden button first and then press the Information Access button together for a couple of seconds until the LCD screen changes. (Sorry this is off the top of my head so I don't remember exactly what you'll see first when you jump into the clinical menu on the 420G).
Then to cycle through all the options keep hitting the Information Access button.

For ramp pressure: You will see that it's ramp because it will display "6 cm" (the starting pressure) and in the bottom left corner of the LCD you will side a triangle sitting on its side = ramp icon.
For ramp time: You will see something like "10 min" and again the ramp icon on the bottom left corner.
Just use the up/down arrows to change the two values.

I would set the ramp to minimum 30 minutes. Also if you can handle it, setting the ramp to start at 7 or even 8 or 9 may help you acclimate better. Currently I'm on 10.5 cm and I don't even use the ramp.

Then, while you're awake, practice with this setup. Starting with a lower pressure (e.g. 6 or 8cm) and working your way up slowly to a higher pressure, it should be become easier to acclimate. Try to relax and breath normally.

Here is a link to the Patient's manual: Goodknight 420G Patient manual
If you want the Clinical manual then please PM me.

You may have noticed that during the sleep study it wasn't as bad beceause you probably only hit 14cm when you were actually sleeping. Thus the whole reason for a longer ramp. The idea of the ramp is that you fall asleep on a lower pressure, and by the time you're asleep you won't notice the higher pressure.
If 30 min doesn't work, try setting it to 45 minutes of ramp time, or try a slightly higher starting ramp pressure.

If you truly find that after a few days or a week you still cannot acclimate to the 14cm pressure, then I would talk to your sleep doc. The other machines have, for example, C-flex or EPR, which will lower the pressure on exhale by a few cm, making it easier to exhale. Or you might just need an APAP. Some people can handle 14cm.. but you will have to see if it works for you.

EDIT: Also, are you happy with the mask? If it's not sealing well or if it feels like it's leaking, that may also be a reason that the higher pressure is uncomfortable. My vote of course is for the Activa , if you want to try a new mask I could never get the F&P mask to work for me.

[Guest]

This is a great conversation to have with your sleep physician. I'm sure he/she will have tips. For me, I was in a fight between the anxiety of breathing through it (and worrying I'd not get enough air) and waiting for my body to realize that CPAP = good night's sleep.

One thing I'd suggest is watch tv for a few hours with it on. Get used to the feeling of breathing through it. It will help. In the end, it just takes time. My body realizes what it needs to do to get sleep now (mask, plus breathe through nose and keep mouth shut), so now it just works.

[DepDave]

Thanks for your help everyone. I really appreciate it. Last night I woke up in a panic feeling like I was practically choking on the pressure from the machine. It seems like when I was awake, I knew I had to exhale more forcefully. When I fell asleep it's like I forgot. I know that this is an adjustment period and I am giving it my all, but man this is huge. The mask does leak after a while. I've tried all sizes and if I don't get any better results, I'll call my Dr. this week.

[ozij]

Dave,
14 is almost up there where they decide to give you a bi-level machine, that is, one that gives you different levels for inahlation and exhalation. Some insurance companies need proof you tried fixed pressure and could not tolerate it before they will switch you to a bi-level. If you don't get used to your pressure soon, start complaining to the doc about your discomfort.

If you can afford another machine, you may also want to consider a PB 420E or Sandman Auto. Both do not have exhale pressure relief, however they have a different way of handling pressure needs, which may leave you at lower pressure for most of the night, and only rise to 14 when its really necessary. The difference between a self adjusting (i.e. auto) machine and a bi-level is that the self adjusting machine does not change your pressure per exhale / inhale, rather it calculates what general pressure level you need now, based on your breathing pattern, and will lower or raise it - for both inhale and exhale together, based on those calculations.

Your very very basic machine supplies fixed pressure you may actually nees only for 15% of your sleep time. It does not give you any info about how your therapy is working. Sleep lab titrations are a one night snap shot of your sleep - and are sometimes off - whether too hight, or too low. By getting a machine and software that will show you your therapy results, you will help yourself understand what is going on with your therapy.

Some sleep docs know nothing about how machines record breathing events, nor about how they respond to them. Some docs pooh pooh the machine's results. Most of us here have discovered that the reported data is very helpful in setting the machines up to give us good therapy.

In summary: You've go pretty high pressure for a fixed pressure machine without exhale relief. If you get used to it - fine. But keep in mind that you have alternatives:
An automatic machine
A machine with pressure relief
A bi-level machine.

You only need a new script for the third.

O.

[Snoredog]

Well, I edited my profile and hopefully the equipment info will pop up now. But in case it doesn't, I have a GoodKnight 420G and a FlexiFit 431 full face mask. My machine is on a ramp setting (starts out at 6 and goes to 14 in a bout 10 min). I believe it is the same mask as I used in the study, but I'm not sure.

I would increase that Ramp timer to maximum of 30 minutes. If you are still not asleep hit that center button again and it will reset it back down to 6 again. You may find 6 to be a bit low, if the air feels stuffy increase it to 6.5.

[DepDave]

Everyone, thanks for your input and advice. Last night I fell asleep and was actually dreaming until I coughed and blew out the seal! I couldn't get it back no matter what I tried. Ugggghhh. At least it was on for 2 hours before it came off.

There is so much help from all of you who responded to my post, I believe I'm on the right track and know what to do/ask for when I speak with my Dr. Keep the cards and letters coming, they are all appreciated. Thanks and I hope I'm on the right track to getting a good night's sleep.