Newbie!

[TiggerMomNine]

My husband is the brand new CPAP user, not me. But I'm the researcher of the family, so I thought I would introduce myself and seek some help!

I read all the stuff that came with the machine, and we hooked it up last night.

We put the machine on an upside down plastic bin, used distilled water, and plugged it in.

He wore it for a few minutes, but couldn't keep it on. The problems were twofold:

He couldn't swallow without it plugging his ears, and he couldn't unplug them without removing the mask

AND

He couldn't exhale against the pressure, which wouldn't let him get to sleep.

I've looked through a bunch of these threads, but wondered if posting wouldn't be more helpful.

Thanks in advance for any advice!

[mars]

Hi TiggerMomNine

Sorry to hear you are having a bit of difficulty, but that us usual to begin with.

If you could post the pressure range being used, and if your husband is on the ramp feature, that would help others to help you.

and he couldn't unplug them without removing the mask

Not sure why that would be necessary ?

Others will respond as time goes by,

cheers

Mars

[TiggerMomNine]

He was using the Ramp feature - I'm not sure what the time was set to. Also, I think it's set at 16-20 CM (at least that's what the paperwork says - I haven't figured out how to read the machine yet).

Is there a way to tell if the machine is set on A-Flex or C-Flex?

Thanks again!

[robysue]

My husband is the brand new CPAP user, not me. But I'm the researcher of the family, so I thought I would introduce myself and seek some help!

Welcome! And best of luck to your hubby.

He wore it for a few minutes, but couldn't keep it on. The problems were twofold:

He couldn't swallow without it plugging his ears, and he couldn't unplug them without removing the mask

Swallowing with the CPAP on is a big challenge. As is yawning. And talking. I personally find that if I try to do any of the three, I run the risk of getting a stomach full of air. And I can identify with the swallowing => plugged ears & can't seem to unplug the ears without taking the mask off problems. I'd first suggest that your husband report this problem SOONER rather than later to the sleep doctor's office and ask to speak to a nurse or PA about this issue.

If hubby has any problems with nasal congestion, that could be aggravating the problem with the clogged ears. In that case, dealing with the congestion should help the ears. An OTC decongestant that doesn't prevent your hubby from getting to sleep might help.

For trying to get used to the sensation of the air blowing at him and learning how vigorously he can try to swallow with the mask on, he might want to use the machine for an hour or so each day while sitting on the couch watching tv or reading. Lots of people need to acclimate themselves to how the mask feels on their face while they're awake.

He couldn't exhale against the pressure, which wouldn't let him get to sleep.

and

Is there a way to tell if the machine is set on A-Flex or C-Flex?

Not sure which PR System One your hubby is using---they all look alike, but they don't all have exactly the same features. But if it's a Pro or an Auto, then it has a setting called C-Flex (or C-Flex +) or A-Flex (or A-Flex +) that is supposed to be a comfort feature. Turning on the C-Flex/A-Flex will cause the machine to drop the pressure slightly at the beginning of each exhale, making breathing a bit more normal. The higher the number, the more the relief. The thing to check is whether the tech who set the machine up set it so that the patient can turn it on and adjust it. On the LCD, there should be four "boxes". The one in the upper right corner should say something like C-Flex or A-Flex on it. See if you can select that box and look at the menu items. On my BiPAP, that box allows the user to test and switch between the settings to find the one that works best. And the machine will automatically set the Flex to whatever the last setting that was used in the test was, if I recall correctly. But unfortunately, it's possible for the tech who set the machine up to have LOCKED this feature. There's no good reason for the tech to LOCK it, but some do. If you cannot turn the Flex on, give the DME a call and request that they unlock the flex. Have them unlock the patient data as well so that you can at least see the 7 and 30 averages for the AHI. [The 7 and 30 day averages for Large Leaks is meaningless on the PR System Ones, in my humble opinion.] If leaks seem to be an issue---or if you can't tell if leaks might be an issue---getting the Encore Viewer patient software is really critical so that you can actually download the data and look at the leak line.

I don't know if the Plus model has C-Flex or not. I do know that the Plus does NOT record any efficacy data. I'm pretty sure it also doesn't record any leak data.

So look at the machine carefully. Does it say PR System One Plus, PR System One Pro, or PR System One Auto. If he's got the Pro or the Auto, then the machine will record full efficacy data. That's useful---seeing good low AHI numbers can keep you motivated if (when) you run into problems with adjusting to the machine. And super high AHI numbers let you know the therapy is not yet working properly and that the pressure setting most likely will need to be changed. But, alas, if hubby has the Plus[/i], the only data it records is compliance data---how many hours did he use it every night---so that the DME can get paid by the insurance company. If your hubby was "given" a Plus by the DME, now's the time to complain and try to get the machine switched. Look for posts by a user named Janknitz. She's got a link in her signature about what you need to know about DMEs.

[rested gal]

Not sure which PR System One your hubby is using---they all look alike, but they don't all have exactly the same features.

Clicking TiggerMomNine's name shows her Profile which lists this machine:
PR System One REMstar Auto CPAP Machine

She probably chose the correct machine for her Profile since she mentioned this in her second post:

Also, I think it's set at 16-20 CM (at least that's what the paperwork says

[DoriC]

Hi Tigger, Welcome to the "Wives Club"! I don't know your machine but Robysue seems to have covered all the bases. Your hubby's pressure is set pretty high,(maybe that can be adjusted down at some point), so the ramp and flex features will probably be important at least until he adjusts. As soon as things settle down you'll want to get the software to monitor his daily data but in the meantime check the LCD screen to get an idea of what's going on. Pay attention to the mask leaks, don't worry, you'll probably hear the hissing and "farting". Search for Janknitz's tips and others on mask fitting. My husband is quite disabled so I don't get much input from him and he depends on me solely to monitor his therapy so I know how hard it is being on the outside looking in. Read everything you can here and ask lots of questions, there are some excellent pros here to guide you, I know I couldn't have succeeded without them. The beginning is hard but once you get past it, and you will, the rewards will be more than worth it, you'll have a new and improved version of your husband back. Feel free to PM me if you have questions of a "personal " nature. It's strange but after many private discussions with several spouses, most have seemed to desert me! Did I say something wrong? ? Good luck.

[rested gal]

It's strange but after many private discussions with several spouses, most have seemed to desert me! Did I say something wrong? ? Good luck.

Dori, my guess is that you helped them so well, and everything started going so great -- they didn't have to ask about anything else.
Most likely your support and advice in the beginning made this happen...

The beginning is hard but once you get past it, and you will, the rewards will be more than worth it, you'll have a new and improved version of your husband back.

[TiggerMomNine]

Thanks for all the help!

Last night went much better - we put C-Flex on, and changed the ramp to 45 minutes. Hubby was able to keep the mask on all night! There was an issue with the humidifier, but I think we just didn't have the heater on it - I'll check on that later. He also says he wants to try and increase the Flex from 2 to 3.

[DoriC]

Flex is just a comfort feature so he can try all 3 settings and see which feels better for him. My husband turned the flex off because it seemed to be rushing his breathing. He uses an older Remstar M Series which I think has a different algorithm. Keeping the mask on all night is a big victory!

[TiggerMomNine]

Well, it's been a few nights, but since that second night, hubby hasn't been able to keep the mask on after the ramp period. He keeps springing leaks, and multiple tries to get back on track have failed. We tried reducing the pressure to 12-16, with the logic that not being able to wear it all all doesn't help in any way, figuring we could always increase it back up once we could get through a night. That hasn't happened.

Hubby sleeps mostly on his back, and sometimes on his side, but nothing has worked.

Is this normal? What do we do? He hasn't been able to wear it at all after the 45 minutes of ramp, for the last sevearl nights....

Thanks in advance for any help.

[PST]

I am responding to the issue of leaks with the Quattro. This repeats something I had to say in another post recently, but given all the time I have spent playing around with this particular mask, I always feel an urge to share.

1. Get the right size mask. Many people have noticed that the right Quattro for them is smaller than they would have guessed. I have a big head and assumed I needed a large, but a medium fits me best. ResMed has a tool on its web site for estimating the right size. The mask nests in the indentations above the nose and above the chin. A mask that's even a little too big can never fit right.

2. Clean the inner cushion. I hate making the effort every day, but I have oily skin, and that oiliness wrecks the seal. I use a little liquid soak and warm water, and I don't bother daily with the whole mask, just what touches my skin. I believe other people have good success with wipes. It makes a huge difference.

3. "Float" the mask. The theory of the Quattro, I believe, is that pressurized air should fill the gap between the inner and outer layers of the pad, kind of like a tire inner tube, creating a pneumatic cushion. This lets the pressure help push the seal against the face instead of just trying to blow the mask off your face. I have never had anyone at my DME show any sign of understanding this. Their only technique is pull the straps ever tighter until the mask seals by brute force. I simply think they are too busy to bother. This makes the mask too tight for comfort. Getting the "float" takes effort and experimentation. What has worked best for me is to pull the lower straps as tight as I feel comfortable with, then start with the upper straps loose and pull them tighter bit by bit, testing at pressure each time, until the seal is good. You have to test for leaks up in the range of actual use. What works at the start of a ramp up may leak at 16 cm.

4. Fine tune the forehead dial and memorize the setting. The dial gives lots of flexibility, but it easily gets turned. I start at the closest setting and then dial it out with the mask on until the pressure is just barely off the bridge of my nose. Too close causes pain and can raise a sore, but too far encourages leaks under the eyes. The closest setting that doesn't leave redness in the morning is best and should be left alone.

There is not much to say about discomfort exhaling. At first it feels like sticking your head out of the car window and holding your mouth open. Strangely enough, though, the feeling disappears. After a few weeks, one wakes up not even noticing the pressure when exhaling. It is hard to believe, but we can adapt to anything.