Newbie needs help with pressure and leaking

[Simbot]

Hi all, three nights into this so far, lots of frustration.

Waking up every night at around 3am, the thing is blowing hard, much harder than when I first turn it on around 10pm. It is leaking like crazy from both sides, blowing into my eyes on both sides usually. I have to tighten it really tight to get it to stop leaking, then it still leaks a little when I move. Is this normal? The tech who did the fitting said I might have to make some small adjustments, but I'm making big adjustments, and still it leaks. It just seems like if it wasn't blowing so hard it wouldn't leak. When I open my mouth my cheeks puff out from the pressure. It's like I'm driving at 40mph and sticking my head out the window.

Rather than try to adjust the fit in the middle of the night, in the dark, so as not to disturb my wife, how can I get the pressure to increase to the 3am force level, on command, during the day, so I can adjust the fit at high pressure? I don't see any way to manually adjust the pressure, it seems to increase on it's own during the night. Peaking around 3am waking me up with a rush of wind and flapping silicone. Also it blows a stream of air straight out the bridge of the nose, can be felt 2 feet away, bothers my wife when I'm facing her. I always sleep on my sides.

Did I get proper instruction on this thing? They told me how to connect everything, clean it, turn it on & off and that's about it. Nothing about pressures. I looked at the user guide but it's pretty light on useful information.

Also, I have the humidifier set for 4 and I still have dry mouth, the tech said to use 2-3.


OK I put the equipment into my profile but it's not showing up here, why?

REMstart Auto A-flex, Mirage Quattro mask, heated humidifier

[Guest]

I am having similar issues, but can't get past 3-4 hours before taking the darn thing off and giving up in order to at least get some sleep.

[archangle]

What are your pressure settings? If you don't know, just look at the pressure indicated on the LCD when you turn it on and then look at the pressure when it's blowing too hard. It sounds like your pressure may be adjusting up because it's on "auto." You can also check the pressure on the display when you wake up in the morning before you turn the machine off.

Do you use the ramp function when you turn it on? i.e. do you just turn it on, or do you push another button first?

Do you really have the ancient "legacy" REMstar machine listed in your profile?



Or do you have one of the confusingly similarly named more modern "REMstar" machines?

Look here for pictures: https://www.cpap.com/cpap-machines/apap ... /1:1::::20:

If your machine is "autoing" up too much, it probably means it should be adjusted to start closer to the "correct" pressure level when you start. Without this, you're starting out with the wrong pressure and having apneas until it gets to the right level. If you have a good DME or doctor, and you're a new patient, they'll do this after checking your data. Unfortunately, good doctor/DME combinations who do a good followup are all too rare.

If you want to see what the machine feels like when it adjusts upwards, you can fake it out into adjusting upwards. You might not want to do this if you're still gathering data in the initial adjustment period especially if you're on insurance and they will be checking "compliance" data. It will show up on your data as false apnea events. If your doctor or DME uses these events to readjust your pressure, you might get your machine set wrong.

Now that you've been forewarned, here's how to fake out your machine into autoadjusting upwards.

Put the mask on and turn the machine on. Breathe normally for a minute or so. Then hold your breath for half a minute or so. Breathe normally for half a minute or so. Repeat while watching the pressure display. If it's doing "auto," it will eventually start increasing the pressure. It will probably only want to increase the pressure very gradually. It make take several fake apneas before anything changes.

If you're trying to fake it, it may be more difficult than you think. The machine may look for breathing, so just plugging and unplugging the end of the hose without a mask going to your face may not work. Turn the machine on, put the mask on and breathe. Quickly take the hose off the mask end and plug the end of the hose with your thumb. You can breathe normally through the mask with no hose attached. After 30 seconds or so, hook back up to the mask. It may take several cycles before the machine autos up. You could also try simply holding the mask to your face, breathing a while, then quickly pressing the mask against your shirt or something and blocking the airflow that way.

Some of the machines may be too smart to fake out at all.

[Simbot]

Thanks for the info, man do I have a lot to learn about this stuff. I do not have the machine you pictured, I have this one:


Are these any good?

Seems like they all have the same name. I was told by the tech that ramp mode has been disabled. I know the pressure starts at 5, I don't know what it peaks out at, I don't know how to get that info. I'll have to see if I can figure it out. I don't think they gave me enough information or training about this thing, sounds like that's not unusual.

Thanks for your help.

[Simbot]

The only data I can find: 90% pressure = 13.5

[archangle]

Thanks for the info, man do I have a lot to learn about this stuff. I do not have the machine you pictured, I have this one:

Are these any good?

Seems like they all have the same name. I was told by the tech that ramp mode has been disabled. I know the pressure starts at 5, I don't know what it peaks out at, I don't know how to get that info. I'll have to see if I can figure it out. I don't think they gave me enough information or training about this thing, sounds like that's not unusual.

Thanks for your help.

If it looks like that, it's a "Philips Respironics REMstar Series One". I presume it says "Auto A-FLEX." If so, you have a "Philips Respironics Series One REMstar Auto A-flex." It's a good machine.

There's a pretty good chance that 5 is too low, but the machine will adjust upwards to your correct pressure. The problem is that when you first turn it on every night, you're not getting enough pressure to prevent apnea until you've had a few events and the machine adjusts upwards. This isn't desirable, but it shouldn't do any serious harm. Once you have used the machine for a while, if your doctor and tech are any good, they'll probably adjust the starting pressure upwards if you need it. Some people just assume that the machine will auto up correctly, but that means you spend part of the night not getting good apnea control until the machine ramps up to the pressure you need.

To figure out the peak pressure, look at the display while it's blowing a hurricane at 3 AM. It should indicate the pressure it's currently at. Don't turn the machine off before you check the pressure. You may need a flashlight to see the display.

Your higher pressure at night probably indicates you need the higher pressure it's adjusting upwards to. Look at the readout when you're getting leakage and see what pressure you're getting. Unfortunately, I think that leaks make actually cause the machine to auto adjust pressure upwards and make the problem worse.

You do need to try and figure out how to fix the leaks.

[Pugsy]

Software is available for your machine (BTW it is an excellent machine). If you want the clinician manual send me a private message with your regular email address. I have it and can send it as attachment but can't do attachments with forum emails.

EncoreViewer 2.0 $99 patient version of the software. Simple to use. Missing waveform data that Pro offers.

EncorePro 2.4 this is the doctor or clinic version of the software. Big, bulky and sometimes PITA to install. Available by request from the software fairy. Only difference between it and the Viewer software is waveform data and price.

Both of the above are Windows based software. If you have other OS or Mac must give it a Windows environment to run in.

http://www.onkor.net/

Above link will give quick and easy access to the data off your SD card. Instructions are there. Same information that is on the software reports but just visually different. The auto will try to fix leaks by increasing pressure, so some of your increased pressure could be from leaks or also from events. This will show on the reports.

Sounds to me like your settings are 5 cm minimum and I wouldn't be surprised to have it at 20 cm maximum. Wide open for newbie still working on leaks sometimes makes more work for a person and makes for poor sleep.

Use Onkor above to see exactly what is going on and decide if you want the software (which one). Pretty steep learning curve but with a bit of work and education, not difficult to attain.

[archangle]

The only data I can find: 90% pressure = 13.5

That means 5 is probably way too low, although it will adjust upwards slowly after you turn the machine on each night.

Setting the machine low and slowly ramping up is actually a good thing to do when you're first starting out. That way, they can get a measure of what you need while you're at home, sleeping in your own bed rather than stressed out in a sleep lab wired up like a borg from Star Trek. I just hope they adjust your minimum pressure up after your followup visits.

[Janknitz]

Welcome, Sim.

The reason you are having these mask blowouts is that you are adjusting your mask at the lowest pressure and the seal can't hold against the pressure as it increases during the night.

Since the PR S1's don't have a "mask fit" feature like the ResMed S9 autos, the only way to get the pressure up is manually. You have to go into the clinician's menu and set the pressure for 14 (since your 90% pressure is 13.5) in straight CPAP mode with no ramping. THEN adjust your mask for that pressure. Once the mask is adjusted at that pressure, return the settings to your usual settings. It's a PITA, but works way better than trying to hold your breath again and again trying to get the pressure up while you're awake .

Be sure to take a look at my blogpost for "Taming the Mirage Quattro" as it will help you adjust your mask. The biggest thing to remember is that it's an AIR cushion, and if you make it too tight the air cushion cannot inflate and you will have MORE leakage. Be sure to adjust the mask with the machine ON at full pressure, lying down in your bed.

As other's have mentioned, if your pressure setting is wide open you're always going to be chasing your apneas and you won't get optimal therapy that way. Such a setting is fine to dial in exactly where your pressure should be (a home titration), but not for the long term. If you don't already have a follow-up appointment with a SLEEP doctor to adjust those settings (your PCP doesn't know how to do this!), make one, or if you are in one of those referral situations where you will never actually see the sleep doctor then you need to take matters in your own hands by using the software to help you determine the best settings.

[Pugsy]

Couple of hints. You mention dry mouth no matter the humidifier setting. Mouth breathing even with a full face mask will give you dry mouth. Can't add enough moisture with the humidifier to prevent this for some people. What to do about it?
Well, if you can breathe through your nose at all, try learning to keep mouth closed. Some people even use a chin strap with full face mask. Some people add Biotene mouthwash because it adds a bit of moisture. Keep yourself well hydrated with water. Do you take any meds that might increase mouth dryness? If so, alter time that they might be taken to see if it helps with dry mouth.

That 90% pressure that you see? This may or may not be close to what you need for the bulk of the night. This number can be falsely elevated by the pressure increases that happen when the machine tries to fix the leaks. All it means right now is that you were at OR below this pressure for the bulk of the night. You can do the mask fitting to accommodate this pressure as Janknitz has described. It is a PITA but other choices involve doing stuff that a newbie probably shouldn't do at this time, especially since we haven't seen exactly what is going on in those reports.

Mask fit and leaks are the worst part of this whole cpap therapy thing. Leaks have to be addressed before anything else can be evaluated properly.

[Simbot]

Thanks for all the info, it's very helpful. The leaks are getting better, but they still happen, and wake me up.

I looked at the display last night at high pressure, 14.9. I don't know how to get it into clinician mode I'll have to look into it.

I am seeing a sleep Dr. he is highly recommended, I don't see him for another 3 weeks though.