Some Newbie Questions

[DrDeke]

Greetings,

One week ago, I started CPAP treatment for OSA with the following equipment: Resmed S9 Escape, Resmed H5i humidifier, a nasal pillow mask, and a chin strap. My pressure setting is 9 cm, and the machine is set to EPR level 3, and EPR inhale medium. Things seem promising so far but I have a few questions.

1) I thought the lady at the DME (Wright & Filippis) said that EPR was turned off on this machine. However, I thought I noticed pressure reductions sometimes at a certain point while inhaling (probably while slowing down at the end of the inhale), and checking the settings via the clinician mode setup instructions found here revealed that it is in fact on. I don't necessarily mind, but I am wondering what the "EPR inhale" setting means. (The two options are medium and fast.)

2) On-purpose air leakage on my nasal pillows apparatus occurs through a patch of holes on the back of the "mask". Sometimes I have a tendency to bury my head in the pillow (the sleeping pillow, not the nasal ones ), and I am wondering what happens if I block the outflow by doing this. Will I eventually breathe deeply enough that I'll suck fresh air in all the way through the mask, tube, and machine? Or will I breathe more and more CO2 and less and less oxygen until I wake up? It seems like that would be bad...

3) The S9 Escape that my DME gave me only logs hours-of-use; it does not record any other data such as AHI, leak rate, and so on. I would prefer to have a machine that does record that kind of data. I guess the S9 Elite would be the appropriate model here? Anyway, I read on a website linked from here that it may be possible to get a DME to exchange a non-data-logging unit for a full-logging one within the first 30 days or so. I've only had mine for 7 days, but I am not exactly sure how to go about asking them to do so. I assume they would want to know why, and I am not sure what to tell them. My main reason is that, although I think the system is working pretty well right now, I want to make sure it continues to do so, and sometimes you don't really notice gradual problems until they've gotten pretty bad. Also, I do tend to mouth-breathe so I am using a chin strap to help keep my mouth shut, and it seems like it would be a good idea to be able to monitor that. (Presumably, it would show up in the data as leakage, right?)

4) I was going to ask whether it was really so bad to use tap water in the humidifier, but I see someone just posted a new thread on that topic, so I'll just read that thread after it gets some responses.

5) My nose is often congested enough during the day that it is difficult or impossible to breathe through it. I have found that breathing through my nose on the CPAP is *much* easier and more comfortable, presumably because the pressure helps force the nasal passages to open more widely. However, on one night so far, my nose got so congested that I couldn't breathe through it at all even with the CPAP, so I finished that night without it. Because I was out of town, I used Afrin (oxymetazoline) nasal spray for the next two nights, and when I got home yesterday, I got a prescription for fluticasone (Flonase) spray, which can be used long-term unlike Afrin. That worked fine last night, but I suspect there will still be some nights when I can't breathe through my nose. I'm thinking I should get a full-face mask for those nights, but I'm not sure how that works between my doctor, DME, and insurance. Do I need a different prescription for a different mask, or can I just tell the DME that I want a different one? My insurance is willing to pay for a mask something like every month or two, so if I don't need a different prescription, that seems like the way to go...

Well, that was long, so thanks for reading and thanks in advance for your feedback.

[avi123]

Greetings,

One week ago, I started CPAP treatment for OSA with the following equipment: Resmed S9 Escape, Resmed H5i humidifier, a nasal pillow mask, and a chin strap. My pressure setting is 9 cm, and the machine is set to EPR level 3, and EPR inhale medium. Things seem promising so far but I have a few questions.

I think that Resmed S9 Escape does not provide downloadable data.

1) I thought the lady at the DME (Wright & Filippis) said that EPR was turned off on this machine. However, I thought I noticed pressure reductions sometimes at a certain point while inhaling (probably while slowing down at the end of the inhale), and checking the settings via the clinician mode setup instructions found here revealed that it is in fact on. I don't necessarily mind, but I am wondering what the "EPR inhale" setting means. (The two options are medium and fast.)

As I understand it the EPR works only on Expiration. The E stands for Expiration. Expiration Pressure Relief.

2) On-purpose air leakage on my nasal pillows apparatus occurs through a patch of holes on the back of the "mask". Sometimes I have a tendency to bury my head in the pillow (the sleeping pillow, not the nasal ones ), and I am wondering what happens if I block the outflow by doing this. Will I eventually breathe deeply enough that I'll suck fresh air in all the way through the mask, tube, and machine? Or will I breathe more and more CO2 and less and less oxygen until I wake up? It seems like that would be bad...

Yes, this mask does not have anti Asphyxiation valve as full face masks do, So you are correct that you should not block them.

3) The S9 Escape that my DME gave me only logs hours-of-use; it does not record any other data such as AHI, leak rate, and so on. I would prefer to have a machine that does record that kind of data. I guess the S9 Elite would be the appropriate model here? Anyway, I read on a website linked from here that it may be possible to get a DME to exchange a non-data-logging unit for a full-logging one within the first 30 days or so. I've only had mine for 7 days, but I am not exactly sure how to go about asking them to do so. I assume they would want to know why, and I am not sure what to tell them. My main reason is that, although I think the system is working pretty well right now, I want to make sure it continues to do so, and sometimes you don't really notice gradual problems until they've gotten pretty bad. Also, I do tend to mouth-breathe so I am using a chin strap to help keep my mouth shut, and it seems like it would be a good idea to be able to monitor that. (Presumably, it would show up in the data as leakage, right?)

In my case my DME agreed to change the "Brick" that they gave me originally with S9 Elite, at no cost to me (Medicare rental), but after 2 month I, on my own purchased from the DME an S9 Autoset for $830 (the humidifier is the same on both machines). I could not ask that the Autoset should be paid by Medicare b/c it carries the same item classifaction as a CPAP (the Elite) but costs more. I used the Autoset to auto titrate myself and I have found that the 5 to 6 cm of optimal pressure that were prescribed during my first PSG sleep study were wrong. It should have been 13 cm on CPAP. Later, I switched from CPAP mode to APAP and it works great. I would switch from your pillows mask to a nasal mask similar to my and a chinstrap to improve your treatment.

4) I was going to ask whether it was really so bad to use tap water in the humidifier, but I see someone just posted a new thread on that topic, so I'll just read that thread after it gets some responses.

Yes it's bad. I use distilled water only.Faucet water can contian bacteria.

5) My nose is often congested enough during the day that it is difficult or impossible to breathe through it. I have found that breathing through my nose on the CPAP is *much* easier and more comfortable, presumably because the pressure helps force the nasal passages to open more widely. However, on one night so far, my nose got so congested that I couldn't breathe through it at all even with the CPAP, so I finished that night without it. Because I was out of town, I used Afrin (oxymetazoline) nasal spray for the next two nights, and when I got home yesterday, I got a prescription for fluticasone (Flonase) spray, which can be used long-term unlike Afrin. That worked fine last night, but I suspect there will still be some nights when I can't breathe through my nose. I'm thinking I should get a full-face mask for those nights, but I'm not sure how that works between my doctor, DME, and insurance. Do I need a different prescription for a different mask, or can I just tell the DME that I want a different one? My insurance is willing to pay for a mask something like every month or two, so if I don't need a different prescription, that seems like the way to go...

I suffered from Vasomotor Rhinitis and used Ayr and Water Pik nasal sprays effectively.

Well, that was long, so thanks for reading and thanks in advance for your feedback.

[DrDeke]

As I understand it the EPR works only on Expiration. The E stands for Expiration. Expiration Pressure Relief.

Yeah, that's my understanding too. It just seems to kick in a little early, when I'm almost but not *quite* finished inhaling. It's not necessarily a problem, I seem to be getting used to it alright.

[Pugsy]

EPR also has 2 speed options available in the clinical menu.
I think the default is for Medium but there is a Fast choice.
Listed under Options...EPR inhale.
If Medium seems to quick for you Fast may be worse but might be worth a try.
If the rhythm becomes too annoying and you are having trouble adjusting you could always try doing without EPR.