Newbie with very high pressure (21/17) - can't sleep!

[Blade2000]

Hello everyone. I am a newbie on this forum, and a newbie when it comes to CPAP/VPAP in general. I have been recently diagnosed with severe sleep apnea. I have been given a ResMed VPAP machine with a pressure of 21/17! From what everyone is telling me (pulmonologist, sleep technician, and even medical supply company) this is a very high setting. But it is what my sleep study came back with for their diagnosis.

A bit about me. I am 45 years old, 5' 11" and 205 pounds. Not overweight and I go to the gym (weightlifting) 2-3 times a week. I am close to my ideal weight so losing a few pounds will not make a difference according to my doctor. Which is unfortunate because I wish there was something I could do to reduce my VPAP needs and/or at least pressure.

I have only been on the VPAP for 4 days but it is impossible for me to sleep with it. It is a full face mask, the nose mask didn't help me - I felt like I was suffocating with that. And because the pressure is so high my doctor said I probably could only use a full mask.

Anyway, I have yet to spend even 30 minutes with this thing on my face! The machine slowly ramps up from 3 to 21 over the course of 45 minutes. But once it is on the high setting it is hard to have a good seal unless I make it so tight it hurts. I am trying to get used to it, but so far it has been a failure.

Any suggestions? Anyone been in my shoes before? Glad there are groups like this available online. Not sure where to turn.

[Pugsy]

Can you breathe through your nose normally just fine?
If so try a nasal pillow mask. You can wear a nasal pillow mask with success with your pressures...see this thread.
viewtopic.php?f=1&t=87166&st=0&sk=t&sd=a&start=135
I finally talked him into trying the nasal pillows...his pressure right now is 20/16.

You know maybe you could try a lower pressure setting and work up to the prescribed number...some therapy is better than no therapy.

Which VPAP are you using? ResMed S9?
Are you fitting the current mask at the lower ramp pressure or at the full end result after ramp pressure?

[Blade2000]

Hello Pugsy.

I can breathe OK through my nose. Sometimes it is harder to breather through one of my nostrils (maybe deviated septum?) but usually I am OK.
I have heard of the pillow masks and have not tried that - yet. I will need to call the doctor and my insurance company I assume to get one.
My wife also said I should try a lower setting for a week and gradually move up. I am seriously considering that option.
I am using the ResMed S9 VPAP S. It ramps up slowly and I do adjust the mask on the low setting. But even at the high setting I have adjusted it. No improvement there.

Thanks so much for the response and link.

[Kenwood]

Can you breathe through your nose normally just fine?
If so try a nasal pillow mask. You can wear a nasal pillow mask with success with your pressures...see this thread.
viewtopic.php?f=1&t=87166&st=0&sk=t&sd=a&start=135
I finally talked him into trying the nasal pillows...his pressure right now is 20/16.

Hey, I resemble that post Look at that....I'm helping others through my experience.

Blade - Grab a cup of coffee and read my novel of a journey with the help of my CPAP mentor, Pugsy.

[Blade2000]

Thanks Kenwood - will do!

[Pugsy]

Don't give up on the nasal pillow mask till you try it. Lots of people use them with great success. Not for everyone of course but there is no mask out there that is universal and guaranteed to work with everyone. That's why there are so many to choose from.
You won't know until to try.

Send me a private message here at the forum with your private email address and I will send you the provider/clinical manual for your machine via attachment to a private email.
Just click on the little PM button under my deer avator to get it started.

I have the auto version of your machine so I am familiar with it. It takes a bit to get used to those hurricane force winds even with the mask sealing perfectly and it is really hard to get and keep a good seal with hurricane force winds.
Especially with the full face masks because there is simply a larger area to have to deal with. The smaller the surface area touching the skin...the easier to get and keep a good seal.

Do consider a pressure reduction temporarily and work yourself up to your prescribed pressures. Eventually we do get used to the pressures and what seems like a hurricane becomes a gentle breeze but it takes a bit of time to get to that point.
Any pressure is better than no pressure not using your machine.

[Denial Dave]

I started out at 21/15, so I know what you are experiencing....

try wearing the mask with pressure while watching TV or reading.. do it 10-15 minutes at a time & then take a short break....... Just work on getting accustomed to the pressure & breathe normally......don't worry too much about leaks.

for me, I needed quite a bit of time to get used to breathing against that pressure. it felt like I had a hurricane inside my mask.

when you go to bed, adjust the mask straps while laying down. doing the fit while sitting on the edge of the bed is a waste of time at our high pressures.

Dave

[JDS74]

I run 18.5/15 pressures with the Oracle 2 mask and only get leaks when the mask is older and should be replaced. This mask is an oral mask and doesn't cover the nose, etc.

The mask does have a single strap that goes around the back of the head and, with your pressures, you might have to use it.

I don't use the strap at all.

The mask has an inner flap and and outer flap and looks remarkably like a scuba diving mouthpiece.
The only adjustment is the distance between the two flaps and you should use the largest distance compatible with low leakage. Screwing it down tight will make your lips hurt in the morning.

Just another type of mask you should consider.

Fisher-Paykel, who makes the Oracle mask, also makes a new kind of nasal mask which is a cross between pillows and prongs.

I think it is called the Pilairo and is the lightest weight mask I have ever seen. The factory rep explained how it works and it may be suitable for you at your pressures.

Anyway, getting the correct mask is more than half of the battle in being able to comply with the CPAP and have effective treatment so keep trying different masks until you get one that fits.

You might see if the sleep center technician can help you get a correct fit. They must have done something right to be able to titrate you to the pressures prescribed.

As posted, adjusting the fit in other than sleeping position and at correct pressures mostly gets the fit wrong.

[Xney]

If you haven't done cpap/bipap before, ask your doctor if you could start a bit lower and move yourself upwards over time.

[Guest]

My bipap pressures are 23/18 & I use nasal pillow mask with success. I do use an extra homemade strap for extra stability. It took me awhile to accused to those pressures & I still use the ramp setting starting at 16 with 1/2 hour rise time
, by that time I fall asleep & do not notice the high pressures.

[tomma]

As hard as it is to imagine right now, things will get easier.

I was on a pressure of 15 when I first started CPAP, I absolutely hated it. I could not a good seal no matter what I tried, I think I went through 4 or 5 different masks before I finally found one I could live with, and even that one wasn't perfect. So, fast forward 6 months or so and I'm now on an ASV machine, with pressures of 19/15 (sometimes higher). I'm so used to it now I sometimes have to check to make sure the thing is on. It was a long road, but I did finally get used to it.

The suggestion of starting out a little lower until you acclimate is perfect. Even if it's not the perfect pressure for you, something is better than nothing for now.

Stick with it, it will be tough at times for sure, but the alternative is a lot tougher!

[Blade2000]

Thanks for the great advice everyone. I hope to be an active member on this board. It is great to have people to share ideas and experiences with. Thanks again.

[LaurieRenz]

My BiPAP pressure is 20/16 and I use nasal pillows. They tried a nasal mask and a ffm during my sleep study and I couldn't tolerate either. With the nasal pillows, I have been able to sleep with my mask 7-9 hours every single night since the day I brought it home.

[pickuptruck]

You say you are using the ramp starting at 3. Many Many people have problems at 3 to 5 with feeling suffocated. Chang the ramp or get rid of the ramp and see the difference.

[Xney]

I should add: if you have to tighten your mask more than a little bit, it's not fitting right (or it won't fit right).

Over-tightened masks will make you miserable and xPAP therapy very difficult.

Your first priority in my opinion should be to find a mask that you can wear comfortable, that fits, and that seals well. This is a trial and error process, and may take a while. It's not unusual to try half a dozen masks before finding the right one. I've tried on about 15 masks, and only two are what I would consider acceptable. You should try it at the higher pressures and move around with it while laying down to see how it'll work.

Second, it's very hard to start with high pressures like 20+ for almost everybody. While you should test your masks at your full, eventual pressure to see how they work, I'd ask your doctor if you can try something more like 10/14 or so (with or without ramp, depending on how you like it), and get used to it a bit. Then bump your inhale and exhale pressure by .5cm every half a week or so. Your body will adjust to higher pressures (mostly), but it's very difficult out of the gate.

Yes, it means you're not getting your full "therapy" levels at first, but you'll get there.

You'll probably want to have a ramp time for when you get to the 17+ pressures.

Don't be afraid to try any type of mask to find the right one, I've used nasal pillows just fine at 20. Nasal masks and nasal pillows can allow for mouth leaks for some people, and that can be an issue. (Sometimes solved by a chin strap, or taping)