first night - updated sleepyhead data

[bluesky5]

It was my first night and everything was ok till my resmed auto changed the airflow over 5.5.

The air pressure went up to 14.9 and my lungs are not strong enough to exhale, so I had to sleep without the mask. Can I lower the pressure ?


ResMed S 9 auto, climate control tubing
Humidifier Hi 5
F and P Eson nasal mask

[avi123]

I am changing my post to:

Have you tried to contact your Doc to tell him/her that:

The air pressure went up to 14.9 and my lungs are not strong enough to exhale, so I had to sleep without the mask.

And ask about lowering the pressure?

[Pugsy]

What settings are being used on your machine? CPAP mode or APAP mode.
What is the minimum pressure setting and the maximum if in APAP mode?
Are you using the ramp feature...if so for how long?
Are you using the EPR feature...if so at what setting?

Disregard Avi's comments about mouth breathing and chin strap...it hasn't been proven yet that you have a problem with mouth breathing requiring anything to be done. Just because he can't use a nasal mask without mouth breathing doesn't mean everyone else has his same problem.

Let's figure out exactly what the settings are on your machine right now before we start worrying about reducing the pressure.

Do you know about the software that you can use? Check out my signature line for Sleepyhead information.

Don't know how to get into the clinical setup menu area of your machine to check out and confirm what the settings are??
This is the provider manual for the S9 and it explains how to get into the setup menu area.
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf

[bluesky5]

Thank you so much for the quick reply. I want to use my machine this night and I am working on solving the problem.
I think my mouth is not open and I had the sleep study just done, doctor prescribed the Eson nasal mask.

My resmed S9 auto is in autoset mode - is this called APAP? Not sure about that?

Dr. wrote on the prescription EPR off, but I could change it "on" and level 3.

Dr. wrote ramp 5 min. but the machine could be set to 45min.

The minimum pressure is 4 the maximum is 15.

[Pugsy]

EPR is exhale relief..1 cm reduction in pressure during exhale phase of respiration per setting on the machine...setting of 3 is 3 cm reduction...setting of 2 is 2 cm reduction and setting of 1 is a 1 cm reduction in pressure.
You can't feel the reduction at 4 cm starting pressure though even if it was turned on because the machine can't go below 4 cm.
EPR doesn't kick in until pressures increase above 4 on inhale.

The S9 AutoSet is called an APAP machine because it has APAP mode but it also has CPAP mode available.

Are you having trouble actually exhaling or are you feeling like you are suffocating?

If your minimum pressure is 4 cm and the maximum is 15 then ramp really doesn't come into the picture because all that ramp does is start you out at a lower pressure and work up slowly to a higher prescribed pressure.
Example would be if your pressure settings were 10 minimum and 15 maximum...then ramp would start at 4 cm and work up to 10 cm over whatever period of time ramp is set to function. The factory default is 45 minutes.
Not many people would be comfortable at 4 cm for that long. It simply feels like there isn't enough air moving. Feels like we are suffocating...of course we aren't but it sure feels that way.

[bluesky5]

Thank you for the explanations.

I have trouble exhaling because the incoming air is too strong. I have to make serious efforts to exhale and I cannot sleep. It is for me like I have to inflate a balloon. But no feeling of suffocating. But my muscles get tired after a while and I have to take the mask off.
I could turn the EPR on 3.
I can leave the ramp on as it does not come into the picture anyhow.

Can I change the settings of min. 4 and max. 15?
As the machine was always up on 14.9 the EPR alone would not help - it would only lower to 11.9. Still too strong to exhale.

[Pugsy]

I would turn EPR on at 3 and try that first. I think you will find it much easier to exhale with at any pressure.
Do you have the software to see what was happening when you saw the pressure pushing 15 and had such problems exhaling and I assume woke you up and that is how you know it went that high???
It normally will not go above the 4 cm minimum until we go to sleep and the apnea events and warning signs start triggering the pressure increases.

The minimum of 4 cm is likely too low to prevent the collapse of the airway in a timely fashion because the machine can't increase the pressure quickly enough so the machine is likely trying to play catchup all the time instead of doing a better job preventing in the first place.

I would suggest getting the software up and running so that you can see for sure what is going on with the pressure.
Maybe with a better minimum pressure the maximum won't go so high. Wouldn't be the first time.
Software information in my Pugsy's Pointers link in my signature.

[bluesky5]

I was not sleeping at all, no event. The pressure went from 4.0 continuously higher to 14.9 and never down - only when I shut off the machine. I tried it over several hours. Even when I got up and was standing or sitting it only went back to 11.0. But the mask fitting symbol was green.
I will try it now with EPR on 3.

[Pugsy]

I was not sleeping at all, no event. The pressure went from 4.0 continuously higher to 14.9 and never down - only when I shut off the machine.

Okay, that sounds like straight cpap mode and not auto adjusting mode.
The pressure wouldn't go that high while awake in auto mode with no events to trigger the increases.

Try EPR at 3 tonight and see if that helps.
Get familiar with the software...I have a feeling we are going to need to evaluate things with the software.

That green smiley face for leak...it doesn't turn to red Mr Frowny face unless you have excessive leaks over 24 L/min for over 25% of the night. If you didn't sleep much then there wasn't much chance for prolonged big leaks of the magnitude to trigger Mr Frowny face.

[bluesky5]

I tried it now for 20 minutes with the EPR on 3. The EPR helped a lot but the pressure started with 4.0 and constantly went up to already 12.2 after several minutes.
It did not go down when I was sitting. You think it is a mistake in programming? We downloaded the program. Not sure if I can be on 14.9 for the night.

[Pugsy]

What was your prescribed pressure? Did you have a sleep study where they put the mask on you and made adjustments in the pressure as needed?
Sounds like they came up with a pressure of 15 being needed.
That's a pretty good size pressure to have to deal with even with EPR for some people.

I don't know if it is a mistake in programming because I don't know what the prescribed pressure is.
I don't even know what the settings currently are but it sounds like straight cpap mode at around 15 cm with ramp starting at 4 cm.

When you turned EPR on and set it at 3 did you do it from the clinical setup menu or did they already have it turned on and tell you that you could use it if needed?
In the clinical setup menu you should see which mode of operation has been chosen and what the settings for pressure are.
Sounds like cpap mode because apap mode wouldn't increase like that while you are awake.

I don't know what to tell you because I don't know what any of the particulars are in your situation because I am just assuming here base on what little you have been able to tell me.

Of course it's the weekend and you can't reach anyone at your DME or doctor's office....so what do you wish to do?
If you absolutely can't get used to that 14.9 or 15.0 cm pressure and can't sleep then something needs to be done to at least get you some therapy and some sleep.
If you reduce that pressure you stand a chance of allowing apnea events to happen especially with the EPR at 3 but you have to get some sleep and some therapy is better than no therapy.

You could try reducing that pressure to something a little more comfortable...like 11 or 12 but be prepared to use the software so that you can see just how many events happened at the lower pressure (assuming you can even get some sleep).
Sort of maybe start a little lower and work your way up to the prescribed settings with some time.

Finally...a pressure of 15 cm is right up there where sometimes people need a different type of machine...called a bilevel pressure machine where the inhale and exhale pressure are further apart than what you can get with your 3 cm EPR reduction. That's really a discussion to have with your doctor after you figure out if you can even use what has been prescribed.

Short term for the weekend...maybe try the reduction from 15 down to something you feel like you can manage to get to sleep...evaluate the reports and then if the need for greater pressures than you can manage is confirmed then perhaps a different machine...

But first thing is to get some sleep. Can't evaluate anything while you are awake. Some pressure is better than no pressure and if you can't sleep at the current settings then if you are comfortable changing the pressure short term to see if you can work your way up to the higher pressures then that's certainly an option.

[bluesky5]

I was for a sleep study but they have not tested a machine or a mask.
My machine is on auto set, is that the APAP?
Prescription is for 4 -15 and current setting is 4-15. Ramp 5 min.
I turned EPR on on my machine, but it was not disabled although the prescription said EPR off.

After the first 5 minutes( ramp) the machine climbs to 12 now ( 15-3 EPR). There is no reason to climb as I am awake. But the machine pretends an event.
Maybe we change the setting to lower than 15 because for the night it is too hard to breathe.

[Pugsy]

Your machine doesn't sound like it is set to auto (apap) mode...it sounds like it is set to cpap mode.
If it was set to APAP mode it wouldn't go from 4 to 12 in 5 minutes.

My suggestion is to go into the clinical menu setup area and make the change to APAP mode...I would bet money it is set in CPAP mode.
Then leave it at 4 minimum and 15 maximum. It won't go above 4 while you are awake in APAP mode. It can't.

[bluesky5]

Checked it again - it is on auto mode. And again it went to 12.2 when I was awake and even when I was sitting or standing.
I have no explanation. I plan on reducing the max pressure to 12 ( minus EPR it is then 9) for the night and read the data tomorrow.
Either the machine has a problem or there is an event. How can I add the signature line? Thanks so much for your help.

[Pugsy]

How to add equipment to your profile? Explained here.
wiki/index.php/Registering_Equipment_in_User_Profile

Tomorrow use SleepyHead and get a detailed daily report and post it so I can see what the settings show on the machine and what the pressure line does.
Screen shots are the easiest....how to post them so we can see what you are seeing explained in this thread.
viewtopic.php?f=1&t=81072&p=737779#p737779

Oh...one other thing. The default setting for Sleep Quality in the clinical set up menu area is for "Usage"...please change it to "On".
Otherwise we can't see the pressure line or anything but hours of use.

Something is not right either with the settings or with the machine.
In APAP mode the machine will not/ should not go from 4 to 14 in 5 minutes. It won't even go up that fast in response to a collapsed airway.