Exhale!

[bonmac]

I just started my new cpap this week. I have mild apnea and was put on a dream station with nasal mask. My pressure is set at 6. My problem has been exhaling. I have tried the past five nights to adjust to this, using the ramp frequently. I will last from 2-3 hrs before I turn it off and go to sleep. Auggh!

Is this all mental ? Sometimes I feel like I need a good deep breath - mouth open!! Is a bipap a thought? Help!!!!

[Julie]

Look in your manual for an EPR (Exhale Pressure Relief) feature - you set it to whichever level works best for you... one thing you may notice is that AHI will rise a bit as a result, but usually not by much and you can find a balance that works for you.

[bonmac]

I cannot find mention of an EPR in my manual. Do I need to connect to my computer?

[Julie]

It should be a built-in feature, but as I don't know your machine, I suggest you call Cpap.com and ask them about it (they'll be able to look at the machine).

[Sleeprider]

On a Respironics Dreamstation, the exhale relief is called CFlex of AFlex. It would help if you registered and put your equipment into your profile. The Flex settings all provide about 2 cmH2O pressure relief, settings 1-3 affect the timing of the relief with 1 being fastest and 3 being slower. Since you want the machine to switch to lower pressure faster for exhale relief, use setting 1. If you need a clinical manual for your machine to access the setup controls, they are available from the Apenaboard forum at this address: http://www.apneaboard.com/adjust-cpap-p ... tup-manual

[OkyDoky]

The most pressure relief is at the 3 setting and at most this is about 2cm H2O. This is how Flex is described in your manual. So if this has been locked you have to go into the Clinical setup to adjust.

This allows you to adjust the level of air pressure relief that you feel when you
exhale during therapy. Your home care provider can enable or disable this
feature. When your provider enables Flex, a level will already be set for you on
the device. You can increase or decrease the setting from 1 to 3. The setting of
“1” provides a small amount of pressure relief, with higher numbers providing
additional relief.
Note: If a lock icon is displayed on this screen, it indicates that your
provider has locked this setting and you cannot change it

You 6 is a low pressure and the machine can only go down to 4 so the 2cm is the most you can decrease. Is this a fixed CPAP pressure or the start pressure of a range in APAP mode?

[BlackSpinner]

Get some good movies, put the thing on and watch the movies. Just like everything else sometimes we need to practice to get in shape. Exhaling against pressure is one of those things, you chest muscles and diaphragm need to get in shape, your mind needs to believe it is safe.

[palerider]

It should be a built-in feature, but as I don't know your machine, I suggest you call Cpap.com and ask them about it (they'll be able to look at the machine).

only some resmed machines have EPR. the OP hasn't stated what kind of machine they have.

[palerider]

On a Respironics Dreamstation, the exhale relief is called CFlex of AFlex. It would help if you registered and put your equipment into your profile. The Flex settings all provide about 2 cmH2O pressure relief, settings 1-3 affect the timing of the relief with 1 being fastest and 3 being slower.

that is *NOT* correct, *flex will provide, *at most* up to around 2cm/h2o, but that's only if you're taking very heavy breaths, the amount that flex changes the pressure depends on both the setting, AND how forceful one is breathing.. timing has nothing to do with it.

[bonmacc]

Wow thanks for all the support! I have adjusted my machine and picked a movie for the evening. Hope this all works - say a prayer!!

[Michelle-OH]

Good luck, the exhale was the hardest thing for me to adjust to.

[bonmac]

Reading through some other's experiences, I hope I am doing this right. I have lowered the pressure on my machine to 4.0 which has helped with my exhale concerns and I am more relaxed trying to go to sleep. I am now using a size M mask (started with a S) which helps with the feeling I am breathing heated air, and is not so suffocating. Maybe I should adjust my humidity setting?

However, I have not actually gone to sleep, and after 2-3 hours of laying quietly, breathing calmly, I take the mask off and go to sleep. I am thinking this at least gives me some rest. I actually pretty good this morning! I am hoping that some day I will eventually go off into a normal sleep, mask on, without killing myself in the process???

Is this a good plan?????

[OkyDoky]

Reading through some other's experiences, I hope I am doing this right. I have lowered the pressure on my machine to 4.0 which has helped with my exhale concerns and I am more relaxed trying to go to sleep. I am now using a size M mask (started with a S) which helps with the feeling I am breathing heated air, and is not so suffocating. Maybe I should adjust my humidity setting?

However, I have not actually gone to sleep, and after 2-3 hours of laying quietly, breathing calmly, I take the mask off and go to sleep. I am thinking this at least gives me some rest. I actually pretty good this morning! I am hoping that some day I will eventually go off into a normal sleep, mask on, without killing myself in the process???

Is this a good plan?????

We really need to know what machine you are using. No one was talking about lowering your fixed or auto minimum pressure, but another setting and what that setting is called depends on what machine you are using.
What settings were you originally on? What did your Sleep Study show?
If your machine is data capable we could show you how to download free computer software and post screenshots so we could give you ideas.
Some people have a suffocating feeling at lower pressures and this may be what you are experiencing. A 6cm/H2o is low but 4cm is very low.

[bonmac]

Here's what I know:

I have a DreamStation with heated humidifier. It was set at 6.0 pressure with ramp feature of 4.0 When I had trouble exhaling, it was suggested I lower the pressure to 4 which I did. That made it much easier for me to adjust. I am using a DreamWare nasal mask with under the nose cushion.

Honestly, I have never seen my sleep study, which was ordered by my cardiologist. I have been told only that I have mild apnea. I will admit to being fatigued and needing naps daily - I am 68 so maybe this is age related.

I am just concerned that I start this journey with good habits. Is it "normal" to try the CPAP at bedtime as long as possible then revert to sleeping maskless? Will I eventually fall asleep at some point with it on??

[OkyDoky]

Get a written copy of your Sleep Study and a copy of your prescription. They are your medical records and at some point you are going to need them.

The DreamStation has several models and all have full data except the CPAP one. Let us know which one you have. Take the water out and look for a number that starts with DSX.

Apneas occur when you sleep day or night and to prevent them you have to use your machine anytime you sleep. Your set pressure at 6 is low and 4 is the lowest the machine goes, so I'm wondering if your exhaling difficulty is from your mask cushion movement or needing another cushion size. I don't use this mask but maybe someone that does will have suggestions.

The setting that people were discussing on this thread is A-flex on your machine. So what I would try is putting the pressure back at 6 and setting the A-flex to 3.