What do you think of this plan?

mj · Post by mj » Mon Mar 12, 2007 8:46 pm

I've been on an APAP machine for a little over four months and still struggling to get more than a few hours each night with the mask on. I typically wake up and find that I've taken the mask off sometime after 3 to 4 hours.

My prescription was for a pressure range of 5-12 and I've left it that way. I think what might be happening is when I get into a REM sleep the pressure goes high enough that I find it uncomfortable and I automatically take off the mask.

Sorry - no software or card reader yet so I can't provide any more details. I have tried a couple of different masks with no success.

I'm thinking about adjusting my pressure settings to a range of 5-8 (initially) and "training" myself to become accustomed to sleeping with the mask on all night. Yes, I know I wouldn't be getting adequate therapy - but then again I'm not getting it now.

Of course once I was making it through the night with the mask on I would gradually increase the upper levels of the pressure until I was at my full prescription. From what I've read on the boards it also seems at that point I would want to narrow the range.

Has anyone ever tried anything like this? Does it sound like the potential benefits are worth any risk of reduced therapy? I'd welcome any thoughts or suggestions anyone might offer.

Thanks!

MartiniLover · Post by **MartiniLover** » Mon Mar 12, 2007 8:58 pm

My first thought is that you are only going through what a lot of us did.

Changing your machine doesn't sound like the thing to do.

If the machine only gives you what you need, and the key word is need, then that is what you are getting to keep your throat open. Less than what you need, and you will be back to having sleep apnea.

My expierence.....................Doc said get over it. Keep the mask on. I started that night thinking about NOT getting weak. It worked, for me. I average over eight hours every night.

Hang in there. When you wake up, put it back on.

Good luck and happy breathing.

JimW · Post by **JimW** » Mon Mar 12, 2007 9:04 pm

That 5 for the low pressure is very low. Mine had been starting at 6, and that was a little low for me. If you think that the pressure changes may be causing you some problems, you might consider raising the 'low' setting a little, as well as lowering the high number. Try something on the order of 6 to 10, perhaps. (This is if you are set on trying a lower setting for your 'high'.)

Wulfman · Post by **Wulfman** » Mon Mar 12, 2007 9:08 pm

mj,

My intuition tells me that your bottom pressure is way too low and you are probably leaking therapy air out your mouth.
And, because of that, you're probably pulling the mask off because you're feeling starved for air.

Best wishes,

Den

mj · Post by mj » Mon Mar 12, 2007 9:42 pm

Thanks everyone. Sounds like the consensus is that I need to raise the lower pressure first and then work with the upper limit only if I have to. I'll try it tonight. Who knows I may actually wake up with the mask on in the morning!

Linda3032 · Post by **Linda3032** » Mon Mar 12, 2007 9:49 pm

MJ, if you have the correct machine listed, then you do have access to some numbers. Try this:

How to access M series LCD data: You just need to press either of the arrows on the control panel to scroll through the LCD data. It will show average pressure, AHI, leaks, hours of use, etc.

Hold down the <- -> buttons while plugging in the little power cord in the back, wait for 2 beeps release buttons. Then press the + key to enter setup mode, use the <- -> buttons to move to the next field, use the -/+ keys to decrease/increase values, when set press the On/Off button to exit Setup.

It is strongly suggested going through your existing settings and writing them down in case you have to reset them to their previous values.

There is a feature called:
Show AHI/Leak=On (enables logging to display, leave On).

Let us know what the numbers are. Also, what was your titrated pressure? Let's work from there.

DreamStalker · Post by **DreamStalker** » Mon Mar 12, 2007 9:51 pm

Just make sure to collect a few days of data before making additional changes. Also make sure you are not leaking air ... that is the first thing to get under control if you leak from your mouth or the seal.

As I understand it, you can get basic data from your machine's LED ... jot it down each morning or better yet put in a spread sheet (pressure, AHI, OAI, HI, leak).

Snoredog · Post by **Snoredog** » Mon Mar 12, 2007 10:41 pm

mj wrote:I've been on an APAP machine for a little over four months and still struggling to get more than a few hours each night with the mask on. I typically wake up and find that I've taken the mask off sometime after 3 to 4 hours.

My prescription was for a pressure range of 5-12 and I've left it that way. I think what might be happening is when I get into a REM sleep the pressure goes high enough that I find it uncomfortable and I automatically take off the mask.

Sorry - no software or card reader yet so I can't provide any more details. I have tried a couple of different masks with no success.

I'm thinking about adjusting my pressure settings to a range of 5-8 (initially) and "training" myself to become accustomed to sleeping with the mask on all night. Yes, I know I wouldn't be getting adequate therapy - but then again I'm not getting it now.

Of course once I was making it through the night with the mask on I would gradually increase the upper levels of the pressure until I was at my full prescription. From what I've read on the boards it also seems at that point I would want to narrow the range.

Has anyone ever tried anything like this? Does it sound like the potential benefits are worth any risk of reduced therapy? I'd welcome any thoughts or suggestions anyone might offer.

Thanks!

There can be many reasons why you remove the mask. You don't mention what the 7-day and 30-day averages have been for AHI and LEAK?

Did you have a titration study and did they find a pressure for you between that 5-12cm setting?

I would suspect that your Minimum pressure of 5cm is too low and that is why you are removing the mask, you are starving for air just to breathe. Our normal fight or flight tendency is to remove anything from our face if we are not getting enough air.

It is also possible you have a sleep pattern that is running the pressure up. Next time it happens, put a flashlight next to the machine and check the LCD for the displayed pressure. If it is at 12cm or 13cm then you will need to fix that by Lowering the Auto:Max=12 to Auto:Max=11cm.

Next, if the Auto:Min pressure is too too low, you can starve for air while asleep. When you are are awake the incoming air may feel stuffy or very humid.

If it feels that way, it can mean you are rebreathing too much of your own exhaled CO2, this is caused by the Auto:Min being too LOW. You are now at 5.0cm from your prescription, many people find that to be too low.

Most masks need a pressure of at least 6 to 6.5 to exhaust out the CO2 that you exhale properly. So my suggestion would be to increase the Minimum by 1cm to 6.0cm from current 5.0cm.

Now since you suspect it is the higher pressure that is disturbing you, you should enable Auto:Ramp feature available on your machine.

Auto:Ramp is a cool feature it would allow you to push the Ramp button (anytime) on the top left of your machine and it would immediately drop pressure back to a lower set value, in your case back down to 6.0cm.

So I would go through your settings and make sure they match below (it won't mess up any data your doctor may want).

So here's is my suggestion:

1. Hold down the <- -> buttons while plugging in the power
on the back, wait 2 beeps, release buttons.
2. Press the + key. <- -> buttons move to next field, -/+ keys decrement/increment
3. Check the following field(s):

-Therapy Mode=Auto (CPAP/Auto)

-Auto:Max=12 (default=20.0cm)

-Auto:Min=6.0 (default=4.0cm)

-CFlex Setting=2 (options are off, 1, 2 or 3)

-AutoRamp Time=30 (options are 05 to 45 min)

-AutoRamp Pressure=6.0cm (4cm->AutoMin)

-Mask Alert Feature=ON (On/Off)

-Auto Off Feature=Off (On/off)

-Split Night Time = Off (off, 120, 180, 240)

-Show AHI/Leak Feature=ON (On/Off)

Press On/Off button to exit.

Theory of operation with the above settings:

1. Put on mask, machine should start at 6.0cm pressure.
2. It will increase pressure as needed up to the Auto:Max=12cm.
3. IF you again wake up from the pressure, push the RAMP button on top of the machine. It will immediately drop the pressure back to 6.0cm for 30-minutes. This should allow you to fall back asleep where machine will after 30-minutes begin autopap therapy.

If you are having difficulty falling asleep and pressure increases, push the Ramp button and it will delay that from happening for 30-minutes. You can push the Ramp button as many times as you like.

The above settings will also enable the AHI data from the LCD if you are not getting that now. To reset the LCD data back to zero so you can see the results the next day, go into the setup mode above BUT push the -> button, when the Therapy screen is displayed, press the (-) button for 5 seconds, it will reset that data to zero.

Next morning observe your AHI data, pressure & leak data. If leak is over 45L/min, you could be mouth breathing, that could also wake you up and cause you to remove the mask. The reason is you have an apnea, mouth is open cpap pressure goes out the mouth and doesn't eliminate the apnea. Waking up with dry mouth or going through more than 1/2 tank a water per night would be indicators of possible mouth breathing (if using a nasal mask interface).

SleepGuy · Post by **SleepGuy** » Mon Mar 12, 2007 11:50 pm

mj, for the first three years of using my cpap I would regularly wake up between 2 and 3 in the morning, mad as hell, and wanting nothing more than to smash my machine to pieces with a hammer. Now that's not my typical personality--I'm usually quite passive, even-tempered, etc.

Stick with it--you'll get it figured out. There's so much riding on successful therapy that it's definitely worth every effort. And I can see you've had some amazing advice on this thread. I'm impressed!

mj · Post by mj » Wed Mar 14, 2007 9:35 pm

Hi everyone. I didn't want to go to bed tonight without taking the time to thank everyone who responded to my request for feedback. As usual you guys were right on the mark. I've increased my lower pressure limit and had TWO GOOD NIGHTS!

Den and JimW - your intuition is right on the mark. Maybe you guys should open a CPAP psychic hotline!

Linda - Thanks for reminding me to write down my inital settings. I'm always a little timid when I start to tinker with the set-up features and that helped me to be more confident. It also prompted me to note when I made the changes so I can track my progress.

Snoredog - thank you for such thorough instructions and especially for lettting me know about autoramp feature and how to reset the data. I love knowing how things work!

Dreamstalker - thanks for reminding me to write down my daily information. I had done this religiously in the beginning, but had become quite sloppy about it as I became more discouraged.

Martinilover and Sleepguy - thanks for your support and encouragement. I'll admit I can be a bit of a whiner about this! It sure helps to know that others have struggled and overcame these very same obstacles.

To everyone, I can't say thanks enough. I've been lurking on the message boards picking up every tip I could for months now. Hopeully this is the magic key that will turn the corner for me. Not only will I begin feeling better, but I hope I will soon be able to contribute as all of you, who have been so generous with your time and expertise.

Thanks again!

What do you think of this plan?

What do you think of this plan?

Re: What do you think of this plan?