New User - First Night - Not Sure On What I am Doing

Cancun9 · Post by **Cancun9** » Fri Sep 28, 2007 12:22 am

I am military, overseas, and just got my CPAP yesterday. It was issued to me by military hospital. I received a GoodKnight 420E with the humidifier, and a Advantage Series TMS-2520 mask.
There was no training available so I took it home and read the instructions and set it up. The mast is not very comfortable and the head gear block most of my vision. It is set to 40 and will not let me ramp up, so it is loud and has allot of pressure from the beginning. Is it suppose to be so loud? It has little vents at the hose that faces the hose, so the air makes even more noise as it bounces off the exterior of the hose itself. The pressure seemed pretty high to me, as I could not exhale as easily as I could inhale, so I was worried that it was not correct and I turned it off and did not use it.
Are there better masks that are not so cumbersome and does not have straps all over the face? I know it is my first day with it, but I did not expect it to be so loud. Is this normal?
Any advice from those of you have are experienced with all of this would be greatly appreciated.
Thanks.

Slinky · Post by **Slinky** » Fri Sep 28, 2007 12:52 am

Welcome to the forum. I've never heard of the mask you were given so I can't really comment on it.

I don't think the 420E can provide 40 cms of pressure. I'm not sure that there is ANY xPAP that can provide that high of a pressure. The 420E is an excellent autoPAP and the Silverlining software is available for it so that you can monitor your own therapy. Those that have them really like them.

However, the 420E is not capable of providing any form of expiration pressure relief. None of the Puritan Bennet xPAPs have any form of expiration pressure relief to the best of my knowledge. So far as I know only the Resmed and the Respironics machines have expiration pressure relief (called EPR for the Resmeds and A-Flex or C-Flex for the Respironics). I'm taking a guess that the pressure range for your 420E might be set from 4 cms to 20 cms rather than 40 cms.

I would suggest that you contact the doctor who ordered your equipment for you to ask about a pressure adjustment after explaining what you are experiencing w/the discomfort when exhaling. It may be that he will order a narrower pressure range for you - at least until you can adjust to using an xPAP.

Also explain the difficulties you are having w/that mask to the doctor or the RT at your issuing military hospital. Did you have to do any assembly with the mask? Perhaps it isn't quite assembled correctly? Ask to see what other full face masks they have on hand.

I did find some information on what I think is the mask that you have.

https://www.cpap.com/viewImage.php?PNum ... e-mask.jpg

https://www.cpap.com/productpage/full-a ... -mask.html

It is a full face mask. Full face masks can be difficult to find a good fit and seal. You might try looking over the full face masks offered at cpap.com to see if there is another one that you think might better fit your needs.

https://www.cpap.com/simple-find-cpap-p ... /cpap-mask

I'm sorry I couldn't be of more help. Good luck!

Cancun9 · Post by **Cancun9** » Fri Sep 28, 2007 1:07 am

Thanks for the response. The JPG is the mask I have. It has the exhalation port in the frame that makes allot of noise. Of course, I am new and it may be quiet compated to others.

I apologize if my pressure number is incorrect. I was looking at the little screen when I was wearing it and it said 40. Maybe because I cannot wear my reading glasses with the mask, it was displaying 4.0. So I assumed that was 40 cms. When I go home tonight I will verify.

Since I took it off because I was worried it was not set right, I have not actually slept with it yet, so maybe I should at least see if it is just a matter of adjusting to this new device and not just me.

Thanks for your help.

Slinky · Post by **Slinky** » Fri Sep 28, 2007 1:36 am

Nothing to apologize for. There's a lot to learn and absorb with this CPAP bit! To just be handed your equipment and sent on your not so merry way w/o explanation and demonstration AND FITTING OF THE MASK is enough to overwhelm anyone!

Heck, at least I had a short and simple demonstration and some attempt at mask fitting and there was still too much to learn and absorb in too short a time. It was like information overload even tho there wasn't that much information presented.

I don't have the same xPAP as you do but mine does start out louder at first and then quiets down and I'm not sure just what that is all about or why. Its not just my imagination or my getting used to the sound. Its the same each time I turn it on and it has occurred w/all 4 of the xPAPs I've used. Later in the night, or the next morning when you wake up its running so quiet I almost have to pull my mask away from my face to hear the air rushing to be sure the xPAP is still running.

Some masks are quieter than others. And leaks when they don't seal well or properly can be pretty loud. And, of course, when its all new and we're not used to all the paraphernalia we are MUCH more conscious of the new sounds and sensations. I'm sure a good share, if not most of us, even go thru a short period of trying to breathe according to the xPAP instead of breathing naturally.

AutoPAPs, which is what the 420E is, are often first set w/a pressure range of 4 cms to 20 cms and as you use them they adjust to your breathing and start out providing only that 4 cms of pressure then gradually build up to the pressure(s) needed to stop an apnea or hypopnea and once the obstruction in your throat is remedied it drops down in pressure only to build up pressure again as needed. The theory is to provide the pressure needed to stop apnea/hypopnea events but allow you to sleep at a lower pressure most of the night.

The software then provides the data to ascertain what pressure range you do best at. They are often used to auto titrate a straight pressure and then are set to straight CPAP mode at one set pressure rather than a pressure range. Generally it is kept in auto mode a week, or better yet, two weeks to determine your best pressure. And sometimes the data suggests that you will do better remaining in auto mode but at a narrower range of pressure.

All this was clear as mud I suppose. Sorry I can't explain it better.

Even tho you are military you are entitled to some information and education about your xPAP therapy. Don't be bashful, get some help from the RT at the military hospital or the doctor who ordered your equipment and get better information and explanation.

msheda · Post by **msheda** » Fri Sep 28, 2007 3:10 am

If you thought 4 was alot of pressure, wait until you hit 20!

Weeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee!

(I still haven't found the site that converts pressure to mph, but it would be interesting to see)

You might also want to play with (I mean umm, experiment and test, try to fit the leaks, etc) when it's not bedtime. Familiarize yourself with putting on the mask, and trying to get it to seal. Adjust the straps (and readjust them with the machine on and your laying down, on your back, on your side etc...). That way when it is time for bed things will go easier.

Guest · Post by **Guest** » Fri Sep 28, 2007 4:50 am

Thank you for the advice. I am sure 20 is not a level I want to experience.....

Cancun9 · Post by **Cancun9** » Fri Sep 28, 2007 6:28 am

Thanks for the advice. I guess I am still a little nervous about sleeping with a mask pushing air down my throat. Especially since I have had no training or counseling or guidance on how to use a CPAP (that is how the military works sometimes, especially overseas). I am not sure if I am to breath out of my nose or out of my mouth back into the mask....it is little things like that which would be good to know....

bdp522 · Post by **bdp522** » Fri Sep 28, 2007 6:33 am

Always try to breathe in and out through your nose. Try to breathe as normally as you can. It gets easier as the night goes on.

Brenda

Slinky · Post by **Slinky** » Fri Sep 28, 2007 6:38 am

Cancun, with a full face mask which covers both nose and mouth, breathe thru either or BOTH. Makes no difference, that is the reason for a full face mask! So you CAN breathe thru your mouth if you want, or your nose, or both. A full face mask doesn't care!! That is their biggest advantage and reason for being.

Go to the Red Ball at the top of the page with the Question Mark in it. Scroll down to Mask Fitting. Read thru that and it might help you adjust your mask to a better fit. Just understand that our faces come in all shapes and sizes and one man's great mask is another man's intolerable mask.

Cancun9 · Post by **Cancun9** » Fri Sep 28, 2007 6:43 am

Thanks. I assume my questions are pretty dumb, or pretty simplistic, but I am pretty new to this and still not comfortable with the whole idea of sleeping with a machine.

tuna · Post by **tuna** » Fri Sep 28, 2007 6:53 am

Cancun9 wrote:Thanks. I assume my questions are pretty dumb, or pretty simplistic, but I am pretty new to this and still not comfortable with the whole idea of sleeping with a machine.

There not dumb! The only bumb question is the one you never ask!

Slinky · Post by **Slinky** » Fri Sep 28, 2007 6:56 am

Don't sweat the small stuff, Cancun. Unless you weighed 20 lbs at birth you weren't born walking either.

First try to master breathing with the mask which ever way is easiest and most comfortable to you. If, eventually you master breathing thru just your nose, you can 'graduate' to a nasal cushion or nasal pillows mask which are lighter in weight. For now just concentrate on trying to breathe as naturally for you as possible w/the mask and xPAP.

I'm sure you've been told before, or at least heard, that the only dumb question is the one that doesn't get asked. Questions are the reason for this forum and answers are what keeps it going. The support and empathy here is unsurpassed. Hang with us. We'll get you thru this 'til you become a veteran PAPper helping others.

Cancun9 · Post by **Cancun9** » Fri Sep 28, 2007 8:50 am

think their may have been a misunderstading on my mask, as it does not cover my nose. So I was not sure if exhaling through my mouth, and back into th machine, would exert more pressure back as it analyzes, and increases my pressure from 4.0 to something higher.

I will work on the nose breathing and actually use i tonight. I should have stayed the course last night, but will tonight.

It is also set as APAP, and from my reading, I know this means I can adjust it. I ordered the software and hope to figure all of this out eventually. I really need a good night's sleep....

Guest · Post by **Guest** » Fri Sep 28, 2007 9:13 am

Are you wearing a nasal mask over your mouth???

Wulfman... · Post by **Wulfman...** » Fri Sep 28, 2007 9:15 am

Cancun9 wrote:think their may have been a misunderstading on my mask, as it does not cover my nose. So I was not sure if exhaling through my mouth, and back into th machine, would exert more pressure back as it analyzes, and increases my pressure from 4.0 to something higher.

I will work on the nose breathing and actually use i tonight. I should have stayed the course last night, but will tonight.

It is also set as APAP, and from my reading, I know this means I can adjust it. I ordered the software and hope to figure all of this out eventually. I really need a good night's sleep....

I don't know how you're trying to wear it, but the mask you listed in your first post.....Advantage Series TMS-2520.....IS a NASAL mask and should be worn over the NOSE.

http://www.homecare-medical.com/php/sho ... tailFlag=1

http://www.viasyshealthcare.com/product ... sp?catID=4

Den