first night w/ Bi-Level CPAP...frustrated

new-to-BiPAP · Post by **new-to-BiPAP** » Fri May 30, 2008 9:03 am

ok...I know...it's only the first night. I had it on somewhere between 1-2 hrs. My main problems seem to be the mask and the position I sleep in (which is being affected by the mask). I did notice I was fighting with the machine when it wanted me to breathe a different direction than I wanted to. But the mask was really annoying. I was (intentially) sleep deprived during my titration study so the masks felt fine...but I also did not try sleeping on my stomach with the nose one during the study (which I should have). I don't think I quite have it adjusted yet...hopefully my hubby can help me with that tonight...the velcro kept getting stuck in my hair when I tried to adjust it laying down. The main problem is that I want to go to sleep on my stomach. It's easier for me, more comfortable, less painful, etc etc etc. With the mask if I do sleep on my stomach the mask really gets pushed into my face which is not conducive to sleep! I wonder now if I was given the wrong size...I went onto cpap.com and put in my face lengths and it showed I needed the petite of the mask. The only problem is that the DME guy said I could swap out a mask of the same brand only ONE TIME in the first 30 days. So I'm kind of afraid to ask for the smaller better fitting one and not have it work for my stomach and be stuck for 3 months. *sigh* I know I have to find a way to make this work...but I am frustrated. I'm not sure if I should call the sleep dr since he prescribed the mask (but I dunno if he gave the size) or the DME and use my only swap out on the first night.

new-to-BiPAP · Post by **new-to-BiPAP** » Fri May 30, 2008 9:05 am

ok...I did check the prescription and the sleep dr did order the specific mask (HC407), there is a smaller mask (HC406) but I dunno if that would help very much with me wanting to sleep on my stomach...dunno what to do...

Slinky · Post by **Slinky** » Fri May 30, 2008 11:09 am

Two things: one buy a good, soft pillow (I recommend a down pillow unless you have allergies), one that you can punch into the shape you need to provide for your mask and hose.

The other is to buy a PAPillow. A google search will bring up the URL. These pillows are great for side sleepers especially. You can just lay your face close to the edge of the comfy PAPpillow and the mask and hose will lay off the edge.

Guest · Post by **Guest** » Fri May 30, 2008 2:21 pm

I'll check into the pillows...thanks! Looks interesting.

new-to-BiPAP · Post by **new-to-BiPAP** » Fri May 30, 2008 3:12 pm

I called my sleep dr office and the DME. I also have been having asthma problems which might because the humidifyer was too low (we live in the desert). The dr is going to send over a prescription for another mask. Dunno how it will work with insurance however. I might try a nasal pillow. My hubby has one and I tried it on
(tho it was too big) it did allow me to lay down on my stomach. But will see how this one goes till then. Hopefully I can keep it on for longer tonight...

EdAPAP · Post by **EdAPAP** » Sat May 31, 2008 11:33 am

You are going to love your bi-level CPAP machine when you get used to it!

After suffering for several months on APAP at very high pressure, my Sleep Lab prescribed a top of the line Respironics BiPAP. I simply could not exhale sufficiently agains 18-20 cm of pressure. This affected the gas exchange in my lungs and triggered some central apneas. The doctor prescribed fixed pressures of IPAP = 18 and EPAP = 13. It was like night and day. The ability to exhale easier allowed me to adapt to the high inhalation pressure. No more central apneas.

I think the realization that allowed me to adapt to the high pressure was relaxing and not sucking in the inhalation pressure to the max. Now when I'm going to sleep I try to get into a cycle in which I start inhalation slowly and then let the machine build up to full pressure and complete the inhalation phase. Next I consciously exhale just before inhalation ends and the pressure drops instantly.

This is exactly the cycle I notice when I am starting to wake up in the morning - a slow, steady inhalation and exhalation pattern.

After almost a year on the BiPAP, I feel I am breathing much more normally and easily on the machine than I am when I take off my mask in the morning. The sense of high pressure is gone and feels just right.

Warm regards,

Ed

new-to-BiPAP · Post by **new-to-BiPAP** » Sat May 31, 2008 12:45 pm

Well...last night was strange. The second night. I didn't take benadryl cuz I didn't want to dry out. I increased my humidifier from 2-4 (out of 5) and that was fine at first. I did try and sleep on my stomach with my same mask but I noticed I was tightening my neck to keep myself from having too much mask pressure so I gave up on that. I did take a muscle relaxant (I know that can make some things worse) so I could get to sleep. I slept for 5 hours straight! However, my hubby said I slept horribly...I kept waking him up. My legs were moving and I was having quite a bit of what he thinks was mask leak noise (I had loosened the mask to try and sleep on my stomach so it was prolly a bit loose. Tho he is not sure if it was my opening my mouth of the mask he thought it was the mask. What's strange is that I thought I slept fine. I was so happy when I woke up and noticed how late it was...since I wasn't sure how long I would be able to sleep with the mask last night. He actually had to turn off his CPAP to try and get a better night sleep cuz apparently I was waking him up (tho I didn't know I was awake if I was...he thouht I was adjusting my mask but I don't remember). So I did sleep longer...prolly because of the med...but apparently the quality was no good. Also, at times I woke up thinking I had missed a breathe (dunno how accurate that is...especially since I don't normally have apneas...but I've heard sometimes the PAP machines can cause some people to have apneas). So I'm not sure what to think. I will try the mask thru the weekend but I'm not sure what to do if I need to turn in this mask to get a new one. I'd hate for that one to be too much pressure in my nose (which is why I didn't like it at the sleep study) and trade in one problem mask for another problem mask.

Sorry a bit of rambling...this is all a bit confusing for me...

I think I will be able to adjust to the Bi-Level. My pressures aren't that high (10/6) tho usually when I wake up, use the bathroom, and try and get back to sleep I feel like I'm fighting breathing against the machine and that is why I take it off. I will be half way thru inhaling and the machine will stop pushing. Or I will not be done exhaling and it will want me to inhale. So I end up feeling like I am breathing really shallow. Even with ramp...I guess I can't get to sleep in the middle of the night before it ramps up apparently.

ozij · Post by **ozij** » Sat May 31, 2008 1:10 pm

I will be half way thru inhaling and the machine will stop pushing. Or I will not be done exhaling and it will want me to inhale.

They have to adjust the machine so it doesn't do that,
O.

new-to-BiPAP · Post by **new-to-BiPAP** » Sat May 31, 2008 1:19 pm

Is that kind of adjustment something that the DME can do...or do I need a sleep study to find out what needs adjusting? I would assume it is the sensitivities...which I know how to change...I just don't know how I need them changed. Don't want to mess around with it if I don't know what I'm doing. But glad I know how incase... It seems to be when I try and get back to sleep after waking up that the breathing doesn't jive. I must fall asleep faster at first so it doesn't bother me.

ozij · Post by **ozij** » Sat May 31, 2008 9:21 pm

It's the sensitivities -
viewtopic.php?p=233654#233654

BarryKrakowMD wrote:General Bilevel

I'm not aware of any bilevel machine setting a breathing duration by number of seconds, but I don't know all the details about all the machines.

All of the machines as far as I know have a rise time setting that indicates how long it takes for pressure to rise from EPAP to IPAP once the person starts inhaling. The settings on rise times are usally in a range of 1 to 5 or 6 with the higher number usually indicating an allowance for a longer period of time to increase to the highest (IPAP) pressure as a means of more comfortably transitioning during the bilevel E to I switch. But, this transition phase is marked in milliseconds as I understand it.

PB 425 Bilevel

The PB 425 has a most unique setting called "sensitivities" for both inspiration and expiration, that is, two distinct settings. These sensitivities determine how easily or how hard you want to make it to trigger the change from I to E or from E to I. The scale is 1 to 10, with lower numbers reflecting greater sensitivity, that is, faster triggering of a switch, whereas higher numbers reflect less sensitivity, so the machine needs more input from the patient's natural breathing to make the switch.

As an example, we note that insomnia patients with SDB and anxiety have some trouble with being able to "finish inspiration" before being cut off by a drop off in pressure to expiration. So, we set the I sensitivity very low to easily trigger IPAP, but we set the E sensitivity very high so that EPAP is much harder to trigger, thus giving the patient more time to finish inhaling.

We like the PB 425 because we can adjust the 2 sensitivity settings in the sleep lab and actually monitor this process while the patient is asleep.

Sleep vs Wake Sensitivities

We think we're learning something very intriguing about this system, because it seems to produce very different results depending upon a sleeping or a waking state. In other words, if you try to set someone's sensitivities while they are awake, the patient will always select something that feels most comfortable. But, if you then test the patient in the sleep lab, the sleep tech will usually discover that the sleeping patient breathes more comfortably with a different set of sensitivities.

I believe this finding is in harmony with the fact that we really do breathe differently under sleeping conditions. And, I think it's yet another reason why we so strongly emphasize retitration studies in the sleep lab for PAP therapy users.

O.

new-to-BiPAP · Post by **new-to-BiPAP** » Sat May 31, 2008 10:18 pm

O,

thanks for the link and info. I had read some of that on Dr Krakow's website but the link has a lot more info. I'll mention the sensitivity problem and see what they say.

Guest · Post by **Guest** » Mon Jun 02, 2008 9:18 am

slept all night w/ the machine saturday (woke up 1-2 times)...but then was completely exhausted yesterday. Dunno what is causing such a bad sleep with the machine. last night could only use for 4 hrs. thought i was going to be able to do this but i dunno how now...

cflame1 · Post by **cflame1** » Mon Jun 02, 2008 9:04 pm

When you got the machine... did it come with Silverlining? If it didn't... you should get it.

Silverlining allows you to see the detail of how your sleeping... whether it's something simple like a leak or something more complicated.

new-to-BiPAP · Post by **new-to-BiPAP** » Tue Jun 03, 2008 7:46 am

Well...the DME offered to download my info and give me a report any time I wanted. Which is fine by me cuz I don't have a PC (I have a mac) and I don't have th softward on the Mac to run Windows to run the software. So I will be bringing that in soon (in the next day or 2). I'm fairly certain that the Bi-level is causing apneas (and I wasn't supposed to have apneas...only UARS and PLMD). my hubby said I stopped breathing at least 2 times last night when he woke up around 4. I took it off shortly adter because I was trying to get back alseep and kept being awaken needing air. Very annoying! Plus, I seem to be MORE tired after using the Bilevel thansleeping without it. So hopefully the download can tell me about leaks and apneas. I am getting really tired (pun intended) of this. hopefully they can fix that. My levels are not that high(10/6) I thought if they were really high they could cause apneas. but mine doesn't seem that high. I think I am getitng used to the sensitivites...or maybe i'm just too tired to care...who knows!

new-to-BiPAP · Post by **new-to-BiPAP** » Wed Jun 04, 2008 11:35 am

Ok...I spoke to the DME and he said the software for my machine really didn't record much data. Doesn't record apneas, just average breaths per minute. I was kind of unclear if and how it recorded leaks. In any case...I got a new mask. I will try this for a while and then maybe have him download to see if there is a difference.

first night w/ Bi-Level CPAP...frustrated

first night w/ Bi-Level CPAP...frustrated

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