new to CPAP and having a little problem...

Billmanweh · Post by **Billmanweh** » Tue Jun 03, 2008 2:41 am

Without going into all the backstory, I recently saw my doctor with some sleep issues and he sent me to a sleep clinic where I was diagnosed with sleep apnea. The doctor recommend the CPAP machine I have now, the RemStar M Series Auto CPAP with A-Flex. I also got the ComfortGel Nasal mask.

Well, I don't seem to be having any of the typical problems. It doesn't really bother me to wear it, I fall asleep fairly quickly, I don't leak air through my mouth, etc. And no doubt it's working, I feel incredible when I've worn it all night.

The thing is, as I sleep and the air flow increases through the night, I start getting a lot of air leakage. Sometimes at first it's just a little air leaking into my eyes around the top of my nose. Often to the point that it wakes me up. But by the middle of the night it's whistling and making all kinds of flatulence noises. And if it doesn't wake me up, my girlfriend tells me that it's still happening. If it does wake me up, it just feels shocking how forceful the air is blowing. It's like I've got a shop vac attached to my face.

What is typically the cause of that? Maybe the mask is too big? Not tight enough? I kind of feel like it's a mask issue, because if it's not leaking the forcefulness of the blowing isn't enough to wake me up.

dsm · Post by **dsm** » Tue Jun 03, 2008 3:52 am

BillManWeh

What you are describing seems like a mask fit problem. But one other thought is that when we are new to using cpap, sometimes we don't realise how oil from our skin can cause the mask seal to not fit as well.

I tend to wash the seal of my mask each day (I use a tiny drop of dishwashing detergent) and I als wash my face & generally, get by. When I don't I'll be inclined to get the fffffting mask.

On a different theme, there was a time I thought air was coming out my eyes but I believe it was just air escaping from the top of my mask seL INTO MY EYES.

I use a F/F mask myself.

Good luck

DSM

tangents · Post by **tangents** » Tue Jun 03, 2008 6:37 am

Hi Billmanweh,

Welcome to the forum! I agree with dsm that it's most likely a mask fit problem. There's lots of ideas for mask leak/comfort fixes under the yellow light bulb at the top of the page.

Glad to hear that your therapy is working well so far. Keep posting questions.

Regards,
Cathy

DreamStalker · Post by **DreamStalker** » Tue Jun 03, 2008 6:48 am

If you are certain that you are not leaking air from your mouth, you may want to consider trying a nasal pillow type mask. Since it fits and seals to your nares instead of the face around your nose, there is less facial real estate that needs to remain sealed and the nares (at least mine) tend to get less oily than the rest of my face.

Nasal PIllow type masks you may wish to look at include:
Opus 360
Aeiomed Headrest
Breeze
Swift LT (to be released sometime this month)

NightHawkeye · Post by **NightHawkeye** » Tue Jun 03, 2008 7:05 am

Billmanweh wrote:The thing is, as I sleep and the air flow increases through the night, I start getting a lot of air leakage. Sometimes at first it's just a little air leaking into my eyes around the top of my nose. Often to the point that it wakes me up. But by the middle of the night it's whistling and making all kinds of flatulence noises. And if it doesn't wake me up, my girlfriend tells me that it's still happening. If it does wake me up, it just feels shocking how forceful the air is blowing. It's like I've got a shop vac attached to my face.

What is typically the cause of that?

From your description, you've got runaway pressure. I'm guessing that your APAP is set with the range wide-open from 4 cm to 20 cm. Any chance you have the Encore software? Your profile doesn't list it. If you had that it could confirm a pressure increase.

There are host of reasons pressure increases happen, but rather than going into that now, can you confirm your pressure settings. The quick fix is to limit the upper pressure to just slightly more than your titrated setting.

Regards,
Bill

Hawthorne · Post by **Hawthorne** » Tue Jun 03, 2008 9:12 am

I must be getting better at this Nighthawkeye! I thought exactly the same thing you did about pressure range being too wide!
I am really learning lots on this forum when I come up with the same opinion as more experienced users! I have been on cpap since 2002 and found this forum in 2004 but it was just this January I really got involved in my own therapy, with software,etc and help from forum members to set a pressure that works well for me. I know that could change but right now it's great. So keep asking questions here, Billmanweh, these folks are a great help!

Sleeprider · Post by **Sleeprider** » Tue Jun 03, 2008 9:37 am

I'm in about the same place, just completed the first full week of therapy. I also found the use of the APAP relatively easy, and its getting easier. The use of the Encore viewer software has been invaluable. After a few nights, I narrowed the range down from 6 to 14 after experiencing what I thought was run-away pressure. The software told the reality was a ramping up of pressure that woke me up,and it settled after pushing the ramp button.. I am still averaging 5 to 6 AHI but the pressure has been stabilizing and actually trending downward over the week.

If you don't have the software yet, get it. I got the reader/software combo for $149 delivered. I think I'll take other advise in this thread and wash the mask seal. I was experiencing some slippage last night, but no major leaks. Good luck. Sounds like you're doing well with this stuff.

Billmanweh · Post by **Billmanweh** » Tue Jun 03, 2008 9:43 am

dsm wrote:BillManWeh

What you are describing seems like a mask fit problem. But one other thought is that when we are new to using cpap, sometimes we don't realise how oil from our skin can cause the mask seal to not fit as well.

I tend to wash the seal of my mask each day (I use a tiny drop of dishwashing detergent) and I als wash my face & generally, get by. When I don't I'll be inclined to get the fffffting mask.

On a different theme, there was a time I thought air was coming out my eyes but I believe it was just air escaping from the top of my mask seL INTO MY EYES.

I use a F/F mask myself.

Good luck

DSM

I must have mispoke. I am definitely not having air blowing out of my eyes.

It's just air leaking out of the top of the mask *into* my eyes.

You might have a point about cleaning the mask, I definitely haven't been diligent about cleaning it every day.

Billmanweh · Post by **Billmanweh** » Tue Jun 03, 2008 9:59 am

NightHawkeye wrote: From your description, you've got runaway pressure. I'm guessing that your APAP is set with the range wide-open from 4 cm to 20 cm. Any chance you have the Encore software? Your profile doesn't list it. If you had that it could confirm a pressure increase.

There are host of reasons pressure increases happen, but rather than going into that now, can you confirm your pressure settings. The quick fix is to limit the upper pressure to just slightly more than your titrated setting.

Regards,
Bill

I do believe I have mine set to run wide open, like from 4-20. I think my original prescription was for 14. Maybe I'll try setting the machine to max out just over that, like 16?

Maybe with that, and keeping the mask cleaner it might solve the problem.

Billmanweh · Post by **Billmanweh** » Tue Jun 03, 2008 10:02 am

Sleeprider, it did come with some sort of card slot and a software card. My sleep doctor said I should make an appointment and bring in the card and we could look over it, I just haven't felt like I was using it consistently enough to make use of the card.

NightHawkeye · Post by **NightHawkeye** » Tue Jun 03, 2008 11:14 am

Billmanweh wrote:I do believe I have mine set to run wide open, like from 4-20. I think my original prescription was for 14. Maybe I'll try setting the machine to max out just over that, like 16?

Oh, boy! No wonder you're complaining about the blow. You might even want to try the titration pressure of 14 as the maximum.

Face it, you're not getting all that much benefit from the machine the way things are now. Bring the max pressure down to where you can tolerate wearing the mask all night. Partial treatment is a lot better than no treatment. Once you get used to things then you can take time to figure out what else is wrong, make the necessary corrections to improve the therapy and increase the pressure as needed.

I'd also strongly advise getting the Encore software and card reader so that you can monitor your therapy. I'd be surprised if your doc and/or DME will provide you with anything more than compliance info (how many hours use per night). Only a handful of folks have ever reported getting any more info than that from their medical providers.

Good luck.

Regards,
Bill

Hawthorne · Post by **Hawthorne** » Tue Jun 03, 2008 11:48 am

I have the software and reader and am so glad I got it! With that, and the help of people, on the forum I have my pressure range set at 10.5 cm -13cm. My 90% pressure (I spent most of the night at that pressure or below) is 12 cm. At the moment, this is a great pressure range for me. I am hardly ever at 13, just the odd night. I spent most of the every night at 11 and 12 cm. I found I was struggling to breathe, when I was falling asleep, when I had it at 9 -14 cm and my pressure would go up to 14 a lot but my numbers were not as good as with this narrow range . Just small changes, one cm or even 1/2 cm at a time, help in fine tuning your pressure for maximum results. I have an AHI of below 1 almost every night and am feeling good! As time goes on, I may have to change the pressure range again but I will do it gradually, in small increments. The software gives more detail and more accurate numbers than the display on the machine. I would also suggest getting it.

Billmanweh · Post by **Billmanweh** » Tue Jun 03, 2008 5:35 pm

So the software works with the Smartcard module in the machine? It reads the card on my home computer?

Billmanweh · Post by **Billmanweh** » Tue Jun 03, 2008 5:46 pm

Ok, I found that my 90% pressure was 12.8/14 for the 7 and 30 days respectively. So I set the min/max pressure to 5/15, from the original 4/20.

That, and I'll clean the mask good tonight and see how that works.

I'll also look into ordering the software.

Thanks a ton!

Hawthorne · Post by **Hawthorne** » Tue Jun 03, 2008 6:45 pm

Those pressure changes will be a good start. You will probably find that 5 is still a little low for the minimum but it is a start and you may change that fairly soon. I think your upper pressure is also a good start. It is good to give each change at least a week to let everything adjust, unless it appears that a change should be made sooner. You will determine that by how you feel. It may take a few nights though. A clean mask will make a difference too. If you get the software and reader you will make more educated changes as you get used to using it.
Like the others, I strongly advise you to get the software and reader, if you can. You will get so much detail about each night that you will be amazed! Then you can really start fine tuning your therapy!
Lots of people here are able and willing to help you to use the software to your best advantage so you have the best therapy and to help you, even without the software. I guess you've seen that today. Let us know if you notice some improvement with these changes. Have a good night!

new to CPAP and having a little problem...