Newbie alert!

[dr_bob]

Hi,

So - it might've taken me 7 years, but eventually, here we are - diagnosed with obstructive sleep apnoea. I went for a sleep study a couple of weeks ago and had a call from the hospital the other day to come in and 'discuss' my results. Turns out I have an AHI level of.... 91, average oxygen levels of 82% - dropping to around 35% at times, all which, according to the sleep therapist I was dealing with makes me 'a poster-child for Sleep Apnoea' and 'frankly - someone's pHD'!

They apparently got me in immediately so that they could give me a CPAP machine straight away, rather than any further study or tests, which apparently they would ordinarily do here in the UK as these CPAP machines cost a lot of money and they don't want to be handing them out to everyone that just 'thinks' they have OSA. I have been given a ResMed S9 machine and a Quattro FX mask. The box just manages itself - I just switch it on and go - it starts at a low pressure and then ramps up.

As you would expect - I am struggling like hell with it. The very first night has been my most successful, I only managed to get a couple of hours of sleep with the mask on, but I woke feeling far better than usual (perhaps a placebo effect?) - but since, I've only gotten anywhere between 1 to 4 hours a night with the mask on (I wake up, freaked out by the pressure, and my mouth - er - inflates(!?) - or because the seal has gone and my mask is whistling away like a kettle!) and still feel terrible in the morning. I just can't seem to get the seal right.

I will keep on plugging away - I had a taste of normality on the first night, if I can get back to that, my whole life would right itself.

I hope I learn a lot from you guys!


bob.

[Slinky]

Did you read the literature that came w/your Quattro FX mask on proper fitting?

Fit your Quattro FX first, then turn your Elite on, skip the Ramp and go straight to your set pressure when adjusting your Quattro FX. If you have a good fit and no leaks and then later encounter leaks first try lifting the headgear up on the back of your head by pulling the top straps up in the back. I find that often eliminates any leaks that have started. Lay down on your back before fitting the Quattro FX. Our facial tissue is subject to the law of gravity just as everything else.

[Lizzzabeth]

If they didn't do a titration study, how did they set your levels? Maybe they're just wrong for you?

[JointPain]

Hi Dr. Bob and welcome to the forum.

average oxygen levels of 82% - dropping to around 35% at times

Ouch! The PhD topic would probably be why you're still with us.

Anyway, you've come to the right place. There are lots of very friendly people on the forum who will help with the various issues you'll encounter. One thing you can do to help us is to go into your user profile and select your exact equipment, including machine and mask, so that that is automatically displayed at the bottom of all your posts. Choose the display as text option, because many of the images look very similar to each other.

Be very careful selecting which machine you have. It sounds like you have a Resmed S9 APAP machine, but there are two different models: the S9 AUTO ESCAPE and the S9 AUTOSET. (We all hope you have the latter.) My Autoset has "AutoSet" printed on the top panel just above the Start/Stop button. Do you also have a humidifier?

I don't have your mask, so can't help you there. I'm sure others will chime in.

What you've experienced so far is very typical. That first night (often in the sleep lab) feels fantastic, and subjectively what follows is never quite as good. An analogy might be living in a pitch black dungeon for several years and then walking out into the light. The first time it will seem really, really bright.

The good news is that if you stick with the therapy you will more than likely eventually sleep better and feel much more energetic during the day. There will be an adjustment period during which you need to optimize the therapy to suit your needs, and adapt physiologically and psychologically to sleeping with a CPAP machine stuck to your face. It's easier and faster for some than others.

It sounds like your S9 Auto might be set to the full range of pressures: 4 cm to 20 cm H2O. It starts off at 4 cm, and when it detects breathing abnormalities such as flow limitations, hypopneas and obstructive apneas it raises the pressure fairly rapidly with the goal of preventing further events. When no events are detected it gradually lowers the pressure and in this way automatically adjusts to the correct pressure you need. Your pressure needs can also change from day to day and can depend on your sleep position, so an auto machine is very nice to have.

But there's no free lunch. When you initially put on and adjust the mask, the pressure is at its lowest setting, and this often isn't good enough to prevent leaks at the pressure you need, so you need to adjust the mask at a higher pressure. The S9 has a mask fit function for this (from the home screen select setup and then mask fit).

Also, if the pressure range is set very wide it will take the machine too long to raise the pressure to prevent an apnea, and you will unconsciously wake up to deal with the apnea. The pressure by now will be a lot higher than you're used to, and there's likely a gale in your face, and that will make you fully awake and uncomfortable. Hopefully your sleep doctor can fine tune your lower pressure so this doesn't happen often, and when it does the pressure change isn't enough to concern you.

In the meantime, you just just quickly turn the machine off and on to start again from the lower pressure. (Personally, I can't breathe comfortably below about 7cm, so I didn't like doing that, and got my minimum pressure raised.)

The best thing you can do is stick with the therapy every time you sleep or nap. Never consciously go to sleep without your CPAP on. If you ever feel you can't, take the mask off, get out of bed and do something else until you're ready to put the mask back on and go back to sleep. Ask here for some pointers if necessary the next day.

All the best.

[Mary Z]

dr_bob, wow, with that sleep test you sure do need to be using the machine. I doubt the first night was a placebo effect, but instead a taste of what to come. It takes some time to get the mask fit right, or even the right mask. You might need to fiddle with fit (good advice about reading the fiting instructions).
http://www.resmed.com/ap/products/quatt ... c=patients, http://www.sleepguide.com/video/quattro-fx. Here are two videos which might help you with the fitting of the mask.
Good luck, hang in there and keep us posted. An O2 sat of 35 % is nothing to fool around with!

[JohnBFisher]

dr_bob, welcome to the forum. Sorry you have to be here, but if you have to come somewhere for good practical advice, this is it.

One thing that can help with the Quattro FX mask are mask liners. Here are three different varieties. Not sure if they ship to the UK, but it's certainly an option.

http://www.remzzzs.com/Default.asp
http://quietusliners.com/
http://padacheek.com/PAC_Maskliners.html

[mayondair]

Hello dr_bob, welcome! please fill in you equipment profile in text so that it will be easier to help you. Do you know what your pressure is set at? Here are links to soft wear and clinical manual http://tinyurl.com/24x73 http://storage.resmed.com/software/ress ... n_3.13.exe. Hopefully you have S9 Elite or Autoset and will be able to get data. You'll be on the road to that good sleep in no time. Kathy

[dr_bob]

Hi,

Thanks for the advice, links and videos. I will digest them as quickly as I can!

I've clarified my setup in my profile, I definitely have an S9 Autoset. I don't have a humidifier. I don't know anything about the software on the CPAP machine - the sleep tech just basically told me that the pressure stays low for the first 20 minutes and then ramps up if apnoeas are detected. I wasn't told of any settings or to mess with anything - just how to switch the thing on and off!

I wasn't aware of the mask fit function (in honesty, I hadn't read the manual - the sleep tech really tried to make it sound idiot-proof, so I didn't think I needed to ) - I'll try that out before bed tonight.

Thanks again.

[cflame1]

your machine will adjust... but it will take it time.

So for an example, if it takes a pressure of 12 to alleviate your apnea, and your current pressure is 4, it won't go to 12 directly... it'll go up a little (I'm not sure how much the little is) check it again, go up a little more, check it again... and so on. So that's the reason to know what it takes to rid yourself of your apnea. If you can get your bottom pressure close to what it'll take to rid you of your apnea then the problem will be alleviated a lot quicker.

Getting it closer will also help with a feeling that you're not getting enough air.

[mayondair]

S9Autoset is very good, it's top of the line, has info on the screen, and with that soft wear, even more . Are you sure you don't have a humidifier?, it's usually attached to the machine, so doesn't always look like a separate thing. Read the clinical manual, or others will be able to help you unlock the info on the machine if your supplier has locked you out. At this point you just want to look, don't change anything, tell us what numbers you see for settings. most don't use the ramp function very long, if it's to low you will feel like you aren't getting enough air. If the machine is set wide open 4-20, it may take to long for the machine to respond to apnea events, which won't make you feel good. It may be set that way now for titration, to find a pressure that's effective for you, but you don't want it that way for long. Do you have a follow up appt soon? If you don't have a humidifier you will want to ask about one. Hope they aren't planning to not let you keep the Autoset.

[Bobby269]

This will help you fit the mask properly. http://www.resmed.com/us/products/quatt ... c=patients

Look in Uncle-Bob signature for resScan software and clinical manuel memberlist.php?mode=viewprofile&u=38643

This can help if your mask leaks http://www.padacheek.com/PAC_Maskliners.html/ Scroll down.

[rested gal]

If I were given an autopap set at 4 - 20, the first thing I'd do would be to change the minimum pressure so the range would be at least 8 - 20. But that's just what I'd do, and I'm not a doctor. Actually, I'd go for the gusto and set it for 10 - 20.


Results: 1st night with Auto A-Flex (topic started by TSSleepy)
Two nights graphs posted using pressure range 4 - 20 and 10 - 20
viewtopic.php?p=349073#p349073

November 2008 Just got an APAP (topic started by turbosnore)
viewtopic.php?p=319619#p319619

October 2008 Turning off Aflex and Cflex (topic started by DoriC)
viewtopic.php?p=307265#p307265

September 2008 New Guy - Need Help w/Settings (topic started by alanhj13)
viewtopic.php?p=294319#p294319

Wulfman, DreamStalker, and ozij explain why autopaps make changes slowly.
December 2008 Why adjust APAP. Isn't it auto? (topic started by oxygenium65)
viewtopic.php?p=323218#p323218

[BlackSpinner]

If getting a mask liner is going to take too long to get , it is easy to make your own. Find an old well washed 100% cotton knit t-shirt or undershirt (in a pinch your wifes cotton undies) Lay your mask on it and out line the mask with an extra inch all around. Now cut a small triangle in the center. Lay the piece on the mask and lower your face into it. The triangle hole should be to small, trim it slightly bigger and try again until it fits comfortably. Now trim some of the excess. Lay this now on a piece of paper and trace it. And "Bob is your uncle" - you just made a pattern for a mask liner. Depending on how oily your skin is they last from one night to a week.

[ozze_dollar]

I think everyone has problems with a full face mask. I know I did. I think either nasal pillows or nasal mask with chinstrap if needed is the way to go.

[archangle]

Whenever you're having problems, look on the display of your machine. It should tell you what your pressure is at that instant. Make a note of what your pressure is when you start it and when you wake up.

Most masks take some tinkering. Remember that tighter is not always better. Sometimes you need a different mask.

You may be able to get used to the pressure by doing CPAP when you're sitting reading, watching TV, etc. when you're awake.

Most importantly, with that 35% number, if you sleep without the CPAP, you're going to die. Figure out how to not take the mask off during the night. If you have to take it off, get up for a few minutes and get fully awake before going back to bed. If you're not careful, you'll find yourself taking the mask off in the middle of the night without remembering doing it.