Question about proper setup

[Bob_123]

In my first week of use I've had a heck of a time trying to get used to CPAP. I've only been able to tolerate using CPAP/APAP for a few hours at most. Also I'm having a worse night's sleep as well using the CPAP/APAP. So I have a few questions I hope some of you may be able to help me with.

First I should say that I have upper airway resistance syndrome (UARS) with the consequences of basically waking up many times per hour. A CPAP with a pressure setting of 8 was prescribed. I acquired and I'm using a ResMed S* Autoset Vantage and a Respironics ComfortClassic Mask. I think this is a great machine that it's quiet enough and that the comfort is good and I feel I'm using the machine properly.

I'm using it in it's auto-titration mode but I've tried it in it's conventional fixed pressure mode as well.

Here's the problem. I feel that I just don't get enough airflow by breathing through my nose. I typically take off the mask so that I can get some unobstructive breathing through my mouth. It seems like using the machine should make breathing easier.

So my basic questions revolve around what breathing should feel like in the two cases; with a CPAP/APAP breathing through a conventional nasal mask versus breathing though one's mouth without a machine. The machine is better if I only were able to breath through my nose in either case.

So, it would seem that a mouth-fed mask rather than a nasally-fed mask would be better to keep an airway open under the circumstances of nasal obstruction.

Any suggestions and recommeded reading materials would be much appreciated particularly in light of the fact that I have UARS.

I'm going to try to get in to see my Doctor (Dr. G at Stanford) to get a better understanding of my split night sleep report and titration. By looking at the split night report that was done it doesn't look like the pressure settings deduced by the technician were justified as I had even more hypopneas at a higher CPAP pressure than at a lower pressure and my EEG shows even more awakenings per hour than without the CPAP. It does not look like the CPAP made things better from the data I see.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, Titration, CPAP, auto

[yardbird]

You may simply need a full face mask. It covers nose and mouth and you can breathe through either. That being said... I used to have a lot of nasal congestion. I'd wake up with a stuffy nose. No problem as a shower loosened everything up and I was fine all day. On CPAP I find that I no longer have the morning stuffy nose. Took a while for that to happen... couple weeks maybe, but I sleep pretty well now. I do not have any physical obstruction that I'm aware of in my nose.

The mask is the key to this therapy and you will probably find that opinion repeated many times in various posts. You need to get a mask that works for you. If you're a mouth breather, then a nasal mask simply isn't going to work.

If it's a congestion problem in your nose, you may find that using FloNase or something before bed keeps your nasal passages open. Works for some. Doesn't work for others. See where this is going? We're all kinda different even though we all use CPAP. What works great for one person may not work at all or with only limited success by someone else. HOWEVER there is a large pool of knowledge here. And while we may all have little differences, we also share a lot of similarities.

Talk to your doc. Make sure he's listening, and work on getting the breathing comfort working. Tweak pressure settings once you are in a mask you can sleep with. But stay at it. Don't give up in frustration.

[WillSucceed]

You may simply need a full face mask.

You might find that you will do well with a nasal pillow mask (Breeze, Swift, Comfort-Lite, etc.) moreso than with a regular nasal mask.

[Snoredog]

you need to go through the programming on the machine to make sure it is set correctly, most machines come from the factory at 4cm pressure.

Your prescription is 8cm or the high pressure. If they programmed a Ramp (where you ramp up from a lower pressure to your high pressure) they may have left the starting pressure at default 4cm. This is way too low for most patients and report just as you have.

You need to bump up your starting Ramp pressure from 4cm to 5cm or 6cm. Then if you use the ramp button on the machine it will start at this pressure and increase up to your titrated 8cm. Hopefully by that time your asleep so the higher pressure won't bother you. the problem sounds like your having difficulty falling asleep. If that machine is like the Spirit, you hold down the black and red keys together for 3 seconds to enter the Clinical mode where you can change it. Consult the Owners manual for using the Ramp feature. If your new starting out, I would set the Ramp timer to 30 to 45 minutes. If you don't fall asleep in that amount of time, then hit the Ramp button again it will reset the timer. That machine may also have a feature called Settling. With this feature the machine stays at your lower pressure for the time value set and won't respond with higher pressure until that timer has elapsed.

If you ARE falling asleep and waking up starving for air using this ramp feature then the timer value is too long (try shortening it to 20-minutes). You want to match that timer to how long it takes you to fall asleep.

that mask you have is sometimes referred to as the crappy classic for a reason. But I don't think that is your problem at this point, just don't over tighten the straps like the lab techs do.

[Bob_123]

Thank you all! I appreciate your responses.

In looking at the pressure versus time chart from my APAP and the ResMed Autoscan software package it looks like my machine pretty much stays around 5cm H20. (whereas my cpap prescription was for a continuous pressure of 8cm) It only rises above a pressure of 5cm H2O during and after a respiratory event and then only for a short while. Perhaps the APAP alogorithm is not suitable for UARS-caused events.

I'm going to switch back to the exact prescription of 8cm H20 continuous pressure (CPAP) for a few days to see if that works. If it doesn't, since I know I have a sinus issue and an allergy issue that constricts my sinuses, I'll then have to think about the full face mask. I'll adjust the ramp parameters as suggested as well.

There's a multiweek CPAP class at Stanford for CPAP users ("Sleep Improvement Program for Patients on Positive Airway Pressure Therapy") that I think I'll attend but it's not until April. Hopefully I'll have my treatment approach tuned by then however.

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, CPAP, Prescription, APAP

[Linda3032]

Assuming you have a heated humidifier, bump it's setting up also. More moisture will help clear the sinuses, hopefully.

[GrumpyInKC]

Bob_123, Keep us updated on what you find out.

Your problems sound a lot like what I'm experiencing. I can't sleep unless I can breath through my nose, but there's always some blockage. I've been using Naxonex for a couple of months and started sinus irrigation a couple of days ago but they haven't helped much.

I've been on the hose for about a month now and I'm almost back where I started. I've been checking my charts in MyEncore and I've got my apneas and hypopneas down pretty low, but I still wake many, many times through the night. Lately I feel like I'm not even sleeping at all.

I didn't understand what she was talking about at the time but the morning after my titration the sleep therapist said she was able to get rid of apneas and hypopneas at a pressure of 7 but she said I continued to have a lot of arousals.

[WAFlowers]

You might find that you will do well with a nasal pillow mask (Breeze, Swift, Comfort-Lite, etc.) moreso than with a regular nasal mask.

To expand on what Will said (and he is correct), a nasal pillow mask (I use the Swift, but the others will do this as well) has the effect of using pressure to hold your nasal and sinus passages open in addition to working just as any CPAP mask works on your palate. The reason for this is the pressure differential between the air inside your nose and outside of your nose, something that doesn't happen with a traditional nasal or full-face mask.

Having said this, some people find that their nasal and/or sinus passages are so severely obstructed that nothing short of surgery will correct it. For them, a full-face mask (or the surgery) may be the only solution.