Wondering if I should change from CPAP?

[Roch369]

I've been on the CPAP machine for one month. I'm waking up every hour or two. Once I wake up - it's hard to just lay there with mask on -- I have to take the mask off. I've been desensitizing myself by watching tv with it before I go to sleep. I'm okay with the nasal pillows - anything more (nose or full face), I'd feel claustophobic. I have to train myself to breathe different. I'm okay breathing in - but breathing out is another story. Very difficult for me - feel like I'm not getting enough air. Then I go to the gym and do exercise and you exhale through your mouth (which is contradictory to nasal pillows).

Wondering if I should switch to a BI-pap machine - is that easier? I have to stop playing games with myself also. When I wake up as I frequently do - I tell myself I'll rest for eyes for a few minutes before putting on mask -- then two hours go by without machine....so I'm defeating the purpose.

All this CPAP stuff is messing with my head... Having a tough time accepting all this!

My breathing just doesnt feel natural -- does the BIpap or something else make your breathing feel "more right"?

I am so gratefult to this forum and all the kind and helpful people.

[RandyJ]

Which PR System One machine do you have? Are you using a flex setting of some kind?

And yes, bipap can be a lot more comfortable.

[zoocrewphoto]

Can you give us some more info?

What machine are you using? What pressure settings do you have? And are you using any kind of exhale pressure relief (different names depending on brand of machine)?

I know what you mean about taking it off and planning to put it back on, only to fall asleep. I do that too, and I am struggling to make myself get up and put it back on. I know how much it helps me as I can feel the difference since starting. So, I get mad at myself for falling asleep without it.

[Roch369]

not sure why the equipment is not showing up = I have the REMstar Pro C-Flex + and am on 7 cm

[Pugsy]

The machine is a PR System One Pro CPAP ..60 series.
Currently using CFlex + set at 3...with 7 cm pressure.
AHI is excellent for the most part...less than 2.
Severely fragmented hours of sleep and barely making compliance to give you and idea how fragmented and short number of hours of sleep.

[zoocrewphoto]

It's possible that 7 is too low for you to feel like it is enough air, even if it is sufficient for your sleep apnea. My settings are 11-17, and 7 feels too low for me. Do you feel like you are not getting enough air in, or do you feel like it too hard to breath out against the air?

Bipap is usually for pressure settings that are higher, usually in the 18+ range.

[RandyJ]

Hardly seems like it could be an exhalation pressure issue at only 7 cm and flex setting of 3... Have you tried the other flex settings?

During my titration 8 cm hardly felt like enough air...

[Pugsy]

Suggest that you play with the CFlex settings to see if one of the other settings is more comfortable.
Also might try the next size up on the nasal pillows to see if the slightly larger volume will offer any relief.

http://cflexplus.respironics.com/

[rosacer]

When I started CPAP I was set at 7 cmH2O and believe it or not I found that very difficult to exhale, yes it was only 7 cmH2O. I used the ramp for several months, it was set to start at 5 cmaH2O for 20 minutes (enough time for me to fall asleep) and it helped me to get used to the pressure. I never used EPR or Flex (EPR at the time).

At that time I had no problem at all to breath with 5cmH2O pressure, I didn't feel I was choking. I think it depends on each person an on my case because 7cmH2O was too high to exhale I think 5cmH2O was just good to breath.

[Hawthorne]

With a pressure setting of 7 cm and C-Flex set at 3, the exhalation pressure is then too low. It would feel like you are not getting enough air for sure when you exhale since the pressure drops on exhalation as per C-Flex setting.

I would set the C-Flex at 1 and try that for a week. It may also be that you need to raise your pressure some (0.5 cm). If changing the C-Flex to 1 does not help after a few days, then try this pressure raise. Leave it at 7.5 cm for a week and if you are still having problems raise it another 0.5 cm for another week and see how that is. Don't worry about going too high. A pressure setting of 10 cm is about average. You do need to go up slowly though.

If you had an Auto, you may do better. You may not necessarily need a bi-pap but at least an auto so that you could set a pressure range to see where your pressure is 90% of the night.

Do you have software to see what is happening during the night or are you using the machine display?

[Pugsy]

Update for those following this thread.

OP does have the software. You know who pointed her in the right direction. Other than severely fragmented sleep and maybe one time with sleeping on her back...her reports aren't bad at all.
Right now she needs to concentrate on consolidating her sleep so that we can evaluate the data better.
The 7 cm pressure setting was a compromise to maybe help with some anxiety issues with the mask and machine.
It may or may not be quite what she needs but she needs to get adjusted to the overall experience and sleep more than 1 or 2 hours at a time first.

She tried using the medium (had been using the small) nasal pillow last night and told me last night that it made a huge difference in the overall comfort of inhalation and exhalation both. Still waiting to hear how that went.

She is totally afraid to alter anything on the machine herself even the CFlex setting. It may take some time before she feels secure enough to go down that road. That is okay...she can go to her DME and/or doctor about it if she feels the need. Only been trying to use the machine for a month. DME put the fear of God in her about "don't change a thing".... I will work on that with her

[jen4700]

It's possible that 7 is too low for you to feel like it is enough air, even if it is sufficient for your sleep apnea. My settings are 11-17, and 7 feels too low for me. Do you feel like you are not getting enough air in, or do you feel like it too hard to breath out against the air?

Bipap is usually for pressure settings that are higher, usually in the 18+ range.

This isn't necessarily true. My Rx is 6/11 and I was given a bipap. They said I couldn't tolerate the exhale pressure during my titration. I suppose it depends on your sleep center / DME. I'm now up to 9/12.

[Pugsy]

jen4700 is correct. Bilevel pressure machines aren't necessarily limited to those who are needing to use "high" pressures (over 15 cm) though they sure could be a nice plus for those who need the higher pressures.

Robysue uses a bilevel machine at what most people would say are relatively low settings but she needs it for aerophagia issues.
Some people may just have a hard time exhaling against even what we would normally think are low pressures. They may seem low to us but they don't seem low to the individual having a hard time exhaling. We can't assume that because we can easily use a higher pressure that everyone should be able to use a similar higher pressure.
I use a bilevel machine because I feel more rested with it and when I used APAP machine my minimum was only 10 cm...it was really easy to adjust to exhaling at that pressure. So I didn't have any issues exhaling but I found out that I feel better with bilevel...feel better as in more restful sleep...sleep a bit longer...feel better the next day..not nearly as sleepy and wanting to nap the next day.

For some people exhaling against a "low" pressure of 7 or 8 just seems like they are trying to exhale against a hurricane. It is how they perceive things and how they perceive it is the perception that matters.
I do admit that I tend to chuckle a bit when someone complains that "my pressures are just to high" and then they go on to say it is 7 cm...but that is all I do..I chuckle because I know that to them it does seem awfully high and I can't really assume that because I would feel suffocated at 7 cm that they should also feel the same way.
It just doesn't work that way...we are all different and perceive things differently.

I did get an email from the OP just a bit ago. Using the medium pillow last night helped a great deal with overall breathing.
Still having frequent wake ups though so for right now she needs to work on trying to isolate the cause of the wake ups. Having some leak issues and until I can see a leak line graph and figure out if the leaks are a good bit of the problem and need work or if we figure out that general anxiety and the brain being hyper aware is the problem..we are just going to have to take it one step at a time.
We are also battling some general issues with the diagnosis, the treatment, apprehension, claustrophobia....etc.
Not an easy adjustment for the OP in this case. Going to take some work and some time.

[RandyJ]

Good call on the nasal pillow size. Maybe that will solve the problem.

[archangle]

How long have you been doing CPAP?

Most people adjust to exhaling against the pressure, but there are exceptions. When I turn mine on at 16, I sometimes have to lift up the edge of the mask to convince myself the machine is blowing because I can't feel the pressure. I presume my "exhale muscles" get stronger over time.