New to CPAP Machine - Using a setting of 20 !! Help!

BigEd · Post by **BigEd** » Thu May 25, 2006 2:46 pm

I recently completed a sleep study and was diagnosed with severe sleep apnea. (no surprise). I'm using CFlex with Mirage Swift nasal pillows. However, with the pressure setting set to 20 I find it absolutely impossible to even breathe with this device....let alone sleep. Exhaling is almost impossible. The "ramp" option starts out at 8 and by the time it reaches 16 I'm in trouble.

Does anyone have any advice on how to cope with this high of a setting? Would a BIPAP machine be better? Is a setting of 20 really used for human beings or is this for some kind of Rhinoceros. I’m scheduled for my 2nd sleep study in about 10 days to help fine tune my settings.

Any suggestions or help would be greatly appreciated.

Amigo · Post by **Amigo** » Thu May 25, 2006 2:56 pm

Ed, are you sure the C-flex is turned on?

I'm only at a pressure of 14, but with my C-flex setting at '2' I get NO resistance when I exhale. It's very comfortable.

I'll send you the instructions for checking/changing the settings via a PM.

dsm · Post by **dsm** » Thu May 25, 2006 3:55 pm

I can tell you from my own experience that a Bilevel will help substantially.

Some Bilevels ...
Resmed VPAP III
Puritan Bennett
Respironics Bipap Family

(If you do want to get a Bilevel *try* it first as you need to be very sure the brand you choose will work with the mask & configuration you want to use.

Goodluck

DSM

DME_Guy · Post by **DME_Guy** » Thu May 25, 2006 6:07 pm

I think your pressure is too high for nasal pillows from a comfort stand point. You may do better with a regular nasal mask such as the Resmed Activa. I would also set the the C-flex at 3 and see if that helps.

If you can't tolerate the pressure, the next step is to try an auto-titrating CPAP. You may only need to be at a pressure of 20 a portion of the night but will be fine at 14-15 the rest of the night. The next step up from there is a BiPAP. I'd go with the Respironics BiPAP auto. It will adjust pressure the same way their auto CPAP does.

Goofproof · Post by **Goofproof** » Thu May 25, 2006 10:13 pm

Your machine tops out at 20 cm, if you do need 20 cm, you should have been given a Bi-PAP, they can operate to 30 cm. You have nowhere to go but down. Jim I think you are the victim of the Evil DME.

tooly125 · Post by **tooly125** » Thu May 25, 2006 10:16 pm

Is a setting of 20 really used for human beings or is this for some kind of Rhinoceros.

My pressure is 19 There is no way I can use a nasal interface it's just too much air I would have to clamp my lips shut to stop the mouth leaks
I use a full face mask and have become accustomed to the high pressure
If I wake up in the middle of the night sometimes it seems like the machine isn't even on! I have also bumped my start point on the ramp to 13 because any lower than that and I feel like there is not enough air.

Gidgie · Post by **Gidgie** » Thu May 25, 2006 10:39 pm

I have a sneakin' suspicion 'they' did to you what 'they' did to me, when I was using an auto......they didn't set the machine.......just let it auto-titerate.......And nearly blew my fragile little brain right out my ears......! When I wised up (that's one of the best things about this forum) I duked it out with my RT/DME........with the result of getting it actually set at 17......was still hard to deal with, but my Doc prescribed a steroid nasal spray......toughened up my nasal membranes, etc. Now I hardly ever use the ramp.......I probably should have had an auto as my 'always' machine, but hey, I've adapted.........us humans are sooooo adaptable......even maybe to being assimilated by our equipment......!! (TIC)

Darth Vader Look · Post by **Darth Vader Look** » Thu May 25, 2006 10:53 pm

Hey Big Ed, I'm with anybody that posted getting a BiPAP. As Goofproof has said you have no upward room should you need more pressure. Since you are going back to fine tune things I would ask about switching to one of those units instead.

rested gal · Post by **rested gal** » Fri May 26, 2006 2:21 am

Ed, between now and when your second sleep study will be done, I'd be pushing VERY hard to get a trial at home on an autopap, set for 10 - 20 cmwp. Purpose being to get additional information on whether you truly need the extremely high single pressure that has been prescribed for you.

If the autopap trial, as well as the second study, show that you do, indeed need high pressures much of the night, then my next push would be for:

First choice: the only combo bi-level/auto-titrating machine -- the Respironics BiPAP Auto with Bi-Flex.

Second choice: a bi-level machine that can use software for you to monitor your data -- Respironics BiPAP Pro 2 with Bi-Flex or ResMed VPAP III

I'm not a doctor. That's just the route I'd go if I were faced with being prescribed a very high pressure.

Personally, I think it borders on nearly criminal stupidity that they gave you a straight CPAP (even one with C-Flex) and expected you to be able to cope with exhaling against a pressure of 20. The kind of momentary relief C-Flex is designed to give -- just at the beginning of an exhalation, not all the way through the exhalation -- is not enough relief, imho, to be helpful at extremely high pressures.

Also, C-Flex is very dependent upon the force or strength of a person's exhalation in the first place. The few times I experimentally tried a straight pressure of 20 with C-Flex turned on, it gave me no exhalation relief at all. Terrible.

A bi-level machine would have been much the better choice, imho, for them to have put you on.

Good luck at getting them to switch you to a machine capable of giving you treatment that's comfortable enough to actually use. The experience they're putting you through now doesn't have to be that way at all. It can be a whole lot better.

JamesCPAP · Post by **JamesCPAP** » Fri May 26, 2006 3:44 am

Seeing that machines only go up to 20cm I'm surprised there's quite a few people in this thread being on such a high figure!

How many apnoeas or hypopneans were you having before CPAP treatment ?

I was around the 140 AHI mark (2 per minute) but on CPAP on APAP am only seeing a maximum pressure of 13.

Are any of you seeing higher AHI's than this ?

BigEd · Post by **BigEd** » Fri May 26, 2006 7:37 am

Thanks for all the info and suggestions. I did check my settings and the C-FLEx setting was already set to 3. I was hoping it wasn't set properly, but no luck there.

Sounds like the BI-PAP Auto with BI-FLEX is the way to go. Will I still be able to use a nasal interface?

JamesCPAP: My AHI is 105, oxygen level is 60.

Thanks again to everyone for your help.

Ed

JamesCPAP · Post by **JamesCPAP** » Fri May 26, 2006 10:25 am

Ed I don't think you mentioned (or maybe I missed it) about which RemStar model you have. If you don't have the RemStar Auto then this may be better for you as it's auto titrating, or if you do have this then a BiPAP in theory would be better but only for exhaling.

However my first thought would be to go back and ask them to check their data. 20 is the maximum setting any of these machines will go to. Over and above this according to my discussions with Respironics and ResMed, most humans cannot tolerate much more pressure. Going by my own AHI of around 140 pre-CPAP my ResMed S8 AutoSet Spirit shows that I'm not going about 13 so if you are being set at 20, it sounds to me that something is wrong here.

If you are only having an AHI of 105 I would ask them to check the sleep data again or perhaps see if you can try an Auto Titration machine like the RemStar Auto or ResMed S8 AutoSet Spirit.

Bingo · Post by **Bingo** » Fri May 26, 2006 11:39 am

JamesCPAP wrote: ...
How many apnoeas or hypopneans were you having before CPAP treatment ?

I was around the 140 AHI mark (2 per minute) but on CPAP on APAP am only seeing a maximum pressure of 13.

Are any of you seeing higher AHI's than this ?

I'm not sure from the syntax of your post, but do remember that AHI and the pressure settings are not neccessarily intertwined.

While it's true that they often increase in relation to each other, the inspiratory pressure setting of a machine is based on how much actual pressure is needed to splint open the patients airway.

Just wanted to point that out since it sorta sounded like what you were getting at!

Bingo

Bingo · Post by **Bingo** » Fri May 26, 2006 11:43 am

Hi Big Ed!

Just wanted to make sure here - have you spent much time talking to your MD and your DME company about the issues and more importantly, the CONCERNS you are having?

Remember that in most cases, the doctors base thier prescriptions on what the sleep technologist at the sleep lab has suggested.

If the technologist made an error, the doctors generally do not actually catch it. It's not lack of concern on the MD part, it's just that everyone is human and can make a mistake sometimes.

If you discuss these concerns with your MD, you both may find a much better solution that would ease your worries and your discomfort.

Just a thought -

Bingo

BigEd · Post by **BigEd** » Fri May 26, 2006 5:16 pm

I spoke with my doctor and equipment provider and they are changing my equipment to to a BiPAP Auto with Bi-Flex unit. (Thanks Rested Gal for the suggestion.) I should have it by Wednesday the 31st. I'll report back on my progress. Thanks again everyone. Great site.

Ed