New to all of this

[PAman]

Like so many others on this board I've been recently diagnosed with OSA after two in-clinic sleep studies. After years of extreme daily fatigue and chasing many dead ends I asked my ENT to evaluate me for OSA. I'm 5'8 and 170lbs with a very normal looking external neck, a mildly narrow pharynx, and nasal endoscopy showed a mildly deviated septum. We both thought it was a long shot diagnosis and the ENT thought at worse I'd have mild OSA which may or may not explain the horrible fatigue. The sleep study showed 70 apenic/hypopnec episodes per hour and no REM sleep whatsoever. A second in-clinic sleep confirmed this and PAP around 13cmH2O to be a good pressure.

Now I'm struggling with adjusting to PAP. My insurance refuses to cover the DME so I'm figuring this out without the benefit of a respiratory therapist. I've gotten a Respironics Dreamstation AutoPAP (Respironics DreamStation AutoCPAPHumHT
DSX500T11) with heated tube and humidifier. I set the Ramp to 45 minutes and at 4cmH2O but I often wake up due to the discomfort of the mask, the machine trying to make me inhale before I'm ready to, drool on my face, air leak into my eyes (very annoying), etc. I'm hoping the nasal mask I just ordered will be a better fit.

My profession is in medicine (family medicine and urgent care) so the tables have turned and it's a humbling experience.

[Julie]

Hi, welcome and hope you feel better soon... two things stand out right now.

Your low pressure's apparently set at 4, which is the default machine low and it's next to impossible to breathe at all there - docs don't understand that for the machine to deal with events at higher levels, the low setting needs to be at least 6 or 7 to catch events effectively, and may eventually need to be higher. As well, a 45 min. ramp time for the machine to 'reach' a 4 cm setting is pointless and deprives you of even that therapy for all that time... you don't need the ramp so turn it off - big waste of time and energy at this point. Most of us don't bother with it at all, even at higher pressures.

If you need help to bump up the 4 cm setting, let us know.

You said you're getting a nasal mask, which may be fine, but do you know if when asleep you're a mouth breather? If so, a FF mask would be more appropriate because otherwise you'll lose Cpap air out of your mouth that should be going down your airway. If your present mask - fitted properly (which it may not have been) allows leaks and is uncomfortable, there are very many other choices available, so that also needs to be looked at.

If it helps at all, 70 events/hr is not 'mild' of course, but many of us scored quite a bit higher, so don't let terminology of 'severe' scare you too much.

And try to return to this thread with follow ups - makes it easier for us to keep track of your history.

[ChicagoGranny]

I'm figuring this out without the benefit of an respiratory therapist

Many never found them of much value. You've come to the right place.

Respironics Dreamstation AutoPAP with heated tube and humidifier

Good machine!

I set the Ramp to 45 minutes and at 4cmH2O

Began to familiarize yourself with free Sleepyhead software. Most of the regulars here rely heavily on it to optimize and troubleshoot their CPAP therapy. http://www.apneaboard.com/wiki/index.ph ... ailed_Data

discomfort of the mask

Of course I don't know why you have discomfort, but many newbies overtighten the headstraps. Watch the manufacturer's videos on how to adjust the mask headgear. There is a medium range, not too loose and not too tight, that needs to be achieved. Many of the manufacturer's adjustment instructions can be found at youtube.com and cpap.com.

the machine trying to make me inhale before I'm ready to

The machine you have does not force inhalation. You are having another common newbie problem - you are thinking about your breathing and the CPAP pressure. Try to totally distract your mind from breathing and the CPAP. I am sure you know your body can breathe without you thinking about. We breathe this way most of the day and all of the sleeping hours.

air leak into my eyes

Besides watching the manufacturer's video on fitting and adjusting the mask, here are some more tips to prevent leaks:

- If you use a low ramp pressure or a low minimum pressure, you should fit and adjust your mask at the higher pressures it is operating at for most of the night. You would temporarily change the machine pressure settings while you do the fitting and adjusting. It's best to do this well before bedtime before you are tired and ready for sleep. Don't forget to change your settings back to the ones you prefer.

- Make sure to use good hose management - the hose should not pull on the mask. Notice how your hose is positioned between machine and mask. It should be positioned to minimize any pull on the mask. Hose management is an individual practice. How it is done depends on the mask, the position of the machine, your sleeping position and other factors specific to the individual.

- If you still have problems, learn from the forum what mask liners are available.

- If your mask still has excessive leak, try other masks. Many people report trying several masks before they find one that works well for them.

drool on my face

Start washing your face before you leave the house.

Seriously, after you have optimized your CPAP process, this problem may go away.

Welcome!

[bonjour]

The good stuff starts to happen when you upload your data charts to here.
Download Sleepyhead (free) and very important, organize your data (some charts are much more important than others,
Please see my signature for the how to.

We can, and will, help you dial in your therapy, likely better than anyone else.

[Pugsy]

Let's look at your reports and see what is going on and see if we can maybe come up with some ideas to help improve things.
Which mask are you using that leaks and which mask are you getting new to try?
Make sure you have the correct size.

Get SleepyHead
https://sleep.tnet.com/equipment

and learn how to post your images and which graphs we like to see initially (we don't need all of them)
Here's a thread with examples of what we like to see
viewtopic/t103468/Need-help-with-screen-shots.html

and here's how to use imgur to host your images
https://sleep.tnet.com/reference/tips/imgur

and how to organize the graphs..3 pages..be sure to read them all
https://sleep.tnet.com/resources/sleepyhead/shorganize

Your machine won't give you a flow limitation graph so don't go looking for it. Instead your flow limitations are shown on the Events graph as long as you are in auto/apap mode.

Are you okay with the 4 cm starting point in terms of comfort? Many people find that there is simply not enough air moving for comfort. We won't suffocate at 4 cm but it sure feels like it.
If you are okay with it and your reports don't point to needing a lot higher pressure then it doesn't hurt anything to start out at 4 but if you aren't okay in terms of comfort or your reports point to needing a lot more then maybe a higher starting point or shorter ramp period is needed.
Let's look at the reports and decide what it looks like you need and talk about your comfort.

It's possible that when you fit the mask at the lower starting pressure that the leaks are happening because of higher pressures later. You may need to fit the mask at a higher pressure to start with.
Again...let's look at what the machine is telling us and decide the best plan of attack.

Do you normally breathe through your nose just fine or do you have chronic nasal issues that force you to breathe through your mouth a lot?

[Pugsy]

Oh BTW...you are using a Respironics machine and if you are in ramp still and you have an apnea event try to happen the machine will still respond and increase the pressure. Ramp is suspended until the "danger" is over and then it goes back to wherever it was in the ramp cycle if you are in auto adjusting pressure mode.
You can still get "therapy" with pressure increases even in ramp as long as you are using auto/apap mode.
Not all brands suspend the ramp but Respironics will. So the long ramp time is not necessarily allowing apnea events to go untreated as long as you are in auto mode and have settings that allow the machine to increase as needed.

[OkyDoky]

Welcome to the Forum,
You will soon become old hand to this strange new routine.

A second in-clinic sleep confirmed this and PAP around 13cmH2O to be a good pressure.

Are you using a fixed Cpap mode at 13 cm or the auto mode? If auto mode what are your pressures?

Now I'm struggling with adjusting to PAP. My insurance refuses to cover the DME so I'm figuring this out without the benefit of a respiratory therapist.

With a little learning, it's not hard to take control of your therapy and become successful.

I've gotten a Respironics Dreamstation AutoPAP (Respironics DreamStation AutoCPAPHumHT
DSX500T11) with heated tube and humidifier.

You have a good full data machine that you can use software to see how you are doing. To learn about downloading Sleepyhead I like to use this link. https://sleep.tnet.com/resources/sleepyhead If you have any questions you can always ask here.

I set the Ramp to 45 minutes and at 4cmH2O but I often wake up due to the discomfort of the mask, the machine trying to make me inhale before I'm ready to, drool on my face, air leak into my eyes (very annoying), etc. I'm hoping the nasal mask I just ordered will be a better fit.

Many people find the 4cm feels hard to breath at and increase this to 6-8 cm and decrease the ramp time. It is a comfort setting so see what feels best for you. Many no longer use ramp because we quickly get used to the pressure.

My profession is in medicine (family medicine and urgent care) so the tables have turned and it's a humbling experience.

Agreed. Sometimes when we have a taste of our own medicine it gives us a different perspective.

[palerider]

without the benefit of a respiratory therapist.

you're probably better off.

I've gotten a Dreamstation Auto... , the machine trying to make me inhale before I'm ready to

I won't go into repeating everything else that's been said, but I'll address this.

your machine *DOES NOT* breath for you, or try and get you to breath, it responds to your effort to breath, and *nothing more*, however, if you've got aflex turned on, what it will do is drop the pressure as you start to exhale, then it raises the pressure back up towards the end of your exhalation... people that don't know any better get confused into thinking the machine is prompting them to take another breath. it's *NOT* doing that, it's just getting ready for your next intake of air.

either ignore the small pressure increase, or if it really bothers you, turn off aflex.

[PAman]

Gosh, I sure didn't expect all of the helpful and thoughtful replies. Thank you, all. I'll try to answer the questions but it's also late at night and I've had a super long day at the clinic.

I normally sleep on my back and breathe through my mouth, but I also sleep on my side with my mouth closed and breathe through my nose. My hope for the nasal mask is to breathe well on my back while using a strap to keep my jaw closed. I understand about mouth-air leak and will work on that.

A ramp of 4cmH2O is good for me and I don't mind the 45 minute ramp as it takes me around that long to fall asleep.

I've ordered an eye mask from Amazon and hope it'll come tomorrow. That's a good suggestion for the air blowing into my eyes.

I've set the PAP machine to a range between 8 and 13. From what I can tell it's been hanging out around 11. I'm going to download and install the sleepy dream program over the weekend and configure it.

I'm going to tinker with the AFLEX settings. I realize the machine isn't trying to induce inhalation or exhalation and I'm definitely overthinking it. It's all so new.

Thank you for the help. Please reply with follow up responses/thoughts/questions.

[Julie]

Well, that helped clear up some confusion - your low pressure setting is apparently 8 and not 4 - the ramp is a separate feature altogether... it may start at 4 but moves to 8 over 45 mins, though i still think it could be delaying your sleep rather than helping anything. Don't mix up pressure settings with ramp settings - the ramp is a facilitator, not therapy.

Another suggestion would be to wear a soft cervical collar rather than a chin strap - it will keep your head up, jaw closed and airway more open... many like it better than straps.

[ChicagoGranny]

the sleepy dream program

I like that.

[PAman]

I deactivated the AFLEX setting last night and that helped a lot in terms of feeling like the machine is breathing for me. I also tried out the CFLEX setting and that was interesting. The problem occurred after ramp up at 11cmH2O when the mask was leaking with a high pitch squeek by my left maxilla and nothing I did was able to seal it so I removed the mask and slept the old fashioned way. I think it's due to my beard and it needs a trim but the nasal mask should also remedy this.

[ChicagoGranny]

Please reply with follow up responses/thoughts/questions.

Please fill out your equipment profile - https://www.cpaptalk.com/ucp.php?i=prof ... pment_info

[OkyDoky]

If your titration pressure was 13 cm your APAP settings are probably to low. What has your treated AHI been running? The minimum setting is the most important in controlling your apneas. The maximum setting allows the machine to go higher when events happen that the minimum does not control. The goal is to control most with minimum but have the freedom for the machine to increase for the occasional increase during REM sleep or back sleep. Apnea can increase during REM and back sleep.

I want you to look at SleepyHead and see what your pressure is doing during the night. But if your titration pressure was right, your APAP settings may need to be somewhere around 10 cm to 15 cm. Then if your pressure is running at the top quite a bit, or you are having uncontrolled apneas, fine tune it from there.

If you want to post screen shots of your data, we can take a look and let you know what we see. Here is a link to show you how to organize, take a shot, and post. It is 3 pages long so when you get to the bottom of the page, click on the next link. https://sleep.tnet.com/resources/sleepyhead/shorganize

Wanted to add when you take a screenshot do not put SleepyHead in full screen as instructed. It has frozen some screens and takes extra effort to get out.

[PAman]

Please reply with follow up responses/thoughts/questions.

Please fill out your equipment profile - https://www.cpaptalk.com/ucp.php?i=prof ... pment_info

I just did so now. Is it showing up OK?