Another Newbie - No choice given for machine / mask

[kered]

Hi all. I've just started CPAP (2 whole nights) and found your forum here and it looks very informative. I've found that users tend to be the best source, and most reliable for just about anything in life.

My sleep study revealed that I had 43 episodes in an hour. Looks like that falls into the serious category, but looks like I'm lucky in that they have assigned my effective therapy at 5 cm which I understand is the lowest setting. (Please excuse incorrect terminology - I've read a bunch of stuff but am sure I'm screwing up.)

Getting my equipment was easy - they just sent someone out with it. However, I was given a machine, and mask, with absolutely no choice. I asked if they had different masks, and the tech just said this was the easiest and most comfortable.I was given a REMstar Pro M series with heated humidifier, and a ResMed Ultra Mirage II Nasal Mask. The DME seems to be a big outfit (Total Home Health - IL) with 24/7 support.

I've read about the machine and although there seems to be some controversy, it seems to be a decent machine. I do wish I had reporting capabilities other than the basic compliance(?) on the panel. An APAP might be nice but not sure if I need it at such a low pressure. The mask I can't say is uncomfortable (as far as if you have to wear a mask), but other than the study, I've never tried another one.

Over my two nights, I've used it 3 -4 hours a night, taking off and putting back on a few times because it's a pain in the @#$. Can't say it's the mask, or just the whole mask / being connected to a hose thing. I was always a stomach sleeper and that almost seems out of the question now. Can't seem to fall asleep on my back, so I've been trying to settle on my side.

Anyway, what do you think about being assigned my equipment? Should I complain and try to get more choices in machine? mask? Sorry about being so long winded but wanted to give a little background as a newbie.

Thanks, Ed

[Bearded_One]

The machine and mask seem like reasonable choices for a first machine. With the mask, you have to start somewhere. If you find that you hate the mask during the first month it is possible that the DME will exchange it, and you should be able to get a new one in six months.

It is going to take a few days and maybe a couple weeks to get used to the CPAP and the mask. If you can't get a good seal with the mask you should call the DME for assistance and possibly to exchange the mask.

[SelfSeeker]

Hi Ed,

Welcome to the forums.

The M Series Pro is a good machine with data capapbility. Then only one better would be the Auto. Some people like the older Remstar versions. (In this case the Pro 2 would have been the one that records data.)

As for the mask (interface) that is a very personal choice. I think the interface makes or breaks the compliance and good CPAP treatment.

Tell the DME it is not comfortable etc. You tryed it. Try other ones, when you do try other interfaces; make sure you are laying down and that there is a CPAP on at your Rxed pressure. Bring your pillow.

Some masks need more then 5 cm of pressure for the Carbon dioxide to be washed out. (Comfort curve needs a minmum of 6 cm water. This inforamtion is on the instruction/info manual page that comes with the interface.)

[Lyza]

your prescribed pressure is 5 ?

[oldgearhead]

your prescribed pressure is 5 ?

My thoughts exactly. Anyone else ever hear of a titration this low?
The check valve on my full-face mask won't even stay closed at
5 CM/H2O. Furthermore, I have difficulty inhaling at that pressure.

[blarg]

I've read about the machine and although there seems to be some controversy, it seems to be a decent machine. I do wish I had reporting capabilities other than the basic compliance(?) on the panel.

Welcome!

Your machine can tell you your average AHI and leak info on the panel (I'm pretty sure) if you enable those displays in the provider mode.

[Slinky]

Get a copy of the data from your sleep evaluation study and titration study, not just the reports. You'll have a better idea of what is going on and can provide better answers when folks here ask you questions to try to help you out.

Do a search here in the forum on 'tummy sleeper' w/o the quotes. There is a thread w/comments from other tummy sleepers on what mask(s) have worked best for them. That should help narrow down the field of mask options for you to try.

My sleep lab manager told me that usually a week is long enough to know whether you can "work" w/any particular mask or not. Don't wait the full 30 days. Often, a DME will allow you to exchange at least one mask for another during the first 30 days - after that - it takes a pretty special DME to allow further exchanges until you are due for insurance to buy a new one.

You might also contact your sleep lab for assistance in adjusting to this mask or trying another. (The sleep labs can sterilize and re-use masks, DMEs are NOT allowed to do so). The best fit I got was when I went back to my sleep lab when I wasn't getting anywhere w/my DME.

The sleep lab fitted the mask and headgear whilst I was sitting up w/a PAP machine set at my pressure that had the capability of displaying the leak rate on the LED screen. She then had me lay on the bed on my back and checked leak rate and made some minor adjustments, then she did the same w/me laying on each side. (I can't sleep on my tummy due to a whiplash injury). THAT finally got me the fit I needed. It sure beat my DME's RT fitting sitting up in a chair w/a xPAP w/o data capabilities running.

You might also be wise to go to cpap.com and check out their online mask fitting guide. Get someone to help you do the measurements then talk to cpap.com about what masks they suggest might best fit according to your measurements. Compare them w/the suggestions from the tummy sleepers here in the forum. I believe the Respironics website also has a mask fitting guide.

Since you are going to have EXTREMELY limited opportunity, if any, to exchange your mask w/in the next six months you might as well avail yourself of every bit of assistance you can in selecting the next mask you want to try. If you narrow the field down to 2 or 3 or so, go w/asking your DME for the most expensive one. (That leaves you w/the option of purchasing the cheaper ones from cpap.com via self-pay).

[bookwrm63]

I too was just initially given my machine, humidifier and mask. They did fit me for my 1st mask right in the office and I did use it for 3 months. However, I had surgery in Aug. and could hardly wear it in the hospital due to people coming in and out of the room disturbing sleep. As a result, when I got home I felt like I was starting over. The mask never felt right again. I called my DME and she had me come right in and we changed mask types. I'm still getting used to it but I know that I have to stick with it for awhile to make sure I've given it my best shot. It seems to get better ever night. Please hang in there, but if it doesn't work, just call your DME. They will help you out. My mother just started cpap two weeks ago and just got a new mask to try as she had trouble with the 1st. Her DME said she had 30 days to try it and to call them back if she was having any more problems. As SelfSeeker said, a mask is a very personal choice and you have to be comfortable with it to get the most out of your therapy. Good luck!!

[Snoredog]

nothing wrong with your mask or machine, you could have gotten much worse.

for your pressure requirement, that Pro machine is much better than the cheaper planer jane Plus. It should give you AHI, pressure and leak information right from the LCD display.

the UMII mask is not bad either, for many years it was a long time favorite. It can take the avg. person 4-6 weeks to get used to wearing the mask where they can finally sleep through the night.

I don't think it is pressure that is causing you the problem, could be the pressure of 5cm is too low and you are "starving" for air just to breathe normally. If you are starving for air, the incoming air will feel stuffy or even humid, this is because you are not getting enough air to flush out your exhaled CO2.

I doubt you'll have many leaks at 5cm pressure, so you shouldn't have the straps too tight to cause discomfort. Stomach sleeping with the mask is near impossible, but some do it. What many of us do is hang the mask off the end of the pillow. Some even use a pap pillow, you can do the same thing with your turkey carving electric knife and a foam pillow, carve a notch in the side (again many of us just hang the mask off the edge of the pillow, so that may not be needed).

If it is the new noise you are not used to, try putting the machine on the floor to move it farther away. They also have longer cpap hoses available from cpap.com and elsewhere which would allow you to move the machine farther away to lower the noise.

You have to be careful with the machine you have and the humidifier tank, you can easily spill the water inside the machine just by moving it. Water damage isn't covered under warranty.

Your pressure is low, don't let yourself starve for air. You may want to discuss with your doctor increasing to 6cm so that doesn't happen. Keep an eye on the Cflex setting at that low a pressure you need Cflex to be low 1 or off or it could make things worse. You can change that setting yourself, you push the CFlex button, use the +/- keys to move the arrow to 1, 2 or 3 then press the On/Off button to lock it in. Experiment with the 3 settings to find the one most comfortable. It has to be disabled via setup if you want to turn it off or disable it.

Personally, at your pressure I don't think there is another machine that would benefit you more than what you already have.

[Jcastle]

I was not given a choice by my DME either. They provided the Resmed S8, H3i humidifier, and Ultra Mirage II interface. It's been a week and am still working out how to get get comfortable.

I have developed a small irritation around the bridge and sides of my nose due, I belive, to the silicon in the interface. I have washed the mask with mild soap and water, but still show a little redness during the day.

As to the equipment type I say you have to start somewhere. Continue to work with the model provided. You may find that you like it.

Good Luck and Welcome!

[snoregirl]

Good advice above.

I agree that 5 may be too low for comfort or possibly exhusting the co2, either of which could lead you to want to take off the mask.

If your pressure truly is 5, there is little to no reason for an AUTO.

The machine you have is good and does indeed give data.

I would double check your pressure with the doc and/or sleep study report. I would also run through the setup menu to make sure it really is set as it is supposed to be.

Even if 5 is correct, I would be tempted to go at least 6 or even 7 for comfort. Try one number at a time. Try it for a week at a time at least.

You might want to try a different mask after you give this on a good trial, and you should check your leakage numbers to see if you are mouthleaking.

If so, read about taping and chinstraps. Maybe both. If you are not leaking more than what is normal for the pressure/mask combination, you may be one of the lucky ones who can do without help in that area.

[Linda3032]

Jcastle: A lot of people develop a red rash where the silicone touches the face. Sometimes it's from a slight allergy to the silicone. I also think it's a form of heat rash. You might try using a nasal pillow interface as it has less facial contact.

Kered: Here is the topic for "tummy sleepers".

viewtopic.php?t=16184&highlight=tummy+sleepers

[Slinky]

JCastle, you have a good PAP machine there in that S8 Elite along w/the Humidaire 3i. That is what I have too and I love being able to check my Efficacy Data each morning (before noon) on the LED screen! Were you given access to just the standard menu or were you also given access to the advanced patient menu (Efficacy Data)?

I've got a loaner RemStar Auto w/C-Flex for the moment since we couldn't get a good titration study despite two tries. I'll have to return that shortly to find out what my pressure(s) should be and then I can go back to my Elite and access to information! Hallelujah! Altho I do have to say, other than not enough info via the LED screen I like this RemStar Auto and I sure do like these better pressures, whatever they are!

[kered]

You guys are quick - and thanks for all the input. Yes, my level is 5 and it says that on the panel when I turn it on. The DME said it was not adjustable by me and if it had to be changed, they would either send a new smart card or send someone out. Not sure if there's a button combo that would allow me to do it myself.

As far as data, all I can seem to get by pressing all the buttons is: Therapy Usage Hours/Night in 7 and 30 day average, and Sessions lasting greater than 4 hours for 7 and 30 days. They say I have to bring the card in to the doctor (Sorry, probably should have mentioned it had the smart card?) when I go so I'm sure he can get more data but I don't see a way that I can. Seems like a plot to get you into the doctor more just to check on things I could be checking myself.

Also, in getting used to all this I'm kinda dealing with two problems because I've had a hard time just falling asleep for more years than I care to think about. I'm now on Ambien (also tried Lunesta) for that.

Again, thanks, Ed

[Slinky]

Oh, HORSEPUCKIES! I can't tell you how to access the Clincial Menu where you "can" get into mischief, but the advanced menu for patients will give you the Efficacy Data: that night's AHI, AI, HI, etc.

Your sleep doctor should be willing to include the access to the Efficacy Data via the advanced patient menu if you ask w/your Tx'ing order. The DME can't give you that access w/o his okay.

Here's how to do it: Press the Right and Left buttons down at the same time. Then you can easily figure out when to use the Up, Down, Left and Right buttons individually to see the various Efficacy Data available. I believe this combo works on all data capable Resmed products. I know it works for the Elite.