First Night!

[BuckarooBanzai]

Hi,

Just received my Resmed AirSense 11 Autoset with Resmed AirTouch F20 full face mask. I have not used it yet. I must admit that I am a little scared to try it, because I haven't been instructed on this guy at all. It's all set up and ready to go, but how do I know the settings are correct?

I have been all over this board, and yes I have gone to the 'read this first' and such, but links are broken and I cannot find any information about the first night, i.e., what to do when you are brand-spanking new without any trial or instruction?

I mean, do I just set the CPAP on 'auto' at every turn and cross my fingers?

Sorry, I feel really stupid, but there is something scary about trying out and trusting a breathing machine given I have absolutely no idea what I am doing.

[Respirator99]

G'day BuckarooBanzai, welcome to the forum.

By the time you read this your first night will probably be over. Hopefully everything went OK for you. If perchance you haven't yet slept with the machine, let me allay your fears. The pressures generated by the Airsense 11 can't hurt you, even if the settings are completely wrong - the pressure just isn't high enough. Your supplier should have set the pressure and other settings (eg EPR, humidity) for you but if not, you can just leave things on the default and see how it goes.

Did you have a sleep study and a titration test? That should give you (or your suppliers) a reasonably starting point, but in reality you'll probably need to make some adjustments as you go along. The key to this is to get hold of a free software program called Oscar. After a night's sleep, take the SD card out of your machine, insert it in your computer and let Oscar show you what happened on a breath-by-breath basis. You can then upload a "daily page" here and members will be able to provide some targeted advice.

Good luck!

* Download Oscar
* Oscar help
* Organise your Oscar charts

[Pugsy]

Where or how or from whom did you get your machine and mask? From a local DME (medical equipment supplier) or just off the internet?

do I just set the CPAP on 'auto' at every turn and cross my fingers?

Well it depends on if you have had a titration sleep study done in a lab or who and how you obtained the machine.
Most likely it was left at the auto default settings which may or may not work depending on your pressure needs.
But for now essentially yes...you have it set to auto and cross your fingers and after using it a few nights you can evaluate the results (with the help of forum members) and make adjustments if needed.
At this point we don't even know if any changes need to be done.

Your primary job right now is to sleep with the mask and machine because without sleep we have absolutely nothing to go on in terms of any sort of advice to give you.

To get used to it...just turn it on and use it while awake and under no pressure to sleep.
Use it while awake...watching TV or reading a book or whatever.

[Jlfinkels]

Follow Pugsy’s advice, but also if you can download OSCAR as Respirator99 suggested that will provide the detailed data folks like her and others need to analyze things. You’ll need to put an SD card into the machine if not there to capture the nightly data which is then loaded into OSCAR to analyze.

For more information on OSCAR :

http://www.apneaboard.com/wiki/index.p ... OSCAR_Help

Your machine is likely on the default pressure settings of 4-20 cmH2O, not sure about the defaults for temp and humidity. If you don’t have a ClimateLine hose consider getting one to try as it helps with rainout (water in the hose and/or mask) when using humidity. Once you have some data with OSCAR post the graphs as Respirator99 has the links in their signature ( http://www.apneaboard.com/wiki/index.p ... ganization).

We have all been in your shoes with little help from our Drs and RTs. The thing you need now is patience and a bit of an adventurers spirit. Plenty of folks here who can help with the correct settings on your machine, but they need info to help. OSCAR graphs gives them that data. They can still help without it using the information on your machine, but it is a lot harder for them.

[palerider]

but how do I know the settings are correct?

Let me put your mind to rest. The settings are almost certainly not correct. Almost everyone has to go though a trial and error process to get the settings right for them. If things were normally correct from the start, this forum wouldn't exist.

I cannot find any information about the first night, i.e., what to do when you are brand-spanking new without any trial or instruction?

Strap it on, do your best to sleep, then post some data the next day and let us help you get things adjusted better, but we have to have *data* to do that.

I mean, do I just set the CPAP on 'auto' at every turn and cross my fingers?

It'll still be better than not having it.

There's virtually nothing that can happen with the machine that will be in any way harmful to you, the worst is that you won't benefit as much as you could from the therapy.

[Miss Emerita]

I want to underline Pugsy's advice about using the machine while you're awake. That will help you get used to the experience and make it easier to sleep with the machine and mask on. Ideally you'll set the machine up outside your bedroom, mask up, and then watch TV or read or whatever.

Also, try fitting your mask lying down on your bed. Google your exact mask type and watch a few videos about how to adjust the straps. A common mistake is to tighten them too much, but play around with the straps until everything seems pretty comfortable and you don't sense any leaks. Try lying in bed in your normal sleep postures (back/sides/stomach) to see how that goes.

Don't be upset if the first time you try you lie there awake and don't drop off. You'll get there.

Could you take a peek at your settings and tell us what they are? To see them, follow these simple steps: While looking at the main screen, simultaneously press and hold the two buttons (labeled "My Options" & "My Sleep View") for 3+ seconds until the screen transitions to the "Clinical Home" screen. Look for your minimum pressure, your maximum pressure, and your EPR setting (expiratory pressure relief).

[BuckarooBanzai]

Thank you so much to everyone who responded! I was concerned that the machine could do me damage if the settings were wrong, but now I understand from your assurances that, well, they're going to be wrong by default, but the machine cannot hurt me anyhow so best to just shove off. I did not sleep with the machine last night because I had a turbinectomy on 12/20, and I am waiting for my ENT surgeon to give me the green light. Will speak to the nurse today.

I had a one night home sleep study through Kaiser Permanente. I have not seen the results or spoken with the MD. I have only received a phone call from a nurse or sleep tech who told me the MD said I have mild to moderate sleep apnea and should begin CPAP therapy. Kaiser ordered the AirSense 11 and it was delivered to me via Apria, their DME supplier.

I am very excited about starting CPAP therapy and really want to make this work. I am so desperate for a good night of sleep! I'll be following all of your instructions, especially regarding using the machine while awake.

Believe it or not, I've been all over this website. I see you are all quite excited about OSCAR, which I gather provides much more information than the AirSense 11 app. Will see what I can do to get it up and running.

CURRENT SETTINGS:

Mode: Autoset
Pressure Range: 4-20
Autoset Response: Standard
Ramp Time: Auto
Start Pressure: 4
EPR: On
EPR Type: Full-time
EPR Level 3
Humidity Level: 4
Mask Setting: Pillows (Which I assume is wrong, because I have a full mask.)
Tube: Slimline
B/V Filter: Off
Patient View: Advanced
Smartstart: ON
Smartstop: Off
Care Check-In: ON

[Pugsy]

Ahhhh...Kaiser. We are all aware of what they do. Home sleep study followed by dispensing the auto adjusting machine to use and then decide on best pressure options. They don't do in lab titrations unless there's a problem pop up with using the machine at home

The machine is set to the factory defaults for now and later they may or may not make adjustments depending on how you do or what pressure adjustments are needed. Most likely you will need more than the minimum of 4 either from needing it to treat the OSA or just from a comfort aspect. A lot of people feel like they are air starved at the 4 cm starting pressure. We won't suffocate at 4 cm but it can sure feel like we are.

EPR at 3...you won't/can't even get that to kick in until the pressure is up to 6 or 7 because the machine can't ever go below 4 cm. EPR is a drop during exhale to make it easier to exhale against the pressure.
If you try the current settings and you feel like you can't exhale or you are suffocating...change the minimum to 6 and I think you will be a lot more comfortable.

Go here and request the provider/clinical manual for your machine and read it. Inside are the instructions on how to get to the setup menu area where you can adjust the settings....plus there's some really useful information in it that probably isn't in the typical user manual.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

What surprised me is you didn't seem to get their usual instructions they give everybody in a class for using the machine and what to expect. I thought that was needed to even get a machine from them.
I thought all Kaiser cpap patients got the in class instructions.

[Julie]

Tip - don't try to match your breathing to the machine - it should be the other way around... in other words just breathe normally (if possible ) and see how things go. As Pugsy said if you feel a lack of air then turn the min. to e.g. 6, but otherwise wait and see.

[BuckarooBanzai]

Yes, Pugsy, you are bang on about Kaiser, the only differences being due to the pandemic and supply line issues. If I had followed the Kaiser plan, it would have taken me almost twelve months to get started with CPAP therapy. So they offered to let me skip the class because (they said) the class was 'all about sleep apnea,' why treatment is beneficial, and various treatment options; the class wasn't even supposed to go into how to use the machine. Well, I already knew I wanted/needed CPAP therapy, so we just jumped over the class and saved me about four months of waiting. I am supposed to use the machine as best I can, and then have a phone meeting with a sleep tech on 1/20.

Pugsy and Julie, I will follow your advice. Thank you.

I feel so much more confident now that I've read your responses. Hope the ENT surgeon gives me permission to start CPAP right away.

[Pugsy]

I had heard there was a bit of delay for the Kaiser cpap class but never imagined it was that long. In 12 months you will be an old cpap veteran and won't even need us.

Now it is a bit weird at first which is why we strongly suggest lots of practice while awake so that you body and brain gets used to the new way of doing thing.

Don't expect perfection right away either. I had an in lab titration myself (and it was a total disaster and waste of time and money) and I knew what to expect and still had some bumps in the road. We get past them with some education and hard work.

Be sure and watch lots of mask fitting videos for your mask. Odds are that your primary bumps will be related to mask fit or comfort or both. That just seems to be the way it goes for most people but we work through it and don't be afraid to try other masks if you want to or need to. You aren't married for life to this first mask....you can always try something else at any time you want to.

[BuckarooBanzai]

Yes, the Kaiser home sleep test queue is about 7 months, the sleep apnea class queue 2-3 months, and then of course a six week queue for the AirSense 11.

I've a strong vested interest in making CPAP therapy work (law student experiencing severe exhaustion plus memory/cognitive deficits), so I will keep on trucking' until I've got this down. It's like a do-or-die feeling.

[Miss Emerita]

Good luck tonight! Do pester Kaiser for a copy of your sleep study. I’m a Kaiser patient, and pre-coved, the deal was you got a copy of the study during the class on how to use the mask and machine. But they can mail it to you or upload it into their system where you can see it.

Keep us posted, would you?

[BuckarooBanzai]

Well, I have not received permission from the ENT to use the CPAP yet, but I decided to try it out anyhow. I wore it while streaming Indiana Jones, and was so immediately relaxed that I wanted to go to sleep. I did not like the initial 4 setting so I changed it to 6, which I like very much. So I rested in bed for about 2.5 hours while using the unit. I liked it but never really fell into a deep sleep; I am not sure I got past Stage 1 sleep, or so I imagine. Then, at about the 2.5 hour point when I was pretty deep, I started yawning again and again, and thought perhaps that meant I was not getting enough air? So I checked the machine and it said I was at about 8.5, so I left it alone. But then I got congested and that seemed to happen pretty quickly. The congestion was bad enough that I turned the CPAP off.

The app readout gave me an atta-boy for perfect mask seal and said I had 1.2 episodes per hour.

Oh, by the way, I had humidity set to auto 4 but the machine didn't use any water at all, so I guess that setting doesn't require water? Can I just not fill the water reservoir from now on? And, is manual humidity only available for those who have a climate line tube?

[Miss Emerita]

Hey, you've made friends with the mask and machine already -- that's great! Plus you took charge of your settings and dozed off while using the machine. A nice low AHI on top of all that. Well done!

Keep doing the daytime usage, which will help you get as quickly as possible to the point where you sleep deeply using the machine.

About yawning: apparently we don't know a lot about it:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678674/

except that it isn't caused by a lack of oxygen.

You might want to check again with the ENT to make sure you're really good to go on CPAP.