Bad Symptoms - Please Help

[zunebuggy]

I have a Remstar Plus 250P and Remstar Heated Humidifier 1056215. I started on Tues of last week and have had this problem every night. I wake a couple of hours with a huge headache and fingers and lips tingling and cannot breathe. I end of taking my mask off and the headache goes away and I can breathe. I have a ResMed Mirage facemask. My pressure is at 7. My CFlex is 2. I am convinced I am rebreathing CO2. Last night I almost didn't wake up because in my dream state I thought to myself I had taken the mask off. Then at the last second (I felt like I was losing consiousness) I woke up and ripped it off and all symptoms stopped. I told the CPAP store and they say they have never heard of this and it is impossible to rebreathe CO2. In the sleep study I had the best night sleep ever and woke up so refreshed. I should have known something was wrong though because when I picked up my machine, I had trouble breathing when tryingon the mask. It has a valve that is supposed to let the CO2 out I guess, but something isn't right. Also, I have tried the humidifier on all settings and I wake up with my mouth feeling like it had cotton balls in it all night. I really want the CPAP to work because it stopped my snoring and apnea symptoms in the sleep study. It just wont work at home. Please help. I can't use this thing until I figure this out.
Thank you,
Joe "Zunebuggy"

[harry33]

make sure the air outlet for the mask isnt blocked, something is wrong

a very dry mouth is often caused by mouth breathing with a nose only mask

try not using cflex

[Wulfman]

I have a Remstar Plus 250P and Remstar Heated Humidifier 1056215. I started on Tues of last week and have had this problem every night. I wake a couple of hours with a huge headache and fingers and lips tingling and cannot breathe. I end of taking my mask off and the headache goes away and I can breathe. I have a ResMed Mirage facemask. My pressure is at 7. My CFlex is 2. I am convinced I am rebreathing CO2. Last night I almost didn't wake up because in my dream state I thought to myself I had taken the mask off. Then at the last second (I felt like I was losing consiousness) I woke up and ripped it off and all symptoms stopped. I told the CPAP store and they say they have never heard of this and it is impossible to rebreathe CO2. In the sleep study I had the best night sleep ever and woke up so refreshed. I should have known something was wrong though because when I picked up my machine, I had trouble breathing when tryingon the mask. It has a valve that is supposed to let the CO2 out I guess, but something isn't right. Also, I have tried the humidifier on all settings and I wake up with my mouth feeling like it had cotton balls in it all night. I really want the CPAP to work because it stopped my snoring and apnea symptoms in the sleep study. It just wont work at home. Please help. I can't use this thing until I figure this out.
Thank you,
Joe "Zunebuggy"

Is that mask you use a nasal mask or a full face mask? (I'm guessing the nasal version)
Is it one of these?

https://www.cpap.com/productpage/resmed ... dgear.html

https://www.cpap.com/productpage/resmed ... dgear.html

From your "cotton balls" description, it sounds more like you're leaking your therapy air out of your mouth at night.
For some people, too much humidity can actually have the effect of closing off their nasal passages, so they're forced to mouth-breathe.
And, a pressure of 7 cm. is barely enough to flush CO2 from a full face mask. (I think I've read where it takes at least 6 cm.)

Unfortunately, your machine is not data-capable, either.
If you just started on therapy, I'd suggest getting your equipment provider (DME) to switch your "Plus" model to a "Pro" model (which IS full data-capable) so you'll be able to find out how your therapy is working.

And, in the mean time, either tape your mouth shut or switch to a full face mask. (you may need a slight pressure increase, too.)

Did your sleep doctor ever order an overnight pulse-oximetry test? That would be beneficial to know whether you were getting enough oxygen in your blood. The test should be "free" (your doctor orders it and the DME provides you with the equipment).


Den

[Muse-Inc]

...a pressure of 7 cm. is barely enough to flush CO2 from a full face mask. (I think I've read where it takes at least 6 cm.)...

Ah, Den, would you happen to remember where you read this? I'd appreciate reading more and can't quite come up with the right google terms to access that sort of info...thanks!

[Wulfman]

...a pressure of 7 cm. is barely enough to flush CO2 from a full face mask. (I think I've read where it takes at least 6 cm.)...

Ah, Den, would you happen to remember where you read this? I'd appreciate reading more and can't quite come up with the right google terms to access that sort of info...thanks!

There's one in every crowd.....

Not necessarily a "scientific" source......but ol' Snoredog had a lot of good practical knowledge/experience.

viewtopic/t48664/viewtopic.php?f=1&t=36 ... O2#p314967

viewtopic/t48664/viewtopic.php?f=1&t=36 ... O2#p313217

viewtopic/t48664/viewtopic.php?f=1&t=35 ... O2#p310142

viewtopic/t48664/viewtopic.php?f=1&t=35 ... O2#p309789

By the way, there were a lot more, but these were representative enough for this moment.


Den

[ozij]

I had trouble breathing when tryingon the mask. It has a valve that is supposed to let the CO2 out I guess, but something isn't right.

Flushing CO2 from masks happens through a simple vent -- that is some configuration holes without moving parts through which the air blows out.
Anything valve like (with moving parts) should be closed.
If you have a valve opening automatically on your mask -- then the machine is not supplying enough pressure to keep the valve closed the way it should be.
If you (or the DME) opened something on the mask, that may have been the oxygen port that some masks have. Close it. The CO2 venting is only done through the built in vent holes, oxygen ports should be closed unless theres an oxygen bleed connected to them.

Get a copy of you PSG (sleep study) report, and Rx -- mistakes have happened in the past, check both to see what pressure you should be at.

Welcome to the forum, and good luck
O.

[KatieW]

This might not apply to you but....I recently bought a Mirage Ultra FF Mask on auction. It leaked like crazy, so I took it apart, and compared each little piece (and there are lots of them) to the diagram in the User Guide. Turned out I was missing the Valve Membrane. I emailed the seller, and he had inadvertently left it off after washing and reassembling it, so he mailed it to me.

So, make sure you have all the parts to the mask, and that is has been reassembled correctly. Good luck.

[rested gal]

ol' Snoredog gave out a lot of misinformation, too. He stated a lot of his strong (many times erroneous) opinions as fact.

His CO2 musings fall in the category of "his opinion, not fact" ... imho.

Don't get me wrong. I got a lot of entertainment out of reading many of his fire-from-the-hip posts. I liked him, crustiness and all. But to regard him as a scientific thinker (not that you were, Den) or put much credence in his pronouncements about respiratory or medical matters.... nope.

He came to many a wrong conclusion with his "practical experience", but he sure could make it sound like he knew what he was talking about.

[nanwilson]

If it were me I'd take that mask and machine back to the supplier and demand a data capable machine and another mask.

[archangle]

Please go into your profile on this board under user control panel and enter your equipment. Use the TEXT setting. There are half a dozen masks that are called "ResMed Mirage."

CO2 exhaust is through a vent, not a valve. The vent is simply some holes or another kind of opening. Put on the mask, turn on the machine and figure out where the holes are that air blows out of. That's the vent that flushes out CO2. Unless that's not blowing, you aren't rebreathing much CO2. Feel how much air is coming out. Do CPAP for a while when you're awake and get a feel for how everything feels. Note the pressure reading on the display.

The next time "suffocation" happens, before you take off the mask, reach up and feel if there's air flowing out the vent. Look on your machine and see what pressure it reads on the display while you're suffocating. Keep the mask on and consciously breathe air in and out. Feel the air coming in. Lift up an edge of the mask and feel the air gushing out. Note the pressure displayed when you turn it on.

You sound to me like you may be leaking air out of your mouth and dropping your pressure. Or you may simply not have enough pressure and still be having apneas despite the CPAP.

You should at least have a REMstar PRO machine and preferably an Auto. The fact that your DME didn't give you a Pro machine makes me think your DME is going to do the absolute minimum and doesn't care about your treatment. A Pro or Auto machine lets you read the card and figure out how your therapy is going. A Plus machine only records how many hours you have the machine turned on. A Pro or Auto machine would tell you or your doctor if you're still having apneas, if you're having air leaks and a number of other useful bits of information.

[Wulfman...]

ol' Snoredog gave out a lot of misinformation, too. He stated a lot of his strong (many times erroneous) opinions as fact.

His CO2 musings fall in the category of "his opinion, not fact" ... imho.

Don't get me wrong. I got a lot of entertainment out of reading many of his fire-from-the-hip posts. I liked him, crustiness and all. But to regard him as a scientific thinker (not that you were, Den) or put much credence in his pronouncements about respiratory or medical matters.... nope.

He came to many a wrong conclusion with his "practical experience", but he sure could make it sound like he knew what he was talking about.

Actually, I found some posts and information over on the Binary Sleep site that suggested Snoredog wasn't too far off on his minimum pressure thoughts regarding clearing CO2.
I think what makes a big difference is the individual, their breathing characteristics while they sleep and the mask they use.
I also think it would be prudent to monitor O2 levels (pulse oximetry) when using lower pressures.

"someday science will catch up to what I'm saying..." Snoredog


Den

[dsm]

ol' Snoredog gave out a lot of misinformation, too. He stated a lot of his strong (many times erroneous) opinions as fact.

His CO2 musings fall in the category of "his opinion, not fact" ... imho.

Don't get me wrong. I got a lot of entertainment out of reading many of his fire-from-the-hip posts. I liked him, crustiness and all. But to regard him as a scientific thinker (not that you were, Den) or put much credence in his pronouncements about respiratory or medical matters.... nope.

He came to many a wrong conclusion with his "practical experience", but he sure could make it sound like he knew what he was talking about.

Actually, I found some posts and information over on the Binary Sleep site that suggested Snoredog wasn't too far off on his minimum pressure thoughts regarding clearing CO2.
I think what makes a big difference is the individual, their breathing characteristics while they sleep and the mask they use.
I also think it would be prudent to monitor O2 levels (pulse oximetry) when using lower pressures.

"someday science will catch up to what I'm saying..." Snoredog


Den

Den

I support you on this. Snoredog was also a smartdog. But RG is right in being able to point out that he had some ideas *back then* that may not have been completely accurate. Although, he was usually willing to debate the points he made even if he could get 'crusty' at times.

It has to be a self evident fact that most regulars have learned a lot about SDB over the years that we have discussed and debated various issues at cpaptalk & for anyone person to step up & claim or imply that they always had it 100% right while others didn't, is disingenuous at best.

Also Snoredog unfortunately isn't here today to defend himself nor to prove that he would have enhanced his understandings in particular areas. It seems odd for anyone to be carping at a man who died 2 years ago but someone here seems capable of it.

Hindsight is always the most wonderful sight to have as long as it isn't all hind and does exhibit some sight.

DSM

[Guest]

It seems odd to me that mask manufacturers would be unaware of the fact that some of their masks, when used at prescribed levels, are not flushing out CO2 effectively. Has anyone seen a warning to that effect, i . e ., "don't use this mask at pressures below x cm....," in the literature accompanying their mask?

[Wulfman...]

It seems odd to me that mask manufacturers would be unaware of the fact that some of their masks, when used at prescribed levels, are not flushing out CO2 effectively. Has anyone seen a warning to that effect, i . e ., "don't use this mask at pressures below x cm....," in the literature accompanying their mask?

There most certainly ARE warnings! I just read the ones for my UMFF mask and am posting them below. I've bolded the part that I believe is most pertinent to this discussion. The Vent Flow Rate graphs start with the pressure of 4 cm. and most flow generators go down to pressures of 4 cm. However, it's my opinion that the reason no specific pressure is mentioned in the warnings is that it is something that would vary from user to user depending on their respiratory needs (which is what I've alluded to previously).


Den



WARNINGS AND CAUTIONS
• This mask should be used only with
flow generators (CPAP or bilevel)
recommended by your physician or
respiratory therapist. A mask should
not be used unless the flow generator
is turned on and operating properly.
The exhaust vent should never be
blocked.
Explanation of the Warning: Flow
generators are intended to be used
with special masks with connectors
which have vent holes or separate
exhaust vents to allow continuous flow
of air out of the mask. When the flow
generator is turned on and functioning
properly, new air from the flow
generator flushes the exhaled air out
through the attached mask exhaust
vent. However, when the flow
generator is not operating, enough
fresh air will not be provided through
the mask, and exhaled air may be
rebreathed. Rebreathing of exhaled air
for longer than several minutes can in
some circumstances lead to suffocation.
This warning applies to most models of
flow generators.
• The exhaust vent flow is lower at lower
mask pressures (see Pressure/Flow
Curve— section A). If the mask
pressure during expiration is too low,
there may not be enough exhaust vent
flow to completely flush the air delivery
hose of exhaled air before the start of
the next inspiration.
• The mask should not be worn if the antiasphyxia
valve membrane is damaged or
missing. If the valve membrane is
damaged, distorted or torn, it should be
replaced with a new valve membrane.
• The mask may not be suitable for those
at increased risk of gastric regurgitation.
• The mask must be cleaned and
disinfected/sterilized if it is used
between patients. Refer to the section
“Cleaning the Mask between Patients”
for details.
• If oxygen is used with the flow
generator, the oxygen flow must be
turned off when the flow generator is
not operating.
Explanation of the Warning: When the
flow generator is not in operation and
the oxygen flow is left on, oxygen
delivered into the air delivery tubing
may accumulate within the flow
generator enclosure and create a risk of
fire. This applies to most types of flow
generators.
• Oxygen supports combustion.
Oxygen should not be used while
you are smoking or in the presence
of an open flame.
• Always ensure airflow is being
generated by the device before the
oxygen supply is turned on.
• Always turn the oxygen supply off
before stopping the airflow from the
device.
• Please refrain from smoking while
oxygen is in use.
Note: At a fixed flow rate of supplemental
oxygen flow, the inhaled oxygen concentration
will vary, depending on the pressure settings,
patient breathing pattern, mask selection, and
the leak rate.


.

[Wulfman...]

Also........
Accompanying the Vent Flow Chart is this note:

Note: As a result of manufacturing variations, the vent flow may vary from the values listed in the
following table.


I believe it would be safe to say there are no absolutes in this therapy. (or, at least very few)


Den