newbie problems

[Tim1956]

I've been trying to get use to my cpap for 4 weeks now. The first two weeks were wonderful. The only problem I had was with the 6' hose that came with the machine. I have a ResMed Escape Auto, set to apap, I am using a Mirage Quattro at first. Plus I got a nasal pillow to try that out. The pillow is not comfy to me. I have since bought from my own pocket a Quattro FX, it's ok at first but as the night goes on I have problems with it. I Bought a Mirage SoftGel nasal mask. Comfy but i wound up with open sores on the bridge of my nose. (Thanks to this forum I've learned to loosen up the straps a bit and it helped.) I kept ripping the mask off due to the short hose length so I got a ten foot hose from this site. Plus a hose hanger.. Best thing in the world. Since I've started using the longer hose I haven't had a good night sincel. I set the maching to the proper hose size. (slimline to standard) but it keeps building pressure that forces the mask to cause leaks. I use the humidifier set on a low setting like .5 or 1. Please help with any suggestions. I can't afford to keep buying things to try out. I going broke from it. I know the machine will help if I could just get the right combo.

[Pugsy]

What are your pressure settings? Minimum and maximum?
Do you use the ramp feature? Do you use EPR?

[tim56]

Yes I have the EPA set, and the min is 4 with the highest 20. I changed that down to 10 with no luck. I got the ramp set on 20 min.

[Pugsy]

If your pressure starts out at 4 and you adjust your mask at this pressure and then it goes up to 8 or 10 or whatever...that adjustment is not going to be sufficient to control the leaks at the higher pressures.

You need to fit your mask at or near where your average pressure seems to be.

I do not use a ResMed machine but I think there is a mask fit setting on some of the models where a person can make adjustments at the higher pressure so that when the machine increases the pressure it is more likely to maintain the seal.

Perhaps someone who is familiar with ResMed machines can offer more details. I can't offer specific details.

Do you have the clinician manual for your machine? It should also describe this feature.

[tim56]

My machine doesnt have the mask fit feature. wish it did

[Pugsy]

The Escape Auto offers minimal stuff to help you. If there is no mask fit feature and you are using higher pressures in the auto range (impossible to tell because this machine I think only shows AHI) then you have to figure out something to help you do your adjustments at higher pressures. Problem is..you don't know which pressures you are going to do you?
If you had an idea what was needed you could make adjustments at that pressure.

How did they come up with the 4 to 20 range? Did you have a titration study on a cpap machine and they come with with the default settings?

I am sorry but this machine doesn't have some features that would be of great benefit to you. It may be an auto unit with varying pressures but it does not offer much to help you. Any way you can get it swapped for the S9 Autoset which does have mask fit and does show pressures and leaks and you can use the software to see exactly where the pressures are going and exactly how bad the leak is affecting things?

[GumbyCT]

Tim, Pugsy is giving you good advice. You MUST adjust your mask at the higher pressure BEFORE you go to sleep, else when the force against the mask increases leaks will develop.

The only problem I had was with the 6' hose that came with the machine.

You don't say why this was a problem. So why do you think it is a problem?

It sounds like you've gone from 4-20cm to 4-10cm is that correct? What was your titrated pressure?

[Tim1956]

The 4-20 range was what the provider set the machine up for. I figured out how too change the settings to get the max pressure lower. The sleep study said I needed 8. I'm so new to all of this that I just trusted what it was set up for. I was told by the provider that leaving the max setting at 20 would have no effect because the machine would determine what I needed.
To answer the question about the 6' hose problem, it wasn't long enough and I kept getting getting my arms wraped in it and jerking the mask off. Hurts like heck when you do that also. I've since gotton a 10' hose. One thing I did wrong was to forgot to change the hose settings from slimline to standard.

[Slartybartfast]

The top setting really isn't important for the reason you gave. But if your titrated pressure is 8, you really should set the minimum pressure to about 6 to start with or your machine is going to spend a lot of time ramping up and down chasing events. If the minimum pressure is set to 6 you machine can respond more quickly and effectively.

[GumbyCT]

The 4-20 range was what the provider set the machine up for. I figured out how too change the settings to get the max pressure lower. The sleep study said I needed 8. I'm so new to all of this that I just trusted what it was set up for. I was told by the provider that leaving the max setting at 20 would have no effect because the machine would determine what I needed.
To answer the question about the 6' hose problem, it wasn't long enough and I kept getting getting my arms wraped in it and jerking the mask off. Hurts like heck when you do that also. I've since gotton a 10' hose. One thing I did wrong was to forgot to change the hose settings from slimline to standard.

This new info will help others help you.
You mentioned several masks which is not unusual but tell us have you settled on a fav?

Since I've started using the longer hose I haven't had a good night sincel. I set the maching to the proper hose size. (slimline to standard) but it keeps building pressure that forces the mask to cause leaks.

Sounds like you are having leak problems also not uncommon. Besides making your therapy totally ineffective leaks can cause a vicious cycle of runaway pressure increases when in auto mode. Is that why you dropped the top pressure down to 10?

Many people don't get enuff air at 4cm so yea starting at 6 is better but when you throw in the 10ft hose you increase the volume and thus a drop in pressure at the business end of the hose. This will also make the machine less sensitive to events when used in auto mode.

So your prob better off to either -
stay in cpap mode with a pressure of 10cm when using the 10ft hose.
Or put the 6ft hose back on even if that means rearranging your bedroom to accommodate.

Posting the graph of your leak line will also help us to see how you are doing.

HTH

[tim56]

Thinking really hard about setting the machine back into cpap mode. Then start from 6 and go up to 10. I like the extra comfort of the longer hose. Can't do any worse than I am now.

[tim56]

You all are great. I got home last night and with the help of this forum and the videos that are poste d here, I found out a bit more on how to find the stored settings in my ResMed Escape Auto. If I understand it right the machine is going to an average of 13.8 for the pressure. I stayed with the 6' slimeline hose and the Quattro FX (I think that's the name of it. I know it has the fore head support built in.) I set my start pressure at 6.6, the max pressure at 14 and lowered the ramp time to 10 min. Turned the humidifer down to 5 (I think that's right) I did pretty good last night. Very few problems with leakage. Thanks for getting me pointed in the right direction. Didn't wake up but 5 times last night. mainly due to bathroom and dry mouth. Thanks to all!!!!

[Pugsy]

Didn't wake up but 5 times last night. mainly due to bathroom

5 times to pee? If you don't have a prostate problem then perhaps your AHI is still pointing to less than optimal treatment. Minimum pressure being too low. The Escape Auto does offer AHI data on the LCD screen.
It may be turned off in the clinical settings so that you can't see it. You can turn it on so you can see it. Need to look before noon though as it resets to zero at noon.

Using the software would also show AHI which is the only piece of data the Escape Auto shows.. I am assuming S9 Escape Auto.

You can get the software and the clinical manual in UncleBob's signature. The manual may be slightly different from your model machine but the basics are there.
memberlist.php?mode=viewprofile&u=38643

Software tutorial video
http://montfordhouse.com/cpap/resscan_tutorial/

[Guest]

Pugsy, what is a good AHI? Really just getting up 5 times in one night is really really good for me. I get a really dry mouth along with the bathroom. Best thing was being able to go right back to sleep. Been a long time since I had the alarm wake me up. I was getting up 1-3 hrs before it was time. Allso should I use an average of the readings or do it one night at a time?

[Pugsy]

Pugsy, what is a good AHI? Really just getting up 5 times in one night is really really good for me. I get a really dry mouth along with the bathroom. Best thing was being able to go right back to sleep. Been a long time since I had the alarm wake me up. I was getting up 1-3 hrs before it was time. Allso should I use an average of the readings or do it one night at a time?

Dry mouth is from mouth breathing. Even if using a full face mask if one breathes in and out a lot the mouth will dry out. Need to keep mouth closed as much as possible.

AHI less than 5 is considered acceptable. For me personally I found that I didn't feel as well with AHI 4 to 5 as I did with less than 2.5.... so that is where I like to be. I look at nightly numbers for an idea how I did last night or to get an idea what might have been going on. Overall averages don't tell you what you did last night and with the progression of time it simply takes too much of a change to even impact the overall average. I have been doing this for over 2 years now. I have so many nights that even if I had an AHI of 20 last night...it would not really affect my overall average at all.

Edit..BTW nocturia (frequent need to urinate during the night) is a common symptom of OSA. It was the first thing that stopped when I finally got my therapy optimal. If you have no other health issues to explain the nocturia...ineffective therapy would be my first suspect.