Great start,problems later on.Recommended solutions ?

[mattleffler]

Hallo,my name is Matt.
I've been using my new Apap (Resmed S9-Quattro Fx mask) for a month now.The study showed an AI of 65 and with 4-6 pressure it got to 2 miraculously.The machine was set to work with a range from 4 to 7 cmH2O pressure.
The first 2 weeks were marvellous.No problems at all,with long 6-7 hours of sleep with 1-5 AHI.Then ,my mask started making some kind of noise while leaking but by tightening it and cleaning it it's now ok(beginner's problems i guess).
I feel a bit of skin irritation because the mask goes to the exact same place every night but this though a bit irritating,isn't making sleep any worse.

Right now i keep waking up every 30-45 minutes feeling i have to get up and remove the mask and reset .Something i was getting before the mask.After 4-5 nights like this ,with sometimes the AHI going as high as 40 and sleeping with and without the apap i begin to feel both tired and nervous of what i should do next.

Should i increase the pressure ? (low-high or both ? ) Buy one more mask to change ? Should i ask for a sleeping pill to combat excess nervousness ? Should i just keep on trying and accept this as just a bad phase ?

All advice welcome-i apologise in advance if these questions have been answered elsewhere ,i just feel i need some quidance from more experienced users.

[jamiswolf]

Hi Matt,
Welcome. I hope you register and stay. Not at all uncommon for people to have a honeymoon phase and then problems occur later. Happened with me.

Your idea of raising pressures seems reasonable to me. It's true that mask leaks tend to be pressure related but problems don't usually occur till up above `10-15cm.

Those low pressures have a couple of problems. One is that with some masks, it feels like you aren't getting enough air...a suffocating sensation.

The other issue is that the vent is there to blow off CO2 also...so perhaps you're not getting rid of your carbon dioxide. I can get by with a level of 4cm if I scrupulously sleep on my side, but for comfort I run my bipap at 8 to 12. Some masks seal better at higher pressures too...as paradoxical as that sounds.

Ideally, you should identify your 90% pressure and run your auto machine at 2 above and 2 below...that's sort of a norm.

Jamis

[mattleffler]

Could you please elaborate on the 90% pressure ? How do i find this ? Does this also mean the range should be at least 4 (like 5 to 9 cm) ?

I do experience the suffocating sensation,but not the leaks anymore.
Also,in the past i had trouble with too much pressure waking me up (because the machine sensed it had to increase it of course) feeling the air was too much for me to inhale,"drowning" me kind of,with air.So,i'll increase pressure with caution because of this.

[jamiswolf]

Matt,
The machines record and report data. Some of it is available in the machine LED and most folks on this forum have computer software to read the complete data the machine records. The 90% data is a number that represents the average pressure the machine was at 90% of the time.

Hey, it's useful to list your machine, mask and software in your signature. Use your user control panel.

You're saying with a setting of 4 to 7 that you've had high pressure problems? Just to put things in perspective, high pressures are considered above say 15 cm and ASV users frequently go above 25cm pressure. So I don't know what sort of high pressure problems you were having. From my opinion, it sounds more like low pressure problems. Just saying...
Jamis

Edit: If you were having high pressure issues at those settings, I'd guess it was the machine "chasing leaks". It occurs and is sometimes called a "runaway"...only happens with auto machines and happened to me when I was using an auto machine. I'd wake up with my cheeks pooched out and my mask leaking like crazy.

[mattleffler]

I should be more clear about what i said earlier. I had tried an Autopap machine a few years ago during the sleep study with a setting of 5-16 and during sleep it would go to the upper limit or near and this would wake me up with the feeling i was drowning from too much air i couldn't inhale and i just didn't take the machine home back then.
Now the setting is 4-7 and don't have this problem anymore,but this former experience will prevent me from increasing pressure in big steps.

[jamiswolf]

Matt,
So you had a sleep study two years ago but didn't follow through with therapy. And now two years later you're on a machine set at 4 to 7cm? Just trying to get a clear picture.

The runaway issue I mentioned can occur at any setting...it is not related to what your machine is set at.

Hardly anybody can handle a setting of 4cm. Just too low and barely enough air movement to blow out CO2. I'd suggest 6cm as a minimum. And maybe 10cm as your top number. It sounds to me like you aren't getting good therapy and my guess is pressures are too low. Is the 4-7cm pressures what your sleep study titration dictated? Do you have software to look at your data?

Sounds like you may need to try out a few different masks. It took me 6 or 7 masks before I settled in on one. And I still change every now and then to give my face a break. Not everyone does that...but I know i'm not the only one.
Jamis

[Lizistired]

... Right now i keep waking up every 30-45 minutes feeling i have to get up and remove the mask and reset .Something i was getting before the mask.After 4-5 nights like this ,with sometimes the AHI going as high as 40 and sleeping with and without the apap i begin to feel both tired and nervous of what i should do next.

Matt, I don't see anything that indicates a need to increase your pressure.
Leaks affect your therapy the same at 7cmH2o as someone else's at 15cmH2o. If your prescribed pressure is leaking and isn't keeping your airway open, it doesn't matter what pressure that is.
The 4cm may be waking you up because it is low. Also, many of us are more sensitive to pressure changes and do better on straight cpap.
It's hard to say without looking at your data in ResScan but some of the apneas you are seeing might be unknowns that happen when you take the mask off with the machine running. Also you'll begin to notice that you don't breathe or block your airway when the machine makes you anxious or nervous, or when you are restless.
The links to the software and tutorial are in my signature below.

I wouldn't raise your pressure. I would try straight cpap at 6 or 7, since 6 was your prescribed pressure. You could use the ramp from 5cm for 20 minutes but I doubt you will need it. Also, check the EPR setting on your machine. DMEs often set it at 3, and like the ramp, you probably don't need it. I would turn it off, and if you feel like you need it, start at 1 and go up from there if necessary. The red graph in my avatar is my AHI in ResScan. Where it drops off is when I turned ff the EPR.

[mattleffler]

Jamis,
Correct,i didn't go through with therapy back then thinking i cannot use the machine at all.A couple of months ago the settings were much different,i told the doctor of the past problem and although i don't know how the machine was set,the graph of the study shows it went from 4 to 6 and eliminated apneas,so i'm using a 4 to 7 now.I don't have the software of the study,just the complete printout of the results.
The problem is the sleep study is only about one night-another night may be a different story and may need different settings due to being more/less tired,anxious or sleepy.

I understand the runaway problem,i now have no leaks from the mask and the "mask fitting" icon on my machine always shows a green happy face.

Giving my face a break is also how i see it-the mask doesn't create a problem at all but every night from the second week on the moment i first put the mask on i understand the skin right at the meeting points with the mask needs a break.

Lizistired,
Indeed,when i wake up i feel i need "more air right now" and it's also true when i feel anxious or nervous i tend to block the airway (this happened during first testing the autopap 2 years ago)

I hadn't thought of having a steady pressure,it seems this is the smallest first step i can make without really changing everything around.
You are correct about the other settings too-i didn't need the ramp and haven't used it at all ,but the EPR is set at 3.And though it feels better at 3 when awake,this isn't worth much during sleep.I will turn it off (and hope to have your result ! ).

Right now i think i'll change the settings to straight pap 7,without EPR and go from there.Then if not successful,i will try to slowly increase pressure.
How many nights should i give each change a good chance to work ? I know if it works i will know from the very first one ,but how about it if doesn't ?

Thank you very much for the precious advice ,i feel i now have a map to follow,rather than walking alone in an uncharted land !

[Lizistired]

Try it tonight and post how it goes. I would stick with that for a week if you can. Get the comfort features right first. ie. ramp, epr and humidity before you start messing with the pressure. If you need to take it off and "reset", don't worry about it. On cpap, when you turn the machine back on, you will be at 7cm and not suffocating at 4. Good luck tonight.

[mattleffler]

Thank you !

[Lizistired]

ok, so what did you learn last night

[mattleffler]

I changed the pressure to a steady 7 and turned the EPR off and after about a week i slept really well again !!!
The one thing i didn't expect was that i had more mask leaks,and an unhappy redish smiley next to the leaks report which i could decrease by tightening the mask a bit.This time i'll be prepared for that by tightening it from the start (or leaving it as is after the adjustments).I understood there were leaks but not to the point i'd see an unhappy face on my screen...perhaps the machine compensated for them and i got the pressure i needed,because subjectively i felt great despite the numbers.

SO,overall, a huge step to better sleep ! No awakenings,no need for more air,no too much air drowning me-i woke up rested and ready to go.AHI 5.6 .

I'm a side sleeper and mouth breather and the rather large full face mask tends to leak when it touches the pillow.Minimizing leaks would make things perfect right now.When trying the different (resmed) masks i was told the mirage quattro had a better track record than my quattro fx in terms of less leaks ,perhaps if this persists i could buy that mask as well .

Lizistired ,your advice was spot on and thank you for that !

[cindjo717]

Mat I think I mentioned this once before but... with the Quatro FX that top strap has to be in a certain spot or else it will leak like crazy.. the spot is the back of your head about 1/4 from the top.. if you look at the mask instructions it shows that.. I did not realize that I had the top strap in the wrong position for a long time and could not get a handle on the leaks until I realized that was my problem. Now this mask is really performing very well.. good luck.

[mattleffler]

Thanks !
I guess i'll have to check myself in the mirror and see how i usually have it and then make the adjustment as per your suggestion.True,small changes can change things in a huge way...

[Lizistired]

That's great. Glad you had a good night. Work on the leaks and if you want to download the software you will be able to see the leaks and zero in on your therapy. The big thing is how you are sleeping.