Anxiety to the Max

[2 B Sleeping Soundly]

SleepyToo2 wrote: Does this mean what I think it means - that you start off on a pressure of 4.0, and take 20 minutes to ramp up to your pressure of 17.5/15.0? No wonder you get anxious! That pressure of 4.0 to start is some ridiculous person thinking that we only need 4.0 cm to breathe normally. Absolute hogwash, BS, or whatever term they use in your neighborhood to describe utter and complete nonsense. There are MANY people, myself included, who cannot tolerate a pressure that low.

truckee147,

I think SleepyToo2 might be on to something that could be making your adjustment to PAP therapy that much harder. IMO, the ramp feature has nothing to do with helping the machine in its treatment of OSA, but everything to do with patient comfort. I believe my machine was set with the ramp only 2 cmH2O less than my lower titrated pressure range (11 cmH2O - 17 cmH2O, so ramp was set to 9 cmH2O for 20 minutes). I do not use the ramp feature any longer as I found that I was having apnea events 45 minutes or so after going asleep and the machine was still pretty far away from getting to them because of the lower pressure start of the ramp. If it were me I would learn what I could from the seasoned hose heads here and think about changing or eliminating the ramp feature...

Good luck to you! You can and will get to the other side of your difficulties with PAP therapy, just like many of us have who are regulars here. We have all been in your shoes and would gladly take the tough, unpleasant, learning curve/experience away from you if we could, but you will have to walk that journey. Do know though, we will be here every step of the way, helping and cheering you on, just as it was done for us, and even for those before us.

John

[Pugsy]

On a Phillips respironics system one.

Quarto FX resumed mask

Ramp 20 on 4.0

Pressure 17.5/15.0

There are several models of PR System One machines. 2 pressures shown indicate BiPap..is that correct? Is there any other model information shown on the machine that you see? BiPap Plus? BiPap Pro? BiPap Auto...there is also an identifying model number on the bottom of the machine like DS 650 or 750???
In the equipment list for your profile equipment...look for the grouping for PR System One.....and that is where you will find your choices.

Ditto on the 4 cm ramp thing if that is what you are doing. While technically we won't suffocate with that pressure it can certainly seem like not enough air is moving and if that is contributing to your anxiety you don't have to use that low of a number or even ramp at all.

[HoseCrusher]

I may be in the minority here, but I love creature comforts.

I use the ramp feature and feel that it provides additional comfort when drifting into sleep.

However, you need to use it properly, and setting it to start at the lowest pressure setting and run for a long time is not the correct way to use it. To borrow a line from a famous movie "You'll shoot your eye out." Actually in this case you will add to your anxiety level and set the stage for a "less than wonderful" nights sleep.

You can review your data and if your pressure adjusts automatically you can get an idea of where you are most of the time. This is reported as a median value. There is a difference between median and average. If your data reports average that's fine, but many report the median value and I twist that to suit my purpose.

Actually it looks like you are on set pressures, so this makes the adjustment of the ramp easier.

With APAP use setting the ramp to start at 1 cm H2O below the median value averaged over a couple of weeks of data works very well and provides that little extra comfort when falling asleep. You don't want the ramp to go all night. Only 5 - 10 minutes are needed to adjust. The higher the pressure the greater the ramp offset pressure is needed to provide comfort. The key is to play with this to find the sweet spot. If your pressure was 8, starting at 7 may provide all the comfort you need. But if your pressure was 20 you may find that starting at 15 may be better. 5 minutes is usually enough adjustment time, but if you are looking at a large difference in pressure you may find that extending the time to 10 minutes provides more comfort.

With a set pressure you can set the ramp to start at a slightly lower pressure than you are using. You mentioned a pressure of 17.5/15.0. I look at this as CPAP set to 17.5 with EPR of 2. In this case try setting your ramp minimum at 10 or 12 and a time of 5 - 10 minutes. If you set it at 12 to run for 10 minutes it will start off at 12, which is much more comfortable than 17.5, and much more helpful than 4.0, and work its way up to your 17.5 over 10 minutes. This gives you a chance to gently enter into slumber while still offering support to keep your airway open.

When properly used the ramp is like flannel sheets in the winter... very comfortable.

[truckee147]

Thanks to all for the input. Last night had two good sleeps one for two hrs and one for three hours. I just flat out am not comfortable having the mask on my face. Hard to get to sleep. This morning I could feel the difference from the night before were I had no cpap sleep. Great energy the whole day compared to before the cpap.

I do not see a announcement section. Can you point the way.

I had dry mouth fairly badly. Am I supposed to breath through my nose only? I have a deviated septum so that is tough.

I found last night sleeping more upright in a lounge chair helped me adapt tonit. Is that bad? Thanks again.

[BostonGal]

My own personal experience is that the RAMP is a TORTURE device. My ramp was set at 4 for I think 30 minutes. When the RT was going over the machine she showed me it and how i can shut it off if I want. I went to bed that night and after 1 minute of breathing like I just finished a marathon, I shut off the Ramp. Of course it might be useful if you have to ramp to a high pressure, but not if you just have to get to 10 or so. I also had my minimum pressure changed from 6 to 7 because I found the original min of 6 to be to low. I think that can cause anxiety because it's hard to breathe...even with air blowing straight up your nose! Try one night without the ramp. if it's still hard to breathe have the doctor write a prescription to change the min pressure.

[HoseCrusher]

I can see your point. Starting at 4 and taking 30 minutes to get up to 6 would be torture.

My ramp is set to start at 9 and only goes for 10 minutes.

If you want to try your ramp again, set it for 6 and limit the duration for 5 minutes.

[big_dave]

It took a month before I could consistently sleep 6-8 hours on CPAP. Don't give up. The first few weeks are the hardest.

[SleepyToo2]

Thanks to all for the input. Last night had two good sleeps one for two hrs and one for three hours. I just flat out am not comfortable having the mask on my face. Hard to get to sleep. This morning I could feel the difference from the night before were I had no cpap sleep. Great energy the whole day compared to before the cpap.

I do not see a announcement section. Can you point the way.

I had dry mouth fairly badly. Am I supposed to breath through my nose only? I have a deviated septum so that is tough.

I found last night sleeping more upright in a lounge chair helped me adapt tonit. Is that bad? Thanks again.

Sounds like we are making some progress, but more work needed. If you are not comfortable having the mask on your face, why might that be? Claustrophobia? Again, the pressure might be too low at the start. Pain from the mask being too tight? Loosen the straps - masks should be almost too loose, but not quite falling off. There is a seal around them that needs to fill with air to do its job - pulling those straps as tight as possible will break the seal.

Dry mouth? That means you are breathing through your mouth, letting all that wonderful air escape and not go down your throat into your lungs. You either need to get a chin strap to hold your mouth closed, or you need to get a full face mask. The full face mask might be a problem if you are claustrophobic, but take a look at some of the posts here to get some idea of what might work for you. You need to consult with your DME to have them help you.

Sleeping in a lounge chair? My elderly father had ulcers on his legs - the nurses told him he must sleep lying down flat, because the more upright position he found comfortable was not allowing the ulcers to heal properly. Sounds like there might be some issues with blood flow if you are not lying flat. Worth doing a bit of research around that.

Post back with any questions.

[BostonGal]

I'm actually good now with the starting pressure of 7. I tend to stay between 8-12 during the night. But I'm glad you said that it took you a month to sleep 6-8 hours. I'm 3 weeks into this and cant sleep more than 2-3 hours at a time. I'm using pillows and my leak rate is low so I can't complain about the mask. I like the pillows. I used to easily sleep thru the night even with severe OSA and I really miss that. I have been tempted to chuck the machine for a night just so I can sleep through the nite...but i know I have to give it time and be patient. I'm hoping one day everything will click and I'll feel the benefits...and be able to sleep thru the nite.

[BostonGal]

I'm no expert, but would a Hybrid help? Solves the mouth breathing issue and less claustrophobic?

[junior49]

You might be able to get a prescription for some sleeping pills for a couple weeks to help out. I got a prescription but only used it once. If the anxiety is from not being used to the mask, then try putting the mask on (with machine on) while watching tv or reading. This may help you get accustomed to the mask and make it easier to fall asleep with it on.

I agree with everyone on the ramp issue. I found 45 minutes was way too long and that the starting pressure (I think I started with 6 or was way too low. Bear in mind this depends on what your treatment pressure is. Mine is 17. I found that a ramp of 15 mins starting at 13 was just about right. You just gotta mess with it and find what's right for you. Basically though, I'd start with as high as you can go while being comfortable, and as short a ramp as possible. I've seen a lot people on here say they ended up with no ramp, especially if your pressure is on the low end, below 12 or so. Good luck.

[DagoRed]

I'm no expert, but would a Hybrid help? Solves the mouth breathing issue and less claustrophobic?

My next mask is going to be one of those FnP oral masks, but not to sure how I will deal with the swallowing issue. Hmmmmm baby steps baby steps...

[2 B Sleeping Soundly]

junior49 wrote: I've seen a lot people on here say they ended up with no ramp, especially if your pressure is on the low end, below 12 or so. Good luck.

Though I started initially using ramp and exhale pressure relief (called C-Flex or A-Flex on some models of PR System One), my therapy has progressed to the point where I find I do not need to use either now. (stepping up on Soap Box ) I realize each person is different and what is helpful/successful to my PAP therapy may not be helpful/successful to yours, or vice-a-versa, but that is why, IMO, it is so important to periodically look at how your therapy is going. I am not saying to go and try to fix something that is not broken, but every now and then evaluate your numbers, your sleep architecture, and probably most important, how you feel. It may be that it is as good as it will get for you or you may find you will see room for improvement, but you can't know if you don't ever look (stepping down from it).

Sorry for the soap box moment, I tried to stop my fingers from typing it, really... .

John

[SleepyToo2]

Always rely on how you feel more than the numbers! My experience over the last couple of years is that numbers should only be used as an indicator over a period of several weeks. The only one that has been a real concern for me has been the leak, but now that I have got that under control I am seeing lower AHI numbers. I am also feeling much better (generally). Now I just need to work on making sure I get that magic 8 hours of sleep every night!