1st night with Apap - HELP!

[Cinders]

I have the apap machine and nasal pillows. Used 1st time last night using the ramp as I was told. Since it is automatic, it can go from 9-12 as needed. Once it got to 9(after45 minutes) I found nyself breathing hard and fast and still awake. Then it ramped to 10. Finally fell asleep at midnight
Slept for 3hours and woke up with nasal pillows askew and breathing through my mouth. Woke up with bloody nose
and very tired. Prior to this I have been sleeping great 8 - 9 hours. Please tell me it gets better! With the force of air does everyone breathe faster than normal? Do you eventually get used to it?

[Pugsy]

Please add your equipment to your profile like I have mine added.

I am unsure what you mean by "goes from 9 to 12 automatically"...is this the ramp that you are using because normally the pressure wouldn't increase in response to apnea events from the minimum of 9 until you are asleep.
Now the ramp could be set to start at 9 and go to 12 in 45 minutes.
So can you clarify what you are using and the settings?

How to add your equipment to your profile is explained here. Please use text as the icon images are tiny and difficult to see model.
wiki/index.php/Registering_Equipment_in_User_Profile

Bloody nose....are you using the humidifier and if so at what setting?
Did the mask rub your nose raw or is blood coming from up inside the nose...which would indicate not enough added moisture.

Once we know for sure what machine you are using we can explain any of the exhale relief functions which may be a factor in your sensing that the machine is wanting you to breathe faster than you want.

[Cinders]

I added my equipment to my profile. I start out at 4 and ramp up to 9. After that if I need more it can ramp up to 12.
It takes 45 minutes to ramp from 4 to 9 allowing me time to fall asleep. Of course, I could not sleep and was concentrating on my breathing. It then ramped up to 10 and I found it very hard to exhale. I had the humidifier set on 3.
Bloody nose was from inside due to dryness. Even though humidifier was on and used some water, I could not sense any humidity in the air.

I'm not sure my equpment is going to show I have a Respironics System One, Auto cpap A flex
Swift FX for Her Nasal pillows, System One heated humidifier by Philips Respironics

They are monitoring me and can look on their computer to see if I am using it.

[robysue]

Cinders,

Your signature is now showing that you are using a System One (Series 50) Auto CPAP. Those machines have a cream colored panel around the LCD and cannot be used with the PR heated hose. Does that sound right?

At any rate you write:

I have the apap machine and nasal pillows. Used 1st time last night using the ramp as I was told. Since it is automatic, it can go from 9-12 as needed. Once it got to 9(after45 minutes) I found nyself breathing hard and fast and still awake. Then it ramped to 10. Finally fell asleep at midnight

Do you know what the starting ramp pressure is? If you don't know that, you can figure it out by putting the mask on and turning the machine on. The current pressure setting should show up on the LCD and this should change as the pressure slowly ramps up.

It is not uncommon for people to feel like they're not breathing normally right at the start of PAPing. Having a mask on your nose when you're trying to fall asleep automatically makes you focus your attention on your breathing and the very fact that you're focusing on your breathing alters the breathing patterns. And sometimes with all that air blowing at you, it does feel (at the start) like you've got to breath harder or faster than normal. Eventually you will get used to it and start to breathe normally. In the meantime, if you can try to consciously relax and slow down the breathing and also try to not breath quite so deeply, you might be more comfortable: Normal sleep breathing is both shallower and much more regular than normal wake breathing is.

Another thing that can unintentionally cause a new PAPer to feel as though they are breathing too hard or too fast is a mismatch between their personal breathing style and the exhalation relief system and setting used by their machine. The System One machine uses something called A-Flex when you are using it in Auto mode. A-Flex provides a small reduction in pressure at the beginning of each exhalation, and the pressure is increased back up to the therapeutic level in a two step process---it is increased part way back up during the second half of the exhalation and it is increased the rest of the way back up when the machine detects the beginning of the next inhalation. For many people, A-Flex is a godsend----it makes it much easier and more natural to exhale against the pressure. But for a few people, A-Flex can feel like the machine is trying to force them to inhale before they are done exhaline. Some times the fix is as easy as adjusting the A-Flex setting.

So it's also worth figuring out whether A-Flex has been turned on and what it is set to. Here's how you can do that. Look at the LCD. What does the box in the upper right hand corner of the LCD read when you just twist the big round knob when the machine is OFF? If it says Flex or A-Flex then A-Flex is ON. If you select that box and click the big knob and look at what it says, it should tell you what the Flex setting is. There's also a "test" mode available so that you can try each Flex level out with your mask on at your minimum pressure (9cm) to figure out which one you like.

Slept for 3hours and woke up with nasal pillows askew and breathing through my mouth. Woke up with bloody nose
and very tired. Prior to this I have been sleeping great 8 - 9 hours. Please tell me it gets better! With the force of air does everyone breathe faster than normal? Do you eventually get used to it?

Yes, it will get better---with time. But to be honest, it may take you several weeks to a few months of working out the kinks and learning how to sleep with the machine before it starts to get better.

And yes, with time you do get used to the force of the air.

And yes, at the beginning the force of the air does make a lot of people feel as though they're breathing faster than normal.

Finally, have you got a user's manual for your machine? And have you got the clinical manual?

[Pugsy]

Let's figure out exactly which machine model you are using. Your humidifier choice in your profile is not compatible with the PR System One machines. It's important to know which model you are using so that we know what options are available..
Remove the water tank from your humidifier and look on the bottom of the blower unit for a 3 digit number...may be preceded by DS or REF.

It will likely be a 550 number or a 560 number.

The link you have chosen now is for the 550 machine and the correct humidifier choice for that machine is PR System One Heated Humidifier. Just disregard the word Remstar. It's used on all models and doesn't really tell us much.

If you see a 560 number on the bottom of the blower unit then you have a 60 series machine and the correct machine to choose in the equipment menu would be
PR System One 60 Series Auto CPap...
and the humidifier to choose would be
PR System One 60 Series heated tube humidifier with heated tube.
Note the heated tube (hose) is optional and you may not have the heated hose but that is the only humidifier in the equipment selection menu that works with the 560 machine.

If you do have a 560 machine ....look at the hose where it attaches to the humidifier. Is the end attaching to the humidifier black or white/gray? If it is black then you have the heated hose option already.

It's important to know whether you have a 550 or 560 machine because of the different humidifier options available on either model.

So which model and what humidifier setting was used last night?

[Cinders]

Thank you! I corrected my equipment. It was a 560 and a white hose for my humidifier.
I also found my A-Flex and set it to a 3. I guess I should turn on my mask off alert?
I am so tired so I think I should sleep through anything tonight! Thanks for all your help.
Cindy

[Pugsy]

Play with the Flex exhale relief settings to see which one actually feels better and suits your breathing rhythm the best.
The amount of reduction isn't as dramatic as some people think because it is based on your own breathing force (air flow) and it sometimes it isn't the amount of reduction that is important but instead the timing of the reduction.
So don't worry about the setting number...just use which ever setting feels the best to you.

Since your hose doesn't have the black end then it is a non heated regular hose and the humidification system by default is the new humidification system which uses sensors in the machine to evaluate ambient room humidity. This mode of operation typically uses less water than the other option which is Classic mode which will use more water.
So if you are using a lower setting...increase it in an effort to add more moisture to your nasal mucosa. The highest setting is 5 and for some people that isn't even enough moisture.

There is a heated hose option for the 560 machine...3 things are needed to use the heated hose.
A new hose, a new power supply and a new lid on the humidifier.
The heated hose allows for greater customization of humidity delivered as well as temperature of the air itself coming to your nose.
Both the humidity and temperature controls are independent of each other. Comes in handy. Just wanted to alert you to the existence of this feature. You may wish you had it later if the need comes up.

The mask alert alarm...is pretty lame. It's a not so loud beeping. I slept through it often myself but maybe it will be enough to wake you up if you take off the mask and don't know it.

[Cinders]

Slept 7 hours last night with apap!! It helped to change my A flex setting - so much easier to exhale. Also
set humidifier to highest setting - so much better! However, info stated I had 6.9 AHI. Is that per hour or
for the whole night?
I am so glad to have found this forum and that people suggested things that really helped me. Thanks!!

[Foggy1]

The AHI would be per night.

So glad you had a good night of sleep! Just remember that it takes a while to get used to it. Once you have your machine properly set up, and the right mask for you, those good nights will become the norm. Expect to have some ups and downs for a while. That is normal.

I have found that the routine of getting my gear set up at night is helping me to sleep better. I've often heard that we should have a consistent sleep schedule (same time to bed, same time to wake) and a pre-bedtime routine. CPAP helped me to formulate such a routine. Through CPAP, my sleep has improved dramatically. Thus life has improved dramatically!

I'm glad to have found this forum as well. Can't express how much it has helped me. I try to contribute a bit now to pay back. We are glad to have you here and look forward to hearing from you during this journey.

[Pugsy]

I had 6.9 AHI. Is that per hour or
for the whole night?

AHI is Apnea Hyponea Index which is a PER HOUR average...not a total per night.
7 hours time 6.9 events equals roughly 49 events per the entire night.

The AHI would be per night.

Incorrect....indexes are hourly averages and not total number over the entire night.

wiki/index.php/Category:CPAP_Definitions