Loosing sleep please help

[deviusroach]

Hello,

I am new to the CPAP world so I will try my best to explain my scenario.

I recently received a CPAP machine from the VA, specifically the PR System One REMstar Plus CPAP with C-Flex model. My sleep study told me I have an AHI 15, so high mild, low moderate sleep apnea. The person that did my settings set them as starting at 4cm going up to 18cm on auto setting.

I adjusted to the mask pretty quickly and found it to be comfortable, the setting of 4cm did not bother me too much, anyways I have been waking up about an hour after I fall asleep and it feels like I have a leaf blower blowing air down my nose. It is to the point that I feel like I can't breathe and take the mask off. Then I try and restart the ramp process but I am so awake from being woken up that way I cannot go back to sleep. (I also have PTSD so it doesn't help).

I was reading online a few other people have their settings around 8cm - 12cm for the same AHI and havent seen anyone over 15, if I have mild sleep apnea why would they set the machine to go up to 18?

I attempted to contact the VA however I always get sent to a answering machine and I have never received a call back. My next appointment is still a few months away, but after a few days I do not think I can last that long without throwing out that machine.

Please help!

[Pugsy]

if I have mild sleep apnea why would they set the machine to go up to 18?

The pressure needed to hold the airway open and prevent the collapse of the airway tissues is NOT related to the number of apnea events a person might have or the severity of the sleep apnea diagnosis.

The pressure needed to keep the airway open is simply whatever pressure that works and gets the job done.

Someone could have AHI of 100 from the diagnostic sleep study and only need 5 or 6 cm pressure to get the job done and another person might have AHI of 8 which would be very mild...and need pressures over 20 to keep the airway open.

The person that did my settings set them as starting at 4cm going up to 18cm on auto setting.

Did you mean using the ramp to get from 4 to 18 cm?
The PR System One Plus CPAP machine doesn't do auto adjustment...but it will do ramp adjustment from 4 to 18 over whatever period of time the ramp is set for.

To confirm exactly which machine you have...look on the bottom of the blower unit for a 3 digit model number. Might have DS or REF in front of the 3 digits.
The PR System One Plus CPap with CFlex is going to be either model 250 or 260.

[Pugsy]

BTW if you do need 18 cm pressure all the time....there's a real good chance that you would be able to sleep a whole lot easier and better with a bilevel pressure machine.
One pressure for inhale and one for exhale and the comfort level is huge and much less likely to wake you up feeling stressed out.

Not to mention the bilevel machines offer full data and if you do have a 250 or 260 model machine ...no useful data available so we have no way to try to figure out what might be going when you are waking up in the middle of the night and not being able to go back to sleep.

[deviusroach]

Yes it uses the ramp to go up to 18

[deviusroach]

Thanks for the info Pugsy, I guess I will keep trying to deal with it. Hopefully I can get used to not waking up when it kicks into high gear. I believe my next appointment is so they can tell me what my optimal settings would be to keep my airway open.

[Pugsy]

I believe my next appointment is so they can tell me what my optimal settings would be to keep my airway open.

If you have the model 250/260....there is zero way to evaluate your therapy to find out if 18 cm is doing a good job or not or if leaks are impacting therapy.
That's why I mention model number and its importance.
Normally the VA used to dispense full data models so this is sort of new if they didn't with you.

If it were me...and they were wanting me to use 18 cm...I would be pitching a big fit requesting the bilevel model.
The adjustment is SOOOOOOO much easier.

[Janknitz]

If you do have a machine with a model number that begins with a 2, they are not going to be able to tell you what the "optimal settings" are from looking at the data from the card on your machine, because all that your machine records is hours of use. No other useful data!

At such a high pressure it seems it would be particularly important to have EFFICACY data to see how you are doing and particularly LEAK data as a mask that starts out not leaking at 4 cm is going to leak at 18 cm unless you get really good at fitting it at 18 cm. I'll wager THAT's part of the problem.

What were they thinking giving someone with your settings a dataless brick? "Thank you for your service, now we don't care if your treatment is effective or not????"

[deviusroach]

If it were me...and they were wanting me to use 18 cm...I would be pitching a big fit requesting the bilevel model.
The adjustment is SOOOOOOO much easier.

Thank you very much for the info, it is greatly appreciated! I think I am going to talk to them about the bilevel model, I was hoping with a CPAP I would wake up feeling more refreshed and energized, but right now it is a nightmare.

[deviusroach]

At such a high pressure it seems it would be particularly important to have EFFICACY data to see how you are doing and particularly LEAK data as a mask that starts out not leaking at 4 cm is going to leak at 18 cm unless you get really good at fitting it at 18 cm. I'll wager THAT's part of the problem.

What were they thinking giving someone with your settings a dataless brick? "Thank you for your service, now we don't care if your treatment is effective or not????"

The connection from the hose to the nasal pillows does leak air, it feels as if it is a little loose and you can feel the air leaking out through there. Not sure if this is the way it is supposed to work or not?

I also noticed last night there was condensation in the nasal pillows, they appeared "foggy" and had droplets of water.

[Pugsy]

The connection from the hose to the nasal pillows does leak air, it feels as if it is a little loose and you can feel the air leaking out through there. Not sure if this is the way it is supposed to work or not?

I also noticed last night there was condensation in the nasal pillows, they appeared "foggy" and had droplets of water.

Some leaking is normal venting....do you feel air escaping down by where the hose attaches to the nasal pillow?
Look closely down there and you should see a little bunch of weblike holes...those are for normal venting.
I just received this new P10 mask a few minutes ago. I suspect what you are feeling is normal venting.

Water in the nasal pillows? We call it rain out and there are things that can be done to reduce, limit or eliminate it.
Tell me the model number on your machine....it will help me explain your options for reducing rain out at the mask level.
Different models have different humidifier options so it helps if I know exactly what you have so I can explain your options in specifics.

[deviusroach]

I also noticed last night there was condensation in the nasal pillows, they appeared "foggy" and had droplets of water.

I just saw Pugsy's tips and read about this. Sorry for the redundancy.

[deviusroach]

Some leaking is normal venting....do you feel air escaping down by where the hose attaches to the nasal pillow?
Look closely down there and you should see a little bunch of weblike holes...those are for normal venting.
I just received this new P10 mask a few minutes ago. I suspect what you are feeling is normal venting.

Water in the nasal pillows? We call it rain out and there are things that can be done to reduce, limit or eliminate it.
Tell me the model number on your machine....it will help me explain your options for reducing rain out at the mask level.
Different models have different humidifier options so it helps if I know exactly what you have so I can explain your options in specifics.

I do feel air leaking where the hose attaches to the nasal pillows, hopefully it is normal leaking.

When I get home I will look up the model number and let you know.

Thanks again for the help!

[bavinck]

As far as the Swift FX pillows go, I am finding the barrel covers by padacheek to be extremely effective in eliminating condensation in the pillows caused by my breath. I have a heating hose and that does not get rain out, but if I do not use the barrel cozy then I will get some in the pillows themselves due to my warn air exhaled.