Just not working

[Sclark08]

I requested and got a new resmed s9 vpap auto machine. You might say my card is open on both ends Dr says the machine will sense what I need and help me breathe. It's not happening. My mouth is dry all night. I have the copper thermal hose setting is on 80 degrees
I am going to call dme tomorrow to try to get settings changed. I think I did better with PR resmed system I had. Will they let me go back to itI feel like mYbe they are getting sick of me

[Julie]

We can help you change your settings - you don't have to go back to them for that (it's your machine, your body, your therapy, and we've all done our own for years).

Give things a chance before going back to an older machine... nothing can come of that, but if you give us a chance here, we can help.

You also need to try e.g. Pad-a-Cheek liners to help with your mask leaks, or else get a different mask. Did you try my fiddle with the forehead piece?

[kona0197]

I know it's hard. It was for me in the beginning as well. But I keep trying and now using my CPAP machine is just second nature. Give it time, and practice using the machine while you are awake. That's what I did. You will get it, no worries!!

[Sclark08]

Thank you all for your help. I know how to change my settings. I think I will try today to go to10 and 17 and see what happens. Iam already going today to buy pad a cheek. I'll let you know tomorrow how my night went tonight's. Thanks again

[robysue]

Thank you all for your help. I know how to change my settings. I think I will try today to go to10 and 17 and see what happens.

When you say that you are going from "10 to 17", exactly what are you changing?

Are you using straight VPAP or auto VPAP?
What's your (min) EPAP set to?
What's your (max) IPAP set to?
If running in VPAP Auto, what is your PS set to?

It is usually best only make small changes and to only change one thing at a time.

[Sclark08]

Changing ipap from 8 to 10 cause I feel like I struggle at the beginning and changing epap from 22 to 17 cause mask keeps popping off!

[Sclark08]

Ps set to 4

[robysue]

Changing ipap from 8 to 10 cause I feel like I struggle at the beginning and changing epap from 22 to 17 cause mask keeps popping off!

and

Ps set to 4

First, you've got the IPAP and EPAP settings backwards: IPAP is always the bigger of the two numbers.

So "Old settings" are max IPAP = 22, min EPAP = 8, and PS = 4.

Proposed new settings are max IPAP = 17, min EPAP = 10, and PS = 4.

Personally I think that's a HUGE jump in the pressure settings and such a large jump may be very difficult to adjust to in the short run. When you are planning on such a large change in the therapeutic pressure settings, it's critically important to know what specific problem(s) you are trying to solve and how the proposed pressure change addresses the problem to be solved. And when there are MULTIPLE problems that you want to solve by dial winging, it's a good idea to only make ONE change at a time so that it's clear what each change does in terms of both comfort and efficacy of PAP therapy.

Trying to tease some things apart:

When you say you struggle at the beginning of the night, are you feeling like there's not enough air coming into the mask? Or are you struggling to fully exhale against the pressure? The two sensations are very different, and the fixes for them require adjusting the EPAP in different directions. And even if an increase in EPAP is warranted, a 2cm jump in min EPAP is a pretty drastic change. I'd suggest going slower.

Why are you planning on decreasing the max IPAP by a whopping 5 cm???? I understand that at high pressures the mask is popping off. But a smaller decrease in max IPAP might fix the mask popping off problem. Moreover, if you are regularly hitting pressures of 18/14 and higher, dropping the max IPAP to 17 may very well leave you with ineffective therapy. Have you looked at the data recorded by your machine? How often are your pressures above 18/4? What are your median pressure levels? Are there clusters of events that are occurring when your pressures are at 17/13 that lead to pressure increases?

[Pugsy]

I see you mention COPD in your comments section.
Just how severe is the COPD?
Are you on supplemental O2 either during the day or at night?
You may have mentioned this in another thread but if you did I have forgotten.

[Sclark08]

I have no events occurring because I don't think I sleep enough hours to record events. Last night 3 hours ahi 0.3 at old settings

Yes I had numbers reversed. I do have copd and have a terrible time exhaling. When you have copd Drs try to open up the whole range of pressures and they tell you the machine will figure it out! This is the 2nd Dr that told me that . That is why I play around with my settings. After a couple weeks I find a comfortable setting for myself. The Vpap just seems the respond a little differently that bipap although I guess they are the same

My ahi is very good <5 most nights I am just looking for more comfortable settings.

[Pugsy]

If you have trouble exhaling....try playing with the PS just a little. See if that helps. Like PS of 5 instead of 4. With bilevel machines it is the difference between inhale and exhale that often affords the exhale relief comfort.
PS of 4 is easier than PS of 2 or 3...PS of 5 might be more comfortable for you. No need to alter EPAP or IPAP max from what you are wanting to try.

[Sclark08]

I'll try 5 Thanks a lot

[Sclark08]

Slept pretty well. 5.5 hrs ahi 4

Chest doesn't feel like I struggled . Think Ill take ipap from 17 to 17.5 tonight. 10 worked fine for epap. Guess I'm figuring it out with the help of folks on this site. Thanks all