New to CPAP Therapy - some difficulty

[Jonesy35]

Hi! I just got an APAP machine 2 days ago and am using a nasal pillow mask. I am okay for the first few hours and then I wake up feeling like I can't breathe. Did anyone else have this issue at first? I feel that for some reason the exhale resistance gets to me a few hours in. My mask is also leaking water onto my face. Does this mean its not fitting properly? I am not sure how to adjust a nasal pillow mask as he fitted me for the size small. Any suggestions?

[Julie]

Hi - first thing... if your machine (+ humidifier) is on something higher than your head, put it on something lower - water won't run uphill. Second, are you using the ramp feature? And do you know what your pressure settings are? Too often doctors who aren't that knowledgable about using equipment even if they know science about apnea will prescribe the settings to be just the machine defaults (4-20) rather than specific levels, and anyone trying to breathe at 4 will have trouble! But if you feel that exhaling is the problem, your machine can be set for relief at different levels... not knowing what machine you have however, it's hard to say what steps to follow. Please register as a member, then click on User Ctl Panel under the logo, go to Profile and - using text instead of icons please - fill in the full name and model # of your machine and mask, and those will appear under all your posts from now on so we can all know what you're working with and can advise you better.

[Pugsy]

See this thread for explanation for the water in the mask thing. It's condensation or what we call rain out.
viewtopic/t94035/Pugsys-Pointers-3Deali ... -road.html
My second post there I think.
I talk about what causes it and what you can maybe do to help reduce it.

Nasal pillows...that's probably from moisture in your own exhaled breath that is condensing and lowering the machine won't help because of the way the moisture pools in the nasal pillows. With nasal pillows the only way for that pooled moisture to use gravity with machine placemen to help it would involve the water flowing uphill and with nasal pillow masks...it can't flow uphill. You would need to be face down on the bed to have gravity help you.

Please register here at the forum and add your equipment to your profile. Depending on which machine you are using you may have additional options to help reduce the rain out in the nasal pillows. Heated hose would be the best option if available.

Also...what pressure settings are you using and are you using any exhale relief at all?
Which nasal pillow mask are you using...going up a size might help with the "can't breathe" feeling?

[robysue]

Hi! I just got an APAP machine 2 days ago and am using a nasal pillow mask. I am okay for the first few hours and then I wake up feeling like I can't breathe. Did anyone else have this issue at first? I feel that for some reason the exhale resistance gets to me a few hours in.

Is the problem that you feel like you cannot exhale fully---i.e. it feels like there's too much air coming in through the mask and the problem is exhaling against the pressure?

Or is the problem that you feel like you cannot inhale fully---i.e. it feels like there's not enough air coming in through the mask and the problem is inhaling deeply when you want to?

Both problems are common place in new PAPers, and both can be fixed. But the things that typically fix one of these two problems makes the other worse. So it's important to really understand what issue you are experiencing.

My mask is also leaking water onto my face. Does this mean its not fitting properly? I am not sure how to adjust a nasal pillow mask as he fitted me for the size small. Any suggestions?

The water leaking from the mask is called rainout. The problem is humidity condensing in the mask. Rainout typically is the result of warm humid air cooling off inside the mask or tube.

If there is water in the main hose, the problem is probably due to using a heated humidifier to add moisture to the air in the tube. If you are using a heated humidifier, it could be that turning the humidifier down will help. (But your nose may object to having less humidity.) Or you can use a hose cozy to wrap and insulate the hose to keep the air in the tube from loosing all its heat. Or you can run the hose under the cover next to your body to keep it warm. Or you can make sure that the machine is lower than head level so the condensation runs down hill and back towards the machine rather than dripping onto your nose. Or, ultimately, you can switch to a heated hose, which usually ends problems with rainout in the hose.

If the rainout is confined to just the mask, the most likely cause is that the warm exhaled air (which is full of moisture) is hitting cooler air in the small confined space of the nasal pillows. And when warm, humid air hits cooler air, the result is condensation. There's not a whole lot that can be done here, but there are a few things you can try. Padacheek sells pillow cozies for many pillows style masks, and they can help. A heated main hose can help reduce the temperature difference between the exhaled air and the air coming into the mask from the tube. In my case, I find that the heated humidifier on my Series 50 System One takes about 10 minutes or so to heat up, and the rainout in my pillows is worse during those 10 minutes or so; once warmer air is coming in through the tube, the problem resolves. I try to remember to have a cloth handkerchief with me so that if the moisture is really bad, I can just tug the pillows away from my nostrils and wipe my nose. (I can do this without the need to turn the machine off and it only takes a few seconds.) So sometimes patience is a solution.

As for fitting the nasal pillows: It depends a little bit on which particular pillows mask you are using. However, the guidelines that JanKnitz has posted on her blog for the Swift FX are a useful starting place for many nasal pillow masks. Here's a link: http://maskarrayed.wordpress.com/swift- ... ing-guide/

[Jonesy35]

Thanks everyone! I will get my information during my lunch hour today and register and let you know!

[Jonesy35]

I am pretty sure I have the ResMed AirFit 10 for her.

[robysue]

I am pretty sure I have the ResMed AirFit 10 for her.

That's the mask you are using.

We also need to know what the make and model of the machine you are using.

[Jonesy35]

one more thing - I do not know the settings of my machine. I was told that it will figure out what settings I need based on my breathing and in 30 days of use my doctor will assess what settings it should be on as the data is transmitted to him. I was just told to turn it on and how to turn down the pressure. My cpap titration sleep study was denied by my insurance so now I have an auto titration machine. I wish I would have asked for a nasal mask as well. I told him I didn't want lines on my face from my mask as my ex-boyfriend always had red marks on his face after sleeping. He didn't care but I do so the therapist gave me the nasal pillow. I will definitely get my information for my machine and register. I was able to have the mask on for 6 hrs last night but then had to take it off. I was diagnosed with Mild Obstructive Sleep Apnea.

[Jonesy35]

here is my info:

Machine: REMStar Pro C-Flex+
Mask: ResMed AirFit P10 for her
Humidifier: System One Heated Humidifier

[robysue]

one more thing - I do not know the settings of my machine. I was told that it will figure out what settings I need based on my breathing and in 30 days of use my doctor will assess what settings it should be on as the data is transmitted to him.

Sounds like you probably have a PR System One Series 60 CPAP PRO with C-Flex. It has a 30-day limited APAP period. When you get home, you need to take the humidifier tank out and turn the machine over. There should be tag on the bottom of the blower unit (not the humidifier unit) that has the model number. The three digits in the middle of the model number are what we need.

I was just told to turn it on and how to turn down the pressure.

Pardon my language. But that's really crappy patient education. And the only thing that's ever been shown to make a real difference in getting and keeping patients prescribed PAP therapy adherent/compliant with therapy is quality patient education. It's a real bummer than no-one has told you anything useful about what your condition is, how PAP can fix it, how your particular machine works (and about the data it gathers), and what to do if (when) you run into some standard newbie problems.

My cpap titration sleep study was denied by my insurance so now I have an auto titration machine.

You may have an APAP, but my guess is that what you really have is a CPAP with a 30-limited run as an APAP. We need the model number on the bottom of your machine to figure out whether it's really and APAP or a CPAP with limited APAP capabilities.

I wish I would have asked for a nasal mask as well.

Contact the DME and ask about their mask exchange policy for new PAPers. They should allow you to swap out the mask if you want. They may be willing to let you try on a nasal mask (or two) to figure out whether you'd prefer the nasal mask over the pillows mask that you currently have.

[Pugsy]

Once you figure out exactly which model machine you can go here and request the provider/clinical manual for your machine and that manual will tell you all the ins and outs of getting to the clinical setup menu to see what your pressures are along with a lot of other information.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

Sounds like you have an auto adjusting machine of some sort and most likely SleepyHead will work with it as long as it uses a SD card. Check out my signature line for links explaining Sleepyhead software and your options.

Won't hurt a thing for you to look at and see what the DME and doctor can see.
If you have a modem on the machine it might be covering the SD slot...more on that if needed once we figure out which brand and model machine you are using.

Edit:Machine: REMStar Pro C-Flex+
Turn the machine over (remove water tank if water is in it) and look for a 3 digit model number...that Remstar Pro CFlex doesn't tell us much as that covers probably 3 or 4 different incarnations of that model name.

Sounds like you probably have the PR System One 60 Series Pro with CFlex (all the Pros have CFlex now) model number 460 as it is the only model that offers any auto adjusting pressures (APAP mode) since it offers 30 days of APAP mode (I can tell you how to get more 30 days later if you want it)

If that is what you have ..the 460 model which might have DS or REF in front of the 3 digits. Then this is the correct terminology for your equipment.
Machine would be
PR System One 60 Series Pro CPAP and they all have CFlex so if cpap.com's menu choice doesn't mention it..it doesn't matter
and the humidifier would be
PR System One 60 Series Heated tube humidifier with heated tube.
Now the heated hose is optional so you may not have it but that is still the correct choice terminology for your humidifier. If unsure as to whether you have a heated hose or not...the heated hose has a black coupling on the end that attaches to the humidifier. If your hose is white/gray on both ends you don't have a heated hose. More on that later if you don't have one and want more information on it.

[Jonesy35]

Looks like have REF 460P

[Jonesy35]

The therapist also told me not to try to fix it or change settings. Now I am kinda irritated and feel like I know nothing.

[Pugsy]

You may not need to or even want to fix or change things but that doesn't stop you from learning and looking does it?
Just because you learn how to do something doesn't mean you have to go out and do it.

Though in most situations there are a couple of things that are considered within the patient's realm to adjust and those are humidity levels and exhale relief settings ...though I have heard of DMEs telling people not to mess with those and that's just plain idiotic since those are patient comfort settings and non one knows what one person's comfort needs are going to be.

DMEs and docs seem to like to keep us in the dark like this stuff is next to the national secret or something. It's just air..
Now some patient's don't care and don't want to learn and just want to use the damn thing and be done with it.
I have always thought that the better a patient was educated about any medical condition and whatever treatment was being offered...the better the chance for success.
This cpap stuff isn't as simple as taking a little pill and forgetting about it. Comfort plays a big factor in things...if we aren't comfortable we can't sleep and if we can't sleep then the machine doesn't stand much chance of helping.
It's hard enough to get good sleep anyway...let's make this cpap process go as easy as we can if we can and education I think hurts nothing and has the potential for helping tremendously.

[GinnyBear]

Most all therapists will tell you not to adjust or change the settings - seems they want to control the therapy a patient receives. Feel free to take the advise from others to do so and try tweaking your settings - only you know what will work best for you.

Install the SleepyHead software as Pugsy referred to you and monitor the progress of your therapy daily. People on here will help you understand and interpret the graphs and data if you need help or have questions about that.

There is a wealth of information and guidance from people who know what they are talking about in this forum..having been there themselves and all.