Advice for new CPAP patient?

Hi all,

I'm glad I've found this message board as I am hoping somebody can offer some sage like advice.

After the obligatory primary Dr. visits and sleep study stays, I finally got my CPAP machine about a month ago. My girlfriend and I were hoping for an immediate solution to my constant drowsiness, her lack of sleep due to my snoring, her concern of my pauses in breathing, and our constantly sleeping in separate rooms.

Unfortunately it hasn't worked out so well. I have had two major problems that keep me from using the CPAP machine correctly each night.
1) While I fall asleep without issue, I often wake up with the mask on the floor or next to me on the bed. I've read other posts that offer potential solutions to this issue. Thanks!
2) The pressure of my machine (16 cm/H2O) is EXTREMELY uncomfortable. When I don't remove the mask in my sleep, I wake up within an hour or hour and a half of falling asleep with my nose all tingly from all that pressure. The ramp on my CPAP starts out at 4 cm/H2O but once it builds its way up to 16, I cannot stay asleep. I am going to have my CPAP smart card updated to 8 cm/H2O in hopes that I'll be able to stay asleep at the reduced pressure.

Is 16 cm/H2O considered a high pressure? Has anyone else experienced issues with too high of a pressure? Has anyone else experimented with varying levels of pressure?

Any advice or recommendations would be appreciated!

Thanks,
Newbie

Hi, Newbie!

I'm no expert at this, and I'm sure that others with experience at comparable pressures will chime in, but 16 cms is considered a relatively high pressure, and there are a number of alternatives to help you.

1. Some CPAP machines have cycles (i.e., Respironics' C-Flex) that reduce the pressure when you exhale, making use of the machine more comfortable.

2. "Automatic" machines, "APAP", adjust the pressure as needed to prevent OSA events. Thus, if you only need 10 cms at a particular point in time, it will reduce the pressure to that level and will increase the pressure as needed to prevent events.

3. Bi-level or Variable machines, "BiPAP", which have different inhalation and exhalation pressures. Thus, you might have inhalation pressure at 16 and exhalation pressure at say, 10. These machines are siginificantly more expensive but may offer the best relief.

My pressure is only 9 cms, but I had a significant period when I would remove my mask during sleep without realizing it, until I found my current mask.

Stay with it -- it really does help.

Michael

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Yes 16 is fairly high. You may be a candidate for BiPap. At the very least an Auto (APAP) may help if you still can't adjust to straight CPAP. Auto's run at lower pressure much of the night when you don't need as much due to sleep position and stage of sleep. Autos are not perfect for everyone but they can also be set as straight CPAP if you wish.

You don't say what your equipment is. I hope you have some sort of exhale relief (Cflex rfor Remstar) and EPR I think for Resmed. I am not sure if any of the other makers have exhale relief. With your pressure you definately should have it.

For APAP's. Respironics Resmed is the only one currently with exhale relief that works in Auto mode.

Your starting pressure (ramp) is very low. Some (including myself) have trouble breathing at 4. If you don't fine. But the differential may be what is waking you up. Try your ramp much higher. I use 13 titrated pressure (10-15 on my Auto) and start at 10. 13 feels to me significantly higher than 10 so I can imagine with 16 is like.

You don't say (or maybe you don't know) how your mask is getting off. Possible that leaks (hissing noises and other noises) are waking you up and then you rip it off. So it is necessary that your mask seals correctly. This is not good to test at 4. Do it at 16. If you have straight CPAP start it without the ramp and make sure the mask is sealed and comfortable. Then hit the ramp button to start your ramp. Hopefully the fit you got at 16 will be good when you get there. Some people have also said that APAP wakes them up because they are sensitive to the pressure changes. You have quite the large ramp, it could be similar to that.

Let us know what you are working with for equipment.

I know what you mean on the light sleeping spouse or significant other, my husband moved out of the bedroom due to my snoring and I am happy to say he is back!

Hi, newbie and welcome to the forum. Hope you're comfy enough here real quick to become a registered member!!

I can't help you about taking the mask off at night, but I can sure identify with your pressure of 16 cm!! Yep, that's pretty high, considering that most of the machines only go up to 20 cm. That's what I was initially titrated at, too. Man, when the machine cranked up, it felt like my lungs were trying to blow up the world's hardest balloon and the next morning, I felt like all those little unused parts of my lungs had been inflated repeatedly! Sheesh! I used a regular CPAP for about 3 weeks, then went to cpap.com and bought an auto machine, the PB 420E with the heated humidifier and software package. It got delivered in a couple of days and it only took me an hour or so to set it up and adjust the pressures (and before I go any further, let me say that I'm NOT a Doctor, respiritory tech, sleep tech or DME anything, just a regular guy with about 21 months of experience being under the hose). After "tweaking" for about 3 more weeks, I determined my pressure that kept 95% of my apneas/hypopneas from happenind was about 13 cm, which became my high limit (I added another .5 cm just to be on the safe side). About 3 weeks ago, I bumped up another .5 cm cuz it just wasn't doing the trick, my readout showed I was hitting 13 cm regularly and I really felt bad again. I am NOT saying you should get an auto machine and start adjusting pressures, ok? All I'm doing is telling what worked for me.

I start at a ramp of 8cm for 30 minutes, then go to a range of 9 to 14 cm. Most nights, I stay at or below 12 cm which is wayyy below 16 cm on the comfort scale. Without knowing what your Apnea Hypopnea Index (AHI) is, most easily obtained from a machine with good software, you're pretty much having to guess at anything working, much less working well. Yep a real good indicator of successful treatment is that your snoring stops, you keep the mask on all night because it's now comfortable and you start feeling better...in my case, I started feeling better the night of my titration, then the first couple of nights with my own machine.

It can take a while for all this to start working for you, though. We build up a "sleep debt" for years before we start treating the OSA and it can take 3 to 6 months to pay it back. Also, there seems to be a bit of a rebound effect on some folks where they start feeling better quickly, then fade a bit and then gradually get back to feeling better.

One thing for sure. If you don't use your CPAP, you're going to continue going the way it was in the past. So, good luck and hang in there!

This is a great place for sharing information as well as finding support. Hope we see you bunches more!

Kajun

This therapy WORKS!!!

I am going to have my CPAP smart card updated to 8 cm/H2O in hopes that I'll be able to stay asleep at the reduced pressure.

Lowering your pressure from 16 to 8 may help you sleep, but you will probably have lots of apneas, so the therapy won't be very effective, if 16 is actually your titrated pressure.

I agree with previous posters that you could see if you can get an auto and/or an auto bipap. Personally, I think auto bipap is a good idea for any titrated pressure of 15 or more. Lots of insurance requires a patient to attempt to use a straight cpap before they will prescribe the bipap. You HAVE tried, and it isn't working out well, so you could be a candidate for an upgrade.

Best of luck, you WIll start feeling better whenever you can solve some of your issues.

Moogy

The other thing you don't say is what kind of mask you are using.
With that high a pressure (I was told) many of the nasal masks make you feel like your head is exploding.
I have 15cm H2O and am still learning how to make the masks seal right a month and a half into it.
I was told not to even think about trying any nasal pillows, or the CL2 which fits over the nose.
So you might want to experiment with a different mask, too.
Barbara