First night with APAP

I've just used my APAP for the first time and wanted to jump in here and post my results. I have a ResMed S8 Vantage it is set to auto 4-10 cm. The mask seemed to fit tight and shows an excellent fit in test mode. The biggest concern for me is congestion, my nose seemed to be blocked on one side or the other most of the night. I actually took to mask of for 2 hours because of that. Do saline sprays work? or should I see my doctor for something "stronger"? Mouth leakage was a concern when trying to fall asleep, along with the congestion only compounded the problem. Exhaling seems to be a problem too, especially with the blockage, and being asthmatic I get the feeling of suffocating and open my mouth to compensate. I realize it's going to take some time to get used to the machine, and some have pointed out they were miserable for months before finding the right combination, I would like to avoid that!

Here's the results...

Press: 10.0
Leak: 0.46L/s
AHI : 12.4
AI : 2.9
HI : 9.5

Usage: 4.0 hrs

Not sure what they all mean, but from what I read here in the forum they don't sound good. Does anyone use SmartStart? Could these numbers be elevated because I pulled the mask off before turning off the machine?

Thanks,
A. Newbie

What was your titrated pressure? Have you had any central or mixed apneas?
If you have trouble breathing through your nose, do you have a FF mask? If your having leaks you need to get them under control. 4 is a very low pressure to start with so it may make you feel like you're suffocating. Most can't tolerate a pressure of less than 5. A lot of people use saline rinses for congestion. You can do a search for them and find lots of posts.
It does take time to get used to all of this. Some take longer than others. Keep posting and everyone here will try to help!

Brenda

I would call my doc and ask how a pressure of 4/10 was determined and give him your numbers.

A setting of 4 is virtually guaranteed to allow lots of events.

Ask him what the titrated pressure was recommended and if he still acts stupid then set it 3 below this and 3 above it.

You may have a faulty Doctor.

I would be concerned about those stats. Your recorded perssure was the maximum in the range, since your machine was set for 4-10. And you still had far too many apneas for comfort, despite no major leak. It is quite likely that at a higher perssure the number of apneas would be lower. I use the same machine and my pressures are all over the place anywhere from 6 to 11.8, but it works and keeps my apneas low (AHI of monthly average of 2.3 and AI monthly average of 0.1), so I conclude that I sometimes need much more than other nights. I am still looking for a pattern. But I love the convenience of being able to look up my results any time before 12 noon, I write them down and never bothered to buy a card reader and software.

As others said, 4 seems too low to start out. That is probably the reason you are having alot of HI's. Perhaps the DME, or whoever set up your equipment didn't set it right. If the 4 is bumped up to at least 7, your HI's should go down alot.

Since you have asthma, you should consult your doctor before you try to get rid of the congestion. Many new hoseheads have congestion. And sinus rinses do help. Also, Flonase helps. But talk to your doctor.

Most nights one or the other of my nostrils gets congested, so I only breathe out of one at a time. But my therapy still works. My doctor says that it's quite common and nothing to be overly concerned about.

Good luck and hang in there.

I had the same machine as you for a month on hire and the DME set it at 4-14
A setting of 4 was just to low I couldn't get enough air ,so I changed it myself
I have changed it several times it now at 8.5 --14
Hang in there it will get better
Regards Jacko

fearless, since you mentioned "Exhaling seems to be a problem" you might want to see about switching machines to a Respironics REMstar Auto with C-flex. Even though the Vantage they gave you has "EPR" (a type of exhalation relief), EPR cannnot be turned on when the Vantage is being used in auto mode. The Vantage can use its EPR only when being operated in straight cpap mode. So...you are getting the same pressure blowing at you inhaling and exhaling...no pressure relief at all in auto mode with that machine.

The Respironics REMstar Auto with C-flex can use its exhalation relief (C-Flex) when operating in auto mode.

As the others mentioned, 4cm is usually uncomfortably low for most people.

When I'm congested, a nasal pillows mask is MUCH easier for me to breathe through than a regular nasal mask. I always have one nostril or the other start out completely blocked, and be at least very stuffy, throughout the night. As long as I can breathe well through one nostril or the other, I get good treatment (and very important to me, comfortable treatment) with nasal pillows interfaces.

You might want to ask about switching to a nasal pillows mask like the Respironics ComfortLite 2 with nasal pillows, or...my favorite...the Invacare Twilight NP (formerly called the Aeiomed "Aura" and "Headrest".)

Heated humidification helps too. Other humidifiers put out considerably more humidification for me than the Humidaire (came with the machine they gave you) that I used for awhile.

Mouth breathing and mouth air leaks can be definite treatment wreckers. Raising that lower pressure, trying a nasal pillows mask, and getting a machine that gives relief when you exhale (hey, that's a lot to change! LOL ) might help relieve the feeling of suffocation you've been having.

Sounds like you're really determined to make treatment work for you. I think some equipment changes might make it easier to get it going better. I don't think the DME had a very good understanding of your particular needs when they handed you that machine and mask.

It can be a lot better than what you're going through now, but people often have to advocate rather strongly for themselves before it does get better.

Thanks everyone for your feedback...

Before I make any major changes like getting a new machine, I think I will give it a couple of weeks and try to get comfortable with a mask and the pressures prescribed. The first night I used the FlexiFit HC405 Nasal Mask, then switched to the Resperonics ComfortGel last night, only to wake up with a sore nose, the DME gave me the ResMed Mirage Swift nasal pillows to try, so at 3am I switched over, these seemed to be the best so far.

Tried using a nasal decongestant before bedtime and it worked wonderfully, I realize I won't be able to use this every night, but I needed to get some sleep. Having my nostrils clear seemed to help tremedously, so the use of EPR or C-FLEX may not be needed.

Heated humidification seemed to help too, I had it turned to setting 5 out of 6, the first night it was on 1.

Day 2...

Press: 10.0 (does this reflect the max pressure or an average?)
Leak: 0.24L/s
AHI : 9.8
AI : 1.9
HI : 7.9
Usage: 6.07 hrs

As far as what the Dr. prescribed, my sleep study showed I responded best at 8 cm with no apneas at 8, this is why they set it so low. But considering my numbers here, maybe 10 is too low?

Thanks again...

oops, forgot to sign in...

The last post was me.

regarding the congestion...
You may also want to experiment a little with varying degrees of humidification. My humidifier is off all summer, but in winter I have it on and set just above teh mid point. That's what works for me. Your settings will in all likelihood be different. But the way I use my machine I have gone to bed with one nostril congested and woke up with both clear. It's like the air is keeping me open. Now... when I get in the hot shower and get all that nice steam.... I have to usually blow my nose before I even get done toweling off! But.... this is what works for me.

My humidifier is off all summer, but in winter I have it on and set just above teh mid point.

Ditto here. That method works great for me.

I think there is an important aspect to your stats:AHI : 9.8
AI : 1.9
HI : 7.9
The AHI seems high BUT it is almost all hypopneas. Now, hypopneas come in all shapes and sizes, they can be hard to measure for the APAP machine.... if they were big fat hypopneas they might cause oxygen desturation etc. if they were tiny little ones they probably are not worth worrying about.
But it is worth asking your sleep doc/sleep lab/DME (impossible to ever know who gets which issue, but best to go in that order) for an immediate adjustment to a slightly higher maximum and see how it goes

[quote="arthuranxious"]I think there is an important aspect to your stats:AHI : 9.8
AI : 1.9
HI : 7.9
The AHI seems high BUT it is almost all hypopneas. Now, hypopneas come in all shapes and sizes, they can be hard to measure for the APAP machine.... if they were big fat hypopneas they might cause oxygen desturation etc. if they were tiny little ones they probably are not worth worrying about.
But it is worth asking your sleep doc/sleep lab/DME (impossible to ever know who gets which issue, but best to go in that order) for an immediate adjustment to a slightly higher maximum and see how it goes

[quote="fearless"][quote="arthuranxious"]I think there is an important aspect to your stats:AHI : 9.8
AI : 1.9
HI : 7.9
The AHI seems high BUT it is almost all hypopneas. Now, hypopneas come in all shapes and sizes, they can be hard to measure for the APAP machine.... if they were big fat hypopneas they might cause oxygen desturation etc. if they were tiny little ones they probably are not worth worrying about.
But it is worth asking your sleep doc/sleep lab/DME (impossible to ever know who gets which issue, but best to go in that order) for an immediate adjustment to a slightly higher maximum and see how it goes