New Member - pressure Question

Hello to all,

I'm new to this great forum, and don't know why I never went looking for this beforre!

I've used a respronics S7 with heated humidifier for over a year after being diagnosed with central APNEA (I think he said central).

After all this time I'm still not doing very well. Air leaks through my mouth .. feels like I don't get enough air through my nose, or the pressure over powers me. Meds helps my sinus congestion, but still sometimes gets bad at night. The noise from air coming out my mouth wakes me a lot, and I often pull the mask off. Without it I sometimes wake up gasping. Even when I keep it on most of the night, still don't feel rested.

I've tried chin straps and the tape that holds your mouth closed with no improvement. A full face mask leaks from the sides if I turn my head .... that drives me crazy and wakes me.

My clinician insists I need it set at 11 even after two titration tests ..... I told him how it feels to me.

It's causing problems at work even though I've filed FMLA papers - that avoids dicipline for taking time off, but can't stop them from having negative feelings about me. I'm feeling I may have to go out on disability, but that's not something I want.

My main question: is there any risk in reducing the pressure myself against medical advice? Seems to me no more risk than pulling the mask off, but would that give me a false sense of security and insufficient air? I have the menu instructions for changing the setting.

I'm seeing an ENT for a second opinion on the sinus probloems, but expect he will also recomend nasal surgery. I've heard mixed results on that from friends, so am reluctant to go down that road.

Wow, reading this over I've thrown out a lot of information, so sorry for the length, but I can see that people here will understand how frustrating it is dealing with this problem.

Of course any other suggestions are welcome.

George

Hi George,

Sorry to hear things so far, aren't going that well for you. Just to clarify are you using the Resmed S7 (Respironics is another mfg)? What full face mask have you tried? Some are better than others and my guess is based on your stated nasal congestion and the fact you have not been able to get your mouth to seal that a good full face might be your best bet until you can try to ween yourself off of it and on to something else. Are you using a heated humidifier? That often will also help to open a clogged nose.

I would recommend against lowering your pressure, there are other options to try first. You might consider trying (renting) an auto-pap to see if it would help. What this type of machine does is keeps the pressure to a minimum (say 6cm) until you need a higher pressure to clear an apnea. A recent study I read said this can provide an average pressure 37% lower. In your case that would bring your average pressure down to about 7cm and still treat your apnea. Another option is to try a machine (made by Respironics) with a feaure called c-flex. What this does is make it easyier to exhale against the machine. This might help the feeling of the pressure being to high. They (Respironics) also make an auto-pap model with c-flex. Try renting one of these to see if they give you any higher level of comfort.

The full face mask that I've read gives the best result is the Resmed ultra Mirage full face. If you haven't already, give it a try. otherwise my all time favorite nasal mask is the Resmed Mirage Activa. If they made a full face version of this mask it would hands down be the mask of choice when all else fails (we can only hope).

Hope this was not too much information at once. You're on the right track asking questions. Feel free to ask anymore you might have.

Good Luck!

Hey"Wading":

Thanks for the comments. You're right my CPAP is a Resmed S7 with heated humidifier. The full face mask I tried was the Resmed utlra mirage since it was so well rated.

I also tried an auto-Pap twice, each time for a week. It was mostly to get a pressure measurement, but we wanted to see if it helped more. Didn't seem a lot better, and my insurance wouldn't pay for one anyway.

I said my APNEA was central, but on second thought think the doc said it was a type that the airway doesn't close, but gets constricted enough to reduce air flow and hence O2 intake. He said for some reason that's often harder to treat.

The c-flex sounds interesting. I'll see if my supplier can loan me one.

Also saw another post recomending chin straps used like a headband to hold full face masks better. Maybe that's worth a try.

Otherwise like many of us, guess I'll just plod along and keep looking for something that works better for me.

George

wading thru the muck! wrote:Hi George,

Sorry to hear things so far, aren't going that well for you. Just to clarify are you using the Resmed S7 (Respironics is another mfg)? What full face mask have you tried? Some are better than others and my guess is based on your stated nasal congestion and the fact you have not been able to get your mouth to seal that a good full face might be your best bet until you can try to ween yourself off of it and on to something else. Are you using a heated humidifier? That often will also help to open a clogged nose.!

George,

I think the word your looking for regarding your apnea is Hypopnea. Regarding the auto-pap if you have very frequent "events" the machine spends most of the time up at the higher pressure anyway. Maybe that's the case with you. The c-flex may help though.

I saw that post about recycling a chin strap to help seal a FF mask. Give it a try and let us know.

The Resmed S-7 can be upgraded to a Spirit (auto) for about $299. The upgrade is sold on the internet. If you are interestesd


WarriorII

Hey George,

All good posts and suggestions for you to follow. If you are feeling like you're not getting enough air than maybe you have some air hunger problems and the pressure is too low. Some patients actually gasp in the sleep lab until the pressure is increased enough for them. You may also have an obstruction in the nasal passages. Good idea to see an ENT.

Lastly, I urge caution when using the C-flex-feature. It does make it seem easier to exhale but that's because it drops the pressure alittle right before exhalation and this is when apneas can occur. If you are going to try it yourself then just start at the 1 level and see what happens. The correct way to use it is to be titrated in the lab while using the C-flex, this way all events can be corrected at the right pressure.

Good Luck
Bob

Hypopnea sounds familiar - never sure the way docs bring you in, talk a mile a minute and push you out the door for the next patient. Though I think that's more what the health insurance industry has done to medicine.

I think my events were about 60 an hour but I didn't sleep much and never went into REM during the study, so he said that may not be representative

wading thru the muck! wrote:George,

I think the word your looking for regarding your apnea is Hypopnea. Regarding the auto-pap if you have very frequent "events" the machine spends most of the time up at the higher pressure anyway. Maybe that's the case with you. The c-flex may help though.
<snip>

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BBBob,

If one uses the Auto w/cflex why is there a need to be titrated in the lab?

The software will tell you what if any residual AHI you have so that would serve to provide the cautionary protection you suggest.

Hi George,

Lowering the pressure is not a good idea unless you've been titrated for a lower pressure. Since you breathe out of your mouth with the nasal, and the full face mask leaks, try this: Use an ace bandage as a supplement to the head gear. Keeps the face mask in place quite well. Or, attach some velcro hooks to either side of the mask, and go to the fabric store and get a piece of fabric that'll stretch and that you can glue or sew the other part of the velcro to. Kind of a secondary piece of head gear, that lets you put the 'pull' on the mask where YOU need it, not where the manufacturer put it. Just keep up with your DR, and check out cpap.com for other ideas. Let us know if you need more help. That's what we're all here for.

Peter