I am having trouble exhaling ....is this right?

Hi everyone I am new here and have a question. I just hope someone is up to answer it quickly. I just got this Resmed Autoset II and the forma full face mask today. I believe it is set at 7.0 for the lowest and 12.0 for the highest number and epr is at 3. I am having trouble exhaling to the point I can't keep the mask on. I can't exhale normally at all...I have to like force air out of my lungs. Is this right? I know for a fact this wasn't happening at all during the sleep study...so what could be different? I would really like to use it because I have been waiting to get it since June but I can't stand not being able to breath. I fell asleep a few times with it on earlier and I wake up trying to exhale...this has happened at least 3 times already. Should I just tell the docs that the cpap doesn't work for me? Help please..and thanks. By the way I have no idea how to change the settings at all I just know what the home care guy told me. I messed around with buttons to find EPR settings because I thought it would help....

The EPR=3 -- (is it still that after the fumbles?) Should help.

Are you sure your machine is set at Auto mode with the minimum at 7 and the maximum at 12? There have been cases where the Rx said one thing, and the homecare person set up the machine differently. If the machine shows "settling" it is set on auto.

If the LCD shows "ramp" that means the machine starts at 7, and is raising the pressure relentlessly from 7 to 12 during the ramp period.

If your machine is on CPAP mode, then it would be very naturaly to have this difficulty in exhaling, despite the EPR=3, since at this point, the pressure is not correlated to your needs.

There is no need at all for you to tell the doc "CPAP doesn't work for you" -- not at this point, and not for a long time yet. Many of us had problems on their first night, nights, or even weeks.

Do you have your PSG (sleep study) data? Could you share it? Ditto for your Rx. We could give you better advice if we know those things.

Your first night is not at all atypical, dont' worry.
O.

There is a rhythm to the inhale and exhale of these machines, particularly when EPR is being utilized. Some have reported that the inhale pressure kicks in before they have completely exhaled, making it feel as if they can't completely exhale. Maybe you'd do better with a lower EPR setting so the increase isn't such a contrast. I remember early on feeling these sensations, but dropping my exhale relief seemed to help, or else over time I became accustomed to all the "oddness" of this new way of breathing. Do yourself a favor and don't judge the treatment by your first night or first week for that matter. If I were a betting woman, I would bet that in a few days (weeks?) this will be a non issue. Keep trying again, as it's the only way to get familiar. Another possibility is it could be at the point of pressure increases when you feel this. If it continues to happen, you may want to try a fixed pressure or very narrow range to see if it was the fluctuations you are noticing. You will sort this out, just probably not tonight. At least between wakeups you can take comfort in being protected while you sleep. Hope those stretches of sleep get longer and longer soon.
Kathy
EDIT: P.S. Don't be discouraged by differing perspectives. You will sort thru what will work for you.

ozij wrote:The EPR=3 -- (is it still that after the fumbles?) Should help.

Are you sure your machine is set at Auto mode with the minimum at 7 and the maximum at 12? There have been cases where the Rx said one thing, and the homecare person set up the machine differently. If the machine shows "settling" it is set on auto.

If the LCD shows "ramp" that means the machine starts at 7, and is raising the pressure relentlessly from 7 to 12 during the ramp period.

If your machine is on CPAP mode, then it would be very naturaly to have this difficulty in exhaling, despite the EPR=3, since at this point, the pressure is not correlated to your needs.

There is no need at all for you to tell the doc "CPAP doesn't work for you" -- not at this point, and not for a long time yet. Many of us had problems on their first night, nights, or even weeks.

Do you have your PSG (sleep study) data? Could you share it? Ditto for your Rx. We could give you better advice if we know those things.

Your first night is not at all atypical, dont' worry.
O.

Yes the machine says settling on it but it is off. Yes the EPR is still on 3 too. I don't have any of the info you asked me for either. The guy left papers but everything is left blank. Should I still be trying to use it anyway even though I can't exhale well? I tried to sit here with it on for a while but after a while it starts feeling like I need to take the mask off to get some air. I just don't know why I didn't go through any of this at the sleep study. Were they using a different type of machine? Quite frustrating this is.

Settling = off means the machine will start raising pressure as necessary the minute it thinks it has to.
Settling = XX means you decided the machine should wait XX minutes before it starts responding to changes in your breathing.

Breathing out against pressure is disconcerting at times -- more so for some than for others, it's not part of normal breathing, in normal human breathing exhaling is a result of relaxation - cpap means we have to use our muscle to exhale.

Try not to panic, and try to accept the need to use you muscles a bit for exhaling - that's normal - even necessary on cpap.
I can't tell you whether to go on or stop now -- you'll have to use your own judgement for that. Even if you decide to stop, it does not mean CPAP doesn't work for you. It only means that the way it is set up now is very problematic for you on the first night. That's OK.

Can't say what the difference was the study -- the PSG report would make that clearer.

Contact your DME and /or doctor tomorrow and demand copies of your PSG and your Rx. They are legally yours, no one is allowed to refuse to give them to you.


O.

Hi,

Some people find ERP to be weird, while others find it to be a great help. That is one adjustment that is available to you without hacking your way into the clinical menus. Try different settings, and also try it in the lowest or off position.

I know that when I first tried CPAP, I thought that there was no way on earth that I was going to be able to do it. If felt like trying to breathe the output of a jet engine. Today, I don't even notice the pressure, and it seem weird to try to sleep without CPAP. In fact, due to severe OSA, it is risky for me to sleep without the machine, so I will not take that chance.

Some people simply do not do well trying to exhale against pressure. In fact, once you get above 14 or so, it is pretty normal to have that issue. Your upper pressure of 12 is getting close to that number, and if your machine is maxed out to 12, then maybe you are in this category. In that case, you might do better on a BiPAP or VPAP rather than CPAP or APAP. My upper pressure level is 20, and I simply couldn't do this without a BiPAP.

The issue is that these more sophisticated machines are more costly. The result is that insurance companies are not likely willing to supply one without a doctor's order. In some cases, you need to fail on CPAP before they will allow for a BiPAP. This is something you might want to talk to your MD or RT about. In my case, I am self-pay, so I was not limited by insurance options.

Finally, there are a zillion different masks out there. This is probably because no two people have the same face or the same needs. I went through 7 masks before I found something I could live with long term. This was expensive, but still far cheaper than a funeral, and since I enjoy being awake, it was worth the hassle and cost. I found that I am far less sensitive to the pressure when breathing through my nose, and I liked the freedom of a nasal pillow mask. Maybe go back to your DME and try some more masks, or do some more reading of the results of the various mask challenges from the recent past.

There is an answer to this, but getting to the pot of gold can be a real challenge. The results are worth the effort.

-john-

kteague wrote:There is a rhythm to the inhale and exhale of these machines, particularly when EPR is being utilized. Some have reported that the inhale pressure kicks in before they have completely exhaled, making it feel as if they can't completely exhale. Maybe you'd do better with a lower EPR setting so the increase isn't such a contrast. I remember early on feeling these sensations, but dropping my exhale relief seemed to help, or else over time I became accustomed to all the "oddness" of this new way of breathing.

What you're describing, Kathy, does apply to C-Flex, which is the type of exhalation relief your Respironics machine uses. But EPR in a ResMed machine, like GMAD20 is using, works very differently from C-Flex.

Respironics' C-Flex does let the regular ("inhale") pressure back in (as it's supposed to) before you've completely finished exhaling. And yes, having the regular pressure kick back in before I was finished exhaling felt odd to me at first, too -- just as you described it did to you.

However, ResMed's EPR does not do it that way. EPR doesn't let the regular "inhale" pressure back in before you've completely exhaled. EPR keeps the pressure down throughout the entire exhalation. Even during the pause at the end of exhalation, EPR and then waits, and waits, and waits for the person to START to inhale again before it allows the regular ("inhale") pressure to come back in.

If the person's exhalation (including the pause after exhalation is finished) exceeds about 10 seconds, and the person hasn't yet started to inhale, EPR is suspended and the regular pressure is allowed back in. That's a safety measure with EPR...that it will suspend EPR and resume using the regular pressure if a person has not STARTED to inhale again after so many seconds.

From ResMed's "EPR and Easy-Breathe" fact sheet:
To ensure comfort without compromising
therapy, EPR has an automatic time-out
feature. After determining the baseline
breathing average for each patient, the
device suspends EPR if the patient’s
breathing drops 75% below the baseline
for 10 seconds or more. EPR restarts
when the event is over and breathing is
again within range.

kteague wrote: Do yourself a favor and don't judge the treatment by your first night or first week for that matter. If I were a betting woman, I would bet that in a few days (weeks?) this will be a non issue. Keep trying again, as it's the only way to get familiar. Another possibility is it could be at the point of pressure increases when you feel this. If it continues to happen, you may want to try a fixed pressure or very narrow range to see if it was the fluctuations you are noticing. You will sort this out, just probably not tonight. At least between wakeups you can take comfort in being protected while you sleep. Hope those stretches of sleep get longer and longer soon.
Kathy
EDIT: P.S. Don't be discouraged by differing perspectives. You will sort thru what will work for you.

That's excellent advice from Kathy, as always! Hang in there, GMAD20. Keep reading, keep relaxing and this crazy new way of trying to sleep will begin to feel more natural.

Personally, I'd go into the clinical menu myself and write down every setting, every number, every word. I'd want to see for myself (not just take the home health care place's word for it) what EVERY setting in my therapy was set for.

I'd especially want to see if EPR in your AutoSet II is turned on for "Fulltime" or during "Settling" only.

If you would like to have a copy of the clinical manual for your machine, GMAD20, so that you can access and look through the settings yourself, just say so. Any number of people here on the board will be happy to provide that to you.