First couple nights' impressions

I'm brand new to xPAP, and have used the Intellipap Auto for the past two nights with the Swift FX. I find that mask pretty comfortable and stable, especially with my buckwheat hull pillow. The only irritation is the edge of the inner pillows - i can sometimes feel them (slightly sharp feeling), but think I just need to loosen the headgear a bit. Couldn't find any Lansinoh (or whatever that lanolin stuff is called) but had some shea butter, which was nice to put around the nostrils before donning the mask.

I set the machine to auto and pressures of 7-10 (6 felt too low, kind of hard to breath). I had Smartflex on and set to 3, but noticed I was anticipating the pressure bumping up when I was nearing the end of my exhalations. That was annoying and I found myself almost hyperventilating, so I turned it down to 1. Much better.

Didn't have much trouble falling asleep either night, but removed my mask both nights, at around 3 AM. Not sure why. Any suggestions? I was thinking maybe that's when I start getting some obstructions, and the increased pressure might cause me to pull the mask off. I do have a nasal mask, and think I might try that one tonight. The headgear is more substantial, and I might wake up trying to remove it, and then consciously remind myself to keep it on.

Haven't looked at the data yet but I do feel better. I've felt an energized sort of focus the past couple mornings, and a little giddy (like my brain is all excited that it's finally getting oxygenated properly!). And my headache and afternoon fatigue just vanished. I think it's a bit strange those symptoms would disappear so quickly, but I'm not complaining!

I tend to be a bit on the anxious side, and a shallow breather. I've felt much less anxious and find myself breathing more fully and naturally during the day, without thinking about doing that consciously.

Once I get the mask-removing phenomenon fixed, I'll start focusing on the data and see what it's telling me about my condition and what range of pressures might suit me best. Anyway, thanks for listening, and for all the great info here...it is really helping me a lot.

Congrats of a great first two nights! If you are taking your mask off while asleep, you might want to put a bandaid or medical tape across the side pieces so when you pull the mask, the sting of the tape being removed will awaken you. Once you train yourself to leave it on (to avoid that tape sting), you will leave it alone without the tape. Behavior modification of sorts!

I have my Smartflex at 2 with Rounding set at 2 on inhale and 1 on exhale. I've got my AHI down to an average of 1.5 over the last month, and my pressure range is also set at 7-10.

Shea butter.... not sure how that might affect the nasal pillows. Lansinoh is found in the baby aisle...it is used by nursing moms for their sore nipples. It is a purple box/tube and costs about $9 at WalMart. I really like it as it is a bit tacky and helps the pillows get a good seal.

Let us know how your stats look on the software. Best wishes for continued good sleep. You are off to a great start!

Hi Emilia. Thanks as always for the info and encouragement! Could you explain what "rounding" is? I left mine on 3 for both the default settings, as I wasn't sure what they do, etc.

I'm going to try to find that lanolin stuff online. The nearest Walmart is 2 1/2 hours away from me!

Thanks again.

CVS sells medical grade lanolin right next to brand name Lanisoh in the baby aisle, and it is a few dollars cheaper.

I think it's helpful to look at data when you are a person who pulls off the mask. My guess is that in or near REM sleep your pressure goes up and that is noxious enough to make you remove the mask in your sleep. You should see if that's indeed what's happening to the pressure, and if you can either narrow the pressure range so the difference is not so noticeable or try it in CPAP mode--perhaps you won't be disturbed in your sleep that you pull off the mask.

DeVilbiss Marketing describes Rounding on another thread as:

Since SmartFlex seems to be working for you, you might want to explore the Flow Rounding options of SmartFlex - there are two adjustments: iFlx and eFlx. By increasing the setting number you will soften the pressure transition. For instance, a setting of 5 on iFlx will slowly transition from your lower pressure to your higher pressure. Likewise, a setting of 5 on eFlx will slowly transition your higher pressure to your lower pressure. This is a patented technology that we have had in our Bilevel devices for almost a decade and it has been well received.

Any store that sells baby stuff will probably have Lansinoh cream.... pharmacies, grocers, big box stores, etc.

Janknitz wrote:I think it's helpful to look at data when you are a person who pulls off the mask. My guess is that in or near REM sleep your pressure goes up and that is noxious enough to make you remove the mask in your sleep. You should see if that's indeed what's happening to the pressure, and if you can either narrow the pressure range so the difference is not so noticeable or try it in CPAP mode--perhaps you won't be disturbed in your sleep that you pull off the mask.

Ok, I looked at the data from the first night (thanks Emilia for your post on how to do that) and that seems to be what's happening. The first night I had the machine set to 5/10 cmH2O. The graph shows the pressure rising from 5 almost straight up to 10 around 1 AM, and then the mask is off till I put it back on a couple hours later. Then it stays between 9 and 10 till I wake up sometime after 6 AM.

My AHI was 12.39 and my HI was 11.96. So, mainly hypopneas, but my median leak rate 23 L/min. 90 and 95th percentile pressure was 10 cmH2O.

Not sure the data is very meaningful since it was my first night and I hadn't adjusted the mask and hose to minimize leaks (second night's data is all messed up because I had to get up several times for my puppies!).

I'm tempted to try 7/11 and see if I reach the higher pressure. But I'll probably keep the pressure at 7/10 and work on the mask and hose management first, unless anyone thinks upping the pressure tonight would clearly be the thing to do at this point.

Emilia wrote:DeVilbiss Marketing describes Rounding on another thread as:

Since SmartFlex seems to be working for you, you might want to explore the Flow Rounding options of SmartFlex - there are two adjustments: iFlx and eFlx. By increasing the setting number you will soften the pressure transition. For instance, a setting of 5 on iFlx will slowly transition from your lower pressure to your higher pressure. Likewise, a setting of 5 on eFlx will slowly transition your higher pressure to your lower pressure. This is a patented technology that we have had in our Bilevel devices for almost a decade and it has been well received.

Thanks. I just set both the iRnd and eRnd (I'm assuming these are the same as iFlx adn eFlx) to 5, and combined with setting the Smartflex to 1, breathing feels very comfortable and natural. So I'll stick with the auto mode for now, and maybe go to 2 on the Smartflex setting.

Any store that sells baby stuff will probably have Lansinoh cream.... pharmacies, grocers, big box stores, etc.

I live in a very rural area and tried the grocery and pharmacy without any luck. I think the only way to get lanolin locally is to shear some sheep and extract it myself! Fortunately I found some online--look forward to trying it.

Sirca wrote:Ok, I looked at the data from the first night (thanks Emilia for your post on how to do that) and that seems to be what's happening. The first night I had the machine set to 5/10 cmH2O. The graph shows the pressure rising from 5 almost straight up to 10 around 1 AM, and then the mask is off till I put it back on a couple hours later. Then it stays between 9 and 10 till I wake up sometime after 6 AM.

My AHI was 12.39 and my HI was 11.96. So, mainly hypopneas, but my median leak rate 23 L/min. 90 and 95th percentile pressure was 10 cmH2O.

Sirca,

How were these pressures determined? Did you have an in-hospital titration study? The reason that I ask is that it looks like you are maxing out. If you are set with 10 as the upper pressure, and you ran up to 10, that means that the machine found events where it needed more than 10. Also, if you should be running at a higher number like this, you should set your lower number closer to the average. The reason is that if you are at the lower end of the scale, and you have an event, it can take too long for the machine to react, and it cannot treat the event.

I am afraid to tell you to set it higher. Higher pressures can trigger a different class of events called centrals, which can be just as bad as OA events. I am also concerned that you said that you were a shallow breather. That might mean that you need a different kind of machine, such as an ST or ASV. I get the impression that you are not working with a sleep doctor, or at least a doctor that doesn't specialize in sleep disorders. I think you could really benefit from that kind of expertise.

-john-

jweeks wrote: How were these pressures determined? Did you have an in-hospital titration study? The reason that I ask is that it looks like you are maxing out. If you are set with 10 as the upper pressure, and you ran up to 10, that means that the machine found events where it needed more than 10. Also, if you should be running at a higher number like this, you should set your lower number closer to the average. The reason is that if you are at the lower end of the scale, and you have an event, it can take too long for the machine to react, and it cannot treat the event.

I am afraid to tell you to set it higher. Higher pressures can trigger a different class of events called centrals, which can be just as bad as OA events. I am also concerned that you said that you were a shallow breather. That might mean that you need a different kind of machine, such as an ST or ASV. I get the impression that you are not working with a sleep doctor, or at least a doctor that doesn't specialize in sleep disorders. I think you could really benefit from that kind of expertise.

-john-

Hi John,

I'm not working with a sleep doc, but my internist has recommended that I accept a referral to one. Financially, a formal sleep study would be very tough for me right now. I'm aware of the risk of centrals using an auto PAP for titration, and the possible need for an ST or ASV (hope I don't need one since I can't afford one). I appreciate the information and the caution. I'll do nightly pulse ox recordings and leave the upper pressure where it is, and collect some more data for now. Don't want to suffocate myself, that would be embarrassing...

One thing you may want to look at would be your Average Pressure Plateau on the SmartLink Summary report (in the Pressure Statistics table). Pressure plateau time is the percentage of time therapy was at the upper prescription limit. If the time is 10% or higher, the pressure has been railing at the upper pressure and this may be an indication the prescription setting should be increased to allow the therapy to move to a higher pressure than is currently allowed.