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Posted: **Sun Apr 10, 2016 10:31 pm**

Question though, which EPR setting gives the best exhale relief 1 or 3? also what does the "auto" ramp vs a set time do. Janknitz suggested to go with "auto" does that detect and adjust for my breathing pattern

EPR of 3 is the most relief. For me, with a straight pressure of 10 and EPR of 3, that means pressure drops from 10 to 7 during exhale.

The "auto" ramp setting means the machine attempts to determine when you fall asleep, and then begins to ramp up to your desired pressure. Didn't work for me . . . the machine thought I was asleep when I still had the light on and was reading a novel. I'm on straight pressure of 10, and found for the first month or so it worked to do a 5-minute ramp starting at 7. Then I didn't need the ramp any more.

Posted: **Sun Apr 10, 2016 11:24 pm**

Gasper62 wrote:Buy a bag of party balloons. Blow a few of them up several times during the day. Your exhale prowess will improve. A lot.

very clever...

since it takes hundreds of times the amount of work to blow up a balloon as it does to exhale with a cpap.

Posted: **Mon Apr 11, 2016 12:45 am**

Cudos,

I agree with BlackSpinner: For now lower the pressure down to where its more bearable and work on trying to train your body to get used to exhaling against the pressure. Once you start using CPAP consistently, your ability to exhale against the pressure will increase.

I would also say that given the difficulties you are having falling asleep, the ramp may also be useful to you. And it's a shame that the RT didn't set it up with the ramp on in the first place.

Cudos wrote: I cannot fall asleep with the mask, sorry Airfit F10. I am having anxiety attacks and ripping the mask of after a period of trying to breath in it. I can breath in but the exhale is brutal. Exhale assist is on and set to high setting. I have not fallen asleep. As soon as I even start to drift my breathing becomes very shallow and then of course I have take a deep breath in and now I have to blow out and I find the back pressure too much and I can't catch my breath so I start panicking from the oxygen starved sensation in my gut.

Have you had panic attacks before starting CPAP? If so, do you take any antianxiety medication for them? If so, you should take it before putting the mask on for the night.

There's another thing that I'll also suggest that I still do when I'm having trouble getting to sleep and find that the pressure is starting to get to me: You can always turn the machine off and take the mask off for just a few minutes---long enough to catch your breath and settle down. Then mask back up and turn the machine back on. If you have the ramp turned on, the pressure will be lowered back down to 4cm and exhaling may seem easier at the lower pressures at the beginning of the ramp. Evenutally you will "out grow" the ramp---i.e. you will find that you don't need it as much. But for now? The ramp is your friend until you have managed to learn to fall asleep with the mask on your nose.

I try to battle through but after an hour I come up having to rip off that mask, get out of bed and settle down. Mask pressure was set to 5.2, I tried higher and lower to no avail. I'm already at my wits ends, actually afraid to put it on now.

Report this to the sleep doc's office. They need to know that you are having a really rough time and that you are beginning to develop a fear of the mask. The doc may suggest taking sleeping medication for a few weeks. And that's ok if you need to do it in order to learn to sleep with the mask on.

How can i possibly make the mask work if I can't get past the exhale problem. Maybe I'm just too shallow a breather as I get close to dozing off. I really find the exhale extremely hard, bad lungs maybe.

It takes some effort to exhale against the pressure and your muscles are not yet used to doing it. In time they'll develop the (slight bit of) extra strength to exhale comfortably.

Posted: **Mon Apr 11, 2016 3:00 am**

Hopeful50 wrote:
Question though, which EPR setting gives the best exhale relief 1 or 3? also what does the "auto" ramp vs a set time do. Janknitz suggested to go with "auto" does that detect and adjust for my breathing pattern
EPR of 3 is the most relief. For me, with a straight pressure of 10 and EPR of 3, that means pressure drops from 10 to 7 during exhale.

The "auto" ramp setting means the machine attempts to determine when you fall asleep, and then begins to ramp up to your desired pressure. Didn't work for me . . . the machine thought I was asleep when I still had the light on and was reading a novel. I'm on straight pressure of 10, and found for the first month or so it worked to do a 5-minute ramp starting at 7. Then I didn't need the ramp any more.

On my cpap, the ramp starts immediately and lasts as long as I set it to. For example, you can set it to ramp from say 6cm up to your final pressure range in 30 minutes. And it starts to ramp as soon as you turn on the cpap. My cpap never worried about whether I was asleep to start the ramp. In fact, I doubt if my cpap is designed to even try to tell when I'm asleep. Maybe the follow-on model to the S9 can do that, but again, I doubt it.

Posted: **Mon Apr 11, 2016 6:59 am**

Thanks everyone!!!

Turned on ramp, watched tv for some time in bed with the mask, employing lots of the good tips I received here, even Grandma'a "its all in your head" may have helped a little too, Thanks gammy. I did manage to sleep, 7 hours in fact. I haven't downloaded to sleepyhead yet but resmed machine AI showed 4 AI's rather than the 14 I was diagnosed with. We'll see what my numbers looked like and I can post them for critiquing.

Hopefully last night was the start of the beginning of good nights now. If I could manage one that means I can manage to have more. You guys are all great here!!! Thank-You so much

I'm sure I'll have more questions along the way an I'm looking forward to learning lots here. I'll post some reports later and then see If I can a 2nd good night under my belt.

Cheers.

Posted: **Mon Apr 11, 2016 7:47 am**

I found that after a few nights, I got used to the pressure, to where I didn't even notice it. It was like wearing glasses. At first you are conscious they are on your face and the frame bothers/annoys you. After a while, you don't even notice them. Glad last night went better. Just give yourself time to adapt.

Posted: **Mon Apr 11, 2016 8:17 am**

I had the same issue! It took literally weeks to get through a night. I would count every breath all night long. I also recommend wearing the mask while waking, watching TV or reading. Also, try meditating with the machine on, to reinforcea relaxed state with the machine rather than an anxious state. Other good advice is to avoid lying flat on your back. That can lead to a feeling of choking (or it did for me). I did better in a side position. You CAN do this, and will soon see the benefits of a good night's sleep. Good luck.
Best,
Eve

Posted: **Mon Apr 11, 2016 9:37 am**

Cudos wrote:Hold your breath for as long as you can or until you get that horrible feeling in the pit of your stomach, that's the sensation that drives me to rip off the mask. Not so easy to just push through that feeling.

Thanks

If you're using an Autoset machine with EPR on and still feel like this, there's a chance you need more pressure, not less. Counterintuitive, I know.

I have an Autoset, pressures 13-18 and they stay around 16 for most of the night (also with EPR on). Still, after several months of use I will occasionally wake up in the middle of the night and wonder, "Is this thing on?"

Granny is right. You need to get used to breathing without thinking. Try wearing the CPAP and breathing normally while reading or watching TV. Three days is nothing; you CAN get used to CPAP if you don't quit and let your body adjust.

It will come. Trust.

Posted: **Mon Apr 11, 2016 10:04 am**

Cudos wrote:I did manage to sleep, 7 hours in fact.

Posted: **Mon Apr 11, 2016 10:15 am**

ChicagoGranny wrote:
Cudos wrote:I did manage to sleep, 7 hours in fact.

Posted: **Mon Apr 11, 2016 11:48 am**

I think you got a lot of really good advice, and now I'll throw in my 2 cents. When the tech first put the mask on me, at the sleep study night, I really freaked out, pulled it off and said "I don't think I can do this!" But I needed to find out if I had apnea, and so I just slowly kept trying it until I could leave it on. My results came back as severe sleep apnea. For as many times an hour as I stopped breathing, I knew it was not a choice, but a necessity, and a new part of my life. I tried mask after mask, used every type of relaxation tape I could find, etc. I finally tried the Sleepweaver Advanced mask, and I would recommend it to anyone who feels claustrophobic with a mask on. It's so lightweight that you barely know you have it on. Then I suggest you use relaxation apps to take your mind off of the Cpap machine. Once you get comfortable with the routine, then you can try other, sturdier masks until you find the one you like best. The Dreamwear is pretty great, and I stopped searching, but I would still recommend starting with the Sleepweaver Advanced. I too felt like it was hard to breathe out against the air, but I turned the EPR on for least resistance. Wishing you success.
Lori

Posted: **Mon Apr 11, 2016 12:42 pm**

Thank-You Lori!!

I'm trying to be a sponge here so all advice and recommendations are welcome

Posted: **Mon Apr 11, 2016 3:19 pm**

I don't really have any good tips or advice for you but I wanted to let you know that I also started my therapy on the same day as you and I'm still struggling to sleep! Thought maybe it would help you to know that you are not alone. Hopefully things are starting to improve for you. I finally broke down and called my primary care to prescribe a sleep aid. I'm determined to sleep tonight because I just can't take it anymore! Hopefully it works!

Posted: **Mon Apr 11, 2016 5:02 pm**

SEVEN HOURS??? That is so awesome!

Now, don't be surprised if you still have bad nights--I hope you don't, but last night's 7 hours may have been a function of how tired you were. Set reasonable goals for yourself--Fewer bad nights, nights sleeping all the way through, etc. Don't adjust the settings for your AHI yet, let your body get used to CPAP first (but if you find that increased pressure will make you more comfortable than the ramp, that's fine to turn the ramp off--most of us don't like the ramp within a few days because it starts out too low).

The other thing a good night can show you is how awesome you can feel after a decent night's rest. That's what I got addicted to. My first good sleep through the night and wake peacefully night (which, BTW, didn't come until a few MONTHS in to the process) felt so wonderful I couldn't wait to have another night like that. Even now, six years in, when I think about going to sleep, it is something I can't wait to do because I plug myself in to the mask (now so comfortable with the Dream Wear) and the machine (the Autoset really has a comfortable algorithm) and I wake up most mornings at utter peace. Before CPAP I woke up tense, uncomfortable, angry at the world and never rested, so even this long after I so appreciate that feeling. (And totally missed that feeling this morning because my insomniac husband kept waking me and then the dog went ballistic when our smoke alarm battery started beeping at about 4:30 a.m. )

Posted: **Mon Apr 11, 2016 6:19 pm**

judylc wrote:I don't really have any good tips or advice for you but I wanted to let you know that I also started my therapy on the same day as you and I'm still struggling to sleep! Thought maybe it would help you to know that you are not alone. Hopefully things are starting to improve for you. I finally broke down and called my primary care to prescribe a sleep aid. I'm determined to sleep tonight because I just can't take it anymore! Hopefully it works!

I wish you the best, and yes it does help knowing others are struggling as well, sorry . Good luck tonight!!!

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