First night

xxyzx wrote: please explain
most people do not feel air starved at 0
which is atmospheric pressure

why would +4 make them feel air starved

It's not just pressure, it's a flow rate thing. The lower the pressure setting, the lower the flow rate. Higher pressure, higher flow rate.

If I gave you a 1mm diameter straw to breathe through, you're still breathing atmospheric pressure air, but would you be breathing comfortably? Not likely due to a restricted flow rate. At 4cm, yes it's higher than atmo, but it's a fixed flow rate that may be lower than some people are accustomed to under normal awake breathing patterns.

About the comfort of your mask- take a look a http://www.padacheek.com They make very good pads and cushions for masks. I find they greatly help the comfort level of using a mask.
good luck.

Another pretty good night. I'm very relieved and motivated that this is going well for me. I was afraid (as I'm sure most people are) that it was going to take a very long period of adjustment. I got about 6 hours of sleep, with an awake period from about 0100-0215ish. It still seems like the vast majority of my centrals are awake, so still not worried. It does look like the lower pressure limit could be contributing to my waking up in the middle of the night since there are a few events after the pressure decreases right before I know I woke up. I'm going to raise the min to 8 for tonight.

That gap in the middle is where I turned off a session, but I was still on the machine. I took your advice Pugsy and decided that if I'm awake trying to go to sleep for an extended period of time, I'll cycle the machine every 15 minutes or so that way I have sessions to turn off.

My AHIs are definitely coming down. When I select the two sleep periods, it shows about 10 and 7. Room to go but trending down.

Good news, you're trending in the right direct (and a lot more rapidly than many). I suspect that you're one of those (like me), for whom the ramp does more bad than good. When I got my second CPAP (I'm now on #4), I asked for one without a ramp. I was advised that this wasn't available, but that the ramp could be turned off (or set to 0).

Also, try the vinegar thing anyhow. It helps me. BTW, too tight (or too loose) can cause irritation as well. For newbies, too tight is a much more common issue than too loose. If you need to control a leak, think of loosening rather than tightening (I know it's counter-intuitive), and think about the relative tightness of top vs. bottom (i.e. loosen the top instead of tightening the bottom and vice-versa).

compujas wrote:My AHIs are definitely coming down. When I select the two sleep periods, it shows about 10 and 7. Room to go but trending down.

if it were me, I'd set the minimum pressure to 9, (probably needing more like 11)

respironics machines are so slow to react that getting the minimum pressure high enough to take care of most obstructive events is very important.

compujas wrote:I have the regular hose.

Apparently I lied. I do have the heated hose. I just couldn't tell because it's so basic looking. I was looking at my delivery receipt from the DME and it says heated tube, so I looked at the tube connector and it has pins. I guess that's why turning down the temperature actually made a difference in the air temp.

palerider wrote:

compujas wrote:My AHIs are definitely coming down. When I select the two sleep periods, it shows about 10 and 7. Room to go but trending down.

if it were me, I'd set the minimum pressure to 9, (probably needing more like 11)

respironics machines are so slow to react that getting the minimum pressure high enough to take care of most obstructive events is very important.

+1 and I'd be tempted to go straight to 10 and see how it goes, DS are slow and 11 could easily be the next step. I think the clusters of CA at the end and beginning of a sleep period, may be still while you are awake.

The min setting should be closer to the 90% (or 95%) pressure. This means that you were at or under than pressure 90% (or 95%) of the time.

. wrote:The min setting should be closer to the 90% (or 95%) pressure. This means that you were at or under than pressure 90% (or 95%) of the time.

this is only for people that don't understand actual pressure settings.

Last night's data. First time I got to sleep relatively quickly, only woke up once around 0145 and fell back asleep quickly until my alarm at 0520. Any thoughts? Granted it's only one night. My pressure seems to stay pegged at the min for most of the time, so I'm thinking leave it for now and give it a while to see how things go. AHI<5 including my awake period is pretty good compared to where I started. Wondering if I should reduce my flex by 1 just to see if I can tolerate it, but not sure how flex helps or hurts anything besides comfort. Do I stand to gain anything if I reduce it? Or I might try not using the ramp.

Flex is an option for those who find exhaling difficult against whatever pressure they use, but you don't have to use flex unless you need it. One thing to remember if using it is that your AHI is likely to go up by a couple of #'s, but it usually isn't important enough to worry about. That may be what's happening to you, so if you don't need the flex feature, turn it off.

Dang, your AHI has come a long way in just a few days! So awesome to see.

xxyzx wrote:

Julie wrote:Flex is an option for those who find exhaling difficult against whatever pressure they use, but you don't have to use flex unless you need it. One thing to remember if using it is that your AHI is likely to go up by a couple of #'s, but it usually isn't important enough to worry about. That may be what's happening to you, so if you don't need the flex feature, turn it off.

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does that depend on the device ?

i thought they kept the min pressure high enough to keep the airway open
and then had a still higher second pressure which was used so that the flex part kept the min high enough while it lowered it for exhaling easier
at least that is how i read the manual with my device

OMG...I thought you knew everything. Flex is Respironics EPR

My sleep doc advised me that exhalation relief is strictly a matter of personal preference. It is neither directly beneficial nor directly detrimental. It helps or hurts the patient by making the therapy more tolerable or less tolerable. Thus, set it however you feel most comfortable.

The absolute floor on pressure is 4. That is the minimum setting on all machines on the market today. This is considered the minimum pressure to clear exhaled CO2 from the mask. Some very old machines go down to 3, but that's not acceptable anymore.