Pressure Issue?

Greetings all;

I'm new to the CPAP machine, having used it two nights. Both nights I woke up around 0230 or so and felt like my head was going to explode from air being forced into me. My ears were even clogged...you know, like when you are changing altitude in a plane. Is this a situation where I should reduce my max pressure? According to my OSCAR chart, it really isn't that high (I've attached my first night chart, for some reason last night's chart won't import). Both nights I ended up ripping the nasal mask off and being really upset over that feeling, which of course led to no more sleep that night.

My RX pressure is 4-18. I'm using the ramp method of pressure, at 45 minutes.

Thanks in advance for any help.

RSI

Perhaps I should have done some more research before posting. After some google searching, I checked my clinical settings and noticed my EPR was off. Would anyone suggest changing this rather than messing with the pressure as a first step? My sense from the videos I watched is that perhaps the EPR should be on and set to 3?

Thanks for sharing your experience.

RSI

Leave your max pressure alone... it's not relevant, but your min. pressure's very low, so try bumping it to 6 or 7 for a couple of nights to see how it goes (the min's the one that 'counts'). Play with the EPR if you like, but unless you have lots of trouble exhaling, you may not need it at all, or only at a low setting.

By setting the ramp to 45 mins to facilitate the machine going to 4 (the machine's default low) you're getting only partially treated for all that time. Most of us ditch the ramp altogether early on unless e.g. you're someone who has a really hard time adjusting to even 4 when first turning on the machine... it isn't enough pressure to treat anything much.

What is a problem is that your leaks are high... you need to either readjust the mask (but too tight is actually counterproductive) or try others... and full face ones need to be tried lying down as your face changes then.

Your pressure never got higher than 6 during the night...That is a very LOW pressure. It's not going to "blow your head off". You can set the EPR to anything you want, but at your median pressure of 4, it isn't going to do anything for you...Either is the ramp. I think you just need to be patient and learn to tolerate the mask on your face.

rsi wrote: ↑

Sun Nov 10, 2019 11:23 am

Perhaps I should have done some more research before posting. After some google searching, I checked my clinical settings and noticed my EPR was off. Would anyone suggest changing this rather than messing with the pressure as a first step? My sense from the videos I watched is that perhaps the EPR should be on and set to 3?

Thanks for sharing your experience.

RSI

welcome to the zoo! it may sound odd, but raising your minimum, as julie suggests, actually helps. try 6 to start.

as you have stumbled across epr setting may help. i know it has for me. i've been on my journey for 4 years and i still use an epr of 3. it may or may not help you, but it's worth a try.

remember to just make one change at a time and sleep on it. this way, you'll know if it the increase in min pressure OR the epr that helps.

if you could, pleas remain in this thread regarding your therapy as you go forward. makes it easier for folks to keep track.

good luck!

Thank you everyone for your responses. I don't really have any trouble wearing the mask, if you can believe that. After a few minutes I get used to it and don't really feel it anymore.

Julie, or anyone, can you tell me what it my chart indicates a problem with leaks? Is it the 1.72% large leak? Or the leak rate max of 120.00? Or is it the graph with the spikes? Obviously they are all interconnected, but what would I look for to indicate I've solved that issue? The myAir app gave me a 20/20 on my mask seal so I'm confused.

It seems like I have four things to consider:
1. tightening the mask to attempt to eliminate the leak
2. eliminate the ramp
3. bump the minimum pressure
4. consider using the EPR

Since my main goal is to get rid of the pressure feeling in my head, I think I'll try #4 first (along with #1, if you all think that really is an issue). I need to keep the mask on, but that pressure makes me really uncomfortable to the point of panic

Thank you.

RSI

rsi wrote: ↑

Sun Nov 10, 2019 11:08 am

Greetings all;

I'm new to the CPAP machine, having used it two nights. Both nights I woke up around 0230 or so and felt like my head was going to explode from air being forced into me. My ears were even clogged...you know, like when you are changing altitude in a plane. Is this a situation where I should reduce my max pressure? According to my OSCAR chart, it really isn't that high (I've attached my first night chart, for some reason last night's chart won't import). Both nights I ended up ripping the nasal mask off and being really upset over that feeling, which of course led to no more sleep that night.

My RX pressure is 4-18. I'm using the ramp method of pressure, at 45 minutes.

Thanks in advance for any help.

RSI

You're psyching yourself out. you're hitting about 6cm pressure. that's just over 2 inches of water, stick a straw 2 inches into a glass.. blow through that straw, you've just overcome 6cm of pressure... that's *nothing*.

So no, your max pressure shouldn't be reduced, I'd say to increase it.

and what I would do is set your min pressure to 7, with an EPR of 3, and see how that feels to breathe.. EPR won't do you any good at all when your pressure is 4, since even EPR can't drop the pressure under 4. you don't get the full benefit of EPR until you get your pressure up to 7.

One way to get used to the pressure is to use your machine while awake and relaxed watching tv or reading a book. Once you are used to breathing with the machine you won't get that panicked feeling.

Unless the leaks are waking you up they aren't bad enough to worry about. I have ignored much worse.
Now if the leaks are waking you up then that's a different story because it is disturbing your sleep.
They are very brief and aren't going to impact your therapy much if any.

Starting with a few basics.

Ramp is a function that keeps the pressure lower and gradually brings the pressure up. The idea is that if you have a hard time adapting to the pressure, you might fall asleep before it ramps up. It is solely used as a comfort feature -- and typically has the effect of your treatment being at a less than ideal pressure during that time. Your min is 4 and the ramp starts at 4 so...

EPR. This allows you to have a slightly lower pressure on exhale than inhale. But if your pressure is 4, it has no effect. At 7, an epr of 3 would mean a pressure of 7 inhale and 4 exhale.

Context: your pressure is really low. How low? Most standard machines go from 4 to 20. If your pressure was 7.5, this would equal an altitude change of about 200 feet (about 0.1 PSI). The space needle in Seattle is around 600 ft.

That said, a leak can feel like you have a ton of pressure. Or not. Why do you feel like you woke up?

I want to thank everyone for their input.

TropicalDiver wrote: ↑

Sun Nov 10, 2019 4:23 pm

Context: your pressure is really low. How low? Most standard machines go from 4 to 20. If your pressure was 7.5, this would equal an altitude change of about 200 feet (about 0.1 PSI). The space needle in Seattle is around 600 ft.

That said, a leak can feel like you have a ton of pressure. Or not. Why do you feel like you woke up?

I woke up feeling like my head was underwater. I then thrashed around until I took the mask off. When I did that my head and ears cleared up. I understand looking at the pressure numbers that it's really low, so now that I've educated myself a bit, I'm not about to touch the pressure.

babydinosnoreless wrote: ↑

Sun Nov 10, 2019 3:36 pm

One way to get used to the pressure is to use your machine while awake and relaxed watching tv or reading a book. Once you are used to breathing with the machine you won't get that panicked feeling.

Yes, the two nights I read a bit of a book as my sleep routine, with the mask on. Frankly, by the time I put the book down I was probably 30 minutes into my 45 minute ramp. Awake, it isn't a problem at all, it doesn't bother me at all. Asleep, that's different. Probably need to acclimate to it some more, and perhaps turn the ramp off.

Pugsy wrote: ↑

Sun Nov 10, 2019 3:55 pm

Unless the leaks are waking you up they aren't bad enough to worry about. I have ignored much worse.
Now if the leaks are waking you up then that's a different story because it is disturbing your sleep.
They are very brief and aren't going to impact your therapy much if any.

Thank you, that's the sense I had from the sticky post on the newbie area.

When you say "leaks waking me up" would that be because the mask is ineffective and thus the therapy isn't working?

As is, since my pressure is not getting high at all, the therapy is not effective, and I'm not really doing anything here but sticking a mask on my face, and still suffering from apnea. Is my thought process correct?

rsi wrote: ↑

Sun Nov 10, 2019 4:46 pm

When you say "leaks waking me up" would that be because the mask is ineffective and thus the therapy isn't working?

No. I don't mean the therapy isn't working. I just mean that sometimes leaks wake people up simply because they are annoying and they don't necessarily have to be big leaks to be annoying.
Anything that disturbs our sleep is unwanted because sleeping is the primary goal. Some people can sleep through massive leaks and others find that the tiniest of leak wakes them up...won't impact therapy but it sure impacts sleep quality.

Just because your machine doesn't feel the need to go very high to hold your airway open doesn't mean that it isn't effective.
Some people just get lucky and don't need much pressure to prevent the airway from collapsing.
I know people who came out of a titration sleep study only needing 4 cm to hold the airway open...it's not much but it is enough.
And just because some people feel like 6 or 7 cm isn't enough air moving....doesn't mean that everyone feels that way.
All this cpap stuff comes with a huge YMMV sticker.

You have a handful of apnea flags showing up and some of them are right at the same time we know you were awake. We ignore those false positive and even if you were asleep you aren't having enough of them to worry about.
Your therapy is indeed effective in terms of holding the airway open and preventing numerous airway collapses.

Right now your main job is to just do what you can to get used to all this new stuff. Minimize the leaks and you won't feel like the pressure is blowing like crazy. It's all working like it should but your body and brain hasn't had time to get adjusted to the new normal in your life. Give yourself some time....it will come.

I may have missed it, but what type of mask are you using? While the pressure we experience will be the same, sometimes the delivery of that pressure can make a difference. If things don't settle down soon it woudn't hurt to experiment a bit. Some of us old hoseheads with higher pressures feel that a low pressure should be a breeze. I have to remind myself that for a newbie, it is still a change to adjust to. We can't know your particular anatomy that may make you susceptible to ear issues, etc. I'm guessing much of this will resolve after a period of adjustment, but it seems you're getting good advice regarding EPR and ramp use. Most masks either come with or there is available online a fitting guide to help optimize your mask fit. Some do better when looser, some not. I wouldn't automatically say to tighten it. If your ears are prone to being sensitive to pressure, just thinking out loud here, but seems keeping your apneas and hypopneas to a minimum should be a priority for you. Don't want air coming in with nowhere to go. As to leaks, the machines are designed to compensate for a degree of leaking so that treatment remains therapeutic. Your machine manual will probably tell you your machine's specifics on at what leak rate therapy is compromised. The other aspect of leaks is the sound or feel of leaks can disrupt sleep. If you are sleeping through them and the machine is still effective, then they are not so much of an issue. What we can't know is if we are experiencing sleep stage disruptions with the leaks without actually waking, which could affect our quality of sleep and sense of feeling rested. Good luck with things.
Note: I see you had another post while I was typing. Please excuse any redundancy.