CPAPtalk.com

palerider wrote: ↑

Mon May 11, 2020 9:07 pm

Goofproof wrote: ↑

Mon May 11, 2020 7:53 pm

Elite, should be called what it is, E-Lite, Light, means they left out the useful parts that informed people how to better treat Sleep Apnea.

You're wrong, the Elite is a full data machine, it's just not an AUTO machine. It is NOT a brick.

I stand guilty as charged, Never owned a Resmed XPAP, never will, what is the name of their Brick Unit.... Jim

Read, and .... LEARN before posting next time:

wiki/index.php/CPAP_models

palerider wrote: ↑

Mon May 11, 2020 10:13 pm

. . .
wiki/index.php/CPAP_models

Thank you for posting that.
It needs to be a sticky--IMHO.

Miss Emerita wrote: ↑

Mon May 11, 2020 7:50 pm

Could you describe the build up some more? Is air building up in your mouth? Do you have a feeling of exertion in your chest when you breath out? Do you feel like the machine is fighting you when you start to breath out?

Also, is your nose clear, or do you have congestion?

I do notice it more when I am even slightly congested, maybe that is part of the problem. I do suffer from allergies from time to time and when I do it is virtually impossible for me to use a CPAP. That's when the mouthguard thing comes out.

I don't know if I should have used the word "buildup." I know in my head that it's not that much pressure - as someone noted above, it's not even what it would take to blow bubbles in a straw! It's just that the sensation of pressure I find quite uncomfortable, and though I can force myself to keep breathing through my nose when I'm awake, as I start to drift off I have an involuntary reaction which is opening my mouth to release the pressure. But of course, that leads to a loud explosion of air and a weird sensation of having air forced down my nose, up my throat and out my mouth, and that usually wakes me up.

The end result is that it takes me forever to fall asleep using the machine. I do sleep noticeably better once I fall asleep, which is why I often use melatonin to make me drowsy. That way I can get past the sleepiness part into full sleep, when the machine doesn't wake me any more.

I suspect if I could ever just get past this enough to get used to it, maybe a few weeks of everyday use, that I'd get accustomed and stop struggling to fall asleep with the machine on, but I haven't done that yet.

NotMyName wrote: ↑

Tue May 12, 2020 9:14 am

maybe a few weeks of everyday use, that I'd get accustomed and stop struggling to fall asleep with the machine on,

That's the case with many newbies. Here are hopes that your adjustment period is very short.

Thanks for the additional description of the issue. Here are a couple of things you might consider trying.

* It sounds as though you have a nasal mask or a nasal pillow mask. You might consider a full-face mask, at least for the times when your nose is feeling congested. There are some pretty minimalist ones out there; take a look on CPAP.com and see if anything looks feasible.

* Try using Flonase for the stuffy nose. It can take a few weeks to kick in, so give it time.

* Try NeilMed sinus rinse. Be sure to use it well after you use Flonase but at least a couple of hours before you go to bed.

* Ask your doctor for prescription medication to help keep your nose clear. Be sure to mention that you are trying to succeed with CPAP. For example, I am using Singulair pills plus Azelastine spray, in addition to Flonase.

* Work on positioning your tongue so it will prevent air from going into your mouth. Put the tip of your tongue behind your upper front teeth, and let your tongue spread out from side to side. Then press it up against the roof of your mouth, doing a little suck/swallow to create a little bit of suction. You can practice this during the day, which helps with night-time experiences.

* If part of the problem is that your jaw drops down, try a soft cervical collar to help keep it in place.

Do any of these sound as though they might be relevant for you?

NotMyName wrote: ↑

Mon May 11, 2020 7:12 pm

As a followup question, would an APAP or BiPAP machine really make a big difference to solve the problem I am talking about?

There are several flavor axes.

• Data-capable or non-data-capable (brick)
• Auto (pressure changes with flagged events) or fixed (pressure stays the same regardless of flagged events)
• Machines that can reach 20cm pressure (fits most peoples' needs) or machines that can reach 30cm pressure plus a few added capabilities like bilevel

That's grossly simplified, but for most of us, a data-capable auto machine that can reach 20cm pressure is the best tool for the job.

Bilevel machines (Like a BiPap or an AirCurve Vauto) can reach up to 30cm pressure and come in both fixed and auto flavors, as well as data-capable. For most newer model bilevel machines, you're going to want a data-capable auto because a brick at that price range is preposterous.

Data-capable auto machines are better than fixed for these reasons:

• It makes it easier for someone to self-titrate at home, like we do on this forum.
• It makes it easier for people with positional differences in AHI to use a range of pressure than it is to be restricted to a single pressure regime.
• Most auto machines can be set to emulate a fixed machine. Fixed machines can never emulate auto.
• Data allow us to review what happened when during the night, pinpointing challenges that can help you determine the course of your therapy.

Whether you need the more expensive bilevel or something more nuanced is specific to what your data suggest, even when viewing data from a DreamStation Auto or an Airsense 10 Autoset.

So yes. Data-capable Auto is better.

Chris

Miss Emerita wrote: ↑

Tue May 12, 2020 11:12 am

Thanks for the additional description of the issue. Here are a couple of things you might consider trying.

* It sounds as though you have a nasal mask or a nasal pillow mask. You might consider a full-face mask, at least for the times when your nose is feeling congested. There are some pretty minimalist ones out there; take a look on CPAP.com and see if anything looks feasible.

* Try using Flonase for the stuffy nose. It can take a few weeks to kick in, so give it time.

* Try NeilMed sinus rinse. Be sure to use it well after you use Flonase but at least a couple of hours before you go to bed.

* Ask your doctor for prescription medication to help keep your nose clear. Be sure to mention that you are trying to succeed with CPAP. For example, I am using Singulair pills plus Azelastine spray, in addition to Flonase.

* Work on positioning your tongue so it will prevent air from going into your mouth. Put the tip of your tongue behind your upper front teeth, and let your tongue spread out from side to side. Then press it up against the roof of your mouth, doing a little suck/swallow to create a little bit of suction. You can practice this during the day, which helps with night-time experiences.

* If part of the problem is that your jaw drops down, try a soft cervical collar to help keep it in place.

Do any of these sound as though they might be relevant for you?

Thank you to all of you! (not just Miss Emerita, but it's a pain to multiquote so I'm just going to do hers).

I have actually used a mouthguard thing that my dentist did for me called Silent Nite, which is designed to pull the lower jaw forward during sleep to minimize snoring. It helped tremendously at first, although it still allows me to sleep for the most part (my wife doesn't think I'm going to die 10x/night!) it doesn't fix all my problems. I wonder if the combination of a nasal pillow plus the mouthguard might not be an option?

And DD, your post explaining the differences between machines is also very helpful. It sounds to me like the main purpose of an APAP is to increase pressure during events (thus allowing for a lower constant pressure), and NOT, as I had thought, to decrease pressure during breathing out. Is that accurate?

If your primary problem is the pressure when exhaling have you ever tried using exhale relief? With a ResMed machine you can have up to a 3 cm drop during exhale which can sometimes be a huge relief for some people....either when using a fixed cpap setting or an apap/auto adjusting setting. Exhale relief is a drop with each breath during exhale.

NotMyName wrote: ↑

Tue May 12, 2020 4:08 pm

And DD, your post explaining the differences between machines is also very helpful. It sounds to me like the main purpose of an APAP is to increase pressure during events (thus allowing for a lower constant pressure), and NOT, as I had thought, to decrease pressure during breathing out. Is that accurate?

Edit: Short answer, Yes.

Auto-style machines generally use the lowest pressure that will resolve Obstructive Apnea, Hypopnea, Flow Limitations, and perhaps other events, by keeping the airway open, per the machine's internal algorithms. In general, when most of us sleep on our sides, the pressure needed to resolve events is lower than when we sleep on our backs. The auto-style machine doesn't know if you've turned on your back, but it can recognize that you have had a pressure-worthy event and raise the pressure accordingly when you're on your back and keep the pressure at a high enough pressure to resolve events while you're on your back. If you again turn onto your side, and fewer events happen, the pressure slowly goes lower, making it easier for you to sleep on our side. A straight CPAP can't move the low pressure limit. It's fixed. So if you turn on your side or your back, there is no change in pressure.

The two most popular machine makers are ResMed and Phillips Respironics. The ResMed brand is the most popular because of its superior, smoother algorithm for most people. Respironics tends to have a coarser approach to all of its algorithms. From experience, for me Respironics algorithm causes wake triggers. However, there are a fair number of users who prefer Respironics, so there may be something to be said for a coarser approach. Also, there are a few users for whom straight CPAP really is better than auto, but if you have an auto, you can always set your auto machine to emulate a straight CPAP. You can't make your straight CPAP emulate an auto.

Of the popular brands -- brick, data-capable, straight cpap, auto, other more advanced machines -- all flavors include some form of exhale pressure relief even if it's called something else. For the machines with pressures that can reach up to 20cm pressure, that's limited by a simple algorithm.

For Resmed brand, it's simple. 0 equals no pressure relief. It's off. Settings 1 to 3 equal the same number of cm H20 in pressure relief. So if your minimum pressure is 12cm on inhale and your Exhale Pressure Relief (EPR) is set to 2, your exhale pressure will be 12-2 = 10cm H20. It's still pushing, but just 2cm lower than the set minimum on exhale, pretty helpful for some users. There are caveats and twists, but that's the gist of it for ResMed machines.

For Respironics, they use something called Flex, which comes in more than one flavor. It includes settings 0 through 3, but they are not equivalent to cm H20. They do actually provide a slightly lower exhale pressure according to Respironic's site, but the algorithm is more complex and can be a little unsettling for some.

For machines that can reach as high as 30cm pressure, there are some additional settings for pressure relief that are more complicated but can be valuable relief for patients that require very high pressures, or for some patients with lower pressures that require more than the equivalent of 3cm exhale pressure relief. The more expensive of these can be set to emulate an auto or straight cpap as well.

Chris

NotMyName wrote: ↑

Tue May 12, 2020 4:08 pm

And DD, your post explaining the differences between machines is also very helpful. It sounds to me like the main purpose of an APAP is to increase pressure during events (thus allowing for a lower constant pressure), and NOT, as I had thought, to decrease pressure during breathing out. Is that accurate?

Let me paraphrase DD's many paragraphs.

"yes".