Settings adjustment suggestions for newbie?

Hi kind cpaptalk forum folk.

I'm a newbie and like lots of people, am having a very hard time getting started with CPAP. I actually described my 3rd night as "horrific".

I would be very very grateful if someone would be so kind as to look at my symptoms and settings and suggest some changes. I have an SD card reader on order and will start using OSCAR as soon as it comes in tomorrow.

Symptoms:
With the P10 mask, my nostrils became extremely sore, red, and had oozing/flaking skin after 2 nights. I have a keloid scar under my left nostril that is very irritated. Switching from medium to small pillows helped little, but not much. A new N30 mask is on order to see if that helps.

I feel like I'm suffocating when I use it, in multiple ways:
1. I feel like I'm being forced to breathe more rapidly than I want to, so I turned off the pressure relief after 2 nights of that.
2. I also feel like I can't exhale sufficiently, with pressure relief on or off.
3. If the ramp is on, I feel like I don't get enough air when trying to get to sleep, so I turned off the ramp function.

After the 2nd night I woke with a terrible dry mouth so I started taping on the 3rd night with somnifix. This doesn't bother me too much.

But! When I use the tape, once I finally start dropping off to sleep, my mouth fills with air and I startle wake up because I'm not exhaling. This causes mild aerophagia as well. I basically did this over and over again for 3.5 hours on the 3rd night till I took the mask off.

Normally I'm a side sleeper but at the moment, I have to sleep on my back due to recovering from a knee replacement a few weeks ago (sports damage).

Hardware:
Resmed Airsense 10 Autoset
P10 mask

User settings:
Ramp Time: Off
Climate Control: Manual
Tube Temp.: Off (I can't tolerate breathing warm air)
Humidity Level: 1 (I dislike breathing humid air - nose doesn't seem dry at this setting)
Pressure Relief: Off

Clinician settings:
Max Pressure: 20.0
Min Pressure: 10.0
Response: Standard
EPR: On
EPR Type: Full Time
EPR Level 2

Any advice would be greatly appreciated!

takver wrote: ↑

Thu Apr 06, 2023 8:39 pm

With the P10 mask, my nostrils became extremely sore, red, and had oozing/flaking skin after 2 nights. I have a keloid scar under my left nostril that is very irritated. Switching from medium to small pillows helped little, but not much. A new N30 mask is on order to see if that helps.

When I first started using the P10, it made my nose hurt SOOO bad after just a couple hours.

The folks here recommended lanolin, specifically the Lansinoh brand that you find in the nursing mothers aisle at the pharmacy, it only takes a tiny amount, like the amount of a BB, and that helped immensely, after a couple weeks of use, I didn't need the lanolin anymore. The stuff does work really well for chapped lips in the winter, or if your nose gets sore from a cold though.

takver wrote: ↑

Thu Apr 06, 2023 8:39 pm

I feel like I'm suffocating when I use it, in multiple ways:
1. I feel like I'm being forced to breathe more rapidly than I want to, so I turned off the pressure relief after 2 nights of that.

You are *NOT* being forced to breathe at any speed, that's something you need to tell yourself very sternly, the machine follows you, purely and completely, breathe how you want to, the machine will follow.

takver wrote: ↑

Thu Apr 06, 2023 8:39 pm

2. I also feel like I can't exhale sufficiently, with pressure relief on or off.

That's where pressure relief can help.

takver wrote: ↑

Thu Apr 06, 2023 8:39 pm

3. If the ramp is on, I feel like I don't get enough air when trying to get to sleep, so I turned off the ramp function.

Many people don't like ramp.

takver wrote: ↑

Thu Apr 06, 2023 8:39 pm

This causes mild aerophagia as well.

Air in your mouth doesn't cause aerophagia. Part of the poor 'design' of the human respiratory system is that the 'air pipe' crosses over with the 'food pipe' in the back of your oral cavity, so anytime you're breathing, the air's going through the 'food' passage, (which is part of why you can breathe through your nose or mouth, depending on what's going on in the back of your throat. the same structures are what enables you to blow up a balloon without all the air coming out of your nose, (except in reverse).

The best advice is to 'just keep at it', and I hope that the responses might help a little.

Hey,

I was in a similar boat to you, I think it's natural to hope for immediate results (and some people are lucky and get this!) but the majority of us don't!

My nose was painful for the first week or two but now it doesn't hurt at all.

Personally, I'd try turning EPR to 2, this will reduce pressure when you breathe out and might get you used to the sensation of breathing with the machine.

Also, you might find the ramp function to be useful - especially in the early stages of getting used to the machine.
My ramp was set to full time at 8 and after a few weeks I increased it to 14.

It's all about getting your body and brain used to using the machine, it's a learning journey.

Youtube has good videos about fitting and adjusting your mask models.

takver wrote: ↑

Thu Apr 06, 2023 8:39 pm

Hi kind cpaptalk forum folk.

I'm a newbie and like lots of people, am having a very hard time getting started with CPAP. I actually described my 3rd night as "horrific".

On my third night of PAPing, I had a disturbing dream of being an intelligent goose being fattened up for foie gras by being forced to breath in more and more and more air than I could possibly take in. I also woke up feeling like I'd swallowed a basketball and my stomach was rock hard and swollen from the excess air.

It gets better. For some people the journey takes more time than for others.

Symptoms:
With the P10 mask, my nostrils became extremely sore, red, and had oozing/flaking skin after 2 nights. I have a keloid scar under my left nostril that is very irritated. Switching from medium to small pillows helped little, but not much. A new N30 mask is on order to see if that helps.

Lanisoh might help. But I think the switch to the N30 is also wise since the N30 rests against the nose in a different way.

You say your settings are:

User settings:
Ramp Time: Off
Climate Control: Manual
Tube Temp.: Off (I can't tolerate breathing warm air)
Humidity Level: 1 (I dislike breathing humid air - nose doesn't seem dry at this setting)
Pressure Relief: Off

Clinician settings:
Max Pressure: 20.0
Min Pressure: 10.0
Response: Standard
EPR: On
EPR Type: Full Time
EPR Level 2

You also say:

I feel like I'm suffocating when I use it, in multiple ways:
1. I feel like I'm being forced to breathe more rapidly than I want to, so I turned off the pressure relief after 2 nights of that.
2. I also feel like I can't exhale sufficiently, with pressure relief on or off.
3. If the ramp is on, I feel like I don't get enough air when trying to get to sleep, so I turned off the ramp function.

Turning the ramp off was reasonable. Although given that your Min pressure is 10cm, I'm wondering if you might do better by setting the ramp pressure up to something like 7 or 8cm. The default beginning ramp pressure is 4cm, but many DMEs set up the beginning ramp pressure to be 5cm. Almost none of them set the beginning ramp pressure higher than 5, but for someone like you, beginning with a ramp pressure of 7 or 8 cm may help with item #2.

For item #1: Did turning EPR off help with the feeling like you are being forced to breathe more rapidly than you want to? And did this get better or worse when you turned the ramp off?

For item #2: As for not being able to exhale sufficiently, even with the pressure relief on, I've got more questions than ideas at this point. Have you tried bumping EPR up to 3 instead of just turning it off? Does that make things better or worse? Also worth asking, what was your beginning Ramp pressure when you were using it? You might find starting with a Ramp pressure of 7 or 8cm is enough to feel like you have enough air coming in through the mask, but also the pressure is sufficiently low for you to exhale fully.

Also, as silly as it sounds, you need to report this combination of problems to your sleep doctor:

(1) Using the ramp makes me feel like there's not enough air coming in through the mask to inhale comfortably enough to get to sleep.
(2) I can't seem to exhale fully regardless of whether I'm using the ramp or not and regardless of whether I'm using EPR or not.
(3) Using EPR makes me feel like the machine is encouraging me to inhale before I'm done exhaling, and so I feel like I'm breathing too rapidly to get to sleep.

The sleep doc's office is most likely going to say "keep trying", but it's important to establish there IS a problem that is making it difficult for you to get to sleep.

In my case, I could not exhale fully (even at low pressures) and EPR made me feel like the machine was trying to make me inhale before I was ready to. That combined with aerophagia and some super severe insomnia problems that set in after Night 3's Goose Dream were enough for the sleep doc's PA to recommend a switch to bi-level after several weeks of misery and increasing insomnia. Fortunately for me, bi-level felt much, more more comfortable: The feeling that the machine was rushing my inhalations completely disappeared.

After the 2nd night I woke with a terrible dry mouth so I started taping on the 3rd night with somnifix. This doesn't bother me too much.

But! When I use the tape, once I finally start dropping off to sleep, my mouth fills with air and I startle wake up because I'm not exhaling. This causes mild aerophagia as well. I basically did this over and over again for 3.5 hours on the 3rd night till I took the mask off.

Aerophagia is a bitch. Report that you are having aerophagia problems to the sleep doc. Again, in the short run, it's not going to do anything. But if the problem persists and gets worse, this can be used as a justification for moving you to bi-level. And for some people, bi-level helps with the aerophagia. (In my case, bi-level has not totally eliminated aerophagia problems, but it's gone from a constant, nightly problem that disturbed my sleep multiple times a night to an occasional problem that I can live with.)

Your mouth is filling with air because your tongue has moved out of position. If the hump of your tongue stays parked on the roof of your mouth with the tip firmly planted against the back of your upper incisors or the gum line for those teeth, that effectively blocks off the oral cavity from the nasal cavity and prevents air from getting into your mouth.

The fact that you are having problems exhaling against the pressure just adds to the problem: That air coming out of your lungs has to go somewhere, and my guess is that you are subconsciously wanting to open your mouth and let out the excess air and exhale that way. The dry mouth on night 2 fits this scenario as well.

You could try reducing the minimum pressure just a bit. Or you could try reducing the maximum pressure a bit. Or both. But until you've got the SD card and can look at things in Oscar, it will be hard to tell if reducing one or both pressure settings winds up allowing too many OAs, Hs, snoring, and/or flow limitations to get through.

Normally I'm a side sleeper but at the moment, I have to sleep on my back due to recovering from a knee replacement a few weeks ago (sports damage).

How long will you have to sleep on your back? The back sleeping may be making it a bit harder to keep the tongue in place, which triggers the air getting into your mouth and stomach. The back sleeping may also be making the machine increase the pressure higher than it would if you could sleep on your side---many people's apnea is worse on their back and more pressure is often needed to keep the airway open when someone is sleeping on their back.

palerider wrote: ↑

Thu Apr 06, 2023 11:42 pm

takver wrote: ↑

Thu Apr 06, 2023 8:39 pm

I feel like I'm suffocating when I use it, in multiple ways:
1. I feel like I'm being forced to breathe more rapidly than I want to, so I turned off the pressure relief after 2 nights of that.

You are *NOT* being forced to breathe at any speed, that's something you need to tell yourself very sternly, the machine follows you, purely and completely, breathe how you want to, the machine will follow.

Yes, I know the truth of what you are saying palerider.

But (and this is a huge but) ....

As someone who when through months of feeling like my old Resmed S9's EPR was rushing my inhalations by starting to increase the pressure ever so slightly before I felt like I was actually inhaling, it is very, very difficult to just "tell yourself very sternly, the machine follows you, purely and completely, breathe how you want to, the machine will follow" when your actual experience while being half asleep does NOT support that feeling.

What I mean by this is simple: Sternly telling yourself stuff while trying to get to sleep is a good way of preventing you from getting to sleep. No one likes to be scolded, and scolding yourself as you are trying to get to sleep for feeling like the machine is "rushing" you to inhale is not likely to make it easier to fall asleep.

In my case, the switch to a PR System One BiPAP and having Bi-Flex turned OFF and Rise Time set to 3 totally eliminated the feeling the machine was trying to encourage me to inhale before I was ready to.

And now that I'm using a Resmed AirCurve 10 VAuto? I had to change the trigger and cycle settings from the default of Medium in order to get the machine to follow my breathing pattern. At the "Medium" settings (which seems to mimic EPR), I still find myself detecting a small, but perceptible increase in pressure before I feel like I'm ready to inhale.

robysue1 wrote: ↑

Fri Apr 07, 2023 8:05 am

palerider wrote: ↑

Thu Apr 06, 2023 11:42 pm

takver wrote: ↑

Thu Apr 06, 2023 8:39 pm

I feel like I'm suffocating when I use it, in multiple ways:
1. I feel like I'm being forced to breathe more rapidly than I want to, so I turned off the pressure relief after 2 nights of that.

You are *NOT* being forced to breathe at any speed, that's something you need to tell yourself very sternly, the machine follows you, purely and completely, breathe how you want to, the machine will follow.

Yes, I know the truth of what you are saying palerider.

But (and this is a huge but) ....

As someone who when through months of feeling like my old Resmed S9's EPR was rushing my inhalations by starting to increase the pressure ever so slightly before I felt like I was actually inhaling,

You have confused the S9 EPR and the Respironics cflex or aflex, because EPR *does not raise pressure until after you've initialed a breath* I can promise you that. I have pressure trace recordings of that. *flex is documented to raise pressure towards the end of the exhalation, "to get ready for the next inhalation", and that has confused MANY people, feeling like they're being rushed to breathe.

Resmed *does not do this*, I 100% guarantee it.

robysue1 wrote: ↑

Fri Apr 07, 2023 8:05 am

What I mean by this is simple: Sternly telling yourself stuff while trying to get to sleep is a good way of preventing you from getting to sleep. No one likes to be scolded, and scolding yourself as you are trying to get to sleep for feeling like the machine is "rushing" you to inhale is not likely to make it easier to fall asleep.

However, the OP has a Resmed, so it is *NOT* rushing him, in any way. If there's a perception of the machine rushing the OP, it's a mis-perception, and that's why I said to just say "NO! I'm going to breathe the way I want to, and YOU WILL FOLLOW ME!

robysue1 wrote: ↑

Fri Apr 07, 2023 8:05 am

And now that I'm using a Resmed AirCurve 10 VAuto? I had to change the trigger and cycle settings from the default of Medium in order to get the machine to follow my breathing pattern. At the "Medium" settings (which seems to mimic EPR), I still find myself detecting a small, but perceptible increase in pressure before I feel like I'm ready to inhale.

I believe that if you check the flow and mask pressure traces carefully, you'll find that the machine is not initiating a breath before you do, because there is no timing, at all, in that machine to initiate a breath, you have to have a ST machine, in T mode, an ASV, or an iVAPS (ST-A) machine (as far as Resmed's go) before it will do *anything* until it is triggered by the patient starting an inhalation.

Wow! Thank you ALL so very much for taking the time to write such detailed thoughtful replies. It is so appreciated and hearing other people's experiences with the P10 mask really made me feel better to know I'm not the only one.

Last night I made a few tweaks, and was able to use the mask for 7+ hours and got some data. I lowered the min pressure to 8, turned on pressure relief, upped the humidity from 1->3, turned the ramp time on to 5 minutes & ramp starting pressure to 5. Did get up in the middle of the night to replace the small nasal pillows with the medium because the noise from an air leak was making me crazy. The noise went away with the mediums. This all seemed to be a bit better in terms of not feeling as much like I was suffocating, and I had no aerophagia.

I also did some digging through my sleep study reports. My initial home sleep study came back with an AHI of 20, all OSA & no CAs, and no mention of hypopneas.

The next home study to calibrate the CPAP machine came back with an AHI of 12.2 broken down as: 0.8 CA, 0.4 OSA, 11 hypopneas.

Last night my AHI was 3.94 with 1 OSA event and 27 CA events. Maybe I'm one of the "lucky" ones that has the treatment-emergent CA problem?

Here is a screenshot of the OSCAR data from last night. Any suggestions or thoughts?


I'll have to sleep on my back till my knee stops hurting when I lay on my side. It is getting better & I can tolerate maybe 30 minutes on my sides at a time now.

And also, thank you all for the suggestion of contacting my sleep doc. It may sound dumb, but I just kinda feel like I was given the "oh, you have sleep apnea, here have a cpap, bye!" treatment. Will be contacting them.

You might try reducing or turning EPR off and see if it affects the number of centrals or not.
Even if it doesn't help....with some time those centrals might reduce on their own and even if they don't you aren't having enough of them for the doctors to want to try a different machine.

takver wrote: ↑

Fri Apr 07, 2023 7:34 pm

And also, thank you all for the suggestion of contacting my sleep doc. It may sound dumb, but I just kinda feel like I was given the "oh, you have sleep apnea, here have a cpap, bye!" treatment. Will be contacting them.

NOT dumb! we have all been there. not sure just why the docs do that. are they under the thrall of the companies that sell cpap equipment? are they just seeing too many patients?

who knows. but it's the very reason this forum exists. we understand that sleep apnea therapy is a very personal thing and as such must be individually tailored. what works for thee may not necessarily work for me and of course vice versa.

continued good luck!

takver wrote: ↑

Fri Apr 07, 2023 7:34 pm

I just kinda feel like I was given the "oh, you have sleep apnea, here have a cpap, bye!" treatment. Will be contacting them.

If the "medical money system" did a *good* job of taking care of sleep apnea patients, these forums wouldn't exist because nobody would be having problems!

palerider wrote: ↑

Fri Apr 07, 2023 2:08 pm

You have confused the S9 EPR and the Respironics cflex or aflex, because EPR *does not raise pressure until after you've initialed a breath* I can promise you that. I have pressure trace recordings of that. *flex is documented to raise pressure towards the end of the exhalation, "to get ready for the next inhalation", and that has confused MANY people, feeling like they're being rushed to breathe.

Resmed *does not do this*, I 100% guarantee it.

palerider,

You and I have had this argument about my perception of EPR many times before.

Yes, I know that EPR is not supposed to increase the pressure before the inhalation starts.

But the way it felt (and still feels) to me is that EPR does subjectively feel like it's increasing the pressure before I am ready to start inhaling. I suspect that the problem is that I often have a very slight "almost pause" between the time when I can tell that I am clearly exhaling and the time when I can tell that I am clearly inhaling when the airflow into my lungs is so very slight that it does not feel like I have started an inhalation to my brain, but there's just enough airflow to be barely perceptible as an inhalation to the EPR algorithm. And once the pressure is increasing, I feel like the machine is telling my body to "hurry up and inhale and inhale more deeply RIGHT NOW". In other words, I feel like the machine is rushing my inhalation to become deeper more quickly than I want to be inhaling. And that is a very, very uncomfortable feeling when I'm lying in bed fighting insomnia in an effort to get to sleep (or get back to sleep).

And regardless of what Resmed's documentation says about EPR, the perception that a Resmed machine with EPR encourages me to inhale sooner (and deeper) than I want to inhale is a very real physical perception. Now, I grant that this perception is far, far worse with PR's Flex algorithm. But this perception is definitely there with Resmed's EPR algorithm and my natural breathing pattern. Heck, if I have my trigger set to medium on the AirCurve 10 VAuto, I still feel like the machine is encouraging me to inhale sooner (and deeper) than I want to inhale. But when I've got trigger set to high I don't have that same perception.

The sad fact is we're sometimes stuck with how our body perceives what is going on even when that perception is not logical. And I know what I feel with Resmed's EPR algorithm. It's no where near as bad as PR's Flex algorithm, but the fact is that EPR has never felt comfortable or natural to me. And before tweaking the trigger and cycle settings on my AirCurve VAuto from their default settings of medium, the transition between EPAP and IPAP on the VAuto did not feel comfortable or natural to me. Tweaking Trigger to high and Cycle to very high has allowed the transition between EPAP and IPAP to feel reasonably comfortable and reasonably natural. But those tweaks do mean the AirCurve 10 VAuto delays the transition from EPAP to IPAP very slightly and speeds up the transition from IPAP to EPAP very slightly with the result being that the peak IPAP happens at a point in my breath cycle that is much more comfortable than when Trigger and Cycle are both set to medium.

One of the most interesting (and long) discussions about my perceptions of EPR vs bi-level goes all the way back to -SWS's comments on this very old thread about comparing EPR to bilevel's PS. Unfortunately -SWS's images of the subtle difference between when the Resmed's EPR algorithm on the S9's and when the Resmed's VAuto's "PS" algorithm start the increase in pressure is no longer there. But -SWS did find a slight difference in the timing of the start of the pressure increase that is just enough to account for my perceptions of the differences between the two algorithms. And the V-shaped "notch" -SWS talks about showing up in those missing images is quite clear in my Aircurve 10 VAuto mask pressure data.

robysue1 wrote: ↑

Fri Apr 07, 2023 8:05 am

What I mean by this is simple: Sternly telling yourself stuff while trying to get to sleep is a good way of preventing you from getting to sleep. No one likes to be scolded, and scolding yourself as you are trying to get to sleep for feeling like the machine is "rushing" you to inhale is not likely to make it easier to fall asleep.

However, the OP has a Resmed, so it is *NOT* rushing him, in any way. If there's a perception of the machine rushing the OP, it's a mis-perception, and that's why I said to just say "NO! I'm going to breathe the way I want to, and YOU WILL FOLLOW ME!

In other words, you are encouraging the OP to just get mad at the machine. Or you are telling the OP that his perception of what's going on should just be ignored because his perception doesn't match your description of the reality of what's going on and he needs to just ignore what his own body is telling him.

In either case, that's not really helpful: If you are uncomfortable and trying to get to sleep sleep, but something feels wrong with your breathing, it doesn't much matter that what you are feeling doesn't match the technical specs of the algorithm your machine is using. You're still uncomfortable and your breathing still doesn't feel right to you no matter how many times you try to tell yourself that the machine is not "rushing" you to inhale. And because you're still uncomfortable, it's much harder to get to sleep than it should be.

robysue1 wrote: ↑

Fri Apr 07, 2023 8:05 am

And now that I'm using a Resmed AirCurve 10 VAuto? I had to change the trigger and cycle settings from the default of Medium in order to get the machine to follow my breathing pattern. At the "Medium" settings (which seems to mimic EPR), I still find myself detecting a small, but perceptible increase in pressure before I feel like I'm ready to inhale.

I believe that if you check the flow and mask pressure traces carefully, you'll find that the machine is not initiating a breath before you do, because there is no timing, at all, in that machine to initiate a breath, you have to have a ST machine, in T mode, an ASV, or an iVAPS (ST-A) machine (as far as Resmed's go) before it will do *anything* until it is triggered by the patient starting an inhalation.

Again, I know that the VAuto's algorithm is technically following my breathing when it transitions between EPAP and IPAP. But the Trigger setting controls how strong the inhalation airflow needs to be before the machine goes from EPAP to IPAP. If Trigger is set to High, the machine waits to increase the pressure until the airflow into your lungs is just a bit stronger than when the machine will increase the pressure to IPAP when Trigger is set to Medium. And in my case that's just enough of a delay to help me feel like the machine is no longer rushing me to inhale.

In other words, the machine's perception of when I start to inhale and my perception of when I start to inhale is not the same: My body needs to detect more airflow into my lungs to say "Yep, I'm inhaling now" than a very small positive airflow; but the Resmed machine will say I'm inhaling as soon as the airflow into my lungs is a tiny bit above 0. The problem is that my body and the machine have different definitions of what it means to start my inhalation. While the machine's definition is technically correct, the fact that it does not agree with my body's (technically incorrect) definition of "I'm inhaling now" is what causes the feeling that the machine is rushing me to inhale faster than I want to inhale. And maybe I'm just not clever enough, but I just can't seem to order my body to feel differently about when an inhalation begins when I'm also trying to get to sleep. Fortunately for me, the VAuto allows me to tweak the Trigger and Cycle settings so that the transitions from IPAP to EPAP do feel more normal to me than EPR ever felt.

robysue1 wrote: ↑

Fri Apr 07, 2023 10:32 pm

And regardless of what Resmed's documentation says about EPR,

I'm not talking about Resmed's documentation, I'm talking about the *data* from the machines.

You can perform an experiment, just hold your breath, and it'll sit at the EPAP as long as you hold your breath, it *will not increase pressure at all* much less go to IPAP.

robysue1 wrote: ↑

Fri Apr 07, 2023 10:32 pm

One of the most interesting (and long) discussions about my perceptions of EPR vs bi-level goes all the way back to -SWS's comments on this very old thread about comparing EPR to bilevel's PS. Unfortunately -SWS's images of the subtle difference between when the Resmed's EPR algorithm on the S9's and when the Resmed's VAuto's "PS" algorithm start the increase in pressure is no longer there. But -SWS did find a slight difference in the timing of the start of the pressure increase that is just enough to account for my perceptions of the differences between the two algorithms. And the V-shaped "notch" -SWS talks about showing up in those missing images is quite clear in my Aircurve 10 VAuto mask pressure data.

We agree on so many things, it's a shame that we can't agree on this one.
Which of the top two traces here are from a VPAP Auto and which are from a S9? Don't read the fine print, just tell look at the waveforms.

I see the "v-notch" that you're talking about, which occurs *sometimes*, but it's not a standard artifact.

robysue1 wrote: ↑

Fri Apr 07, 2023 10:32 pm

robysue1 wrote: ↑

Fri Apr 07, 2023 8:05 am

What I mean by this is simple: Sternly telling yourself stuff while trying to get to sleep is a good way of preventing you from getting to sleep. No one likes to be scolded, and scolding yourself as you are trying to get to sleep for feeling like the machine is "rushing" you to inhale is not likely to make it easier to fall asleep.

However, the OP has a Resmed, so it is *NOT* rushing him, in any way. If there's a perception of the machine rushing the OP, it's a mis-perception, and that's why I said to just say "NO! I'm going to breathe the way I want to, and YOU WILL FOLLOW ME!

In other words, you are encouraging the OP to just get mad at the machine. Or you are telling the OP that his perception of what's going on should just be ignored because his perception doesn't match your description of the reality of what's going on and he needs to just ignore what his own body is telling him.

I'm telling the OP that the key to success, like so many other thing to do with CPAP success is to have the right mindset. I'm telling him that it's VERY easy to misunderstand something that's happening, and let that psych them out.

This happens all the time with new people, like those that are ranting about the "gale force winds" that will "blow the mask across the room", which is purely hyperbole, and does *nothing* at all to help them. Letting them achieve a more mindful state by telling them the *facts*, like a CPAP is too weak to blow up a balloon, or sticking a straw 8" into a tall glass of water and blowing bubbles means they've overcome more pressure than the CPAP can produce *HELPS* them in their journey into the CPAP life by understanding that their *PERCEPTIONS* were wrong, and that they can overcome them.

No matter what you perceive, or they perceive, the Resmed machine is *NOT* rushing your, or their, breathing. I don't comprehend how you think that facts are going to harm their successful usage of the machine.

robysue1 wrote: ↑

Fri Apr 07, 2023 10:32 pm

In either case, that's not really helpful: If you are uncomfortable and trying to get to sleep sleep, but something feels wrong with your breathing, it doesn't much matter that what you are feeling doesn't match the technical specs of the algorithm your machine is using. You're still uncomfortable and your breathing still doesn't feel right to you no matter how many times you try to tell yourself that the machine is not "rushing" you to inhale. And because you're still uncomfortable, it's much harder to get to sleep than it should be.

You say that, but heretofore nobody had explained to the OP what was actually happening. Most people, who've had that explained to them, were able to go "oh, ok, I'll just breathe how I want to and not worry about what the machine's doing!" Once it's explained to them that the machine, 100% FOLLOWS THEM, they're OK with it, and they're more successful.

robysue1 wrote: ↑

Fri Apr 07, 2023 8:05 am

Again, I know that the VAuto's algorithm is technically following my breathing when it transitions between EPAP and IPAP. But the Trigger setting controls how strong the inhalation airflow needs to be before the machine goes from EPAP to IPAP. If Trigger is set to High, the machine waits to increase the pressure until the airflow into your lungs is just a bit stronger than when the machine will increase the pressure to IPAP when Trigger is set to Medium. And in my case that's just enough of a delay to help me feel like the machine is no longer rushing me to inhale.

Yes, I know what trigger and cycle do, I run my trigger at very high, so the machine helps me in those times when my throat would start to close up, and I'd see a couple of small inhalations before an apnea, yet the machine wouldn't trigger because they weren't enough of an inhalation to trigger IPAP.

If you like running on low, or very low, more power to you.

None of that is applicable to the OP.

robysue1 wrote: ↑

Fri Apr 07, 2023 8:05 am

In other words, the machine's perception of when I start to inhale and my perception of when I start to inhale is not the same: My body needs to detect more airflow into my lungs to say "Yep, I'm inhaling now" than a very small positive airflow; but the Resmed machine will say I'm inhaling as soon as the airflow into my lungs is a tiny bit above 0.

NB for those attempting to follow along, that *is* the definition of an inhalation.

robysue1 wrote: ↑

Fri Apr 07, 2023 8:05 am

but I just can't seem to order my body to feel differently about when an inhalation begins when I'm also trying to get to sleep.

Don't you think that *educating* people about the actual way things actually work is worth it, even in this instance? You're very good at that in pretty much every way, but here you have a problem putting aside your bias. You've been beating this drum for a long time, so I shouldn't expect my comments to be able to sway your perception of what you felt way back then. I'll settle for just continuing to educate new users.

There is so much to learn about this. Thank you all for the details and interesting discussion!

Last night I used the cpap 6.5 hours compared to 7 hours the night before. To try to reduce the CAs I lowered the EPR to 1 as suggested, and my AHI was nearly the same: 3.88 last night compared to 3.94. Once again there were no OSAs and 24 vs. 27 CAs the night before and 1 hypopnea, so it doesn't appear that lowering EPR to 1 helped reduce the CAs. I'll just turn it off tonight.

Given that there aren't that many CAs, should I bother trying to reduce them, or just let it happen naturally hopefully? I'm waking up more exhausted and tired more during the day when I use the machine than when I don't, so I'm just wondering if CAs are the culprit there. Of course I've only used it for a few days, so I'm probably being impatient to have immediate results.

For me, being stern with myself and telling the machine I'm the boss is not going to work too well. I already feel like a failure for needing CPAP (intellectually I know I'm not, but those negative voices are hard to suppress) and if I'm stern with myself and still don't do well, I'll feel like even more of a failure. As a very geeky person, knowing what is going on at the technology level does help reduce anxiety, which is very helpful. It doesn't necessarily take away the primal fear of having something on my face messing with my breathing, but it does lessen it.

Robysue1 - thank you so much for telling the story of your goose dream! While I'm sure it was a terrifying dream, it made me laugh and was VERY relatable!

Today I went over to a friend's to chat about using cpap with them since they use nearly the same setup as me. It was really useful to talk in person with someone else who has been through this recently and they let me try the nasal cushion mask rather than the pillow mask, which was WAAAAAY more comfortable, so I'm looking forward to the N30 arriving.

For other newbies reading this, that tip about having a cpap support team including family & friends is gold!

This forum is amazing! I would have chucked the machine out the window by now without it.

takver wrote: ↑

Sat Apr 08, 2023 6:20 pm

Given that there aren't that many CAs, should I bother trying to reduce them,

There's not much you can really do with little tweaks on your machine to reduce the number of centrals beyond reducing or turning off EPR and that only helps IF (big if) EPR is what is causing the centrals.

It's normal to have a few centrals anyway. Like it's normal to have what is termed a sleep onset central during the transition from wake to asleep. Normal...we ignore them.

1...it is possible that those flagged centrals are SWJ or sleep/wake/junk centrals flagged while awake or half awake.
So if you aren't sleeping soundly yet and instead having multiple wake ups during the night there is a good chance that those centrals aren't even real asleep centrals. Gotta be asleep first before we start worrying about centrals plus you really need to be having more asleep centrals than you are seeing before we start worrying.

If you aren't sleeping soundly your best bet is to work on whatever it is that is messing with your sleep.

Since playing with EPR will sometimes help with the centrals that is why we try reducing EPR...there's a small chance it will help but if it doesn't then that's about all we can do with this kind of machine. If it doesn't help then go back to using EPR if you like EPR and you think it helps you in terms of comfort and maybe sleeping.