After 1 week I am miserable

My best night has been 2 hours with the mask on. The last 2 nights I cant even get 1/2 hour before I must get out of the mask. I can inhale fine but I cant exhale enough. Then I get claustaphobic anxious etc. Also I was never measured for the mask they gave me a medium, I downloaded a sizing template and it indicates I should have large. Can this be the problem? The mask id a RESMED Quatro.. Help Please I want this to work

Adjustment to sleeping with a CPAP isn't easy, that's for sure.

I remember the RT at my DME was amazed I managed 4 hours on my first night.

Something you can do to help us help you is to go into your settings and change your equipment to text instead of icons. That way, we don't have to click on it each time to find out what you are doing.

I had problems on exhalation, too, with the same pressure in inhale as exhale. I'm using a Bipap, but all you may need is a change in exhalation relief.

I'm not familiar with either your mask or your machine, but I don't doubt that someone who does know them will be along shortly.

Your profile indicates a Vantage Auto? Please confirm machine model.

What are the pressure settings? Autos allow for a minimum and maximum pressure.
Are you using EPR (exhalation relief) this would allow for a reduction in pressure during exhalation. How much depends on the settings. An EPR of 3 would allow for a 3 cm reduction in pressure to make it easier.

If the settings are for something that starts with a minimum of 4 cm then likely the amount of air moving will not feel adequate and can contribute to feelings of not getting enough air.

For anyone to help you with more specifics we need more definitive information.

My machine is a Resmed escape epr II, not listed

I cant get into the program to set the EPR.

Your machine choice would be
S8 Escape II cpap machine
It is listed in the equipment choices.

What is the pressure that you were prescribed to be using? This is important to know. Do you know what pressure the machine is set at? Some pressures are hard to exhale against despite EPR. Some just take a bit of time getting used to.

Do you use the ramp feature?

If EPR is not turned on then you can turn it on yourself or have your DME do it.
Here is a link on how to get to clinical menu where you can enable EPR. Be careful this is also where therapy pressure is changed.
http://www.apneaboard.com/CPAP%20Adjustment.htm

Now, that said, the ResMed Escape offers nothing in the way of useful data to you. It will only tell the DME the number of hours you have used the machine to satisfy insurance requirements. Obviously, you haven't been able to do that yet.

Now is the time to get the DME to give you a fully data capable machine. This would be at least the ResMed S8 Elite II (it will have EPR). Others will chime in on the benefits of having data available to you but basically if you don't have the data and get able to use the machine all night, and don't feel so good, you won't have any clue why.

Those first days are definitely miserable for many, including myself. My first few days I never did fall asleep with it on. I'm also claustrophobic and also can't stand anything in my face &/or around my head. I finally broke down and took the Lunesta my dr gave me. Best thing I ever did. You might discuss using a sleep med with your dr.

You might also try listening to music you find relaxing. That will also distract you from the noise of the machine and your breathing. I also have a fan blowing right in my face; might help you, too.

Another thought...unless you're a mouth breather, you probably don't need a fullface mask. A nasal pillow or prong mask has a much smaller "footprint" on your face and may help your claustrophobia.

Of course these things are all in addition to Pugsy's suggestions.
Hang in there and come back with your settings info and of course any more questions. Everyone is here to help.

I agree with Scrappinmom... If you're starting in with a full face mask, that could be part of your problem. When I first started, I had panic attacks... and that was with only a nasal mask! You may want to have your DME switch you to something smaller, like a Swift LT or similar, and since you're in your first week in, you have EVERY right to request a different mask AND get it fitted by the DME! I'm in my third week, and I'm still asking for different masks until I get the one that works for me.

Also, you may want to take your machine back as well, and demand an Elite instead of an Escape. That way you get a fully data-capable machine instead of a compliance-only base model. If he refuses... well, let's face it, he's not the only DME in town. Threaten to take your business elsewhere. The insurance pays exactly the same for both of those models, and he's simply pocketing the difference.

Cygnusia wrote:Also, you may want to take your machine back as well, and demand an Elite instead of an Escape. That way you get a fully data-capable machine instead of a compliance-only base model. If he refuses... well, let's face it, he's not the only DME in town. Threaten to take your business elsewhere. The insurance pays exactly the same for both of those models, and he's simply pocketing the difference.

You definitely want to get at least an Elite II. But, figure out the costs. Get the DME to tell you what your cost is going to be for the elite (they won't want to tell you) and compare your share to what one would cost you online. I got an Autoset II online paying straight out of pocket for less than what my copay for an Elite II would cost me from the DME.

I know all this is overwhelming, but things will start coming together and it will get better.

Just the fact that you say you have trouble in the first half hour leaves me suspect of your ramp setting being a problem. I think most cpaps are given out with the ramp feature on. As others have said, it could be set to start at the standard (and ridiculous) pressure of 4, which I would think would be an even bigger problem with a full face mask. Your description of "can't exhale enough" makes me wonder if EPR is on and the timing of the inhale increase is cutting your exhale short. Others have complained of the same thing. Do report your settings so you can get more targeted suggestions.

I completely forgot about the ramp setting, kteague... good point! When I was first using mine, it was set at 4cm, and it was probably the reason why I had panic attacks. It felt like I was trying to pull more air out of the hose than the machine was giving me. I kept raising the amount until I stopped using it completely. Now, after a few breath cycles, I feel adjusted and relaxed.

Mark, not being able to exhale well against CPAP pressure could make you a good candidate for "failed CPAP, needs a bilevel machine." I'd start complaining to the DME and to your doctor's office that you've tried and tried, but can't breathe out against the pressure you're prescribed. Ask, "Is there a different kind of machine that will drop the pressure when I breathe out?" Stress that you desperately WANT to do this kind of therapy and that you are really TRYING to use the machine every night, but that difficulty breathing out makes you have to take the mask off. They (DME or doctor) should then suggest the possibility of switching you to a bilevel machine.

EPR. Yes, some do find that EPR in ResMed machines helps them exhale more easily. I personally didn't find EPR to be easy to breathe out with at all. EPR doesn't deliver its FULL drop at the BEGINNING of breathing out. As the exhalation progresses, EPR winds the pressure down, but it doesn't give the full drop right at the start of the exhalation. At the start is where I personally want to feel the relief. That's what a true bilevel machine can give -- the full exhalation pressure relief drop every time at the START of each exhalation.

With EPR, it doesn't matter whether you've got it set for EPR 1, 2, or 3... "3" being the most drop EPR can give... 3 cm H2O reduction in expiratory pressure... the full drop is NOT going to happen at the instant you start to breathe out, the way it will with a true bilevel machine.

You might find an EPR level that feels comfortable, but...if you try various EPR settings and still feel like it's too hard to breathe out, I'd be pushing to get switched to a bilevel machine where separate inhalation (IPAP) and exhalation (EPAP) pressures can be set.

Trust me, I had plenty of panic attacks when I started, because I couldn't breathe. You should still be able to turn on EPR I would think. My machine has a setting where you can also set the speed of the change between inhale and exhale. Setting it to "fast" may provide a quicker drop on exhale.

Demand a data-capable machine from your DME: priority one!

Pugsy wrote:Your machine choice would be
S8 Escape II cpap machine
It is listed in the equipment choices.

What is the pressure that you were prescribed to be using? This is important to know. Do you know what pressure the machine is set at? Some pressures are hard to exhale against despite EPR. Some just take a bit of time getting used to.

Do you use the ramp feature?

If EPR is not turned on then you can turn it on yourself or have your DME do it.
Here is a link on how to get to clinical menu where you can enable EPR. Be careful this is also where therapy pressure is changed.
http://www.apneaboard.com/CPAP%20Adjustment.htm

Now, that said, the ResMed Escape offers nothing in the way of useful data to you. It will only tell the DME the number of hours you have used the machine to satisfy insurance requirements. Obviously, you haven't been able to do that yet.

Now is the time to get the DME to give you a fully data capable machine. This would be at least the ResMed S8 Elite II (it will have EPR). Others will chime in on the benefits of having data available to you but basically if you don't have the data and get able to use the machine all night, and don't feel so good, you won't have any clue why.

::RAmp time is 5 minutes pressure is 10h2o if i have that right.

Thanks alll for the help

I would try increasing the ramp time to at least 15 minutes, and increasing the ramp start level to 5 (the default is 4, which is probably where you're set, and many find hard to breathe with). Zero to 10 in 5 minutes is pretty fast! Probably harder than no ramp at all.

When I first started, I had my ramp at 45 minutes, because I wanted to be asleep during most of the transition. I'm now down to 15.

Give it a try and let us know how you're doing.