Fighting with CPAP

Hi, all-

I picked up my ResMed S9 on Monday and have spent two fairly miserable nights on the learning curve from Hell.

I have a few issues that seem fairly serious to me and thought your combined wisdom could help get me on track.

The first night wasn't too bad, except everytime I exhaled the silicone cushion would pop slightly. Last night before bed I did a mask test and found it was way too loose. Tightening the straps for a snug fit got rid of the pop.

Last night, after two good hours of sleep, I woke up and there didn't seem to be much, if any, airflow. I called Apria today and my RT told me that the machine is supposed to be in CPAP mode and should be putting out a constant supply of air. Doesn't the S9 have the capability to provide more or less air from moment to moment, depending on the user's need? If so, could the minimum airflow be set too low?

Also, once or twice I've awakened trying to exhale, but unable to easily do so. I'm wondering if the elbow/Anti-Aphyxia valve https://www.cpap.com/productpage/fisher ... w-kit.html might be bad. Sometimes, when I try to exhale I meet a lot of resistance but the valve eventually pops open. Shouldn't this valve open easily?

Is inhaling & exhaling supposed to be a struggle? I don't mind wearing the mask (except for not being able to scratch my nose) but I don't like having so much pressure that I have to fight to inhale and exhale! I've been wondering if maybe I have a bad unit.

Most of the time, when I exhale, the pressure drops to almost nothing. This is due to the EPR, right? And when I inhale, the air is supposed to start flowing again, also right?

Thanks in advance for your advice!

Best,

kickaha

PS- My pressure is 8 and I have my S9 set to ramp up from 4 over a 25 minute period.

You seem to be doing OK with the mask, so it's the machine settings that may need to be tweaked to make you more comfortable.

First, many of us wake up and think there is no airflow. During the night you acclimate, and it's harder to perceive the airflow. In MOST cases it's there. The quick way to test it is to put your hand in front of the outflow vent--you should feel the air there easily. There have been a few cases where the ResMeds turn themselves off at night, so if you don't feel anything from the outflow vent, contact your DME ASAP.

As for struggling to breathe, a few things might help:
1. many of us feel like we cannot breathe at only 4 cm of airpressure. The majority of us turn off the ramp feature after the first week or so, and never turn it on again. It only helps for the first day or two, when you are just not ready for the airflow, but after that, you really don't need it.

2. Is the EPR (exhalation pressure relief) enabled for your machine? That usually helps that feeling of struggling to exhale. If it's not enabled, call your DME and ask for them to enable it.

3. If the pressure is sufficient, you shouldn't really feel like you are struggling to inhale (at 4 cm yes, at 8 cm, no). Sometimes it's a matter of relaxing and getting your focus off your breathing. You might try wearing the mask a few hours while you are awake and doing quiet activity like reading or watching t.v. until you feel you can relax with it. Or, you can try something distracting in bed--white noise like a fan, soft music, or a sound machine.

Hi there Kickaha, and welcome to the forum!

An anti-asphyxia valve should be firmly shut as long as the blower is blowing, and should snap open immediately when the airflow from the machine stops. When the blower is blowing, you should feel no air coming from that valve

Exhaling against the incoming pressure is more difficult - or disconcerting - for some of us than it is for others. Resmed machines have an Exhale Pressure Relief feature that makes the pressure drop when you exhale -- I am one of those who have trouble exhaling, and at a pressure of 8.4 I use EPR=1.

Your machine can be set to work in auto-adjusting (Auto or APAP) mode, or in fixed (CPAP) mode - that depends on how it was set by the supplier, you can check to see what mode you're on -- sorry I can't help with the S9 - someone else is sure to help. When you know how to use the menu, you'll be able to check your EPR status too.

First thing to do if you wake up and think the blower isn't blowing is to put your hand in front of the mask vents (those little holes in the general area of your nose) - if there's no air coming out of there, you've got a problem with the blower. If it's blowing normally - then you've simply adapted to the blowing air.

I've had a faulty anti-asphyxia valve on a F&P mask (it the same part for all their masks) -- and even have my doubts about the replacement I received - that valve, if functioning properly, should not let any air out when the machine is on.

C-flex is what the EPR (exhale relief) feature is called in the Remstar machines, and you can set it on high, medium or low.