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DoriC wrote:

Uncle_Bob wrote:Laurie most people feel like the suffocate at anything below 6cm.

UB, BTW, get rid of the hamburger and bring back those boys!

Thank You! They're adorable! I guess Grandmas do control the world!!

I slept pretty well for 7 days with the loaner APAP and an EasyLife nasal mask. I had to stop using the EasyLife nasal mask because it was breaking down my skin across the bridge of my nose (headgear was not too tight).

Laurie, if you slept so well on an "unknow APAP" at 4-12 then the first priority for you is to find out which machine that was and what all its settings were. Maybe you were given a machine with a ramp setting on - and that's the cause of your trouble? Pressure settings are not everything.

If the DME is right when the loaner one having the same range as the present one, then pressure changes are not the way to go now. Do you have the report on which the doctor based his Rx? If not, demand it -- it will show you which APAP you were on, and what all its settings were.

The software - correctly recommended by Uncle_Bob - will let you see how high the pressure was during that first hour, and what kind of breathing interruptions you were having.

It could be the ramp, it could be the EPR, it does not have to be the minimum pressure

Slartybartfast wrote:One reason that you're feeling poorly is that the S9 is smart enough to know when you're sleeping and when you're not.

Please tell us where you got this information.

I was "given" the Swift FX for Her with size xtra small pillows. I also have the size small. Both seemed to fit with the xtra small being maybe slightly more comfortable. I don't think I like the nasal pillows, I am very conscious of them and I am bothered by the sensation across my upper lip.

The ramp is set for 20 minutes and I bumped my setting up to 7 cm and left the high end at 12 cm. I went to bed unusually early after not sleeping a wink last night and tried to get comfie and just relax. I had no sensation of suffocation during the ramp phase, but when I got to 7 cm I started to become very uncomfortable, tense, and anxious. My throat feels dry - I have the humidity set at 3.0. I feel like I am occasionally swallowing air.

I don't know what happened. I was fairly comfortable with the loaner unknown make/model APAP set at 4-12 cm and the EasyLife nasal mask (unfortunately caused skin breakdown on my nose) that was ordered by my doctor in order to titrate my pressure. As I mentioned the machine showed that my pressure requirements were 7-8 cm. My doctor then ordered CPAP set at 7 cm. That was disasterous! I could barely tolerate it for 1 hour. (S8 Escape)

So naturally I thought APAP was the way to go and ordered the S9 Autoset. The settings are the very same as during the titration study 4-12 cm. I got a new nasal mask ResMed SoftGel and tried out my new S9 Autoset last night. That's when I felt suffocated. Tonight with the nasal pillows, I don't feel suffocated during ramp.

Before I start to get tired, I am going to reset the S9 to 4 cm, maybe increase the humidity (?) and see
if I experience any feelings of suffocation. If so, I'll switch back to the nasal pillows.

Although I may feel anxious about ever falling asleep again, I realize that this is going to be a trial and error deal. I'll let you know how my experiment goes tomorrow. Hugs to all, Laurie

ozij wrote:

Slartybartfast wrote:One reason that you're feeling poorly is that the S9 is smart enough to know when you're sleeping and when you're not.

Please tell us where you got this information.

Just searched for it and found Fisher/Paykel calls the technology SensAwake. It was reviewed here: http://www.sleepguide.com/profiles/blog ... and-fisher I know I read that ResMed also has that technology, but they call it something else. I'll see if I can find it.

Here's the quote from the above link: "This machine's algorithm detects the kind of breathing you do when you're awake and reduces the delivered pressure to its lowest, most comfortable level at this time. Similarly, the machine's algorithm detects the kind of breathing you do when you're asleep, and increases the pressure accordingly. Other machines try to solve for the discomfort of delivering high pressure while awake by providing a "ramp" feature that requires the user to push a button to have the pressure gradually ramp up. But that is a more crude solution than Fisher & Paykel's SensAwake technology which does the work for you, and keeps the pressure where it needs to be until it "knows" you're asleep. The last thing we need is something else to worry about and fumble with while we're trying to get some shut eye."

So the technology they were talking about in this article refers to F&P's product, while ResMed relies on a programmable ramp to accomplish the same thing, but in a less elegant manner.

*The usual disclaimers of not being a sleep doctor apply*

I suspect that in your case, the transitions from uncomfortabally low pressure to comfortably low pressure to uncomfortably high pressure might be really sharp. A couple things you might try experimentally and base your actions on the results:

1. Try a minimum pressure of 5 cm. Or 6 cm.

2. Try (for a few hours, anyway and then look at the data to see what is happening, because this is below your titrated pressure) CPAP at 5 or 6 cm.

If you are comfortable with the results of step 1, I bet you will get used to the higher therapy pressures fairly quickly. I can tolerate 18 cm no problem (no ramp, EPR or bilevel), but that didn't happen overnight (literally and figuratively!) If this helps, consider lowering your high end to 8 cm for a couple of days. If this is effective for you, try and work back to a high end of about 10 cm (2 cm above your titrated pressure).

If number 2 worked well for you (low AHI plus good sleep), maybe this is a better pressure than what you were titrated at, for at-home conditions. You could choose to stay there, or start to open an APAP range up to about 4 cm above this amount. Conversely, work up to a straight CPAP pressure of 8 cm.

Above all, take good notes and use common sense. Don't stay long at any pressure that isn't treating your apnea (=high AHI) I will agree with the others here that the S9 is a wonderful machine, and has some of the most innovative software in it of any machine on the market.

It will be interesting to see what your data looks like.

Laurie1041 wrote:Hi,

I just received my new APAP yesterday and read the User's Guide 3 x before using last night. I also have a new nasal mask - ResMed Softgel which seems to be very comfortable.

Within one hour, I could no longer stand it. I felt like I was suffocating. My doctor's Rx is for 7 cm. My machine is set for 4-12 cm. I questioned my tech about the huge gap and she said, "That's what your settings were on the loaner APAP "(I don't know the make or model). She went on to say, "You will probably stay at around 4 cm". Huh?

What is the problem? Is it the machine settings, my mask, or both? I am feeling a bit frantic. Did I choose the wrong machine for me? I slept pretty well for 7 days with the loaner APAP and an EasyLife nasal mask. I had to stop using the EasyLife nasal mask because it was breaking down my skin across the bridge of my nose (headgear was not too tight).

Please help!!

Hi there laurie. Here is the thing, although the easylife is a sleep tech favorite- there are definitely some questions as to long term patient use. Even the softgel you put down in your signature may not be so hot. Bring your equipment to your DME company. Have them set your machine for 7cwp and get yourself a decent mask. I'd recomend a resmed swift FX but thats just me. I have seen a lot of patients have good results from them. The trick is to try out a lot of different masks while you are there at the DME and see whats comfortable on you.

Laurie1041 wrote: The ramp is set for 20 minutes and I bumped my setting up to 7 cm and left the high end at 12 cm. I went to bed unusually early after not sleeping a wink last night and tried to get comfie and just relax. I had no sensation of suffocation during the ramp phase, but when I got to 7 cm I started to become very uncomfortable, tense, and anxious. My throat feels dry - I have the humidity set at 3.0. I feel like I am occasionally swallowing air.

Laurie, get into your Clinical Menu and see what your settings are. The S9 Autoset has the option of setting "minimum start", which is your ramp pressure. What is your Minimum Start pressure?

What is your EPR setting--1, 2, or 3? And which option--Ramp Only, Fulltime, and Off.

I think these settings will make a big difference in how you feel.

Hi Laurie,

I hope your second night was better. Let us know.

There are a lot of tweaks that can make the FX more comfortable. I think it is really the BEST mask, but it took me a bit of fiddling to get there.

Night #2: Ramp is set at 4 cm for 20 minutes, EPR is set at 2, therapy is set at 4-12 cm.
Sleep Quality: Total hours 8.7, AHI 0.4
Mask: Resmed SoftGel nasal mask (I also have the Swift FX for Her nasal pillows)
Titrated Pressure - 7-8 cm

I was awakened several times and felt uncomfortable, but not anxious, or panicky. I seem to have dim memories of the need to have more air - of taking a deep breath - but I cannot be sure of that. I was restless and changed positions frequently. I think the mask might be uncomfortable - it left a nice big red mark on the bridge of my nose which is the same thing that happened with the EasyLife nasal mask. My doctor did mention that my nose is very thin and that a nasal mask may not be for me.

Should I bump it up to 5 cm and try the nasal pillows tonight? Any and all suggestions highly welcome! Hugs, Laurie

Laurie1041 wrote:Night #2: Ramp is set at 4 cm for 20 minutes, EPR is set at 2, therapy is set at 4-12 cm.
Sleep Quality: Total hours 8.7, AHI 0.4
Mask: Resmed SoftGel nasal mask (I also have the Swift FX for Her nasal pillows)
Titrated Pressure - 7-8 cm

I was awakened several times and felt uncomfortable, but not anxious, or panicky. I seem to have dim memories of the need to have more air - of taking a deep breath - but I cannot be sure of that. I was restless and changed positions frequently. I think the mask might be uncomfortable - it left a nice big red mark on the bridge of my nose which is the same thing that happened with the EasyLife nasal mask. My doctor did mention that my nose is very thin and that a nasal mask may not be for me.

Should I bump it up to 5 cm and try the nasal pillows tonight? Any and all suggestions highly welcome! Hugs, Laurie

My personal opinion is that you should get used to 7cm pressure. you are already using EPR which is good. I recommend you spend some time on the machine during the day while awake just breathing on the machine and letting it become your friend. It is friendly after all and wants to prolong and enrich your life

If you get to keep the masks (don't have to return them), there are a few tweaks that will help the FX be more comfortable.

1. Sew some velcro HOOK tape (stiff side) inside the back strap. This is UFO13's Lab Rat fix and it's genius. The weight of the slinky hose on the FX tends to pull the pillows, and that combined with the movement of your head on the pillow can make this mask slide around. (UFO13 actually suggested stapling the velcro in there and that could be a temporary solution as you could easily remove it that way--don't use sticky back stuff).

2. I think hanging the hose works really well with the FX. When the slinky hose is hanging down its weight tends to pull the pillows out of your nose AND the 45 degree angle on the vent makes the cold vented air almost inescapable. If you hang it UP from over your head, no more weight pulling the pillows down and the air blows UP, not down on you. Search around here for ideas on jury rigging a hose hanger before you decide if you want to invest in a "system".


3. Make sure you watch the video about how to fit the mask several times so you can see correct placement of the headgear. http://www.resmed.com/us/products/swift ... s&sec=true. The biggest mistake people make is tightening this mask too much and using nasal pillows that are too small.

4. Here are my fitting suggestions:
a. Loosen the headgear
b. Position the pillows up to your nose without putting the headgear on your head.
c. Turn on the machine. The pillows MUST be inflated for a proper fitting.
d. Place the headgear on your head and tighten the headgear just enough to keep the pillows from leaking when you are in your normal sleeping position. They should be fairly loose but not so loose that you have to feel like you cannot move your head without leaking.
e. The pillows themselves are cone-shaped. The fat part of the cone should be AGAINST your nostrils, NOT in them. Only a very small part of the narrow part of the cone actually goes in your nose. (You probably know this already, but some DME’s don’t and actually tell people to cram the entire pillow into their nose).

Some people use Lanisoh or other non-petroleum creams (Ayr gel, KY jelly, etc.) on the nostrils to get a good seal with the pillows and reduce any friction from EPR, but for some reason that never works for me.

I like to say the FX mask is the next best thing to sleeping naked. It’s sooooooo lightweight (except for the short hose) and there is nothing hard to hurt your face.

90% of CPAP is getting used to the mask. I hope you find the FX a good solution.

Hi Laurie,
I was reading through all the posts and your replies and thought I would just add a couple comments from one who is fairly new to the CPAP therapy but can relate to some of your comments.

Regarding the feeling of suffocating and wanting to take some deep breaths, I had that same feeling when I started using CPAP. I also had that sensation even more strongly when I started using a humidifier - for some reason the heated moist air added to the sensation of not getting enough fresh (real) air. Opening my mouth and taking a few quick deep breaths actually helped that temporary feeling. I think some of what you are experiencing are those initial thoughts and feelings and they will slowly pass. That was my experience anyway.

The first time I tried CPAP, a few years ago, I actually stopped using it because of those feelings. My apnea got worse and now I am trying again, have been on it for over a month now and feeling much better about continuing. I can now sleep through the entire night with the mask and actually miss it when I take it off for awhile.

Hang in there and I'm sure there are those on this forum who can continue to help you out. I know I have been encouraged by everyone. As I said, it has taken me about a month to get where I am now and I'm sure I have a ways to go yet but I thought I would share my experience with you.

Kind regards,

I agree that a minimum of 7cms might be better, the EPR at 2 is lowering the pressure to 5cms on exhale anyway. I can't help much with mask issues but you're getting some good tips. You might want to experiment with humifier setting too. Keep us posted.

DoriC wrote:I agree that a minimum of 7cms might be better, the EPR at 2 is lowering the pressure to 5cms on exhale anyway. I can't help much with mask issues but you're getting some good tips. You might want to experiment with humifier setting too. Keep us posted.

OK, both you and UB recommend that I set the minimum pressure to 7 cms. Consider it done! I will also examine my humidifier settings. I will be exploring Janknitz's suggestions for the nasal pillows. I am definitely going to need to engineer some type of pulley system for my hose. When I reposition myself in bed, the weight of the hose pulls out my nasal pillows. I'll give the standard report tomorrow morning. Laurie

Take a look at the jury-rigged pulley system I made out of a key chain and a sewing bobbin on my blog. Looks hideous, but it works.