First night troubles!

Hey, thanks for looking, this is my first night with a machine, and its worrisome!

I got a DeVibiss Intellipap Autoadjust, and a FlexiFit HC431 full-face mask (Fisher and Paykel).

The instructions for both are pretty lacking, especially the mask. I assembled based on the instructions, and the machine seems to be set up fine, except I can't adjust (or it doesn't say how to adjust) the minimum starting pressure, or maximum, or go to straight CPAP mode. It is not locked (no lock showing) AFAIK, and I can adjust other settings, but there are no menu options for this. I have a "philips respironics tubing elbow adapter", I am assuming this goes into the machine? Doesn't say.

The mask is a problem.. the instructions literally don't even go 1-8 they just skip around as they please and don't cover basics. They have a piece "non-rebreathing valve" or something, I am not sure if I even need to use this or not, it is not mentioned until the supplemental oxygen section. When I had the mask on (with the non-rebreathing valve), I felt like I was nto getting any fresh air, and the CPAP was only going from 3.0-4.9 pressure automatically. There was a leak I assume in the middle of my forehead area, might just be re-adjusting required. The "mask release strap" also defintiely does not release the mask.

Scared to try to use the machine, might not be getting any air and i don't want to suffocate! There was very little pressure coming in from the mask, but I guess that might be expected with a max pressure of 4.9. Any thoguhts/ideas/help is appreciated greatly! Thanks

dssdfsdf wrote: There was very little pressure coming in from the mask, but I guess that might be expected with a max pressure of 4.9.

Not much air moving at that pressure and no wonder you feel like you are suffocating.

I can't help with the mask.. I have never used it but if you go to this site...down at the bottom it tells you how to request the provider manual for your machine. The provider manual will tell you how to get into the machine and change the settings. http://www.apneaboard.com/CPAP%20Adjustment.htm

One of our forum members Emilia uses the same machine. She can offer more direct instructions on how to make the machine more comfortable for you to use. Register here at the forum and send her a PM.

I did that as suggested, thanks. 2:20 AM trying to figure out whether I should sleep without the machine or just stay awake until I figure this out! Merry Christmas to everyone as well!

Emilia has the provider manual also. I offered the link just in case she isn't around here at the holidays.

You might also edit your subject topic line to indicate you have the Devilbiss machine and she will spot it more easily and come by to help. I have no experience with the Devilbiss other than general machine stuff so no help with the specifics that you need.

I couldn't sleep easily at such a low pressure easily myself either. While technically we won't suffocate at the low pressure minimum...it can be uncomfortable enough to mess with sleeping comfortably though.
I just imagine 6 cm minimum will be more comfortable for you.

Edit...now that you have registered...check your PMs. I think I have a source for the provider manual for your machine.

Go to Cpap.com and look up your mask - you should be able to find a screen pix eventually that shows how it goes together (possibly under 'parts' or accessories, etc.) because the elbow usually goes between the mask and hose and you do need that valve (unless I'm misinterpreting things) so you don't re-breathe CO2 which normally vents to the outside of the mask.

Watch these videos https://www.cpap.com/productpage/fisher ... -mask.html

Good luck to you. The pressures and mode changes are locked out for you. I suggest you leave your settings as they are (I do perfectly fine at a low pressure) and wait until you get some experience under your belt. By that I mean some time with the machine, how you feel (might take awhile to feel better), the forum and general reading and education (if you are new). I personally believe it's a mistake to start off changing titrated pressures, but perhaps you are just frustrated because they have locked you out. The clinical manual should be available from apneaboard.com which should explain changing your settings. But please, if you decide to make changes give it a fair trial where you are right now and then go slow. One change at a time. I wish you smooth sailing with your therapy. It is just another part of your daily life now and I believe the most important thing you can do is use it all night, every night. It's like brushing your teeth, but a bit more trouble, mask up before bed.
Glad you contacted the forum.
PS: Though some people do need higher pressures, I would not be concerned with 4.89. Sometimes I have to feel for the exhaust from the mask to be sure the machine is working. If you are really concerned with this low pressure I would contact my doc before making changes based on someone elses experience with low pressure. The pressure needed is just that- what is needed to stop apneas and hypopneas, it is not corellated with the severity of your sleep apnea.

Don't mean to step on any toes regarding the advice given- this is MHO as a total and careful layperson.

Mary Z wrote:The pressures and mode changes are locked out for you

Mary,
OP here ordered the machine from cpap.com. OP is not in the US. I am betting that the machine was sent with the standard default APAP settings of 4 to 20. It was not dispensed by a local DME like we would typically expect. His situation is different. He did have a sleep study but I don't remember if he had a titration study. If he did then he would have some numbers to go on. If he didn't then he has to self titrate and changing the minimum would be the thing to do since he can't sleep at the low pressure.

Yes I got the test done here and it was sent to me locked at 3-20, prescribed pressure of 8 to start with, then they wanted to adjust it later. I found the clinician settings from the apneaboard email, had to turn off, on, hold up and ramp, turn off, and on again and it was in the clinician menu. I set it at 6-20, not exactly as prescribed but figured it should be close?

Took apart the mask and had a really hard time putting it back together, was leaking like crazy, going to try to watch the videos posted and see if I can reassemble it properly. Thanks for the help!
Merry Christmas!

think I goti t set up very quickly/easily after watching that video, thanks! I am getting a lot of constant air blowing out from the exhaust holes near the nose, is that normal ? Its constant whether breathing or not.


^_^ thanks

Yes, constant air blowing out the exhaust vents is normal.

Is the air coming from the hose coupling just below the elbow?
--through the holes on either side of the little gray silicone valves that make an inverted 'V"?
Those little gray sheets need to meet together at the top like a little roof.
This is the anti-asphyxia valve.
If my hubby sneezes, they can get lodged into the framework, and won't flip up to block the hole when the machine is blowing.
This is when I have to use the tweezers or a toothpick to lift them up enough so they lay smooth and work correctly.
The exhaust vent is the little cluster of holes right over your nose--not on the hose.

thanks for the info/support so far guys, greatly appreciated.

Assembling the mask seemed impossible/ frustrating while tired with no real instructions, but after watching the video was a piece of cake.

Getting much more comfortable at this-- but had a few dumb questions.

First, it doesn't feel like any air is being blown into the mask at 8 CM or so when I put it on my face, but when it is off, its blowing quite hard/obviously. I would think it would be "similar". Almost feels like nothing is happening until I inhale (when I stop breathing on purpose, it doesn't gently "force" me to breathe, i don't feel like.), and when I exhale it just turns off. Flexi option did not change this too much.

Is tap water okay to use in the humidifier?


but they don't look too great.


Thanks guys : )

czglory wrote:thanks for the info/support so far guys, greatly appreciated.

Assembling the mask seemed impossible/ frustrating while tired with no real instructions, but after watching the video was a piece of cake.

Getting much more comfortable at this-- but had a few dumb questions.

First, it doesn't feel like any air is being blown into the mask at 8 CM or so when I put it on my face, but when it is off, its blowing quite hard/obviously. I would think it would be "similar". Almost feels like nothing is happening until I inhale (when I stop breathing on purpose, it doesn't gently "force" me to breathe, i don't feel like.), and when I exhale it just turns off. Flexi option did not change this too much.

Is tap water okay to use in the humidifier?

I looked up the smartcode, don 't really know what to make of these results



but they don't look too great.


Thanks guys : )

I find that I get so accustomed to the positive pressure that I don't feel it, but like you said, when you take the mask off you can feel it is blowing quite hard. That is normal and you should be able to feel the air rushing continuously from the exhaust vent.
You should not use tap water in humidifier if you can help it. If you have access to distilled water, this is the best because it is free of the minerals that can cause buildup in your humidifier tank.
Good for you that you looked up the smart code. Do that each day. The AHI is high. Optimally you would like it be 5 or less. How do you feel? That is an important factor when looking at all of this.
If your machine is set on pressures 3-20 and you need pressure somewhere around 10, then you may be spending the first part of the night with the machine incrementally increasing pressure with each event. Min pressure of 3 is low. It is also hard to breath on that as a beginning pressure each night. Sometimes a low pressure can feel oppressive. There is a way for you to change your settings. Get the clinical manual on line as suggested and you can see how to do that. My memory is not good, but I think you can press the on button and then hold down the buttons on the right at same time to get into the clinical menu. Member Emilia can help here. If I was in front of my Intellipap I could tell you. If no one responds, I will post tonight with instructions. If you want to narrow the pressures more instead of running 3-20, then you may see some improvement. What was your titrated pressure during testing?

czglory wrote: First, it doesn't feel like any air is being blown into the mask at 8 CM or so when I put it on my face, but when it is off, its blowing quite hard/obviously. I would think it would be "similar". Almost feels like nothing is happening until I inhale (when I stop breathing on purpose, it doesn't gently "force" me to breathe, i don't feel like.), and when I exhale it just turns off. Flexi option did not change this too much.

Several comments:

1) Your upper airway, the mask, the hose, and the blower unit on the machine make up a so-called "semi-closed" pressurized system. The system is only semi-closed because leaks are built in to system so that you don't rebreathe the CO2 that you exhale. The intentional leaks are designed to come out of the exhaust vents on the mask. When the mask is properly sealed and the machine is on you should be able to feel a pretty stiff flow of air coming out of these vent holes.

2) Once the machine has pumped enough air into the system to get the pressure up to 8cm H20, all the machine has to do is pump enough air into the system to maintain that pressure. Inside the system---i.e. in your nose and inside the mask itself---it will feel as though there is very little or no breeze because there's only enough air being pumped in to maintain pressure. But once the seal is broken---when the mask is OFF your face, the machine starts pumping a lot more air into what it thinks is a semi-closed system with a very large leak. It is trying to maintain the 8cm of pressure by pumping enough additional air to overcome that "large leak" and hence the noticeable breeze. If you have a nasal mask or a nasal pillows mask, you can trigger a pretty significant breeze by opening your mouth wide with your tongue on the BOTTOM of your mouth: That lets the air flow into your nose and out your mouth. You'll feel the breeze more in the mouth as it air rushes OUT than you will feel it in your nose. As a very crude analogy you can think of the semi-closed CPAP system as a bike tire: When you are adding a bit more air to the tire by pumping it up, you don't notice any breeze UNLESS there is a leak somewhere. And IF there is a leak, you notice a major breeze right where the leak is

3) I'm not quite sure what you mean when you write: "Almost feels like nothing is happening until I inhale ..., and when I exhale it just turns off." If exhale relief is on, it could be that you're noticing the increase in pressure when you start to inhale. Or it could be that you you are simply noticing the pressurized air more when you inhale for some reason. But the real point is that once you're pretty much adjusted to CPAP, you don't really notice the pressure at all when there are no leaks. Breathing should feel pretty close to normal with the mask on. So this most likely is a sign that you are having very little problem adjusting to breathing with the machine.

4) You also write, "when I stop breathing on purpose, it doesn't gently "force" me to breathe, i don't feel like." It's a common mispreception that a CPAP or APAP is going to try to "force" you to breath when you stop breathing. Machines that "force" you to breathe are, by definition, ventilators of some sort and CPAPs and APAPs are NOT ventilators. (The AVAPs machines and the Bi-level ST machines can be set up to run in a mode with non-invasive ventilator properties.)

The point of CPAP and APAP is to provide enough additional pressure to keep the airway open most of time. It's not a perfect system and the docs and PAP machine designers know that even at a perfect pressure setting, we'll still sometimes have our upper airway collapse and trigger an apnea. The idea with CPAP and APAP is to prevent our upper airways from collapsing dozens of times each hour so that we can get better quality sleep and have no serious problems with O2 desaturations. The machines are NOT designed to "fix" an apnea in progress by forcing us to inhale because they are not ventilators.

Now it is true that an APAP is supposed to respond to events by increasing the pressure. But in the usual APAP algorithm the machine will increase pressure only after it's detected TWO OA's and/or hypopneas in about a five minute period. This is more or less in lines with the guidelines for a manual CPAP/Bi-level titration done in the lab by a sleep tech. (See this pdf from the Journal of Clinical Sleep Medicine for the whole manual CPAP titration algorithm that techs use in a titration PSG.) And many APAP machines now try to detect whether a given apnea is a clear airway (central) apnea or an obstructive apnea. And pressure is NOT supposed to be increased when the machine is detecting CAs because more pressure will not prevent additional CAs from happening. The point of knowing this is that for many people, that traditional newbie experiment of "let's see what happens when I hold my breath" leads the machine to detect CAs and not OAs; hence the pressure is not increased. I believe that on your machine the CAs are called "NRs" ---non responsive apneas and the "NRI" number is the average number of NRs that are detected each hour. In other words, the NRI = (number of NRs)/(hours the machine was used).

If you really want to try to trigger your machine into increasing the pressure while you are awake, then do some fake snoring. Most APAP machines respond to snores and some respond pretty aggressively to snores. So practice your snoring and then snore for about 2-5 minutes while watching the machine's LCD for the pressure setting. It should start to rise. You may or may not actually feel the increase in pressure. It all depends on how sensitive you are to such physical stimuli.

Is tap water okay to use in the humidifier?

On a very short term basis, it's ok. On a long term basis? Distilled water is preferred because there are no minerals in distilled water. Mineral build-up in the humidifier chamber is not good for the humidifier. Also keep in mind that tap water does have things like chlorine and flouride added to it that you probably don't want to breath in night after night.

looked up the smartcode, don 't really know what to make of these results

First, I'd recommend NOT posting that smartcode on an open forum. It lets anybody who reads it go to the DeVilbass site and enter it into the appropriate place and gain access to your usage and efficacy data.

Your AHI is still quite elevated. We'd like to see it under 5. However, for some newbies, it takes a bit (a week or two) before that number declines to where it should be. In your case, the NRI number makes up a bit more than 50% of your AHI total. Since you are just starting out, it could be that your NRs are high simply because you're spending a lot of time dozing rather than sleeping and for some people, there are a lot of benign (meaningless) centrals that occur during the transition between WAKE and SLEEP. This kind of "central" is not even recorded as a Sleep Disordered Breathing event on a diagnostic sleep study. But if that NRI number remains above 5 long term then you should speak with the sleep doctor about it.