New User - trouble adjusting (wants to change settings)

I replied to a bunch of stuff last night, but I guess it didn't post. argh.

So a few quick answers for now - ant, btw, thank you to all who responded with comments or questions.

- My machine does look like the 60-series, although the humidifier is slightly different (where the hose connects is different). And it does seem to be set on the A-Flex

- I don't know what "latency minutes" means either, vs "duration minutes" (from the sleep study)

- switching to a nasal mask probably is not an option for me, as I have allergy problems. Or, rather, I was diagnosed with allergies some time ago and have been taking Zyrtec for some effect for quite a while. Last year I was retested because I wanted to try getting allergy shots, and the tests came back negative so they said I was no longer allergic but have chronic rhinitis instead. Whatever it is, it causes chronic cough due to post-nasal drip and my nose is never really "clear." I've tried Zyrtec, Sudafed, Flonase, and neti pots - separately and combined, with minimal relief in symptoms.

- I'll look into getting the sublingual melatonin over the weekend

- I'll also look at getting my data downloaded onto the computer over the weekend. Since I have such a scarce amount of it, really, I didn't think that would be worth the effort at this point?

- tim - no offense taken. Briefly, I got tested because I was getting enough sleep but was tired all the time and my boyfriend reported that I was snoring and it seemed like I sometimes stopped breathing. I was familiar with apnea from friends/family, so I tried to get tested. I didn't score high enough on the epworth scale last year for them to send me to get tested. It seemed like it was only getting worse, so I gave higher numbers on the scale this time (probably, more honest answers as I usually downplay when I feel bad). They had already tested my thyroid and vit D levels (nothing wrong), and I'm not depressed, so I was sent to the sleep lab. They gave me a home test first, which didn't show anything unusual. But I did have issues using that, and the doctor was concerned enough to send me to the actual lab where they did the test that yielded the results above. I do realize I'm lucky with an O2 level above 90%. And, for however it matters, I'm 33.

jjj:
Latency refers to the time it took from lying down to falling asleep.
Duration is the time you were actually sleeping.
I find a choice of masks works best for me. nasal pillows are the least fussy
--except I have to force my mouth to stay shut.
My élan is the coolest, but my comfortgel ff is reliable and comfy when I'm stuffy.

chunkyfrog wrote:jjj:
Latency refers to the time it took from lying down to falling asleep.
Duration is the time you were actually sleeping.
I find a choice of masks works best for me. nasal pillows are the least fussy
--except I have to force my mouth to stay shut.
My élan is the coolest, but my comfortgel ff is reliable and comfy when I'm stuffy.

Don't mean to hijack the thread, but quick question: Do you find you have to adjust your pressures according to the different masks you use?

Was there a typo in the original post? How did stage two come .5 but stage one at 4.5? That was the part that confused me.

BasementDwellingGeek wrote:Was there a typo in the original post? How did stage two come .5 but stage one at 4.5? That was the part that confused me.

No typo on my part - that's what my report says? I can ask about it on my next appt in a few weeks.

I'm unable to upload the data into Sleepyhead for now (it's not compatible with my machine). I still only have 5 days longer than 4 hours, so I don't think I'd get much useful out of it just yet anyway. :-/

Okay, I still haven't made it through a night with the mask on. The last few nights, it's started leaking, which drives me crazy. Is this just because the liner is starting to wear out already? Because I didn't have that problem at all the first 3-4 weeks.

Anyway, the clinic did say I could go in and have them change the pressure settings. It seems silly to me to drive over there just for that - so I want to change them myself? I do realize they might yell at me... but I think it's kind of stupid they started me out with a pressure range of 5-20. I mean, I understand they want to find a baseline, but as I understand it, many people do not need up to 20. It seems like a better idea to start a new person, still adjusting to the whole thing, lower than needed then gradually increase it.

In any case - I know how to change the settings but I'm not sure exactly what to change them to.

I figured I'd change the max pressure down to 15 (from 20) and see if that helps, and then maybe go down to 10.

Leaving out the obvious settings, like for the humidifier - these are my settings:

Mode - Auto
Auto Max - 15 (changed from 20)
Auto Min - 5
Flex Type - A-Flex
A-Flex - 3
Ramp Time - 5
Ramp Start - 4
Auto on - on
Auto off - off
Mask Alert - off
Mask Fit check - off
Split Night - off

Okay - questions -
- What does A-Flex 3 mean?
- If I increase the ramp time from 5 to 10, does that mean it will ramp up more slowly - increasing every 10 minutes instead of every 5? Because I am often having to ramp it down even before I fall asleep (as it's taking me 60-90+ minutes to fall asleep with the mask on).
- If I turn Auto off, "on" does that mean it will automatically detect when the mask is off and turn the air off? Because that would be nice, as I am often removing it in my sleep without knowing and wake up with the air blowing full blast - seems like a waste?
- What does "mask fit check" do? Should I turn that on?
And, finally - what does "split night" mean? I don't think I need to change that, just curious.

With my sleep study results from the first page, and I know you're not medical experts, but does anyone have educated guesses as to about what pressure I would need? I think 15 would still be too high - am thinking 8-10 is the average?

thanks

Oh, and I've only had it on more than 4 hours for 5 nights, so there is not much data to draw from there. :-/ And sleepyhead won't import the data from this series yet (so I hear, and I did try without success) - and I'm on a Mac.

What little data it has been able to gather, has the AHI around 3.7 and 90% pressure between 10-11.

jjjmac wrote:Okay, I still haven't made it through a night with the mask on. The last few nights, it's started leaking, which drives me crazy. Is this just because the liner is starting to wear out already? Because I didn't have that problem at all the first 3-4 weeks.

Anyway, the clinic did say I could go in and have them change the pressure settings. It seems silly to me to drive over there just for that - so I want to change them myself? I do realize they might yell at me... but I think it's kind of stupid they started me out with a pressure range of 5-20. I mean, I understand they want to find a baseline, but as I understand it, many people do not need up to 20. It seems like a better idea to start a new person, still adjusting to the whole thing, lower than needed then gradually increase it.

In any case - I know how to change the settings but I'm not sure exactly what to change them to.

I figured I'd change the max pressure down to 15 (from 20) and see if that helps, and then maybe go down to 10.

Leaving out the obvious settings, like for the humidifier - these are my settings:

Mode - Auto
Auto Max - 15 (changed from 20)
Auto Min - 5
Flex Type - A-Flex
A-Flex - 3
Ramp Time - 5
Ramp Start - 4
Auto on - on
Auto off - off
Mask Alert - off
Mask Fit check - off
Split Night - off

Okay - questions -
- What does A-Flex 3 mean?
- If I increase the ramp time from 5 to 10, does that mean it will ramp up more slowly - increasing every 10 minutes instead of every 5? Because I am often having to ramp it down even before I fall asleep (as it's taking me 60-90+ minutes to fall asleep with the mask on).
- If I turn Auto off, "on" does that mean it will automatically detect when the mask is off and turn the air off? Because that would be nice, as I am often removing it in my sleep without knowing and wake up with the air blowing full blast - seems like a waste?
- What does "mask fit check" do? Should I turn that on?
And, finally - what does "split night" mean? I don't think I need to change that, just curious.

With my sleep study results from the first page, and I know you're not medical experts, but does anyone have educated guesses as to about what pressure I would need? I think 15 would still be too high - am thinking 8-10 is the average?

thanks

Not real sure on some of your other questions as I'm still learning myself, however, I wouldn't be so concerned at your top end pressure at this point as the machine will only ever increase up to that if needed and unless your suspecting "centrals" or waking up to it blasting you with too much air (not to be confused with leaks as they can occur at any pressure and you will have to resolve them first either way...), I would look at your low end pressure if you want to experiment. I thought you mentioned your 90% pressure was at 10 or 11? Sorry I'm laying in bed typing this out on my tablet and can't find that part now but if so, it has been suggested to set your min pressure at 2 below that number. I would only suggest going up no more than 1cm at a time though and try for at least a week.

I can't remember if you know Encore basic would work for your machine I believe. Hit pugsy up for a link.. You will benefit by having some software to see what's going on and with any pressure changes..

jjjmac wrote:- What does A-Flex 3 mean?

Flex settings available are 1, 2 and 3 for exhale relief. They don't related to the actual per cm drop in pressure that ResMed has with their ResMed EPR which is their version of exhale relief.
You can read about the Flex options here
http://aflex.respironics.com/
It's hard to describe what it feels like but the amount of relief or reduction is based on the flow or force that you breath. There is a demo available so you can actually try each setting to see which you like the best. From my own past experience it felt more like a breathing rhythm changed. A setting of 3 seemed to make me want to breathe a little faster than I wanted, and a setting of 1 was draggy and slow but the setting of 2 pretty much mimicked my own natural breathing rhythm. Since it is a comfort feature you can play with it all you want to see which you happen to like the best or heck, even turn it off to see if you like things better with it off.

Yes, if you increase the ramp time a bit then it will increase pressure a little more slowly till it gets to the end of the time where you should be at your pressure setting.

Yes, if you turn Auto OFF to the "ON" position then the machine will turn itself off if you remove the mask or you have a substantial large leak and breathing is no longer sensed. It takes about a minute. If you have the mask alert alarm on it will beep during that time until it turns itself off. It is not a loud beep at all. I have slept through it many time.

Mask fit lets you check your mask fit at your pressure and get it adjusted then if you start ramp the pressure drops down and you go through the ramp feature.

Split night setting on the machine allows you to do half the night on APAP at whatever pressures you set up and the other half of the night on straight cpap at whatever pressure you set up.

Have no idea what pressure might be optimal without seeing some of your software reports.
The minimum pressure is the most critical pressure though. It needs to be high enough to get to where the machine needs to go in a reasonable length of time. The maximum is not all that important unless it is being reached all the time (need software to see). In general these machines won't increase the pressure unless they think that they have a reason. If your maximum never reaches 14 cm and you have the maximum set at 20 cm then it is a moot point because the machine doesn't go there and if it doesn't ever go there it doesn't matter what it is set at. It can't affect anything if it is never reached.
Now if it often increases to the max or near the max then one would want to try to figure out why if for some reason the pressure changes were disturbing sleep quality. Again one needs the software and depending on cause then there may be a reason to limit the max. If pressure increases are making leaks harder to manage...then again might limit the max.

I know you have a Mac. I think I sent you EncoreBasic information. If I didn't then send me a private message and I will get it to you. Of course it is Windows based software so you need some sort of Windows environment to run it in.

Pugsy - thank you for the thorough explanations! Those things make more sense now. You did send me the info about Encore. I don't have Windows installed on my Mac and wasn't really planning on adding it... but we'll see how the next two weeks go. Until I start being able to use the machine more, there really isn't much data to even bother importing. :-/

I finally had another night over 4 hours of use.... but I was awake the entire night, so I don't think it counts. I'm starting to get discouraged now. :-/ I figured that if i could persevere and just leave it on, eventually I'd fall asleep.... well... apparently not. And now I have to work until 8pm tonight on no sleep.

I'm not giving up yet, but it's getting really hard to imagine that feeling less tired is worth all this. I know, I know - it's about not dying early. Right now I don't really care about that, when using the machine is going to drive me literally insane before I'd get anywhere close to dying.

The air pressure doesn't seem too much... the mask does still seem kind of tight, but it's not entirely uncomfortable... and I've adjusted to wearing the mask a little higher up so it doesn't feel like it's putting pressure on my nose, so I don't get the "panicked" feeling I had before. But the problem is that wearing it makes me way too alert to fall asleep. Does this happen to anyone else? I do take sleeping pills sometimes (did not take one last night) and that helps sometimes and other times not.

When I have my next appt in 2 weeks, I'm going to ask about the dental appliance. I already have a retainer, so it can't be much worse than that - but can it replace wearing a retainer? Because I don't see how I'd be able to wear both?

You gotta get some sleep some how. Take the meds if you have to. Talk to the doctor about inability to sleep with the mask.
Since you had some sleeping pills I assume you have had problems getting to sleep before all this started. Unfortunately for some people adding the mask and machine really puts the brain into overdrive and makes things so much harder.

Do you think that you could maybe use a more minimal mask like the nasal pillows? Even if mouth breathing maybe it might allow you to get some sleep and let the brain know that it is okay to go to sleep with all this stuff on our face. At this point I wouldn't worry so much about optimal treatment as I would about getting treatment period. Get so you can at least get some sleep and then worry about any optimal issues as they present themselves.

If you drive over to have them change the pressure, then an RT might chat with you about your problems and make some helpful suggestions. Maybe also offering a chance to try another mask.

I used the Fischer and Paykel Forma mask for a long time. To keep it biting me across the bridge of my nose, I used "Mole Skin," which is actually not from a mole, but is synthetic. Mole skin has a peel off sticky backing on one side, and a soft fur on the other. It is the foot care section of your grocery store, pharmacy, and so on.

I also know that the longer one uses a mask, the more the elastic of the head set wears out. When it is nearly gone, one ends up without the cushioning of that elastic to get the mask tight enough, which is, to me a big ouchy. My complaint is that Medicare says a head set should last for six months. I am sure this is from a book keeper making decisions. I guess I am going to need to learn how to sew, I can not afford the list price of an elastic head piece either.

In the last year I also got a "Hose Buddy" from CPAP.COM which I think is very helpful in helping me. One could rig something to do what a "Hose Buddy" does for nearly nothing in cost quite easily.

I have found to have successful sleep I must have really spectacular AHI numbers of less than one to feel good, despite what the docs say.

No, I didn't have ANY problems sleeping before. I always fell asleep in under 10 minutes - usually 5. I might have had insomnia (of 2-4) hours two or three times a year. So not falling asleep is driving me crazy more than it probably should. I feel like I've gotten over a lot of the anxiety and plain not wanting to wear the mask (that was mostly just the first week). Now, it just seems like when I put the mask on, I can't get tired. I don't find the air obnoxious or bothersome, unlike with the nasal mask that I tried during my sleep study. I did not like the sensation of that at all. Still, maybe I should try it. I am always congested though, so it seemed foolish to start with a nasal mask, which is why I went with the full face mask. They only had one other full-face model (one of the Mirage line) I could try - which was even larger. Besides that, I can only get a new mask every 6 months so I'm kind of stuck with what I have unless I want to pay out-of-pocket for one, which I'm hesitant to do when I'm low on funds and I don't even know if that would help.

I'm not giving up yet, but I'm going to try the sleeping pills again tonight (I bought some unisom the first week I started CPAP - never used them before). I'm not sure how much of a step up it is though if I become dependent on sleeping pills to fall asleep when I never needed to use them before. And, unfortunately, the few times I've tried using the pills they don't even always work...and when they did, I didn't stay asleep - just fell asleep but woke 2-3 hours later and couldn't fall back to sleep.

I did look up the hose buddy, and I don't really have an issue with where or how the hose falls. One of the special pillows might be nice though.

That's good to know about the headset wearing out. I assume I can only get a new one of those every 6 months too, as it seems to come attached to the mask. My mask doesn't really bite into my nose - it just puts pressure on it/squeezes it. It's relatively slight, but when I already have issues breathing through my nose, anything is probably too much.

anyway, thanks for the responses. Hopefully I've have some more postive news soon!