CPAPtalk.com

Hey Charlie - Welcome to HoseHeadWorld!

Been one for a few months. IMHO mask fit is paramount. And while one may fit well/feel ok when not attached, when and IF your CPAP pressure goes above 15, mask fit is a different thing altogether. I went through the FX - and (pardon me) but the head in your avatar block isn't skinny & small, and all ResMed headgear (the stretchy/velcro thing that holds the mask on your head) comes size MEDIUM on all shipped masks. For me, the straps pulled UP, not around, and therefor pulled the mask up into my eyes. I changed to the Respironics ComfortGel Blue Full Face - and at first tried the Xtra-Large. After a couple of weeks realized it was too big. So SMS sent me a LARGE. I love it! - But when my pressures get up over 12-15, I really have to pull the straps tight.

I have another post around here titled, "Size does matter" - check it out.

Oh yeah, I have SMS and therapist Jane is tops!


PJ

Hi you handsome sonofagun! I think you'll do well with this group!

You've gotten excellent advice on machines. I just wanted to add something about masks. I was also told that I had to have a full face mask by my sleep tech, on both occasions. (I've had 2 sleep tests.) It turns out, that just isn't true. I would encourage you to also try one of the nasal only masks just to test this out. I have had no problem and have gotten better AHI results with nasal mask than with a full face mask. They are much easier to tolerate. Some people use them with a chin strap to keep that mouth closed, instead of a full face mask. My favorite mask is the SleepWeaver, which you can order and try for 30 days with a money-back guarantee from cpap.com.

Good luck with all the adjustment, it's quite a journey but so good when you know you've gotten your sleep apnea under control.

PajamaGuy wrote:Hey Charlie - Welcome to HoseHeadWorld!

Been one for a few months. IMHO mask fit is paramount. And while one may fit well/feel ok when not attached, when and IF your CPAP pressure goes above 15, mask fit is a different thing altogether.

PJ

Absolutely! Compare the mask to a pair of shoes that you will wear to walk on for 8+ ours every day. Would you buy those shoes without trying them on?
Last time I bought new shoes for running I was made to run around the store in my stocking feet, fitted with a pair of shoes, and chased around the store again. When I got my first mask I was told to hold it up to my face and was told it was a good fit from across the desk. This mask that I had to wear every night for 8 hours... It leaked and burnt my face. It was like being told to run a marathon in flip flops.

Char1ieJ wrote:Even though I'm in the "mild OSA" range, should it worry me that my "pressure levels are on the high side"?

Pressure needs have absolutely no bearing on the severity (or lack of) the OSA diagnosis. Pressure needs are determined by the airway tissues themselves. Some people just need more pressure to hold the tissues back and keep the airway open. People can have an AHI of 100 + and need only 7 cm pressure to get the job done and someone else with an AHI of 12 might need 20 cm pressure.
Also doesn't matter if someone is skinny or fatter than they want to be. Skinny person might need higher pressures and obese person might get by with 6 cm.
There is no rhyme nor reason to it. Can't make any correlation...it is what it is. I am a little short woman with a skinny neck and sometimes I see my max IPAP go to right at 20 cm. I sleep through it so I don't care. Some nights it doesn't go very high at all and some nights it gets right up there.

Char1ieJ wrote:

robysue wrote:By numbers, your OSA is in the middle to top end of "mild OSA". Your pressure levels are on the high side. You are a classic example that the pressure setting needed to splint the airway open has nothing to do with the severity of the the untreated OSA.

And this also clarifies exactly why you're starting off with a bilevel: You're dealing with high pressures, had trouble tolerating straight CPAP at 15cm, and stuff settled down when they switched you to bilevel.

robysue,
Even though I'm in the "mild OSA" range, should it worry me that my "pressure levels are on the high side"? I have always blamed my restless/sleepless nights on fibromyalgia. I never really had a clue about OSA until I was talking with my brother-in-law about his CPAP machine. He described his sleep, habits, feelings -- and I kinda thought, "Hey, that sounds like me - every night."

As pugsy has already said: Pressure needs and severity of untreated OSA are not correlated. Some folks have mild OSA and need lots of pressure. Some folks have severe OSA and need very little pressure. The severity of the OSA is determined by how often your muscles relax to the point where the airway actually collapses. The pressure needs are determined more by the physical structure of the upper airway and how much "stuff" the air pressure has to push out of the way once the airway is starting to collapse.

As for "trouble tolerating straight CPAP at 15cm" -- If I remember correctly (it was the middle of the night), I had trouble exhaling and felt like I couldn't breathe at that level. But, when the sleep lab tech made a change (the change I now know was moving from CPAP to BiPAP), I fell asleep comfortably and didn't snore or remember waking the remainder of the night.

Yep. One form of "intolerant of CPAP at 15cm (or more)" is indeed "patient struggled with exhaling at high pressures and reported problems with being able to breathe comfortably." The switch to BiPAP provides an instantaneous pressure drop on exhale and (unlike an exhalation pressure relief system on a CPAP), that lower exhalation pressure is maintained for the entire exhalation. And that can make it feel much more natural and easier to breathe with a BiPAP as compared to a CPAP/APAP, even with exhalation relief turned on.

PajamaGuy wrote:Hey Charlie - Welcome to HoseHeadWorld!

THANKS PajamaGuy! I'm happy to meet ya!

PajamaGuy wrote:Been one for a few months. IMHO mask fit is paramount. And while one may fit well/feel ok when not attached, when and IF your CPAP pressure goes above 15, mask fit is a different thing altogether. I went through the FX - and (pardon me) but the head in your avatar block isn't skinny & small, and all ResMed headgear (the stretchy/velcro thing that holds the mask on your head) comes size MEDIUM on all shipped masks. For me, the straps pulled UP, not around, and therefor pulled the mask up into my eyes. I changed to the Respironics ComfortGel Blue Full Face - and at first tried the Xtra-Large. After a couple of weeks realized it was too big. So SMS sent me a LARGE. I love it! - But when my pressures get up over 12-15, I really have to pull the straps tight.
I have another post around here titled, "Size does matter" - check it out.

No pardon necessary. I'm not a small dude. I'm 5'9", kinda broad shouldered -- and weighed around 235-238 in that photo (on the fat side, as far as I'm concerned). Thankfully, with dietary changes and education, I'm down to 201 this morning, so my face is slightly slimmer... but just as handsome. Haha!

I appreciate the info on masks. That is one thing I am still TOTALLY clueless about. The mask I wore for the titration study was full face, with a blue gel insert around the nose/mouth area. It fit well and only leaked on the bottom, outside "corners" of my beard. I have since changed my facial hair to get rid of those corners, so I think that mask (or one similar to it) would work just fine for me. The "problem" is, I have NO clue what brand or model mask the sleep lab put me in. I'm calling the tech back today, to inquire about the brand/model. I do know it was size large. As I expect to loose another 20-30 pounds over the next few months, the initial mask will possibly not be the mask I end up with in the long term -- at least not size wise. I'll check out the Respironics ComfortGel Blue Full Face. THANKS again PJ!

robysue wrote:As pugsy has already said: Pressure needs and severity of untreated OSA are not correlated. Some folks have mild OSA and need lots of pressure. Some folks have severe OSA and need very little pressure. The severity of the OSA is determined by how often your muscles relax to the point where the airway actually collapses. The pressure needs are determined more by the physical structure of the upper airway and how much "stuff" the air pressure has to push out of the way once the airway is starting to collapse.

Pugsy and robysue, THANKS for explaining this to me. I didn't know whether to worry or not. Now, I know it is what it is -- not to worry. I'm hoping that as I loose weight and learn better sleep hygiene, that things will get better. I'm not fooling myself that I will one day be able to set aside the VPAP. But, I am hoping for restful, restorative sleep -- something I've been longing for -- for several years now.

On a personal note... ya know those conversations when someone asks you what you'd wish for, if you had only one wish -- and the answer has to be something for yourself (not like world peace, etc)? Someone asked me that question a couple years ago. The answer actually brought tears to my eyes... because the first thing that came to mind was, "My one wish, if it had to be for myself, would be -- a day with no pain and a night where I could sleep ALL night." The thought that might actually become a reality has me very hopeful!

Char1ieJ wrote:The thought that might actually become a reality has me very hopeful!

Ode to a newbie: How easy it is.

I wish I could tell you how easy it is.
I put on the mask, I hit the blue light,
I'm adrift in the night.

It did'nt come easy you know,
infact it was a fright.
The straps and that mask,
....and....damn those blue lights,

I screamed and swore,
and cried out in the night,
"Why me? Why me?"
This just isn't right.

Out of thin air, through the ethernet,
came a glimmer of hope, as I cried out my plight,
"..please, don't spook me, don't scare me,
I just want to sleep through the night."

My questions were answered,
my mind put at ease.
We're here to help you,
all you got'a do....
is believe.

So, I listened and learned.
I chin strapped and glued,
and sealed up the holes.
I had tender, scraped nares
and a bruised, bleeding nose.

Night after night, I begged for relief.
"Please, please...give me back my life!"
Then one morning, just after first light,
a release from the pain, the fatigue,
just ever so slight.

Now.....it's just that easy.
I put on the mask, I hit the blue light,
I have a new life.

I agree with Carbonman:
That blue light has such power, the bliss of restful sleep.
It is a beautiful thing.

carbonman wrote:

Char1ieJ wrote:The thought that might actually become a reality has me very hopeful!

Ode to a newbie: How easy it is.
...
I put on the mask, I hit the blue light,
I have a new life.

WOW, thanks for that carbonman. A poem of hope... my hope.

Just got a voicemail from a Resp. Therapist at the DME!! She wants to meet next Wednesday to start the fitting & configuration process. I'm gonna call her back after lunch and ask her if we can meet this evening -- or even tomorrow. I'm ready!

UPDATE: Machines have been ordered, and are expected Tuesday; that's the reason for waiting til Wednesday. She says the DME sells Respironics brand. She's sure it's a System One machine, but not sure which model. She did say it is data capable. I told her to make sure it's a 60 Series and Auto... or there's no need setting it up prior to me seeing it.

Updating this thread... already wrote in the other one I started...

After a lot of talking with the "preferred" DME and the local DME, as well as forum members and a friend who is a Respiratory Therapist, I decided to go with the local DME - not the "preferred" DME mentioned in the last post I offered here. My doc has re-written the order to specify AUTO for my Bi-PAP machine - so there is no confusion on what I want.

I'm pretty sure that I'll go with the Respironics REMstar System One 60 Series Bi-Flex Auto and a full face mask. Since I won't get a mask replacement (at least thru insurance) for a full year, I'm thinking of going with the ResMed -- due to it reportedly having more individual replacement parts that other brands.

The re-written order was faxed to the local DME this morning (confirmed). They have my sleep studies in hand already (confirmed). I am hoping to sign final paperwork this afternoon or tomorrow morning. And, DME has both machines (PR S1 60 Bi-Flex Auto and the S9 VPAP Auto), humidifiers and masks in stock. Sooooo, I could have my machine as early as tomorrow or Thursday. Woot woot!

I want to THANK everyone who welcomed me, replied and gave me information on the machines and the process -- especially feeding me questions to ask the DME's and insurance company. YOU are awesome. This is in no way a goodbye. It's just an end to this thread. I hope to be a long-time, contributing member here.

Good luck, and post again when you get the machine and start using it!

Xney wrote:Good luck, and post again when you get the machine and start using it!

THANKS Xney! I'll post once I get the machine. I talked with the local DME late yesterday afternoon. He sent an approval for another patient to BCBS Monday afternoon and received his paperwork yesterday morning. He faxed mine out yesterday morning, so he was expecting it by this morning. Since he has the machine in stock and I emphasized how ready I am to get moving, he said he would setup my machine as soon as the paperwork arrives and call me to go fit my mask and train on the machine -- then take it home. I am sooooo hoping that happens today. I know, there are two more days in the work week. But the sooner, the better, in my book. I'm ready to really start down this path to better sleep and ultimately another step in better health.

Two of my docs were telling me that getting my heart arteries opened back up (stents after the heart attack), loosing the weight (36 lbs so far) and getting some restorative sleep (after 8-9 yrs) *could* make me feel 10-12 years younger. I am MUCH younger in my mind than my body feels right now. In fact, my body feels much older than my 49 years. So, feeling like a 37 year old beats the heck outta feeling like a 75 year old. I know Bi-PAP won't solve the world's problems. But, I'm hoping it just might make a difference for a few of mine.

Pugsy wrote:The $1,000 difference between ResMed VPAP and similar Respironics machine is due to the fact that ResMed does not allow and reduction or discounts off of MSRP. There isn't a $1,000 worth of difference between those machines. I know because I have one of each and they are the latest models. Minor pros and cons with each. There are some differences in how each one works though.
Robysue took the time to put the differences into words here viewtopic.php?f=1&t=71017&p=655822&#p655822 . . .

Well, this brings up an interesting dilemma for me that I hope will help CharlieJ the original poster of this thread. I'm really close to buying my new machine and was going to get the S9 Auto until I read Robysue's post which makes me wonder if I should consider the System One AFLEX https://www.cpap.com/cpap-machine/respi ... -flex.html.

So, I read Robysue's description of differences between machines in the link Pugsy posted and read this in Robysue's post that has led me to reconsider my next machine: "In my case, I am rather glad (in retrospect) that I was forced to get the System One because the S9 VPAP Auto was not yet on the market at the time I was switched to bi-level. The reason I say this? It's because of my own patterns of pressure increases. On my S1, the most common reason either the IPAP or EPAP is increased is the machine detecting flow limitations and the hunt-and-peck algorithm that picks up very subtle flow limitations. Both of these only increase my IPAP. And so I start the night off at 6/4, but tend to spend significant chunks of time at 7/4 and 8/4 most nights. My EPAP rarely goes above 5cm these days. Since my old S9 AutoSet also increased pressure in response to flow limitations, I would strongly suspect that if I were using a S9 AutoSet, my EPAP would not remain at 4cm for most of the night and my guess is that it would regularly be above 5cm. And for me, aerophagia problems were a major reason for trying biPAP, and it's keeping that EPAP as low as possible that helps with the aerophagia problems. (Those rare nights I snore enough to have the machine increase my EPAP to 6cm are strongly correlated to my worst aerophagia issues.) "

My current Respironics M Series AFlEX wakes me up with too much pressure throughout many nights where I have to push ramp to get back to sleep. I check the data and do not see an event at that time in the night that would have made the machine increase pressure so much. Anyway, my quest for a new machine is one that hopefully will get a machine that prevents events and manages pressure better.

Any thoughts?

Well, check me out! (pssst... look in my signature area). haha

Oh yeah... sportin' a Respironics DS750HS baby; with a ResMed Mirage Quattro full face mask. BiPAP Swagger, y'all.

Just went and picked it up at the DME. Woot woot! Ready to take this baby for a spin tonight.


[Oh... and based on another thread in this forum, I checked the blower hours and data while I was at the DME. All were ZERO -- definitely a brand new machine, straight outta the box.]

Char1ieJ wrote:Well, check me out! (pssst... look in my signature area). haha

Oh yeah... sportin' a Respironics DS750HS baby; with a ResMed Mirage Quattro full face mask. BiPAP Swagger, y'all.

Just went and picked it up at the DME. Woot woot! Ready to take this baby for a spin tonight.


[Oh... and based on another thread in this forum, I checked the blower hours and data while I was at the DME. All were ZERO -- definitely a brand new machine, straight outta the box.]

LOL, you are so funny - and woot! Have a great night : )