By Way Of Introduction... General Rookie Questions

[Michale32086]

I'll try and keep this short, but I believe that, when asking for help/advice, one needs to give as much information as possible..  So I will likely fail miserably.. Fair warning..

I have been (probably) fighting apnea all my life.. I say "probably" because it's never been a real serious problem until relatively recently..

I started the process of diagnosis and treatment about six months ago.. The wheels of treatment turned very slowly in my area and it was only until around Thanksgiving that I was scheduled for a sleep study (1st one of 2).  On the day before T-giving, I was scheduled for a routine out-patient angio-plasty and stent placement..  This turned into an emergency open heart triple bypass.. It was during recovery, both in the hospital and at home that my apnea took on debilitating significance..

Immediately after surgery I was in recovery for about 24hrs.. As one can imagine, I was doped up with a lot of drugs, most designed to keep me "sleeping"... Unfortunately for me, apnea proved to be a bigger challenge for these drugs..  I would, literally fall asleep for 30-60 seconds then wake up gasping for air..  The ward-nurse asked, "You have sleep apnea??"...  Uh yep.. 

Anyways, I would wake up for 5-10 mins, then repeat the whole process.. After about 6-hours of this, the nurse was able to cajole one of the on floor doctors into giving me something to keep me asleep..  After that, I would actually be able to sleep for 10-20 mins at a time.  Which doesn't seem like much, but was heaven compared what it was before..

After recovery, I was moved into a regular room, but being able to stay asleep for more than a handful of minutes at a time was still a problem.  I was able to get the hospital to "loan" me a CPAP machine after which sleeping for a couple hours at a time became possible.. I was promised that I would be able to go home with one, but my insurance company denied it without any official pulmonary sleep studies to justify it..

I am almost done here, promise..

I got home and was miserable.. Could not sleep to save my life.. I would be LUCKY to get an hour, hour and a half sleep a night..This went on for 2 weeks..  Being prior military and prior LEO I have seen and felt the first hand effects of sleep-deprivation and I was into that up to my eyeballs.  Hallucinations was the biggest problem.  As retired LEO, I am certified to carry a concealed weapon but I had to stop carrying for that time (the times I did venture out) for fear of drawing down on a hallucination..

I begged my pulmonary doctor to give me the first available sleep study as I was really going down fast..  

Finally got my study.. According to the monitors, in the falling-asleep process I stopped breathing 8 times.. In the 6 hours I was hooked to the monitors, I stopped breathing 30 times per hour..  Doctor tells me, "Yep.. You got apnea bad..".. Well it's nice ta get it confirmed.   

Unfortunately, at that time I was still more than a month out from my 2nd sleep study (where they fit me with a CPAP) and the follow up to that where they actually give me my machine..  I don't like to sound bitter.. It IS the holidays after all and I am mature enough (usually) to realize the world does not revolve around me.. 

But realizing that it's going to be more than a month of 1hr sleep a night??  I was about as low as possible to be..

Then a friend loaned me his CPAP he had gotten but never used and there was light at the end of the tunnel.. And I was FAIRLY sure it was not an oncoming train..

Thankfully, we are at the end of my long narrative.. If you have stuck with me this long, you have my eternal gratitude.. 

Because, while things are INFINITELY better ( I am getting 4 and 8 hours of sleep now!!!!  WOOT!!!) I do have a couple issues I was hoping that someone could clarify for me..

The biggest issue is that I can only be on the CPAP for 2-3 hours before the pressure jumps so high it makes breathing (exhaling) impossible and I, again, get a rude awakening..

I know it's in my profile, but for the record, I have an AIRSENSE 10 Auto Set and a ResMed full mouth/nose face mask..  When I start to use the machine, pressure is at around 4 and that is comfortable for me..  

Whether it's a setting issue or whether it's the machine detecting I am not breathing, within 2-3 hours, I wake up with the pressure at 15-18 and it's impossible to naturally exhale..  What I end up doing is taking the mask off (the machine auto detects and shuts off) give it a min or so and then put the mask back on and it starts all over again..

Don't get me wrong.. 4-8 hrs sleep in 2 blocks is heaven compared to what it was like before.. So if that's the price I have to pay then I do so willingly and eagerly..  But if that can be adjusted??  So much the better..

Another slightly less serious problem is the slight feeling of panic when I am on the CPAP.  In my head, I am thinking that this airhose is my ONLY lifeline to be able to breathe..  I can keep the panic under control but I am usually right at the threshold..  Due to a military incident I have severe claustrophobia where even an open ended MRI sets me off..  It's my belief that this feeling of panic with the CPAP stems from that..  Yea, I am pretty broken and battle-worn..  Whatareyagonnado??? 

In any case, those are the 2 biggest issues I am facing right now.. I am thinking (hoping) that once I have an official doctor-prescribed and set up machine, that these issues will take care of themselves..  But if they don't, I want to be able to speak intelligently to my doctor as to what is what..

That's where this forum comes in..

In any case, any assistance would be most appreciated.. And, again, my sincerest apologies for this long LONG novel...

[mesenteria]

Hello, fellow firearms user and soldier.  I don't have LEO history, but I was in the Canadian combat arms for 12 years and then switched to military psych (industrial/organizational, not the shrink stuff).

Fortunately, I was exposed to gas masks early, and we had to have annual refreshers where we were obliged to don our masks, enter a gas hut filled with CS fumes, and near the end of our calisthenics where we got sweaty and experienced the inevitable burn, we had to remove our masks, take a whiff, and exit in a hurry.  The whiff was to teach us that our equipment actually works!

So does your CPAP. 


Tell your mind to be calm, and to accept that this mask is just like the one slung on your webbing belt.  It's saving you from a far worse fate.

If you have been reading in some, you'll notice that we urge people to download the OSCAR software (everybody does eventually...if they want our help).  See the black marquee above?  Find the OSCAR link and read about it.  When you can post some examples of your nightly CPAP use, we'll soon know what's going on.

[ApneaQuestions]

If you can download OSCAR and upload some data using the SDcard we can take a look to see what we can see.

It's too early to say this but, Claustrophobia from breathing against too much pressure is common and sometimes requires moving up to a BIPAP.

In the meantime.. if you set EPR=3 this will give the maximum available exhale relief on that machine. (BIPAPs can give much more)

When the pressure is at 18, the EPR=3 setting means you only need to fight against 15 on the exhale.
When the pressure is at (say) 15, the EPR=3 means you only need to fight against 12 on the exhale

See my sig (below here) for instuctions for downloading OSCAR and then setting up the screen to get rid of pie charts etc. Also see the one on how to attach graphs

In the meantime EPR=3 should help if you are not already on 3

[snorybob]

With minimum pressure set at 4 most people are air starved. If you set it at 7cm/h2o with EPR at 3 you'll be exhaling at 4. 

That might help you for now but the best way is to get a sd card, download OSCAR & let the pros guide you in the right direction.

To get go in the setting hold big knob & home button for 3 seconds.


                               sb.

[harrywr2]

You'll need to post screenshots from the OSCAR program at some point if you would like help. (a free program that can read the data from your CPAP machine). THere are directions above how to download it.

The Resmed Airsense 10 Autoset will increase pressure in response to snores and flow limitations.
It can be set to limit maximum pressure for those who have issues tolerating higher pressures.(The max pressure on the machine is less than 1 psi...it feels like a lot but it really isn't much). It also has a setting called 'EPR'..which lowers the pressure at exhale time by up to 3 cmh20. You probably want that turned on.
The lazy/cheap doctors method of setting the machine is an initial setting of 5 minimum/15 maximum and then see how you do for a week or so and make adjustments as necessary. (As an example I said I felt air starved and they said move the minimum to 6 or 7, last I heard from them..which is fine since they want to charge me $136 every time I talk to them).

[SarcasticDave94]

Welcome to the Apnea Board.

Get OSCAR and a SD card to record machine data, any brand is OK, can be standard SD or SDHC between 1 and 32 GB, least expensive. Try digital camera shops, Wal-Mart, Best Buy, etc. We need to see your data to help.

For the time being, I'd agree with EPR 3 and pressure of 7 to whatever you've got on the top now. EPR 3 will still start you at 4 but EPR 3 from 4 is still 4, you can't go lower.

[Dormeo]

I'm so glad you're getting to use a friend's machine for now. You should not have been asked to wait! There's lots of good advice in the previous posts. One additional thought is to try setting the gear up in another room and using it during the day while you are reading or watching TV. This speeds up the process of getting used to the new experience.

If you can use Oscar and post a screenshot of your daily chart, that will tell the experts a lot. It might even be possible to cap the maximum pressure without compromising your therapy -- but the chart is needed for such a call. Meanwhile, what does the readout on your machine say your AHI for the night is?

[Jeff8356]

Michale32086, welcome to the forum! Retired LEO here also.

If you look at the black ribbon at the top of the page you will see a link for CPAP Setup Manuals. Follow the instructions on that page to get the Clinician Manual for your machine (it will be emailed to you). This will get you into the settings you will need to change your pressure as recommended in the previous post(s).

OSCAR is free software that many forum members use. It shows a lot of info that will better help the more experienced users guide you in the right direction. If you don't already have one, you will need an SD card for your machine, and some type of SD card reader for your computer.

Any more questions, please ask. Folks here are very helpful!!!

[Hydrangea]

Great advice in this thread so far, so I won't echo it.

To become at peace with my mask, I channeled some Star Wars mantras. "I am one with my mask. And my mask is one with me." It's absurd, but I literally repeated that phrase until I fell asleep... until I felt more at peace about it, which took about a week.

Remind yourself you are not in danger. Force yourself to look around your room and see 5 peaceful things. Think about the mask & machine, and think of 5 specific ways it is helping you (calming your heart, relaxing your brain, helping your lungs, giving you restful sleep, etc.).

I started out with a very minimal mask (DreamWear), and that helped me. I've now gotten to wearing a FFM and not being bothered, but that took time.

[DeepBreathing]

G'day Michale32086. Welcome to Apnea Board.

A lot of people find their claustrophobia is reduced by wearing a less intrusive mask rather than the full face version. However that does require you to keep your mouth closed against the pressure - if the pressure rushes out your mouth it's not doing your airway any good. Some people adapt to this readily, while others (me) much prefer the full face.

Among all the other good advice you've received, I'd suggest you read the excellent mask primer.