[CPAP] New to CPAP and struggling - feels like my breathing gets "cut off" by the machine

[andrewb]

Hi there,

I'm new to CPAP, I'm currently trialing a Philips DreamStation (the auto CPAP one), and I'm having a lot of trouble getting used to it.

The main issue that I'm having is that sometimes it feels like my breathing is getting "cut off" by the machine - sometimes when I'm breathing in but haven't quite finished inhaling, it drops the pressure, which leads to me suddenly feeling like I can't breathe properly, jolting me awake.

I believe my machine was initially on A-Flex level 3, I tried it with flex disabled (at the recommendation of the technician) which then caused the opposite problem - inhaling was now fine, but when I exhaled it felt like I got cut off before I was able to finish exhaling (or maybe it wasn't "cut off" so much as "just unable to breathe out all the way"), which similarly jolts me awake.

The technician didn't have any other ideas for what to try if that didn't help, my partner suggested I contact Philips to see if they have any recommendations, but I figured I'd try posting here first.

Basically what I think I want is: the pressure stays on while I inhale, keeps staying on until I've fully finished inhaling, then backs the pressure off a bit while I exhale, and keeps the pressure backed off until a little bit after I've finished exhaling. (of course, I'm not an expert, and this is just me guessing based on what I'm observing, I could be wrong about what would solve my problem)

Is this something that I can configure on the DreamStation? Are there other models/brands that work like this? Is there anything else I can try to configure to see whether it would help?

I believe I tried the other flex mode on the CPAP machine and that was bad in both ways, but I'll need to experiment more when I'm actually awake enough to remember.

My starting pressure is currently 8 or 9 I think, I started at 5 initially but that was definitely too low. I think my maximum is set at 15, but I haven't been able to sleep for long enough to get there

PS: I know that the best way to get used to the CPAP machine is to just keep on using it and eventually you'll adapt, so I've been trying to use it every night, but give up after 3-4 times of "fall asleep, then get suddenly jolted awake feeling like I can't breathe"... Should I stick with it for longer, even though it keeps waking me up feeling like I can't breathe? I haven't managed to sleep for more than about 20 minutes without being woken up by it.

Thanks in advance for any thoughts or advice

[NLapnea]

When I first started using the machine (Resmed Autoset) I had a similar feeling. Inhaling was no problem, exhaling felt heavy and it took some time to get used to the feeling. Hang in there, give it some time, once you get used to it you will have a hard time not using the machine.

[Sleeprider]

You say you are "trialing" a Philips Dreamstation APAP. Get the Resmed Airsense 10 Autoset instead.  The pressure delivery on the Resmed reliably follows your spontaneous respiratory lead and it is actually a bilevel machine that has up to 3-cm of pressure relief during exhale.  The way the pressure is delivered is extremely comfortable and has therapeutic value for upper airway resistance, flow limitations, respiratory effort related arousals and hypopnea.  We consistently see better tolerance and results using the Resmed than the Philips.  If you are at a stage of therapy where you can make a change, do it!.

In the image below, notice the respiratory flow rate of the user, and the mask pressure in blue. See how it follows respiration, supporting inhale and exhale alike Even where respiratory flow becomes unpredictable and irregular like the middle of this graph, the Resmed follows. This is the best in class CPAP at work with EPR (exhale pressure relief). Your Philips will never be able to do this, and both Cflex and Aflex anticipate your respiration and raise and lower pressure ahead of when you're ready.  For some people it workd, and for others, it simply feels like a failure to sync.  Swap.

[staceyburke]

You said you are in a trial mode and can return it? If so you would want a resmed S10 autoset. Much better machine and easier to set. Most people on this site use them. I had a dreamstation for 5 years and never got good therapy. Got a Resmed and my sleep was greatly improved. The supplier will want you to stay on the Phillips because it is less expensive. They get the same from insurance for both machines but the resmed costs more so there is less profit. Don't just accept it, you are "stuck" with this machine for at least 5 years before insurance will allow another.

[OpalRose]

The main issue that I'm having is that sometimes it feels like my breathing is getting "cut off" by the machine - sometimes when I'm breathing in but haven't quite finished inhaling, it drops the pressure, which leads to me suddenly feeling like I can't breathe properly, jolting me awake.

I believe my machine was initially on A-Flex level 3, I tried it with flex disabled (at the recommendation of the technician) which then caused the opposite problem - inhaling was now fine, but when I exhaled it felt like I got cut off before I was able to finish exhaling (or maybe it wasn't "cut off" so much as "just unable to breathe out all the way"), which similarly jolts me awake.

I used a Respironics Series 60 Apap for over 5 years (the predecessor to the DreamStation), and the feeling you describe is exactly what I experienced. Unfortunately, I didn't have the option of exchanging it as I waited too long.

You are in a good position to return the machine since it is a trial. Request the ResMed AirSense 10 AutoSet. If they give you a hard time, go elsewhere. You have choices, don't get stuck with something that isn't going to be comfortable for you. Five years is a long time.

In the meantime, don't use a Flex Setting of 3. Turn it down to Flex 1 or 2.

[Dormeo]

Another vote for the ResMed Airsense 10 Autoset. I had home "titration" on a PR machine and had that same problem of feeling I was being hustled. When I got my "keeper" ResMed machine, it was such a relief to me. I felt I could do this. The machine followed my lead beautifully, with a very nice expiratory pressure relief of 3. (My current VAuto also follows me smoothly.)

I think you'll start sleeping for longer stretches with the machine once you get a ResMed, but in the meantime, try setting the machine up outside your bedroom in the day or evening and use it while you read or watch TV -- something a little diverting. This can really help speed up your adaptation, and it avoids setting up negative associations between being in bed and having a sleepless time of it with the machine.

Good luck -- do keep at it, especially until you get that ResMed!

[andrewb]

Thanks everyone for your advice so far. I'll talk to the sleep clinic and see whether it would be possible for me to trial the ResMed machine instead. If not, it seems like ResMed have a 30 day guarantee where I would be able to return it for a full refund if it doesn't end up working for me.

Do you know whether it's possible to use the mask I currently have (F&P Eson 2) with the ResMed machine? I searched online but found conflicting things. That said, I would be open to trying out ResMed masks, it just seems like getting a mask that is comfortable would potentially require some amount of trial-and-error which is a lot harder if I need to do it by purchasing the masks myself and then returning them if they don't work, rather than being able to try a bunch at the sleep clinic.

In terms of insurance, I'm in Australia so it works a bit differently. I'm renting the machine from the sleep clinic for a fixed trial (4 weeks) which I paid for in advance (but it wasn't too expensive so not a problem), and if it goes well I'll be able to buy a machine from them. Regardless of who I get the machine from I'll need to pay out-of-pocket, and then my insurance will refund me some amount up to a limit, which definitely won't be enough to cover the whole machine (I think the limit is like $500, and machines cost around $1500). But even if my insurance didn't cover anything, I'm pretty sure ~$1500 would be entirely worth it if it significantly improved my sleep and energy levels during the day etc.

[staceyburke]

If you must pay 1,000 for a machine, take a look at Supplier #2 on the suppliers list (the shopping ? at the tp of the site). They sell and I believe ship world wide new and used Cpap machines. Resmed is a great machine and they have new machines for under 600 and used for around 400. I bought a used machine with less than a month of use. Great company and machine. At least take a look and post back what you like to make sure it is the best machine.

[OpalRose]

Yes, you can use your current mask with any machine. Masks (regardless of brand) can be used with any brand machine.

Also, hoses are interchangeable except for heated hoses.

[Sleeprider]

Masks are universal. You can use any mask that works for you with either Philips or Resmed. All masks and all CPAP tubes use 22 mm universal fittings.