I need help!!

[bragucci]

Ok, here is my problem.  I was diagnosed with moderate sleep apnea after completing a ' home sleep study'.  I do not have very good insurance and the 'home' study was the less expensive option.  The Dr suggested I purchase a unit 'online' rather than going to a medical supply store, again the most less expensive option.  He gave me a list of 4 online CPAP suppliers that his patients have had good results with.  The medical supply order was for a APAP machine, 5-20 CWP with heated humidifier and related supplies.  I purchased a new  DeVilbiss IntelliPAP Auto CPAP Machine With SmartFlex
and a nasal pillow mask.  I exchanged the nasal pillow mask for a full face mask as I find the full face mask more comfortable. I have the APAP setup as follows: humidifier heat on 2, I have the ramping delay set for 35min, the SmartFlex at 3. I go to bed at 9pm with a wakeup time of 5:30am. I am a sleep within 30min of going to bed, so the 35min ramp delay setup works well. Now my problem.  Anytime after midnight I am awaken by the APAP rushing a lot of air into the mask, the mask starts to leak shooting air into my eyes, making 'farting' noises, and lifting off of my face. Tightening the headgear has helped the 'lifting off my face' issue, but the leaks and noises persist. I have looked at the display during these rush of air incidents and see the air flow at 10-14 CWP, a few nights it was between 15-17CWP. The usual level is anywhere between 4-7CWP.  I understand these auto machines up the air flow when it senses more is needed to keep the airways open. So I am 'thinking' after being asleep for a few hours I need more air and the machine kicks up into the over 10 CWP range ?.  Whatever the reason for the air increase it wakes me up, every night. What I can do is once awaken by this air rush I turn the machine off, then back on. This process usually gets me through the rest of the night without the air rush, but my sleep is still disturbed from being woken. I really need this to work and am asking for advice please. What brought me to the Dr was being tired all day, needing afternoon naps, but the major issue was falling asleep while driving. One morning while driving to work I was awaken by an air horn, only to find I had fallen asleep and drifted into the lane of oncoming traffic. That semi truck was probably 20feet in front of me. It was only by Gods will I was able to correct and get back into the correct lane.  I now have the instructions to change the settings on this APAP machine. I don't know if I should set it to max at say 10CWP, or set it for a steady 7 or 8 CWP.  All help is appreciated! I do not think this machine has the data storing feature so I wouldn't know if or how I could print out a report.
Thank you,
Bart

[DeepBreathing]

G'day Bart. Welcome to Apnea Board. There's nothing like waking up on the wrong side of the road to confirm there is a problem!

I think I'm correct in saying that #SleepyHead software will read the output from your machine and provide detailed graphs which can help troubleshoot any issues. However, I think the DeVilbiss needs an optional "SmartLink" plug-in module to accept the SD card. There is also a "SmartCode" system which generates a numeric code your DME can interpret to provide summary data. Finally the "Quick View" menu will indicate your AHI (apnea hypopnea index), leaks and daily usage. These are all covered in the instruction manual.

You're correct in saying that the system will increase (and reduce) pressure as needed during the night. It will respond to any apnea or hypopnea events, snoring etc. There are a number of techniques to try to reduce the effects of these changes on your rest.

First, I'd try reducing the pressure range so that the swings in pressure are more limited. Try increasing your minimum to around 7, which is probably somewhere your median pressure, and reduce the maximum to 15, which is probably near your current 95% pressure. By reducing the range, the changes in pressure will be less abrupt and less likely to disturb you. However, it will then be necessary to monitor your AHI and leaks using the Quick View menu.

You can also try adjusting the SmartFlex, which includes a flow rounding feature, which may further reduce the sudden pressure surges.

The AirFit mask is a fairly new design and very popular (though not the latest on the market). However the mask is the hardest part of this therapy to get right and many users find they need to try more than one (or two) different masks to get one which suits. This obviously gets expensive, but some dealers will offer a trial / exchange program. There is an excellent discussion on all things to do with the mask here: http://www.apneaboard.com/wiki/index.php...ask_Primer

Hope this helps - good luck!

[Gideon]

I have a DV54D with SmartLink. This is my current backup machine and I used it It as my primary machine from May 2009 thru Dec 2016 just short of 7 years.  My pressures ran from 17 to 20 cmw

I had a similar problem.  I would shift from normal nasal breathing to a hurricane escaping my mouth. My solution was to cycle power and restart therapy.  Eventually it tapered off and stopped.

Fred

[SIRSnoralot]

hi bragucci,
Im only new here, only 4 weeks of Cpap use but thought I could share my experience if it helps you. 

When I did my titration through a therapist, she put me onto an auto machine for a week. After a week, she checked the average 90% pressure- this is the pressure your auto Cpap was at or under for 90% of the night. She took the 90% pressure and put that as the fixed pressure with a 20 minute delay or ramp. I found that with Auto My AHI was high- around th 7-8 mark and I had a restless sleep. With the constant pressure setting, my AHI is down to around 4 and I feel a lot better also. Hope this helps. If you are like me, the changing pressures awaken you and give you a restless sleep. fixed pressures give a more undisturbed sleep.

[Gideon]

Sirsnoresalot

We will have someone autotitrate as you did also.  But we consider the 90% rule a starting point.  We frequently suggest narrowing your auto range until we see that you have trouble with variable pressure.  Post your SleepyHead charts in your own thread and I would bet you could do better.

Fred

[HalfAsleep]

I have an F10. It sometimes farts. It’s annoying as heck. However, this rarely happens any more.

Give this some time to get right, especially if the mask is comfortable.

When the mask farts start in, I usually have to tighten the straps. My quickest solution is to whip the mask off, sit up, re-situate the whole thing, tighten it back up, flop back on the pillows, and head back to dreamland.

If you try to nudge the mask into place, it increases the leaks, since that mis-shapes the silicon cushion. Instead, try putting it in the palm of one hand, pushing it against the face without jiggling, like you’re doing a one-handed face-palm, and then cinching everything down.

Make sure the connection between mask and hose is secure. It can pop out.

Post your charts.

[Sleeprider]

Resolving mask leaks is the first priority, however you can limit the maximum pressure that the CPAP puts out. It would be helpful to know what pressure you actually need to avoid most obstructive apnea events, but your comfort and better sleep are an even higher priority. Get your mask in order, and in the meantime set your pressure for 7 to 12 cmH2O so you don't get overwhelming pressure. Turn your smartflex down to 2 or 1 as this will keep your exhale pressure just a bit higher. Try to minimize your use of Ramp. This is preventing you from getting the fit right as you go to bed and you only find out about the fit problems after you have fallen asleep. This is very disruptive compared to just going to sleep with the pressure.

[trish6hundred]

Hi bragucci,
WELCOME! to the forum.!
Good luck with getting your CPAP therapy fine-tuned, you have come to the right place for guidance on how to do just that.
Hang in there for more responses to your post.