New user - problem adapting?

[pticrix]

Hello all 

Recently diagnosed user here.
Prescription : APAP - 6 to 18 cm
About 28 events/hour IIRC my sleep study.

I've been given a used S9 Autoset by my brother (who might be reading this - he was the one who pointed me out to this community. Allo!) and have been using it every night for the past 2-3 weeks. Bought a N20 nasal mask to use it.

I don't feel any leaks and it is comfortable enough. 

However, I seem having problem using it more than 2 hours per night. I once managed 5 hours, 4 hours a few times, but not many. I sometimes wake up feeling suffocated, and often finding it hard breathing through my nose while using the machine. 

I've been wondering about many thing :

1. Am I exhaling enough? 

I've been finding out recently that when I exhale, at some point the pressure of the machine against the pressure of the air in my lungs evens out. If I then start to exhale through my mouth, there seems to still be a good quantity of air that I can push out. 

Relevant settings : the EPR is set to max (3). 

2. Is it possible that I have uneven nasal cavities?

I seem to have an easier time breathing through my left nostril than my right one. Is it possible that, even though I was comfortably breathing when I went to sleep, that when my nasal cycle blocks my left nostril that I have a hard time breathing?

Relevant subquestion : should I change mask? If so, should I get a mouth + nostril (eg an F30) or, counterintuitively, would a nasal pillow (eg a P10) would be better suited to that kind of situation?

3. Are there settings that I've been neglecting?

So far I tried adjusting the pressure a bit higher than the prescription. At first, I thought I got better compliance using a minimum of around 7.4 instead of the prescribed 6, but now it doesn't seem to have made much of a difference. 
I've also tried adjusting the humidity. I haven't tried adjusting the temperature : I've always been much more comfortable breathing cold air. Breathing warm air usually makes me feel suffocating. But I guess if it can help, I could try to acclimate to using the ClimateLine at higher temp. 

4. Could there be rebreathing? 

The vent on the N20 is a bit far from the nose. When I exhale, I feel the air being vented out is a bit warmer, but I wonder if enough of what I exhale is being pushed out. I don't feel any air circulating inside the nasal mask when it is sealed, so I'm really wondering about that. 



I got the ok for my insurance to get a brand new APAP, but I wanted to get some input before ordering one (which will be an Autoset 10), mostly to see what kind of mask I'll get with it - do I stick with nasal or would I be better served getting a facial one. 

Thanks all!  Let me know if there's any pertinent info I left out!

[mesenteria]

I use the newer version of the machine you have, and I use the very same mask.   My settings are considerably LESS THAN yours, and I don't feel 'threatened' by the mask in any way.  I did find, to be completely honest, that my low setting of 5 was a bit stingy when I first don the mask at night, so I bumped it up to 5.6 and that seems to be adequate; no more experience feeling a bit starved.

I find my own venting to be adequate.  No worries, anxiety, or reaching up to the mask to pull it aside or away for a couple of relief breaths.  Ever.  I don't see how you could not be exhaling enough.

If you don't have persistent centrals, perhaps try an EPR of only 2 and trial that for at least three consecutive night.

You ask if you should try another mask?  By all means.  One critical component of this therapy is that it has to have a strong component of validity.  Face validity, or how you feel about it in your gut.  If you're suspicious, or just generally not feeling much different or better with treatment, then some tinkering is in order.

About the minimum setting you have of 7.6, it may be fine, but what have you found at the suggested setting of 6 that is markedly different?  How long did you stay on that lower setting if you did?

As to rebreathing, every mask offers some of that.  It is inherent in the closed space that they contain.  However, relative to the volume in your lungs and in your bronchia, it amounts to a negligible space.

[Sleepster]

Prescription : APAP - 6 to 18 cm

Post your SleepyHead charts so we can see if this is indeed the best pressure setting.

However, I seem having problem using it more than 2 hours per night. I once managed 5 hours, 4 hours a few times, but not many. I sometimes wake up feeling suffocated, and often finding it hard breathing through my nose while using the machine. 

Rather than removing the mask and sleeping without the machine, get out of bed. Read with the dimmest light that's comfortable until you feel composed enough to go back to sleep with the mask strapped on and the machine running. Sleeping without the machine just prolongs the time it'll take you to adapt. It also increases the risk of cardiovascular disease and stroke. And if you think you are sleeping without the machine you are fooling yourself. The sleep that you think you're getting is weak, and doesn't help you. Consider asking your doctor for something like trazodone to help you sleep, or klonopin to get over the anxiety of using the machine.

1. Am I exhaling enough? 

I've been finding out recently that when I exhale, at some point the pressure of the machine against the pressure of the air in my lungs evens out. If I then start to exhale through my mouth, there seems to still be a good quantity of air that I can push out. 

This is nothing to worry about. You are exhaling enough.

2. Is it possible that I have uneven nasal cavities?

I seem to have an easier time breathing through my left nostril than my right one. Is it possible that, even though I was comfortably breathing when I went to sleep, that when my nasal cycle blocks my left nostril that I have a hard time breathing?

The only way to answer that question is try a full face mask. Post your SleepyHead charts so we can see if this is indeed the best pressure setting.

3. Are there settings that I've been neglecting?

So far I tried adjusting the pressure a bit higher than the prescription. At first, I thought I got better compliance using a minimum of around 7.4 instead of the prescribed 6, but now it doesn't seem to have made much of a difference. 

Stop making these adjustments based on these notions. Post your SleepyHead charts so we can see if a change in your pressure settings are warranted. There's a really good chance that we can help you.

I've also tried adjusting the humidity. I haven't tried adjusting the temperature : I've always been much more comfortable breathing cold air. Breathing warm air usually makes me feel suffocating. But I guess if it can help, I could try to acclimate to using the ClimateLine at higher temp. 

Temperature and humidity are purely comfort features. They have no effect on your therapy. I also dislike the warmer moister air, so I don't breathe it.

4. Could there be rebreathing? 

The vent on the N20 is a bit far from the nose. When I exhale, I feel the air being vented out is a bit warmer, but I wonder if enough of what I exhale is being pushed out. I don't feel any air circulating inside the nasal mask when it is sealed, so I'm really wondering about that. 

When you exhale, even if some of the exhaled air makes its way into the tube, it will quickly get pushed out through the vent holes. You may re-breathe a bit of it, but it's nothing to worry about. It can't hurt you.

[Reznik]

I found that the N20 mask pushes on my nasal cavities in just the right places to restrict my airflow considerably.  If that's how you're feeling, then you may need a different mask

I really, really like the ResMed Swift FX with Nasal Pillows.  I find it to be very comfortable.