Newbie Needs Help

[jhtrader]

I just got my CPAP 2 days ago Resmed S9 and a nasal N10 mask. When the person programmed it for me it was set at 4 for the starting pressure and 12 for maximum. With 4 I could barely breath out with my nose and the airflow coming in was so low that it was harder to take a breath with the mask on then off. It is set to autoset and it would take a long time for it to ramp up to a level that was usable for me so I raised it to 6 which is better but still not great. I wanted to know peoples thoughts on raising it further or should I struggle through with it the way it is for a while. My other question is related to the mask. I wear glasses and have a goatee and I find that it is not really convenient to have my glasses on with the mask on and I want to watch tv with it on before I go to sleep. I also find that it is not that comfortable where it pushes down on my moustache part of my goatee. I went online and found the P10 and wanted to know what people thought about the nasal pillows. In looking at the photos of them they don't look that comforable pushing up in your nostrils. Would love to hear peoples thoughts. Also, was wondering if insurance companies will pay for a different mask then the one that they gave me. They never asked me what mask I wanted and I wouldn't have known what to say anyway but now I know I need a different one.

Thank you so much for your help. I am really hoping that a cpap helps me with my apnea.

[justMongo]

Some people love the P10; others do find it makes their nostrils sore.
Generally, insurance compares are not good at paying for a different mask.
However, some providers will let you swap.

Finding the best mask can be the key to comfortable therapy; and it's a very individual thing.

Many people find 4 too low for starting pressure. Plus if the ramp is on, you may still be starting at 4.
For many, turning off the ramp feature helps.

BTW -- look near your start button for the model S9 you have. Autoset?
Please add that to your machine profile.

And, welcome to apneaboard.

Mongo

[Sleepster]

Welcome aboard, jhtrader. I'm sorry you had to join our hosehead club, but I'm glad you found this forum.

Yes, your insurance company will replace your mask. They have that policy in place especially for the situation you are in. Finding the right mask is trial and error.

Do you have the ResMed S9 Autoset, or some other S9 model (please fill in your profile with as much detail as you can)?

See if the machine is set to "ramp" up the pressure slowly. If so, adjusting that for comfort is fine.

If the low end of your pressure range is set to 4, and you've already raised it to 6, then I'd just leave it there for now.

Download SleepyHead so you can look at your data on your computer. It will help you a lot.

[jhtrader]

Thanks for the help Mongo. I have the autoset and will add it to the profile. I turned the ramp feature off and it still seems to stay at the minimum or initial setting for a while (maybe around 30 minutes or so). Maybe there is something wrong with the machine.

---

Welcome aboard, jhtrader. I'm sorry you had to join our hosehead club, but I'm glad you found this forum.

Yes, your insurance company will replace your mask. They have that policy in place especially for the situation you are in. Finding the right mask is trial and error.

Do you have the ResMed S9 Autoset, or some other S9 model (please fill in your profile with as much detail as you can)?

See if the machine is set to "ramp" up the pressure slowly. If so, adjusting that for comfort is fine.

If the low end of your pressure range is set to 4, and you've already raised it to 6, then I'd just leave it there for now.

Download SleepyHead so you can look at your data on your computer. It will help you a lot.

Thanks Sleepster. I will update my profile to the autoset model. I will download the sleepyhead software - thanks. Hopefully it is pretty easy to figure out how to get the info from the machine to the software.
Thanks again!

[CHanlon]

Usually you can go back to your DME and swap masks until you find one that is right for you. Most of them realize that they're not going to get a perfect fit on the first try.

I have much the same setup as you... an S9 and an N10 mask... and I got the N10 specifically to be able to do things like read and watch tv with the mask on... my original mask (for more than 4 years) was a ResMed Mirage Activa LT. My DME recommended that one because, like you, I have facial hair. Unlike the N10, the Activa has a forehead pad, with part of the frame running from your nose to your forehead. It's actually impossible to ear glasses with. However... I found it to be much quieter, and a far better seal, than the N10. Like you I found that the N10 puts a greater amount of pressure on my upper lip.

I've had the N10 for about a year, so I've experimented with it a lot so I've noticed a few things that might help you out.

First - adjusting it properly is key. Its also a tad counter-intuitive. You'll get a better seal if you *loosen* the straps as much as possible. Tighten them only enough to establish the seal, and tighten the top straps first. That takes some of the pressure off your lip.

Second - and related - how you put the mask on matters. Start with just the nasal part of the mask, don't put the headgear in place until you have the nasal cushion in place. And put the nasal cushion on from the top of your nose, near the tip, and pivot it downwards into place on your lip. Basically, fit the top "V" of the mask over the upper part of the tip of your nose, and then rotate it down into place. And lastly, pull the straps over your head and into place. You sort of want to keep the mask far enough from your face to let the seal balloon out as much as possible. That balloon effect makes the mask a very light touch, and seals it to your face. It took me months to work that out.

Third - I found with this mask that my leak rate was a fair bit higher that with my activa LT, and especially so if I had the straps tighter rather than looser, and I attribute that more to the way I sleep - if I end up on my side, any pressure on the cheek pieces can cause a gap on the opposite side of your nose, if the straps are too tight.

Fourth - I found that this mask was pretty fiddly. The first time I put it on, there was a breeze in my eye that I just couldn't track down. It took a lot of fiddling to figure out where it was coming from. With a bit of practice I got to a point where I could lift the mask off my nose and let the seal balloon out again, and it would finally seal.

Fifth - That bit of funny breeze eventually ended up giving me a stye - having finally gotten what I thought was a good seal turned out not so much after my face relaxed in sleep.

So... all that said, I think it's a great mask, it's a lot smaller and lighter than my Activa LT... but I've just replaced my Activa. With all it's bulk, I think it's the better mask. My AHI is lower when I use it, my leak rate is lower, it's quieter, and there's really no fiddling. And it's as much of a light touch, although it covers more of my face. I've had my beard and moustache both trim and shaggy, and the mask seals every time. If you want to try an alternative mask, that might be a good choice.

[Sleepster]

I turned the ramp feature off and it still seems to stay at the minimum or initial setting for a while (maybe around 30 minutes or so).

It will do that unless and until it notices something in your breathing pattern to indicate that your airway is on the verge of collapse. Or if it does collapse. Then it will raise the pressure.

The thing is, you're breathing at zero pressure without the machine, so it's always providing a greater pressure than that whenever it's on. 4 is the minimum because it takes that much to keep the hose purged of exhaled air. So, just keep in mind that even if it feels like you're not getting enough air, you are. Once you see your data on the computer you'll know if it's ok to raise the pressure. Meanwhile, it's best to keep it where it is until you have at least a few nights worth of data. It takes your body at least that long to adjust to the new machine.

[jhtrader]

Usually you can go back to your DME and swap masks until you find one that is right for you. Most of them realize that they're not going to get a perfect fit on the first try.

I have much the same setup as you... an S9 and an N10 mask... and I got the N10 specifically to be able to do things like read and watch tv with the mask on... my original mask (for more than 4 years) was a ResMed Mirage Activa LT. My DME recommended that one because, like you, I have facial hair. Unlike the N10, the Activa has a forehead pad, with part of the frame running from your nose to your forehead. It's actually impossible to ear glasses with. However... I found it to be much quieter, and a far better seal, than the N10. Like you I found that the N10 puts a greater amount of pressure on my upper lip.

I've had the N10 for about a year, so I've experimented with it a lot so I've noticed a few things that might help you out.

First - adjusting it properly is key. Its also a tad counter-intuitive. You'll get a better seal if you *loosen* the straps as much as possible. Tighten them only enough to establish the seal, and tighten the top straps first. That takes some of the pressure off your lip.

Second - and related - how you put the mask on matters. Start with just the nasal part of the mask, don't put the headgear in place until you have the nasal cushion in place. And put the nasal cushion on from the top of your nose, near the tip, and pivot it downwards into place on your lip. Basically, fit the top "V" of the mask over the upper part of the tip of your nose, and then rotate it down into place. And lastly, pull the straps over your head and into place. You sort of want to keep the mask far enough from your face to let the seal balloon out as much as possible. That balloon effect makes the mask a very light touch, and seals it to your face. It took me months to work that out.

Third - I found with this mask that my leak rate was a fair bit higher that with my activa LT, and especially so if I had the straps tighter rather than looser, and I attribute that more to the way I sleep - if I end up on my side, any pressure on the cheek pieces can cause a gap on the opposite side of your nose, if the straps are too tight.

Fourth - I found that this mask was pretty fiddly. The first time I put it on, there was a breeze in my eye that I just couldn't track down. It took a lot of fiddling to figure out where it was coming from. With a bit of practice I got to a point where I could lift the mask off my nose and let the seal balloon out again, and it would finally seal.

Fifth - That bit of funny breeze eventually ended up giving me a stye - having finally gotten what I thought was a good seal turned out not so much after my face relaxed in sleep.

So... all that said, I think it's a great mask, it's a lot smaller and lighter than my Activa LT... but I've just replaced my Activa. With all it's bulk, I think it's the better mask. My AHI is lower when I use it, my leak rate is lower, it's quieter, and there's really no fiddling. And it's as much of a light touch, although it covers more of my face. I've had my beard and moustache both trim and shaggy, and the mask seals every time. If you want to try an alternative mask, that might be a good choice.

Wow Chanlon - thank you so much for taking the time to help me out with all of that information. I am so glad that I found this place and was so scared 2 days ago when they dropped the machine off at my house and had no idea what to do except for the 5 minutes the person spent showing me what to do. I really appreciate your help and am going to try your suggestions tonight. I was kind of doing some of the things you suggested - tightening the top part more and keeping the bottom strap looser that goes over my mustache but still making sure that it isn't leaking. I keep my goatee/mustache pretty full and it is just uncomfortable having even the soft pressure on it for the night. Thanks again so much!

---

I turned the ramp feature off and it still seems to stay at the minimum or initial setting for a while (maybe around 30 minutes or so).

It will do that unless and until it notices something in your breathing pattern to indicate that your airway is on the verge of collapse. Or if it does collapse. Then it will raise the pressure.

The thing is, you're breathing at zero pressure without the machine, so it's always providing a greater pressure than that whenever it's on. 4 is the minimum because it takes that much to keep the hose purged of exhaled air. So, just keep in mind that even if it feels like you're not getting enough air, you are. Once you see your data on the computer you'll know if it's ok to raise the pressure. Meanwhile, it's best to keep it where it is until you have at least a few nights worth of data. It takes your body at least that long to adjust to the new machine.

Thanks again for for help sleepster. The other thing I forgot to mention which is that at a 4 setting I feel like the airflow is so low that I am breathing in the CO2 that I just breathed out.

[Sleepster]

The other thing I forgot to mention which is that at a 4 setting I feel like the airflow is so low that I am breathing in the CO2 that I just breathed out.

Well, you're not. There's plenty of fresh air coming down the hose and out the ports.

[PaytonA]

jhtrader,

As far as a start pressure is concerned, I use ramp with a start pressure of 9 cm/H2O. My point being that you can use a fairly high start pressure. My minimum EPAP is 14.

It would probably not hurt to raise your low a little but you really need to have some software in order to keep track of what is going on and keep yourself out of trouble. Many of us recommend the Sleepyhead software.

Best Regards,

PaytonA

[trish6hundred]

Hi jhtrader,
WELCOME! to the forum.!
The mask is the hardest part of this therapy so don’t be shy about asking to try as many of them as you need ‘till you find the mask that works for you.
Hang in there for more responses to your post and much success to you with your CPAP therapy.