[Pressure] Brand new CPAP user with questions

[Jabi]

Hi Board Members. I am a brand new CPAP user. Just used mine for the first time last night. I did a home sleep study and did not get a beginning pressure level from the company that did the readings of my test. I suppose you need a real live doctor to give you that. I was doing this on the cheap since my insurance deductible is so high it was all out of pocket.
I have a ResMed S9 Autoset. After reading a lot on this board, I set my Max pressure to 12 and my Min to 6 to start off with, and I also set the ramp to 15 min. I have EPR set to 3. Once the Ramp up finished it seemed to go all the way to the Max setting and I wasn't even asleep yet. At about a pressure of 8 I found it VERY hard to exhale against the air pressure in the mask (full mask). So much so that I was forced to take very shallow, quick breaths. I knew that wasn't a good thing for my oxygen levels. I reset the pressures for 4 - 7 and was good with that, but my AHI was 15.3 and Total AI was 12.5. Leaks were only 9L/min. I know from this reading that I need more pressure, but if I can't exhale fully how can I increase it? Is this normal for a beginning user and is it something that you get used to? I would appreciate any help from you CPAP veterans:-)

[retired_guy]

I do think you'll get used to it Jabi. One thing that could be happening is there is a peculiar effect sometimes, not always, that when the epr is set on three you get this strange "feedback" sensation because you're done exhaling before the inhale starts up. So it's kind of like a mini air-hammer. The net of it is you feel like you can't breath out against the pressure. You might try lowering the epr to 2 instead of 3 to see what happens.

I think I would do that, and increase the min back to 6 and the max at least to 10 and see how tonight goes.

Ramp is ok, although you'll probably decide to make it go away soon. Seems like most of us when we get used to the therapy just want our machines to get on with it.

[surferdude2]

I can tell you from my own experience, which is fairly recent, that I first thought the exhale pressure problem was a terrible issue and that there is no way I would ever be able to tolerate it. I can assure you that that is wrong. I found that it completely disappears in short order.

One thing you can do to speed the process along is to provide some sort of background noise so you can't hear the changing of air flow in the system. Hearing that flow change makes you anxious and you think you need to time your breathing to the machine's pace. The exact opposite is true, the machine will match your pace so not to worry. You're in charge so try to ignore the machine and set your own pace.

Background noise helps to do that as well as helps some people like me get to sleep quicker. I have a hard time getting my brain to stop looking for things to analyze or whatever and usually take an hour to fall asleep. Since using a timed background noise source and setting it at 1 hour, I'm always asleep before it turns off. You may want to try that. Other than that, time on duty will resolve the issue. Set the pressure where you must in order to pull that off.

I set my rig at 6 cm to get me going and be able to accept this beastly method of treatment. That worked fine but did nothing for my apnea events of course. Within a week I found that the pressure not only didn't bother me anymore, I had trouble determining if the machine was even working and had to feel around the air bleed holes to see if anything was coming out. Sure enough, it was.

I've since been able to slowly bump the pressure up and am now at min = 9 and max = 16 and still not feel any discomfort when exhaling. Slowly is the key word there. That has knocked down all my apnea events and it has been smooth sailing ever since. I still have to feel the bleed port air once in a while to see if the thing is working. Go figure.

[trish6hundred]

Hi Jabi,
WELCOME! to the forum.!
CPAP therapy can take a bit of getting used to, but it does get better, just stick with it.
Hang in there for more responses to your post and best of luck to you with your CPAP therapy.

[Jabi]

Thanks for the quick replies retired_guy, surferdude2, and trish! I was hoping for the answers you gave. I will lower the epr to 2 and up the pressure range to 6-10 and see if I can handle that tonight. I did get that hammer effect some. I also noticed that it is really difficult to yawn with the air flow. Kind of like sucking the air from an overfilled balloon!
One other question: should the ramp up go all the way to my highest pressure setting even before I fall asleep? I thought it would ramp up to the minimum and go up from there as needed. It ramped up to 10 which is where I could not exhale and I was still wide awake, so I had to change the settings to the lower range. I did however keep the mask on the entire night - so I was happy that I was able to do that on the first night. Scratching your nose is a real pain though:-)

[surferdude2]

One other question: should the ramp up go all the way to my highest pressure setting even before I fall asleep?

Generally not, but if an event was detected, asleep or not, the algorithm is programmed to bump up the pressure. Also you may have been doing something that fooled the system, such as swallowing or yawning, etc., which caused you to hold your breath for a while and it triggered the pressure rise.

At any rate it sounds like you have found a setting that will allow you to use the rig all night and that is a great first step. Keep up the good work and post back if/when you have any ???

The road gets much smoother ahead.

[retired_guy]

The ramp is supposed to start at a lower pressure then slowly increase over the specified period to the therapeutic pressure (minimum required)

You specify the beginning point for the ramp. So if it appears it is advancing the ramp past whatever you have specified as the therapeutic minimum, check to see what the beginning ramp pressure is set to. If it's higher than your new minimum, that's why it's acting goofy.

A nice place for the ramp setting is "off."

[Jabi]

Hi again Board! I have been using the REsmed S9 Autoset for 9 days now and have played with the pressure settings along the way. The last 2 nights I have had it set to min 6 and Max 14.6. I am still up around 13 to 14 AHI. What was interesting was that last week I had it set to min 6 and max 12.6 and my AHI for that night was 7. I had increased it trying to get the 7 lower, but it went up. I figured that the more pressure the lower AHI. Can too much pressure cause a higher AHI? Also, why wouldn't I want to just set the pressure for, lets say, 8 - 20 and let the machine figure out how much pressure I need? Thanks for the help!!

[Buckeyedog]

What is the breakdown of your events?? Maybe you are getting more centrals with the higher pressure.

[herbm]

Use your ramp and your EPR to make yourself as comfortable as possible but note a couple of effects already eluded to:

It's not always obvious which direction to take these settings for maximum comfort though most beginners to therapy tend to use them as designed and advertised.

Many (most?) of us tend to turn OFF the ramp in fairly short order (it's just annoying for many of us) and even the EPR.

My own EPR I played with to get the absolute minimum AHI (not really useful once you get effective treatment, just "playing a game" with seeing how low I could get it).

Other than that, my EPR is set to off. I turned my ramp off the first night after reading other posts prior to starting therapy.

Don't take this as a recommendation FOR YOU but just as a suggestion you might consider or try at some point.

Knowing you CAN set these the way YOU PREFER is the important point.

While on the subject, there is similar effect with humidity. Generally you want to set it high enough to avoid drying yourself out, however some people get MORE CONGESTED if they set it TOO HIGH or TOO LOW.

It's odd that either extreme MIGHT cause you to become congestion but those are the reports we hear.

So if you are facing congestion problems (especially new problems you didn't already have) then try changing the humidity away from the extreme or toward the other extreme even.

Then within what allows you to BREATH, set whatever level you prefer to control temperature and dryness.

Most of CPAP/APAP is pretty logical but the above settings can be counter-intuitive at times.