Pressure Setting

[Gideon]

You are doing good.  Just login when you come back and post in this thread so we have a history.  And please use it while doing something relaxing, reading, watching TV, listening to your favorite tunes.

An exercise to relate how much pressure you are dealing with.  Get a glass of water and a straw, Place the straw into the bottom of the glass and blow to make bubbles.  That is roughly twice the pressure you are using.  If you want to know how much measure the depth in cm (centimeters).  that is the pressure.

Fred

[trish6hundred]

Hi catspurrrr,
WELCOME! to the forum.!
Good luck to you as you get used to CPAP therapy, it does get better over some time.

[OMyMyOHellYes]

One point that might be helpful.

I've tried them both and the nasal pillows feel like they are blowing with more force or pressure to me. A nasal mask, delivering the same pressure, doesn't feel as "aggressive". I think it has to do with pillows putting everything directly in the nose whereas the nasal pillows have a little bit of an "open" buffer in the mask before hitting the nose holes. You might try giving a good nasal mask a shot if you are having trouble with a pressure of 4 cm (lowest available on the ResMed machines, IIRC).

OMMOHY

[DeepBreathing]

G'day Catspurr. Welcome to Apnea Board.

Just to recap on some of the issues you're having and the questions you've asked...

1. Everybody has some trouble adjusting. Your DME was probably trying to reassure you, but the simple truth is we have all had to learn a new way of breathing with a plastic alien strapped to our face with a compressor blowing air up our nose.

2. The mask has to make an air-tight seal, it's not like a canula at all. Apnea occurs when your airway collapses, blocking the flow of air. The machine provides air under pressure to prevent this collapse. If it wasn't a good fit the air pressure would leak out and your airway would collapse again. Watch the little video here: http://www.apneaboard.com/wiki/index.php...=Wiki_Home

3. It does get better with time. My pressures run up around 20 and sometimes I wake up and wonder if the machine is on. You really do get used to it.

4. As a swimmer you understand about breath control - it's something you learned and trained at. In the same way you will learn to breath with the machine.

5. Getting the right mask is the most difficult part. For nasal pillows, the rule of thumb is to go one size larger than what feels right. This seems to give the best results for most people. At the same time, take every opportunity to try different types of mask to find which is most comfortable for you (everybody is different). Don't be afraid to hassle your DME - they are well paid to provide this service.

6. Learn to use the EPR feature on your machine. This drops the pressure slightly as you exhale, making breathing easier. (EPR stands for exhalation pressure relief). You can set it to 0 (off), 1, 2 or 3.

Good luck, and please feel free to ask any more questions. This thread will stay open indefinitely so you can come back here any time you like.

[catspurrrr]

Hi everyone and thanks for all the suggestions.  I think I am going to call Lincare and see if I can try out a mask.  The comment regarding how the nasal pillow makes the air feel more direct makes sense so perhaps spreading the blast out over a larger portion of my face might help.  I keep telling myself at least it isn't malignant, but short of that I don't think it could possibly get any worse.  OK-new day, rested up, don't have to worry about getting on any loop de loops of four lane traffic ducking and diving at 80 miles an hour around a major metro area, focus on task at hand.  When I first connect the machine there is air coming out of the prongs and I think well maybe this pressure isn't as bad as I thought.  It took me a while and downloading the usage manual to determine I had to push the button at the top of the machine and that is when it starts blowing at 4.  I did manage to log in a minute, the only way I was able to keep the panic barely under control was by just holding it up to my nose w/o the strap in place.  At that rate it is going to take a while to reach the four hours of continuous usage required by medicare.
I still don't understand why it has to blow at 4 when I am not in any kind of an apnea state.  And I do not see anywhere where there is an option to push the exhale down to zero-as that might help.
This thing makes noise, it forces you to focus all your concentration struggling to breath in and out to the point I feel like I am swimming laps in the pool which isn't good.  There is a time for exercise and there is a time to lay down, unwind from the day, and try to get to sleep.  I am starting to think the guy who devised the cpap concept was a sadist!  I just don't know.

[PaulaO2]

The email you rec'd must be because you are subscribed to this thread. What it meant was you will only get the one email notification until you come here to view the new posts. This way, you don't get flooded by emails every time someone posts. Once you come here and view the thread, the software resets itself for you and will send another, similar email the next time someone posts in your thread.

At least that is my assumption. We do not "end" threads unless it gets out of hand or whatever.

[DeepBreathing]

I still don't understand why it has to blow at 4 when I am not in any kind of an apnea state. And I do not see anywhere where there is an option to push the exhale down to zero-as that might help.

A starting pressure of 4 cm H2O is as low as it can go. Staring with a positive pressure helps ensure apneas and other events don't get started. It is a preventative measure.

A lot of people find that 4 is too low to breathe comfortably - they feel starved of air. It really is a very low pressure. Try this: Put your face into the pool (or a basin of water) so that your lips are 40mm (inch-and-a-half) under the surface. Now blow some bubbles. Easy, right? That's exactly the same pressure the machine is putting out. You do it all the time when you're swimming and you don't even think about t. I can do it in my sleep! And so can you.

The EPR will reduce pressure when you exhale, but it won't drop to zero - 4 is as low as it gets. If you're on auto and the pressure goes higher, then EPR will allow easier exhalation.

I am starting to think the guy who devised the cpap concept was a sadist!

Read this: http://www.thelancet.com/journals/lancet...8/fulltext

A couple of quotes from that article: Sullivan “is the towering figure internationally in his field. Colin's intellect is the most impressive that I have encountered in my career and his contributions to respiratory science and patient care have been immense”.

...and this: Colin is a giant without equal in the field of sleep and breathing. In the 35 years that I have been a respiratory and sleep physician there has hardly been a day when I have not been influenced in my diagnosis or treatment by his work.

Maybe he's a sadist, but I doubt it.

[methodicalfool]

The first week of using a CPAP machine was extremely discouraging for me--kept me awake a lot of the time the first week. I started to get used to it after a couple weeks though.

If you give up on your CPAP then you might try a Sleep Apnea Retainer. The doctor that administered my sleep study was actually a dentist. I had never heard of a sleep apnea retainer before. The dentist told me that my case was too severe for a retainer (My AHI was 55). However, he noted that it works great for mild to moderate sleep apnea. I have no experience with it so I can't say but it seems worth checking out. Just do a google search for "sleep apnea retainer" or "sleep apnea oral appliance".

Good luck!

Jeremy

[quiescence at last]

hi. I noticed you mention the windstorm but most of the responses just say that is to be expected.  I just want to add that the point of the CPAP is to create a new, higher pressure inside your airway, because doing that opens the airway and allows a lower resistance to breathing.  AND a windstorm is NOT what should be expected.

let's talk about the wind.  since the machine is trying to create the pressure, it has a blower inside ready to create as much air as necessary.  if you hold the appliance away from full contact, the machine will have to try to overcome way more, and will create quite a wind trying to increase the pressure at the 'wide open' mask.  if you hold it tight against your face, it will be able to build up the small pressure quickly and will never have to speed the air up, or deliver so much air at once.  test this by disconnecting the face mask/pillows from the hose, and then plug the hose with the surface of your palm while you start your machine.  see that the blower will slow to a very low speed.

key to getting highest comfort is to not allow that air speed to get going.  have the mask in full contact before you start your machine.

you don't need to get used to brisk air flow streaming into your life.  you do have to get used to having a higher pressure within your airways (nose, throat, sinuses, and lungs).

have faith this is the path to getting better.

QAL

[SarcasticDave94]

First off, welcome to Apnea Board and I'm wishing the best of your success in this process. I very much despised the concept of CPAP to treat my sleep apnea issue, and maybe for a good reason.

I started as a very overweight person when sleep apnea was first diagnosed. The pulmonary doctor had me do the overnight sleep study and then followed-up with prescribing a CPAP set to 20. As reference, that is at the extreme opposite of your setting of 4. I had lots of problems getting used to it, although the DME tech had actually set the machine to 18. I was using a full face mask as I knew I slept mouth open. I can't lie to you, I could not get used to that setting of 18 no matter how I tried to get used to it. I had problems breathing out against the pressure. I returned the CPAP after I failed to meet insurance compliance. Oh, and I think my AHI was around 75, but I'll refresh my memory to be certain. Regardless, my AHI was extremely high.

At that time, I chose a different direction to treat sleep apnea. I chose to begin a path to lose weight. I discussed the need with a specialist surgeon that does bariatric sleeve stomach surgery. 9/2016 was the day of the surgery after I went through a 6 month monitored diet. When I started the diet I was at 300 lbs. and surgery day I was down to 277. Today I'm at 201, but my sleep apnea is still there; it isn't about a 75 AHI anymore, but it's still very high.

OK, so after another sleep study I was assigned a BiPap (2 pressures, inhale and exhale). I quickly failed that unit too, as I have mixed apneas; one explanation is that is where treating obstructive apneas cause central (brain stops telling me to breathe basically) apnea. So yet another sleep study and an even more powerful device, an ASV, has been ordered. Upon delivery, I'll be entering into the apnea fight stronger and better equipped than the previous two attempts. By the way, I'm also battling COPD.

Regardless of all that chatter of mine, the bottom line is each of us have had some major obstacles to overcome in dealing with this sleep apnea. And I'm certainly not attempting to talk down to you in any way. Those of us here at this board know firsthand the struggles sleep apnea and every other difficulty this medical condition causes. I myself have the above story which is unique to me. You have your own story, and of course everyone else has theirs as well. But there's ONE thing that every single one of us share on this apnea board; each one of us has fought a difficult battle with sleep apnea and because we did not quit, we have won a great battle against a difficult foe. This includes you; do not quit as you will win. There's lots of help here and together we win, period. As I see it, we do not accept NOT winning this battle; so my personal advice is do not quit and make up your mind that you will win.