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Deep breathing
Hi, Everyone:

I've developed a strange [for me] issue recently. I often find myself breathing very deeply when I first turn on the machine. It's like the machine is forcing me to fill my lungs. And if I try to reduce the amount of air I'm taking in the machine forces me to take in more.

Mostly it settles down; but sometimes I have to take the machine off to get to sleep.

This morning I awoke in the middle of the night with the same thing happening. I had to take the mask off and sleep without it.

I've just started a new job and there is some stress involved. The issue coincided with that.

I'm ramping from 8 to 13 over 10 minutes. Full EPR at 3.

Anyone experienced this and have any suggestions?

Meet you in the land of nod
- Johnny Mercer
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It may help us to help you if we may know what it says above the on/off button on your "ResMed 9" machine? E.g., Elite or Autoset? It will also be helpful if you would post some graphs of recent sessions showing pressure versus flow limitations and flagged events. The hope would be that you are operating at a higher pressure than needed and reducing it might make the problem go away or at least moderate it.

The S9 machine will normally follow your lead when using the EPR mode and you will be in charge of when the assist is terminated and the inspiration mode takes over. Some people have trouble with that when using EPR and tend to think the machine is in control of all that and it can get very distressing.

Another thing to consider, if you are suffering from some new anxiety issue, it may be that you are not sleeping as soundly as you have in the past and are now more aware of the pressure that has been applied when you were sleeping more soundly. That type of problem will take care of itself as soon as the issue causing the anxiety is resolved.

That is not to say the machine hasn't developed some problem but that isn't very likely.
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Was the choice of 13 based on a sleep study?

Unless they titrated you there to prevent OSA at a lower pressure, it seems a bit high, but probably not for someone who needs it, of course.

Usually when you need a high IPAP but even full EPR is not comfortable, a different type of machine might be implied. Certainly a conversation to have with the sleep doc.
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I would like to see your actual results. However, your complaint has to do with when you first fire the thing up. So it sounds to me that a beginning ramp pressure of 8 might be a tad high for you. Try reducing the ramp start pressure to 6 and see how it feels.

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I'm wondering if there is a bit of an adjustment going on. I know that the initial added pressure of the CPAP sometimes can feel a bit like it's trying to blow you up like a balloon (and take deeper breaths)...but once you settle in, the sensation should not continue.

Another thing to try is to reduce the EPR a little. Sometimes the transition between the inhalation pressure and exhalation pressure (3 cm of water when the EPR is set to 3, 2 cm at 2 and so on) can be a bit much if we're a little sensitive to it (like when we're not sleeping the greatest anyway due to stress). Maybe try it at an EPR of 2 and see if that helps... Smile

The added stress probably isn't helping either way...hopefully when it subsides, the feeling will too.
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Thank you for all your posts. I had another night last night where I fell asleep with the machine okay, but woke up at 12:30 with the lung-filling feeling. I finally had to take the machine off.

Let me try to answer your points in turn.

> the S9 is the Elite model. I have changed my ID to show that.
> which software should I use for the graphs? ReScan or Sleepyhead? I'm still learning the options.
> it does feel as if the machine is controlling me. And, yes, the stress of a new job feels like a factor.

> 13 is based on a sleep study and ordered by the doctor. He had it boosted from nine [I think] to 13 and I couldn't handle that. That's when I came to this site and found out how to control the machine.

> I will lower the start-point to 6.
> Which results would you like to see?

> I have been using the CPAP at 13 for a couple of years now with no problem. The problems coincided with the new job, when I walked into a full-blown crisis that needed containing. It's calming down now. Sort of.
> I will reduce the EPR to 2 and see if that helps.

Again, thanks for all the input. Please let me know exactly what data you'd like to see.


Meet you in the land of nod
- Johnny Mercer
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(02-20-2015, 09:21 AM)ScottW Wrote: surferdude2:
> the S9 is the Elite model. I have changed my ID to show that.
> which software should I use for the graphs? ReScan or Sleepyhead? I'm still learning the options.
> it does feel as if the machine is controlling me. And, yes, the stress of a new job feels like a factor.

OK on the S9 Elite model. As for software, I prefer the Sleepyhead software since I consider it more user friendly.

I think you should stay the course as far as pressure setting is concerned but I do recommend that you reduce the EPR from 3 down to 2. That can help to moderate the effects of the machine seeming to be dominating the breathing process. You'll still have a degree of expiratory relief but it will be less noticeable.

This recent crisis issue will pass and things will get back to even better than before. If it doesn't do so within another week or two, we can consider more radical measures but I don't recommend that just yet.

Best regards,

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you should be able to press a button to restart the ramp when you are wakened, instead of turning the box off. you want to leave mask on if at all possible.

I have a little different take on your situation.

The crisis at work caused you to go into 'control it' mode. Heightened interest may be translating into 'must have control' at night as well. When you discover you seem to be not in control of the machine you fight it.

I think when the crisis has passed you will quit noticing the feeling of domination. I would therefore agree that EPR drop from 3 to 2 may help in the short term.

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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Thanks again for the responses. I've taken some screenshots of sleepyhead graphs of the last two nights, showing pressure, flow limit, and events [only a few of those].
I've also posted a three-month overview that shows Peak AHI, Resp Rate, and Tidal Volume suddenly appearing right at the time I started the new job. I don't know how to interpret them, but they appear significant


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Meet you in the land of nod
- Johnny Mercer
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yep. you get those partial graphs because the software only reports out the last 30 days. ironically, it has been exactly 30 days since the dreaded disease hit.

more in a while after we take a closer look... he he.
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