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Extremely difficult to exhale, even with the machine off.
#1
Extremely difficult to exhale, even with the machine off.
I am a brand new CPAP user.  I got a Resmed Airsense 10 Autoset and an Airfit N30i mask yesterday.  I didn't work today and didn't work yesterday after picking up the machine.  I've spent a whole lot of time (yes, I know I've only had it a day) trying to get accustomed to both the mask and the machine.

My concern is that I feel that it is very difficult to exhale while wearing the mask.  Hose connected or disconnected, machine running or not running, I feel that I'm suffocating because I can't fully exhale.  I've played around with the different sizes of nasal cushions that were included and even with just the cushion completely disconnected from everything, I feel extremely starved for air.  It's to the point where I involuntarily gasp for breath when I pull off the mask or even just the cushion by itself.

I'm not that impressed with my DME.  I picked the mask that I (thought) that I wanted, they then brought it to me to try on, I expressed my concern that I could not breathe and it was brushed off and she just moved on to the next person (it was a group thing).  I called in this morning to express these same concerns and she immediately assumed that my issue is with breathing against the machine.  I couldn't even get a word in to tell her that I'm talking about just the mask by itself before the call was over.

Is this normal?  Are there other masks with larger holes for exhalation?  I apologize if I'm being a pain, but so far I haven't been able to get anyone to actually listen to what I'm saying.
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#2
RE: Extremely difficult to exhale, even with the machine off.
Inhaling with the mask on with no pressure at all or a very low one will make you feel like you can't breath. It's normal especially if you are not used to it. The air can only come through the mask vent or the hose so you need to work hard to get enough and it's uncomfortable.

Exhaling should not be a problem though with a low pressure.

So are you having troubles exhaling or inhaling? If it's inhaling, just raise your minimum pressure a little bit and it should solve the problem.
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#3
RE: Extremely difficult to exhale, even with the machine off.
Hi spenc938  -  Welcome
Most users find a starting pressure of 5cmH2O too low and describe the starved air feeling.  Try increasing it up to 7cm and make sure your ramp is turned off.  Being new to this treatment you might not be aware that if you use the Mask Fit feature, the test pressure will immediately go to the maximum set pressure.  In your case, this will be 20cmH2O.

Good Luck!
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Extremely difficult to exhale, even with the machine off.
(08-23-2019, 05:21 PM)alexp Wrote: Inhaling with the mask on with no pressure at all or a very low one will make you feel like you can't breath. It's normal especially if you are not used to it. The air can only come through the mask vent or the hose so you need to work hard to get enough and it's uncomfortable.

Exhaling should not be a problem though with a low pressure.

So are you having troubles exhaling or inhaling? If it's inhaling, just raise your minimum pressure a little bit and it should solve the problem.

The problem is solely exhaling.  Even wearing just the mask or even just holding the cushion itself disconnected from the mask up to my nose, exhaling is the problem.  I'm not convinced this thing works with my nose.

With the machine on and running, inhaling couldn't be easier.  It just happens.
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#5
RE: Extremely difficult to exhale, even with the machine off.
Your settings are 5-20 according to your profile, but are you using EPR (exhale pressure relief)? It is the contrast between inhale and exhale pressure that will make it seem easier to exhale and inhale. Try setting your machine to a minimum of 6.0 with EPR at 3. That will provide a starting pressure of 6/4, 7/4, 8/5 etc. It may take some time to adapt to the use of CPAP, but using EPR will make it easier.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Extremely difficult to exhale, even with the machine off.
(08-23-2019, 05:24 PM)Crimson Nape Wrote: Hi spenc938  -  Welcome
Most users find a starting pressure of 5cmH2O too low and describe the starved air feeling.  Try increasing it up to 7cm and make sure your ramp is turned off.  Being new to this treatment you might not be aware that if you use the Mask Fit feature, the test pressure will immediately go to the maximum set pressure.  In your case, this will be 20cmH2O.

Good Luck!
Thanks for the welcome.

The problem is exhaling.  Even with the mask disconnected from the machine entirely, I feel like I can't get any air out.  Inhaling with the machine running is 100% easy.

As far as changing settings on the machine, I have googled to find out how to access those things that aren't meant to be accessed.  We were lectured for about five minutes straight that we're not allowed to change ANYTHING, even the hose temp and humidity settings, that everything is set the way it is for a reason and that we need to not touch.  Frankly, I think that's a bunch of BS.  This is my machine, my body, and my healthcare and in my opinion, I'm in charge.  My only concern is that the machine phones home and gives data to the DME who passes it on to the insurance company to prove that I'm using it.  If I go changing things, especially things in the clinical menu, is the machine going to tell on me and cause me grief?

(08-23-2019, 05:29 PM)Sleeprider Wrote: Your settings are 5-20 according to your profile, but are you using EPR?  It is the contrast between inhale and exhale pressure that will make it seem easier to exhale and inhale.  Try setting your machine to a minimum of 6.0 with EPR at 3.  That will provide a starting pressure of 6/4, 7/4, 8/5 etc.   It may take some time to adapt to the use of CPAP, but using EPR will make it easier.

I can't really breathe through the mask by itself, even with it disconnected from the machine.  Even just holding the only the cushion part up to my nose by hand, exhaling is difficult.  I'm not convinced that this thing works for my nose.

In my two hour class, EPR was never even mentioned.  I have sense discovered the hidden menu and seen that EPR and ramp are both off.

As far as changing settings on the machine, I have googled to find out how to access those things that aren't meant to be accessed.  We were lectured for about five minutes straight that we're not allowed to change ANYTHING, even the hose temp and humidity settings, that everything is set the way it is for a reason and that we need to not touch.  Frankly, I think that's a bunch of BS.  This is my machine, my body, and my healthcare and in my opinion, I'm in charge.  My only concern is that the machine phones home and gives data to the DME who passes it on to the insurance company to prove that I'm using it.  If I go changing things, especially things in the clinical menu, is the machine going to tell on me and cause me grief?
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#7
RE: Extremely difficult to exhale, even with the machine off.
Do you have EPR set up on your machine?  This is Expiratory Relief Pressure, and will help you exhale.

To take advantage of this feature, move your minimum pressure to 8cm with EPR set to 3.
This will allow you to exhale at a pressure of 5.  This will be so much more comfortable for you.

Order your provider manual, so you will learn how to change your own pressure.
https://www.apneaboard.com/adjust-cpap-p...tup-manual

One thing at a time, but we are going to want to see some data.
Download OSCAR software, then follow the links in my signature line to post a screenshot of your daily page here.

This way, we can see what pressure range will help you the most without guessing.

EDIT: Don’t let a DME use scare tactics with you. All insurance cares about is whether you are using the machine. Compliance has nothing to do with changing your settings.
OpalRose
Apnea Board Administrator
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Extremely difficult to exhale, even with the machine off.
(08-23-2019, 05:36 PM)OpalRose Wrote: Do you have EPR set up on your machine?  This is Expiratory Relief Pressure, and will help you exhale.

To take advantage of this feature, move your minimum pressure to 8cm with EPR set to 3.
This will allow you to exhale at a pressure of 5.  This will be so much more comfortable for you.

Order your provider manual, so you will learn how to change your own pressure.
link removed

One thing at a time, but we are going to want to see some data.
Download link removed software, then follow the links in my signature line to post a screenshot of your daily page here.

This way, we can see what pressure range will help you the most without guessing.

EDIT:  Don’t let a DME use scare tactics with you.  All insurance cares about is whether you are using the machine.  Compliance has nothing to do with changing your settings.
I do not have EPR on.  I will try it.

I have gone into the clinical menu, so I know how to do all that.  

I have downloaded Oscar.  My machine did not come with an SD card, so I will have to hunt one down before I can post data.

Thanks for the edit about DME scare tactics.  My entire impression was that they will do everything they can to keep people in the dark, so that you have to go back to them.

A huge question that I have, that I don't think has been answered.  Should I be able to breathe freely wearing just the mask?  Completely disconnected from the machine, there is still a huge pressure resistance against exhaling.
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#9
RE: Extremely difficult to exhale, even with the machine off.
EPR is considered by the manufacturer to be a comfort setting. As far as patient access to settings, Please read the article in CPAP Settings Manuals https://www.apneaboard.com/adjust-cpap-p...tup-manual and consider that to be the stance of nearly 100% of the members and staff on Apnea Board. We feel patients that are knowledgeable and engaged, are better able to advocate for themselves, and those that take control of their therapy are more likely to succeed and stick with it. You are motivated, but if you let someone else command and control your settings, you are more likely to become dissatisfied and uncomfortable, resulting in failure. Your choice. Keep in mind as a patient you have many rights, including the right to make setting changes, accept or decline tests, treatments and follow recommendations. Let me just say, your DME therapist is completely out of line. YOU did not have a titration test. The DME is gave you those wide open settings and is hoping they will work. They know NOTHING about your needs.

Back to EPR...go into settings and navigate the Comfort menu. https://www.apneaboard.com/resmed-airsen...setup-info Set EPR to ON, Full-Time, and set it to 3. My recommendation for a minimum pressure of 6.0 is because you want to have a lower exhale pressure than inhale pressure, so your current minimum of 5.0 will result in 5.0/4.0. That will be nearly imperceptible. A pressure of 6/4 is a better start. FWIW, if you feel better about it, call the DME and tell your therapist you're uncomfortable exhaling and are going to turn on EPR. You don't need permission.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
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Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Extremely difficult to exhale, even with the machine off.
Welcome to the forum,

You talked about taking control of your treatment,  this is a good place to be.
With your settings of 5 - 20 and no EPR we see that you were assigned basically wide open settings that were given with little thought.  Most of us like to provide initial settings of 6 with EPR 2 or 7 with EPR 3.  This usually helps with inhalation and allows the lowest min pressure for exhale.

We help best when we have data.  Our preferred data are the charts that OSCAR provides, so download OSCAR and post some nightly data (see my signature for links.  The Organize link indicates which charts to include.   

The DME is typically allowed to change humidifier settings, and usually the EPR settings.  They are not allowed to change any pressure settings without the doctor's permission.  Doctors are usually quick to take credit for therapy that works.

You asked about, I think, a mask on your face being "free breathing", while you can breath that way most feel that alien on their face which makes it seem harder than it is and yes, there is more restriction than breathing without a mask.  I perceived more issues with inhaling than exhaling and needed at least 10cmw to feel comfortable.  All of us are different.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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