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Extremely difficult to exhale, even with the machine off.
#21
RE: Extremely difficult to exhale, even with the machine off.
I received the N30i not too long ago. I just tried a mask on scenario with hose disconnected. I don’t feel much restriction from breathing in or out. I’m using a Medium cushion.

Which direction did the cushion get installed? The arrows on the frame and cushion need to meet.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#22
RE: Extremely difficult to exhale, even with the machine off.
(08-23-2019, 04:33 PM)spenc938 Wrote: 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.

It is normal for exhaling to feel 'blocked' when not connected to the machine, the mask has an anti asphyxiation valve that opens when inhaling and closes on exhaling, all masks have it.

I understand you thought that if there's an issue without pressure you might not be getting correct treatment when there's pressure, not the case here, at least not for the reason you mentioned.

Whether there's an issue with flow limitation only OSCAR charts may be able to reveal it.
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#23
RE: Extremely difficult to exhale, even with the machine off.
(08-23-2019, 11:43 PM)crowtor Wrote: It is normal for exhaling to feel 'blocked' when not connected to the machine, the mask has an anti asphyxiation valve that opens when inhaling and closes on exhaling, all masks have it.

To the best of my limited layperson's knowledge, typically on CPAP machines only oronasal ("full face") masks have an anti-asphyxiation valve, and all those valves do is open up the mask to room air when there is no positive pressure from the machine. They stay "closed" (to direct room air) as long as their is positive pressure from the machine. The open up to room air if the machine's blower turns off, allowing you to breathe room air in and out directly rather than in and out of the long tube attached to the CPAP, which is a large dead space and could lead to asphyxiation. The anti-asphyxiation valve on CPAP masks doesn't open and close as you breathe in and out as CPAP masks are vented with an intentional leak to washout CO2 rather than using valves to prevent rebreathing.
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#24
RE: Extremely difficult to exhale, even with the machine off.
Hello Spenc938

Your thread prompted me to try out my N30i disconnected from the machine with the hose attached and not attached. I did find a little resistance with the mask in both cases but it was not extreme.

Recently I have had issues waking with a feeling of being starved for air. This was with the P30i pillows and swapping back to the N30i nasal mask made a difference. The thing to know about this mask is that you should avoid having it overly tight against your nostrils. It should sit just underneath them and if you pull them in too tight then airflow is restricted.

The other way I fixed the issue was to up my minimum pressure. I have a BiLevel machine and I felt that the pressure support was going to low which can cause that starved for air feeling.

I have a few other thoughts on this but will wait to see what happens when you make other adjustments.
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#25
RE: Extremely difficult to exhale, even with the machine off.
As just mentioned also ... do you have the right size? If it is too small:

1. The nostril holes will be smaller and hence restrict air.
2. It will also pinch potentially on the sides of the nose and hence squeeze the nostrils tighter and thus restricting air flow.

To you have access to a larger one to try?

Good luck!
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#26
RE: Extremely difficult to exhale, even with the machine off.
(08-23-2019, 07:39 PM)SarcasticDave94 Wrote: I received the N30i not too long ago. I just tried a mask on scenario with hose disconnected. I don’t feel much restriction from breathing in or out. I’m using a Medium cushion.

Which direction did the cushion get installed? The arrows on the frame and cushion need to meet.

No, it's not backwards.  I kind of wish that it had been, that would have been a super easy fix.

(08-23-2019, 11:43 PM)crowtor Wrote:
(08-23-2019, 04:33 PM)spenc938 Wrote: 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.

It is normal for exhaling to feel 'blocked' when not connected to the machine, the mask has an anti asphyxiation valve that opens when inhaling and closes on exhaling, all masks have it.

I understand you thought that if there's an issue without pressure you might not be getting correct treatment when there's pressure, not the case here, at least not for the reason you mentioned.

Whether there's an issue with flow limitation only OSCAR charts may be able to reveal it.

I don't think that the Resmed N30i has that.

(08-24-2019, 01:07 AM)Stom Wrote:
(08-23-2019, 11:43 PM)crowtor Wrote: It is normal for exhaling to feel 'blocked' when not connected to the machine, the mask has an anti asphyxiation valve that opens when inhaling and closes on exhaling, all masks have it.

To the best of my limited layperson's knowledge, typically on CPAP machines only oronasal ("full face") masks have an anti-asphyxiation valve, and all those valves do is open up the mask to room air when there is no positive pressure from the machine. They stay "closed" (to direct room air) as long as their is positive pressure from the machine. The open up to room air if the machine's blower turns off, allowing you to breathe room air in and out directly rather than in and out of the long tube attached to the CPAP, which is a large dead space and could lead to asphyxiation. The anti-asphyxiation valve on CPAP masks doesn't open and close as you breathe in and out as CPAP masks are vented with an intentional leak to washout CO2 rather than using valves to prevent rebreathing.

Yeah, I'm pretty sure this mask doesn't have that.

(08-24-2019, 04:11 AM)holden4th Wrote: Hello Spenc938

Your thread prompted me to try out my N30i disconnected from the machine with the hose attached and not attached. I did find a little resistance with the mask in both cases but it was not extreme.

Recently I have had issues waking with a feeling of being starved for air. This was with the P30i pillows and swapping back to the N30i nasal mask made a difference. The thing to know about this mask is that you should avoid having it overly tight against your nostrils. It should sit just underneath them and if you pull them in too tight then airflow is restricted.

The other way I fixed the issue was to up my minimum pressure. I have a BiLevel machine and I felt that the pressure support was going to low which can cause that starved for air feeling.

I have a few other thoughts on this but will wait to see what happens when you make other adjustments.

I do have what I would consider to be quite a bit of resistance.  I switched out the medium cushion for the small wide and that helped because the medium was pinching the sides of my nose a bit.  I also loosed the headgear slightly and that helped as well, but now I'm concerned about causing leaks.  I did change my pressure as well with some of the settings posted yesterday.  I have Oscar charts to post in a few minutes.

(08-24-2019, 09:52 AM)theoak Wrote: As just mentioned also ... do  you have the right size?  If it is too small:

1. The nostril holes will be smaller and hence restrict air.
2. It will also pinch potentially on the sides of the nose and hence squeeze the nostrils tighter and thus restricting air flow.

To you have access to a larger one to try?

Good luck!

I don't think that I did have the right size cushion.  Switching from a medium to a small-wide helped reduce side-of-nose pinching.  I also loosened the velcro straps.  These two things helped a lot, but I'm worried about increasing leaks.
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#27
RE: Extremely difficult to exhale, even with the machine off.
I come bearing charts.  I used the machine for twice as long last night as I did the night before, so that's great.  With the mask changes and the settings changes, I did feel a lot more comfortable while using the machine.  It is still fairly difficult to exhale, even while wearing just the mask.  I should mention that being able to breathe through my nose is a fairly new experience for me.  I had pretty major sinus surgery this spring.  Ever since then, I've been training myself to breathe through my nose, as my mouth breathing that I had been doing my whole life had been damaging my teeth.  A lot of the time, I still have what I would consider to be excessive nasal congestion.  I've been paying attention to my breathing since yesterday and even while just breathing normally through my nose, I have slightly higher resistance while exhaling.  I think this is a lot of what I've been noticing, but just exacerbated by the mask.  I'm going to try and get back in asap with an allergy specialist to see if we can do more to combat this.

Anyway, back to using the machine.  There were multiple times where I really felt that the machine and I got into a groove and were working together instead of against each other.  This was interrupted once by needing to get up and pee and again a while later by my wife starting to snore.  Annoying interruptions aside, this does give me hope for the future.

I should also mention that I started this whole sleep study journey for probably different reasons than most others.  I went to the doctor for tension headaches and insomnia.  Eventually, my family Dr suggested a sleep study.  I did the little one with just the oximeter, then went to see a sleep Dr who believes that I can't fall asleep because my brain is afraid to fall asleep because of the apnea incidents.  He also believes that the tension headaches that get worse as the days goes on and get horrible at night are caused by the stress of having to sleep when my brain knows that I won't be able to breathe well.


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#28
RE: Extremely difficult to exhale, even with the machine off.
OK, your numbers are good, they do not warrant making changes in and of themselves. Changes should be symptom driven.

Because you are still sensing issues with exhale, post a 2 minute zoomed view of a time where you feel you likely have a problem. Include these charts
Events
Flow Rate
Minute Volume
Tidal Volume
Mask Pressure (not Pressure)

as well as a full night chart as you posted above for reference.

NO promises that we will find or see anything, just for a look.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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#29
RE: Extremely difficult to exhale, even with the machine off.
I come bearing congratulations! It’s good to hear you’re using the mask longer and feeling more comfortable. I wouldn’t be surprised if you’re right that your sinus and allergy problems are a big factor in your perception of difficulty exhaling.

The next step will be to keep the mask on longer, ideally all night. Given your thoughtful approach, I bet you’ll be making quick progress.
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#30
RE: Extremely difficult to exhale, even with the machine off.
FWIW I'm thinking this N30i should have size Wide. I think it's color coded gray.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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