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Feeling like I have to work hard to breathe
#1
Hello,
I'm a newly diagnosed sleep apnea patient trying to get used to my cpap machine.  I see the need and on occasion I get some nice sleep when I hit the right stride.  My biggest complaint is I feel I have to consciously work harder to breath and get enough air before falling asleep.  I am a very active side sleeper and started with a Dreamware nasal mask.  That seemed to cut off some airflow so I switched up to the Swift FX.  It's better but still feel the need to open my mouth sometimes to supplement the airflow and feel like I'm getting what I need.  I can get maybe 4 hours a night with the mask and then abandon it as my chest seems tired from the breathing effort? Suggestions would be most appreciated!
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#2
You have a pretty wide pressure setting at 5-14, and I suspect you'd be more comfortable and effective at a higher minimum pressure. If you already have some data or are using SleepyHead, set your minimum pressure equal to the median pressure so far.
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#3
(05-06-2017, 07:37 PM)speed3914 Wrote: Hello,
I'm a newly diagnosed sleep apnea patient trying to get used to my cpap machine.  I see the need and on occasion I get some nice sleep when I hit the right stride.  My biggest complaint is I feel I have to consciously work harder to breath and get enough air before falling asleep.  I am a very active side sleeper and started with a Dreamware nasal mask.  That seemed to cut off some airflow so I switched up to the Swift FX.  It's better but still feel the need to open my mouth sometimes to supplement the airflow and feel like I'm getting what I need.  I can get maybe 4 hours a night with the mask and then abandon it as my chest seems tired from the breathing effort? Suggestions would be most appreciated!

if your machine is not adjusting to your normal breathing then you could have a problem 
they set mine on fixed and told me to learn to breathe the way the machine wanted to do it

there are also other settings for timing and duration that can be tweaked inside if you get the manual to show you how
and you could  get a machine that is auto and adjusts to your breathing rate and depth
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#4
(05-06-2017, 07:56 PM)xxyzx Wrote:
(05-06-2017, 07:37 PM)speed3914 Wrote: Hello,
I'm a newly diagnosed sleep apnea patient trying to get used to my cpap machine.  I see the need and on occasion I get some nice sleep when I hit the right stride.  My biggest complaint is I feel I have to consciously work harder to breath and get enough air before falling asleep.  I am a very active side sleeper and started with a Dreamware nasal mask.  That seemed to cut off some airflow so I switched up to the Swift FX.  It's better but still feel the need to open my mouth sometimes to supplement the airflow and feel like I'm getting what I need.  I can get maybe 4 hours a night with the mask and then abandon it as my chest seems tired from the breathing effort? Suggestions would be most appreciated!

if your machine is not adjusting to your normal breathing then you could have a problem 
they set mine on fixed and told me to learn to breathe the way the machine wanted to do it

there are also other settings for timing and duration that can be tweaked inside if you get the manual to show you how
and you could  get a machine that is auto and adjusts to your breathing rate and depth

Neither a CPAP nor an APAP adjust to the depth and frequency of breathing. Their function is to provide an air splint to keep the airway open. The APAP uses an algorithm to ajust the pressure needed to keep the airway open. Neither breath for you or provide any kind of ventilator support.
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#5
speed3914,
Your minimum pressure may be too low. This can give you that "starved for air" feeling.

Download SleepyHead. If you don't know your median or 90% pressure reading, then for now, at least raise the minimum pressure to 7cm. This will make a big difference in feeling like you can't get enough air.

Also, some find that using one size larger nasal pillow allows you more air.
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#6
(05-06-2017, 08:00 PM)TASmart Wrote:
(05-06-2017, 07:56 PM)xxyzx Wrote: if your machine is not adjusting to your normal breathing then you could have a problem 
they set mine on fixed and told me to learn to breathe the way the machine wanted to do it

there are also other settings for timing and duration that can be tweaked inside if you get the manual to show you how
and you could  get a machine that is auto and adjusts to your breathing rate and depth

Neither a CPAP nor an APAP adjust to the depth and frequency of breathing. Their function is to provide an air splint to keep the airway open.  The APAP uses an algorithm to ajust the pressure needed to keep the airway open. Neither breath for you or provide any kind of ventilator support.

Yes TASmart, it seems so many clinicians and specialists don't actually know how APAP/CPAP machines actually work, as demonstrated by xxyzx's case.
The machine only responds to your own breathing, it does nothing to instigate or control your breathing, it only reacts to open your airway if you stop breathing basically.

I have an APAP Dreamstation, after my trial on a rental machine my specialist recommended a fixed pressure unit set at 7 as the fixed pressure.

After discussion with the clinician who did my trial I opted to pay the extra for the APAP and just get it set to the fixed pressure settings the specialist recommended for my needs, this gives me the option to easily check if my setting is still optimal for my needs every 12 months or so without having to go through the rigmarole of getting rental unit to do another trial period on auto. 

As the weather has started to cool off I've been getting a blocked nose overnight, so I've tried various things to relieve the issue, albeit with minimal success. 

Both zero and max. humidity have not had sufficient impact on the problem, Vicks Vaporub and nasal sprays didn't work consistently either.

I have also felt I'm not getting enough air to breathe, particularly when I first lie down at night.

So last night I upped my fixed pressure from 7 to 8 and instantly felt much more comfortable with my breathing, this morning I have woken with my nose much more "open" from blockage. 
The test from the nasal congestion point of view will take a few days to see if it is consistent, but the easier breathing has been an "instant fix" with the increase in my fixed pressure setting.
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#7
Yes, thus far I have better results using fixed rather than APAP. It's really pretty easy to dial in my pressure, and Resmed's EPR gives me worse results too.
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#8
I found the wake with tight chest breathing effort, will go in a few weeks. you are using your muscles more.
As sleeprider said, the higher pressure falling asleep with make breathing in and a sense of lack of air easier. You may also feel that you don't breathe out fully. that's ok and you will get use to that, cpap stops the small lung sacks collapsing, you can also use the flex setting, which feels more normal.

It would be a good idea to put up some charts from sleepyhead
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#9
It's natural to feel like breathing out is harder on CPAP, because it is. But, to put things in perspective 10cm of water is pretty darned close to 1% of "normal" pressure at sea level.

So you have to blow out 1% harder (or maybe 2% if you go to 20cm) but that is something you are not used to doing. And of course it's a differential pressure and you are not used to breathing out against it, and it will feel like more than that 1 or 2 percent.

On the good side it's easier to breath in since the machine is blowing air into you. Unless you are unusually weak or very sick your chest muscles will adapt pretty quickly. Give them a chance, it soon will feel just normal.
Ed Seedhouse
VA7SDH

Your brain is not the boss.

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#10
Thank you for the suggestions.  I will download sleepyhead and check what my median pressure is.
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