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Frustrated VPAPAuto Newbie
#1
First post. The short story -- received my prescribed VPAP gear from DME on July 10 and have been using it nightly since (averaging 5+ hours), but getting mixed, non-results.

Definitely need the therapy, just not sure how, exactly, the machine and I are supposed to mitigate my obstructive apneas. This may seem like a silly question, but is it the high pressure that keeps the airway open? Is there such a thing as too high of pressure? Was at 22 max, now at 18 and it still seems too high for me.

My original expectation was that the VPAP would be a silver bullet -- simply put it on and enjoy a better nights' sleep. After this last months' use and much research here, I now understand that this is not a trivial thing to adapt to and results are not guaranteed. But surely it can't be THIS HARD?

I am committed to do whatever it takes because I understand the downside of sleep apnea. However, I am getting progressively more frustrated because I seem to be stuck in a vicious cycle where each night I battle the same issues.

Experiencing many "sessions" each night. Occasionally I'll get a couple of hours without interruption. But mostly way too many short duration "sessions", and not nearly enough sleep.

As I doze off I find myself being prodded by increasing pressure as the VPAP responds to my obstructive apneas. Invariably, each session ends up with me at max pressure and eventually I'm awake. I generally try to only breathe through my nose, but eventually the mask starts to spill air, at which point I know its time to reset and start over.

If I try breathing through my mouth, my cheeks quickly become overly inflated (picture a puffer fish)and I have to strain my face to keep the mask from leaking. When I can hold my face muscles tight, then the pressure continues unabated, at the max pressure. The apnea is over (cause I'm breathing), but it seems to take way too long for it to react and lower the pressure. Is this typical?

The highest number of sessions occur when I'm on my back. But this is the only way I seem to be able to not have leaks. No matter what I do to the mask, if I sleep on either side, the mask will eventually leak. Is there some magic to being able to sleep on your side without leakage? Should I not be using a pillow? Maybe a different type of pillow?

Is there a Newbies FAQ around somewhere? If so, sorry I have missed it.

Anyway, sorry for the long post. Glad this board is here. I have gleaned a lot of info in a very short time, as well as loaded up and learning to use ResScan and SH software.

So the adventure continues. Just not sure where to go from here?

Thanks in advance for your kind attention.

oldbro
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#2
Some of the veteran FFM users will help with your questions about leaks and side-sleeping. I'm wondering what your AHI has been while using the machine. I'm also curious to see some SleepyHead screenshots, which can be especially informative with auto machines and when someone has questions about the pressure settings. We can look at the Pressure graph and see where the pressure went throughout the night and that can help guide any needed adjustments to the settings.

Would you clarify your pressure(s) -- is 8 the Min EPAP and 18 the Max IPAP, and Pressure Support is 4?

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#3
(08-12-2015, 01:11 PM)oldbro Wrote: First post. The short story -- received my prescribed VPAP gear from DME on July 10 and have been using it nightly since (averaging 5+ hours), but getting mixed, non-results.

Definitely need the therapy, just not sure how, exactly, the machine and I are supposed to mitigate my obstructive apneas. This may seem like a silly question, but is it the high pressure that keeps the airway open? Is there such a thing as too high of pressure? Was at 22 max, now at 18 and it still seems too high for me.

My original expectation was that the VPAP would be a silver bullet -- simply put it on and enjoy a better nights' sleep. After this last months' use and much research here, I now understand that this is not a trivial thing to adapt to and results are not guaranteed. But surely it can't be THIS HARD?"

Well think about it. You have no experience that will be of any use with CPAP. Everything happens when you are asleep and feedback gets very fuzzy. Think of controlling the robots on Mars. Think about what you want to do, formulate what you want to do, send it off, and then see what actually happened.

"I am committed to do whatever it takes because I understand the downside of sleep apnea. However, I am getting progressively more frustrated because I seem to be stuck in a vicious cycle where each night I battle the same issues.

Experiencing many "sessions" each night. Occasionally I'll get a couple of hours without interruption. But mostly way too many short duration "sessions", and not nearly enough sleep.

As I doze off I find myself being prodded by increasing pressure as the VPAP responds to my obstructive apneas. Invariably, each session ends up with me at max pressure and eventually I'm awake. I generally try to only breathe through my nose, but eventually the mask starts to spill air, at which point I know its time to reset and start over.

If I try breathing through my mouth, my cheeks quickly become overly inflated (picture a puffer fish)and I have to strain my face to keep the mask from leaking. When I can hold my face muscles tight, then the pressure continues unabated, at the max pressure. The apnea is over (cause I'm breathing), but it seems to take way too long for it to react and lower the pressure. Is this typical?

The highest number of sessions occur when I'm on my back. But this is the only way I seem to be able to not have leaks. No matter what I do to the mask, if I sleep on either side, the mask will eventually leak. Is there some magic to being able to sleep on your side without leakage? Should I not be using a pillow? Maybe a different type of pillow?"

There are CPAP pillows, but I just move to the side of the pillow and hand the mask off the end and I still get leaks. I recently tried nose pillows and have not had any leaks, but they have their own issues.

"Is there a Newbies FAQ around somewhere? If so, sorry I have missed it."

There are lots of posts about what to do and expect. It sounds like you are already doing the basic things. I don't use that high of pressure, but others that do will chime in.

"Anyway, sorry for the long post. Glad this board is here. I have gleaned a lot of info in a very short time, as well as loaded up and learning to use ResScan and SH software.

So the adventure continues. Just not sure where to go from here?

Thanks in advance for your kind attention.

oldbro

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#4
   
(08-12-2015, 02:15 PM)kaiasgram Wrote: . . . . I'm wondering what your AHI has been while using the machine. I'm also curious to see some SleepyHead screenshots, which can be especially informative with auto machines and when someone has questions about the pressure settings. We can look at the Pressure graph and see where the pressure went throughout the night and that can help guide any needed adjustments to the settings.

Would you clarify your pressure(s) -- is 8 the Min EPAP and 18 the Max IPAP, and Pressure Support is 4?

Thanks for comments and response.

Current AHI is 10.2 for the period (since Jul 10)

Would love to provide Screen shots of pressure settings but my understanding is that as a newbie I need to post more before I can provide graphic files. I'll try and see what happens. Just imagine about 20 SH pressure curves, all starting at 8 and then going to the max of 18 over short durations.

You are correct - my pressure prescription is 8 Min EPAP, 18 Max Ipap, and Pressure support is 4.0.

regards,
oldbro
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#5
I am a little confused by your machine descriptions. It sounds like you are using an Aircurve 10 VPAP Auto. Can you confirm that this is correct? Without any data, I am guessing that it might help to try moving the min EPAP up some maybe to 10 cm/H2O.

When you talk about leaks are these leaks that you feel while the machine is running and if so where, on your face, are the leaks occurring? If you are judging the leaks by data, how bad are they?

Did you have a sleep test and titration? Were you titrated to a bilevel machine? If so, what were your titrated pressures? Can you determine which F&P full face mask you are using?

With the high pressures that you seem to need getting masks to seal can be a little trickier than at lower pressures. You need to pay attention to a lot of details to be successful.

We can give you some good tips but we need as much information as you can garner.

Best Regards,

PaytonA
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#6
Looking at your data graph, you see the machine is quick to attack (raise pressure) and slow to retreat.
It's my own opinion that you are set at too low of a minEPAP pressure (8 cm-H2O. Somewhere between 10 to 12 would be better.
I can tell also that you use a short ramp time. Most people do not do well with the ramp turned on for two reasons: 1: They tend to adjust the mask during periods of low pressure. 2: Some feel they don't get enough air during ramp.

It's obvious that you require considerable pressure to quash OSA's. Much as I do.
Your biggest fight is with leaks. With the FFM, you should be able to mouth breathe without cheek puff.
And, even open your mouth without losing seal at the mask to face interface.
I think the AirFit F10 may not be the best FFM for you. I use the Mirage Quattro which has a forehead brace and an adjustable contact distance at the bridge of the nose.

Adjust the headgear straps at pressure. Done at lower pressure and the mask is sure to leak.
A leak wakes me every time. There is an art to be mastered in balancing the mask fit for comfort and seal.

Kindest Regards,

Mongo

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#7
(08-12-2015, 04:28 PM)PaytonA Wrote: I am a little confused by your machine d[/color]escriptions. It sounds like you are using an Aircurve 10 VPAP Auto. Can you confirm that this is correct?


That is correct - see my profile for more information.


Without any data, I am guessing that it might help to try moving the min EPAP up some maybe to 10 cm/H2O.


OK. I've been wondering if this might help. Thanks.


When you talk about leaks are these leaks that you feel while the machine is running and if so where, on your face, are the leaks occurring?


Many sessions I generally know I have a leak cause I'm awake and I reseat the mask until I can get it to quiet down.


If you are judging the leaks by data, how bad are they?


Initially not too bad. But recently I have been surprised, in that it seems I'm getting more leakage when I'm sleeping and unconcious. Disappointing to wake up thinking you had a good night, only to find out that you had many large leaks. I may have overtightened in one instance. I will try to verify.


Did you have a sleep test and titration? Were you titrated to a bilevel machine? If so, what were your titrated pressures? Can you determine which F&P full face mask you are using?


Answered in order -- YES. YES. Indeterminent. F&P?? My current ffm is the AirFit F10.


With the high pressures that you seem to need getting masks to seal can be a little trickier than at lower pressures. You need to pay attention to a lot of details to be successful.


Understood. I'm doing my best to learn what is needed asap. Thanks.


We can give you some good tips but we need as much information as you can garner.

Best Regards,

PaytonA
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#8
(08-12-2015, 05:02 PM)justMongo Wrote: Looking at your data graph, you see the machine is quick to attack (raise pressure) and slow to retreat.


YEP. I agree. VERY quick to respond to apnea.


It's my own opinion that you are set at too low of a minEPAP pressure (8 cm-H2O. Somewhere between 10 to 12 would be better.
I can tell also that you use a short ramp time. Most people do not do well with the ramp turned on for two reasons: 1: They tend to adjust the mask during periods of low pressure. 2: Some feel they don't get enough air during ramp.


Starting last night, I am using 9.4 for min EPAP and 16.4 for Max IPAP. I will test this for a week or so with the F10 mask. Also, I turned off the RAMP. Will just go for the therapy ASAP and make sure the mask is not leaking before I go to sleep.


It's obvious that you require considerable pressure to quash OSA's. Much as I do.
Your biggest fight is with leaks. With the FFM, you should be able to mouth breathe without cheek puff. And, even open your mouth without losing seal at the mask to face interface.


I have yet to be able to accomplish this mouth breathing thing on higher pressures. Perhaps with the new MAX IPAP setting. I will try it for a week.


I think the AirFit F10 may not be the best FFM for you. I use the Mirage Quattro which has a forehead brace and an adjustable contact distance at the bridge of the nose.


OK. I'll take a look at this mask. I had the same thought about the F10. Nice mask, but maybe not for highest pressures. I used two masks in my sleep studies. the F10 and the Quattro FX. Seemed to do better with the FX. Doc. prescribed the FX but the DME thought the F10 would be better, so agreed to try it for awhile. Now I think it is time for me to try another mask.



Adjust the headgear straps at pressure. Done at lower pressure and the mask is sure to leak.
A leak wakes me every time. There is an art to be mastered in balancing the mask fit for comfort and seal.


Thanks so much for the feedback. I really want to see improvements in my sleep situation.

Best Regards,
oldbro


Kindest Regards,

Mongo
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#9
[quote='oldbro' pid='126240' dateline='1439483323']

I have been on the machine for 2 weeks and experienced similar issues as yours : frequent wake-ups & high pressures before wake-ups !

For the past few nights, I found some reliefs by taping my mouth shut . It works for me as the AHI decreases from around 20 to 5 !

There is some concern about taping one's mouth for fear of being choked during the sleep if the nose is blocked for any reason . So I punched 2 overlapped holes in the tape with a paper puncher before putting it on ( 1/4 inche in diameter ) .
It seems OK so far....

Good luck olbro !

[Image: 2AubMmW.png]

[Image: zY1Nc9T.jpg]
Paper puncher

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#10
Hey tommy - That is an incredibly well adapted mouth-tape mod! I like it! And I am against the taping process. you can then also sip water thru a straw (I know that is really the reason you popped the hole in it!)

Hey, welcome to oldbro!

I have a trick for you - while sleeping on your side, turn your face directly up, use a scrunched up/rolled up pillow to press against the side of your face. Ironically, this seems not to result in same obstructions as if your face is up while on your back. And, the mask is not being wiped off your face.

by the way, you know you probably have worse apnea on your back. Most people do. So read up on sewing the tennis ball in the back of your night shirt.

I was surprised that the OA events seemed to be happening at higher pressures. Am I seeing things?

I applaud your adjustment of max to 16ish or maybe a bit less - to ensure that you will not be agitated by the higher pressure.

Good luck!

QAL
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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