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Harder exhale at startup
Why do I have a harder time exhaling at the start of my treatment during ramp-up than I do in the middle of the night? I am almost gasping to force the air out during ramp-up and it makes it very hard to fall asleep. However, when I wake during the night, my breathing feels easy and natural.

My pressure is set at 12 cmH20, with a 10 minute ramp-up (I can't stand it any longer than this) starting at 7 cmH20 (frankly, when I turned ramp-up off, I still felt the difficulty exhaling for a while ~20 mins or so). Per my doctor's instructions I have turned EPR "OFF".

Is it my imagination?
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Hi chezdan9,
You might try turning the ramp off and see if that helps you.
Hang in there for more suggestions.
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(12-17-2013, 01:23 PM)chezdan9 Wrote: Per my doctor's instructions I have turned EPR "OFF".

Is it my imagination?
Hi chezdan9
Not everyone use EPR but not everyone or your doctor is you. The doctor thinking pressure drop during exhale might cause few apneas to slip through but EPR can helps people like yourself who experiencing problem at exhale especially during the start-up. Beside off and full time, you can select EPR to come-on during ramp only (not during treatment) so you get the relief when you mostly needed. If EPR set full time, pressure drop (by whatever level been set) during ramp and during treatment but if the machine detect an apnea during exhale, EPR immediately suspends and pressure revert to set CPAP pressure

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Of course it *IS* actually harder to exhale while hooked up to your machine than it is during the day. But, as to why it's not a problem later during the night, I would 'assume' it's because you've had enough time to get used to 'pushing' air out when you exhale.

I used my ramp for the first 2yrs, but then stopped as I found that I wouldn't go to sleep til I was at full pressure.

Everyone reacts differently, and some have issues, and some don't. I would personally start doing some 'self-talk' each night as you are waiting to fall asleep - telling yourself that having to breathe against the machine is good, it will make you stronger, make your lungs more powerful, that it is a reminder that you are safe, and that if you don't feel the need to push to exhale something is wrong - in other words, brain-wash yourself in a positive way!

Lastly, I do not know how long you've been on your machine, but I suspect with time, this issue will go away - our bodies generally dislike change.
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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I'd set the EPR to 1 to see if that helps any. And yes, it is that when you wake up later, your body has gotten used to it. When you first lay down, you're thinking about it too much and kinda fighting it. Turn on the EPR a little to see if it helps. Leave the ramp where it is for a while longer.

Like most, I used the ramp for a while then finally just turned it off.
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I suspect it is related to you getting used to the pressure again, Chezdan9.

I'd say I experience a bit of the same...In my case, I notice the pressure a bit to start with too, but it isn't so bad that I fee like I'm fighting to exhale: more like resistance. Come morning, I'm not aware of the pressure at all until I turn the machine off....in which case it's kinda the reverse: feels like I'm trying to suck air through a mile long garden hose until I pop off the mask Big Grin
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I was very sensitive to exhale pressure especially in the beginning. It felt like I was having to push against the pressure to exhale. BUT I awaken in the middle of the night thinking there was something wrong with my machine. I couldn't feel anything. When I discussed this with my DME, he laughed and said "that's what you want. You are just getting used to the pressure."

At first I set my EPR to 3, but it felt funny so I decided to make the change more moderate. I set it at 1 and it's been there ever since. My point is that it does feel strange at first. with a bit of time and experience it starts to feel normal.
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Haha! Right! I keep thinking the machine isn't working properly since I don't notice the pressure in the middle of the night. Whew! See? That's why these boards are so helpful and provide so much positive reinforcement for folks. Peter, I especially liked your post - "Positive (Pressure) Thinking." Thanks, everybody!
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I found the same as you chez and the more I thought about it the worse it got, so thought of getting off to sleep, that did the trick.
At the evening service tonight, the sermon topic will be 'What Is Hell?' Come early and listen to our choir practice.
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The trick I use when I think that my machine isn't working right (yes, after all these years I do it too) is I simply open my mouth and allow the air to go in my nose and out my mouth - high volume there! And that tells me that (A) I can breathe, and, (B) everything is as it should be - then I remind myself again that the outside air is poison (or I'll drown, etc) and that I can only breathe through my nose or I'll die/drown/blow-up/wake my wife/get in trouble/smell dog farts - whatever I happen to think of at that time.
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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