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#1
Hello,

I have only had my APAP for a few nights and am fighting with it. It seems I have difficulty exhaling and it is making me feel claustrophobic and I cannot fall/stay asleep, I wind up taking the mask off. The machine is set at 5-20. I really want to be able to get the benefits of this therapy but the difficulty exhaling is preventing me from doing so.

Any help would be appreciated
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#2
Welcome to the forum, truthornothing
Feeling claustrophobic and exhaling the pressure is common at the start of CPAP therapy
Does your machine have 'expiratory pressure relief'
the pressure relief will decrease the pressure being delivered on exhale and make it more comfortable

Many people find helpful using the machine for an hour or so while doing an activity to distract them such as watching TV or reading.
This will help them to adjust breathing with the machine at their leisure and become easier to do so at nighttime

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#3
Hi truthornothing,
WELCOME! to the forum.!
CPAP therapy can take some getting used to.
Wear your mask and use your machine during the evening as you watch tv or read; this will help your body get used to this new way of sleeping. Don't give up and hang in there for more suggestions.
Best of luck to you with your CPAP therapy.
trish6hundred
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#4
Your machine is set to the max's of 5 and 20. The theory is that the machine will figure out what pressure you should be using and settle in at that level. That's fine if everything else is as it should be. But if you need a pressure of let's say 10, and because of mask leaks or mouth leaks or whatever, your machine is dialing up a 20 sometimes, then you're going to have trouble.

Usually they set the machines this way because there hasn't been a "titration study" done to see what the settings should really be.

What you need to do is follow the links to download and install the Sleepyhead software. Then you can put your sdcard in the computer and look at your own results. The data of interest is "AHI," your apnea averages, your median and 95% pressures, and your median and 95 leak values.

From this you can derive a closer range for the minimum and maximum settings, then coupled with EPR support get to a comfortable place.

But it starts with getting your data results, so download and install the Sleepyhead software first.
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#5
Obstructive Sleep Apnea is being caused because essentially your upper airway is collapsing closed (apnea) or closing most of the way (some air getting through but not enough to support good ventilation, hypopnea).

The goal of CPAP is to keep that airway collapse from happening. We do that with Continuous Positive Airway Pressure. That resistance you feel during exhalation creates back pressure. That back pressure in your airway keeps the airway from collapsing.

So, the entire purpose of a CPAP machine is to create that expiratory resistance you are feeling. Most of my patients tell me it takes a good 2-3 weeks to really get used to the mask and the pressure (some quicker, some longer).

Don't give up. I've spoken with 100's of patients that have told me that CPAP has litterally changed their lives. Many of those success stories will be posted right here on this message board.

Getting a good fit with your mask & getting a mask you are comfortable with are the responsibility of your DME company. Make sure you are satisfied with the mask/fit they give you.

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#6
(06-25-2014, 05:42 AM)zonk Wrote: Welcome to the forum, truthornothing
Feeling claustrophobic and exhaling the pressure is common at the start of CPAP therapy
Does your machine have 'expiratory pressure relief'
the pressure relief will decrease the pressure being delivered on exhale and make it more comfortable

Many people find helpful using the machine for an hour or so while doing an activity to distract them such as watching TV or reading.
This will help them to adjust breathing with the machine at their leisure and become easier to do so at nighttime

(06-25-2014, 11:09 AM)retired_guy Wrote: Your machine is set to the max's of 5 and 20. The theory is that the machine will figure out what pressure you should be using and settle in at that level. That's fine if everything else is as it should be. But if you need a pressure of let's say 10, and because of mask leaks or mouth leaks or whatever, your machine is dialing up a 20 sometimes, then you're going to have trouble.

Usually they set the machines this way because there hasn't been a "titration study" done to see what the settings should really be.

What you need to do is follow the links to download and install the Sleepyhead software. Then you can put your sdcard in the computer and look at your own results. The data of interest is "AHI," your apnea averages, your median and 95% pressures, and your median and 95 leak values.

From this you can derive a closer range for the minimum and maximum settings, then coupled with EPR support get to a comfortable place.

But it starts with getting your data results, so download and install the Sleepyhead software first.
I do have pressure relief, but it doesn't seem to do as much as I would like it to. I don't think I have any leaks on this mask. The first mask I had was a hybrid and forget about it. It leaked from everywhere. I think it is the sudden ramping up and down that is getting me. I took the advice and set my ranges to 10 low 20 high. This machine has a sensitivity control that changes how quickly it responds to changes. Perhaps I should set it down so the sudden changes do not wake me. I downloaded the Sleepy Head software but it doesn't work with my machine. If anyone knows a a software that will it would be helpful. My machine uses something called I code but I don't think it is as helpful
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#7
(06-25-2014, 03:39 PM)truthornothing Wrote: I downloaded the Sleepy Head software but it doesn't work with my machine. If anyone knows a a software that will it would be helpful. My machine uses something called I code but I don't think it is as helpful
SleepyHead is of no use to you, does not works with your machine

The clinical manual available via Email, scroll down to section three - '3B Products RESmart CPAP & Auto-CPAP (combined manual)'
http://www.apneaboard.com/adjust-cpap-pr...tup-manual

Talk to your supplier about the software or email the manufacture, ResMed S9 and PRS1 are the most widely used

Here some info obtained from Supplier #1 site:
iCode information maybe entered here: iCode Report Site
https://www.bmc-icode.com/

Access advanced data remotely! The RESmart iCodes are displayed in the patient menu. View a sample of the RESmart iCode Report showing:

Days Count
Days of Therapy Greater Than 4 Hours
% of Days with Therapy Greater Than 4 Hours
Average Daily Compliance
Average Pressure for 95% of Treatment
Mean Pressure
AHI Apnea-Hypopnea Index
SNI Snore Index

The RESmart holds 365 days of information in the on board memory. When the data storage is full the oldest data drops off to make room for the new information. iCodes are available for:

1 Day
7 Days
30 Days
90 Days
182 Days
365 Days
http://f409096db18d4d4c5ac8-7518c0400f86...pdated.pdf

View the RESmart iCode Quick Reference Sheet for more information on iCode functions.
http://f409096db18d4d4c5ac8-7518c0400f86...erence.pdf


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#8
(06-25-2014, 01:36 PM)jaycee Wrote: Don't give up. I've spoken with 100's of patients that have told me that CPAP has litterally changed their lives. Many of those success stories will be posted right here on this message board.

I'm one of them. I spent my entire adult life waking up feeling awful.

Now I wake up and feel awesome almost very day. Even when I don't feel awesome, I feel "OK".

Whenever someone mentions "compliance" problems, I always get a chuckle, because the difference is so astonishing, I absolutely won't ever sleep without my machine, anywhere, ever.

It does take a lot of trial-and-error. I actually ordered probably a half dozen different masks on the internet because my DME only carried one brand. It figures that the one that doesn't hurt and doesn't leak at all is one he doesn't carry and disparaged as "old fashioned", so it might take a little pro-active work, but it's definitely worth it.

Terry
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#9
(06-25-2014, 04:03 PM)zonk Wrote: The clinical manual available via Email, scroll down to section three - '3B Products RESmart CPAP & Auto-CPAP (combined manual)'
http://www.apneaboard.com/adjust-cpap-pr...tup-manual

The RESmart iCodes are displayed in the patient menu. View a sample of the RESmart iCode Report showing:

Days Count
Days of Therapy Greater Than 4 Hours
% of Days with Therapy Greater Than 4 Hours
Average Daily Compliance
Average Pressure for 95% of Treatment
Mean Pressure
AHI Apnea-Hypopnea Index

SNI Snore Index

OK, so this should work for you. Run with your new pressures for a day or two then evaluate the averages. If your ahi is staying nicely controlled at a pressure of let's say 14, then set the max pressure to 15 or 16 and evaluate again.

Once you get the min/max's going good, then you can adjust the epr for comfort if you need to.
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#10
(06-25-2014, 01:36 PM)jaycee Wrote: Obstructive Sleep Apnea is being caused because essentially your upper airway is collapsing closed (apnea) or closing most of the way (some air getting through but not enough to support good ventilation, hypopnea).

The goal of CPAP is to keep that airway collapse from happening. We do that with Continuous Positive Airway Pressure. That resistance you feel during exhalation creates back pressure. That back pressure in your airway keeps the airway from collapsing.

So, the entire purpose of a CPAP machine is to create that expiratory resistance you are feeling. Most of my patients tell me it takes a good 2-3 weeks to really get used to the mask and the pressure (some quicker, some longer).

Don't give up. I've spoken with 100's of patients that have told me that CPAP has litterally changed their lives. Many of those success stories will be posted right here on this message board.

Getting a good fit with your mask & getting a mask you are comfortable with are the responsibility of your DME company. Make sure you are satisfied with the mask/fit they give you.
Thank You very much for the help. I do not intend to give up. I suffer from moderate to extreme claustrophobia. The inability to exhale really exacerbates it. I am committed to sticking with it. I have not had a restful sleep more than 15 years. I will keep trying until I get this right. Thank you all so much for your help
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