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New to the CPAP World. Help!
#1
Hi Guys,

I'm new to the forum. I was diagnosed with OSA in august. I just got my ResMed CPAP machine today. At my provider, the technician dialed it up to level 15 where my doctor said I needed it. I simply cannot exhale. I'm using the pillow nasal small mask. It's just waaaaaaay too much pressure. It even makes my ears and head wanna explode. 

My doctor said I could tone it down to 13, but at 13 I was still having episodes of obstructiveness. The thing is the most of the time I don't, for I thought she would give me an automatic machine but she (my DR.) said that automatic machines where not good for obese patients. 

That being said;

1-How do I exhale with that amount of pressure?

2-Is it true that because I am obese It's not good to use a machine that auto-regulates? Seems to me that if I don't need the pressure at 15 all the time, I'm suffering for it.

Any advice or help would be greatly appreciated.

Best,

J.
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#2
Bien Venido Javielo. Your Airstart 10 CPAP has a feature called EPR (exhale pressure relief). It can be turned on to settings 1-3, with 1 corresponding to 1-cm pressure, and 3-cm. Instead of exhaling against 15 cm pressure you can implement EPR at setting 3, and exhale against 12 cm pressure.

This should be available in the menu for My Options. If not, you will need to enter the clinical settings and enable EPR.

CPAP needs to be used in order to be effective, so if you need to reduce pressure until you can adapt, it's better than quitting. If you just can't tolerate 15 cm pressure, either use ramp, which gradually increases pressure; or just reduce your CPAP pressure to a tolerable level. Chances are, that will be better than no therapy at all.

Unfortunately, your machine does not provide efficacy data, but it will summarize your AHI. The idea is that you want your AHI to be more than 5/hour, and when you make changes, you don't want AHI to increase.
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#3
I have a nasal pillow mask my pressure is 11. Takes me about 3 breaths to start getting used to it, that first one feels like no way can I breathe. Also to start getting used to it set your ramp to start at 4 and gradually increase - you will get used to the pressure quickly.
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#4
I'm obese, my sleep doctor (was - he's since moved)) obese, and he still prescribed an APAP machine for me, even with the restrictive rules Ontario imposes for funding. Even obese people roll over in bed, and need to be comfortable, and their pressure requirements change. If I ran the world, nobody would have a fixed pressure, non-data-collecting machine.

By the way, it's my understanding that the AirStart machines only keep usage data, and not any data on what it is doing. We say that machine is as smart as a brick If that is so, I would recommend that you try very hard to get an AirSense AutoSet machine. Not only will it adjust itself to your needs (within limits), it will collect data to allow you and your doctor to verify the effectiveness of your treatment.

I don't know if your AirStart machine offers Expiratory Pressure Relief (it's a new machine, and we don't have a Setup Manual -see link at top- for it yet), but that is designed to lower the pressure while you exhale. It's a big help for people with pressures over 10 cmH2O. In addition, you can probably set a 'ramp start' pressure to 6 or 7, with a time of 10 or 15 minutes or more, to allow you to settle into sleep with a lower pressure, which slowly increases to your set pressure over the time you select. These are considered comfort features which you can select yourself or have your machine supplier do for you.

Edit - Sleeprider said pretty much the same things I said, but faster...
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#5
Hi Javielo,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy, you came to the right place for help.
Hang in there for more responses to your post and feel free to ask questions to help you better understand sleep apnea.
trish6hundred
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#6
Thank you for the feedback guys.

It's been a rough couple nights. I haven't been able to keep it on for more than a couple hours. I did notice that if I extend the air tube completely it's easier to exhale. Maybe cause the EPR works better that way? Idk. Last night I got it up to 12 but could not handle it for the entire night.

I switched from a medium size pillow to the small one. It fits so much better. The medium was way to large and it hurt. Something that is sorta scary is that w/o the machine on it's very difficult to breathe. So if the electricity goes out that would seriously suck.

I'm considering taking some sort of sleeping pill to see if I can sleep all night with it. It just feels so un-natural that even if I'm super tired I lose my sleep and wake back up.
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#7
Javielo,
Are you using the EPR feature? You can set it to 3 and your exhale pressure would drop 3cm. This would make it much more comfortable for you.
OpalRose
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#8
Hi OpalRose,

Yup I have it at level 3. I'm supposed to be at 15 pressure but I can't tolerate that. Max I can handle is 12 and I wake up a lot in the night and take it off. Otherwise I can't fall asleep. My machine is not automatic, its fixed pressure. I honestly don't feel the diff between having the EPR and not having it.

Changing to a smaller nasal pillow  (mask) did help last night. Problem is I think I breathe with my mouth at night and I'm waking up possibly because I open my mouth?

I don't know if I can but I'd like to possibly have a Benadril or something to knock me out and maybe have a good night sleep with the mask on.
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#9
It does take some time to adapt.

I think it's best to keep your pressure a little lower until you adjust and feel comfortable with it.

Keep at it, don't give up.
OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
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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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