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New to this - I'm not getting enough air
#31
I visited a tech at Kaiser today and learned a few things, although his skills seemed rather low. He encouraged me to set the minimum pressure as high as I want. I tried 14 tonight.

My breathing is not comfortable and I'm now thinking the shortness of breath that I feel is due to the greater effort of exhaling. My machine has a "Flex" setting and it has long been on 3, which the instructions say maximizes the ease of exhaling. But I experience very little difference for the (three) Flex settings.

I even tried the ramp feature for the first time tonight and found breathing easier at lower pressure, which also eases exhaling - thus validating my thoughts that the effort of exhaling is the culprit here.

I have not managed more than about 1.5 hours of CPAP and have run out of ideas. Perhaps I can find a smarter provider in my area (San Francisco Peninsula).

I'll also seek good books or articles on how to use CPAP. If you have any suggestions, I'd greatly appreciate them.

Regards,
Alan
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#32
english is not my native tongue and technical terms are especially challenging - so please forgive me, but I want to toss in some ideas and maybe you can make sth out of it.

If you believe that the amount of oxygen is essential, than please keep in mind how the lung works. the comparison to a plastic bag where all that matters is the volume is a bit far off.

first of all the pressure: a higher pressure increases the "dead volume" which is no longer available for breathing. (it's the amount of air that gets pushed into your lungs by the higher pressure and cannot be exhaled)

higher pressure (which is only in your airways and not outside your body) results in an increased muscle effort. so you have to try harder to breath against that pressure. (try coughing with the mask on^^)

the second thing is the amount of air that your lungs can work with. if you breath in short and deep the amount of "fresh" air is higher but it doesnt get evenly distributed thorugh the lungs. If you breath slower (and shallower) the distribution increases but the amount of fresh air gets reduced.

I myself found it really challenging to breath during the first weeks. My machine has a function (might be the same as the ramp) where it start with the lowest pressure for a given time and slowly increases. Really helped with falling asleep. I'm running on APAP - not CPAP. During the first weeks I reguarly woke up after 4-5 hours due to the pressure and the increased effort to breath. (I'm OSA so the good thing was: I was than really well rested (compared to before) and simply got up)

But the problems with the breathing effort on higher pressures totally vanished after that. (I believe I have build more muscles Bigwink )

I'm also not so sure if the "flex" setting works if you are using the CPAP-mode (C for constant pressure). If so it would be the same as some sort of bilevel-PAP. Maybe you try the APAP mode? (and with a decreasing flex-setting to get used to the "new", higher breathing effort)

But maybe I'm totally mistaken ... I'm only a few months on my mask and still have to learn a ton
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#33
I'm not sure I uunderstand why the tech would tell you to set the minimum as high as you want?
Based on what???

I think it's time you posted some data here for us to look at. Changing pressures up and down without having a "reason" to do so doesn't make sense.

Pressure changes should be based on the type of Apnea events you are having, and comfort.

Follow the tutorials and post a screenshot here.
http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur


OpalRose
Apnea Board Moderator
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How to Organize and Post ScreenShots

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https://sleep.tnet.com/reference/tips/imgur

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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#34
as far as I understood his problem he ist not treating any kind of OSA.

there are many more disease you can treat with xPAP than just OSA. COPD for example - it helps a lot without any kind of apneas.

Although having some solid data would actually help a lot.
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#35
Yes, he said he was diagnosed with RLS, and he choose to go on cpap. He also stated he has a problem breathing out against pressure.

Flex settings should help with that, but it is not the same as using a ResMed machine as far as pressure relief. With Flex, the most relief you can obtain is 2cm, whereas with ResMed it is 1,2 or 3cm relief.

Still would like to see data. Some of these studies may show a low AHI and say it's not high enough to be treated. But there still may be some Apnea going on. Dont-know
OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

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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#36
I agree with OpalRose. I use an auto bilevel machine, after years of using Respironics auto CPAP. The difference is pretty amazing, and for me, I actually find 3-cm of pressure relief (pressure support in bilevel) is all I need or tolerate. So I could probably be equally comfortable with an Airsense 10 as with the Aircurve 10.

Respironics AFlex provides up to 2 cm pressure relief at the onset of expiration, but the pressure does not stay low regardless of setting. It returns to CPAP pressure before inhalation. The time and amount of relief increases with the settings, but it is not a true bilevel relief as provided in the Resmed exhale pressure relief (EPR), which provides up to 3 cm pressure relief upon exhale, and does not increase pressure until spontaneous inhale begins.
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#37
Hi Again.

I think this is just semantics.

First blogger reported restless leg syndrome and thought the root cause of his problem was low blood oxygen. He decided to try CPAP to improve his oxygen levels at night as I presume he suspected hypoapnea or sleep apnea since as you pointed out that would be the treatment. I also presumed that he didn't use oxygen during the day.

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#38
(12-07-2016, 01:11 PM)Elaine TC Wrote: Hi Again.

I think this is just semantics.

First blogger reported restless leg syndrome and thought the root cause of his problem was low blood oxygen. He decided to try CPAP to improve his oxygen levels at night as I presume he suspected hypoapnea or sleep apnea since as you pointed out that would be the treatment. I also presumed that he didn't use oxygen during the day.

Actually the algorithms used by Resmed and Respirionics are significantly different in actuality and effect. This applies not only to the implementation of I:E transition relief, but to the pressure response of the machines to events and obstructive indicators. Not sure why that would constitute semantics. Dont-know

Whether CPAP is applicable therapy for RLS, that is another matter. To my knowledge this therapy has no formal approval for this application; however there may be some useful lessons in the anecdotal experience of this "blogger if we choose to listen.
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#39
Since you clearly have a need to be right I will unsubscribe from thread.
Your comparison of machines is way off point.
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#40
(12-07-2016, 09:30 AM)Sleeprider Wrote: I agree with OpalRose. I use an auto bilevel machine, after years of using Respironics auto CPAP. The difference is pretty amazing, and for me, I actually find 3-cm of pressure relief (pressure support in bilevel) is all I need or tolerate. So I could probably be equally comfortable with an Airsense 10 as with the Aircurve 10.

Respironics AFlex provides up to 2 cm pressure relief at the onset of expiration, but the pressure does not stay low regardless of setting. It returns to CPAP pressure before inhalation. The time and amount of relief increases with the settings, but it is not a true bilevel relief as provided in the Resmed exhale pressure relief (EPR), which provides up to 3 cm pressure relief upon exhale, and does not increase pressure until spontaneous inhale begins.

Dear Sleeprider,

I was not aware of bilevel machines. I did some research on BIPAP machines. Am I correct that this is what you use? I read that these machines permit a choice of timed changes in pressure or sensor-controlled changes in pressure.

Which of the above modes do you prefer? Also what are your inhale and exhale pressure settings? Finally, do you know if the Dreamstation Flex setting of "3" means a 3 cm drop in pressure during exhale, or is "3" just a label.

This board is very helpful. Thank you all.

PS

A bit more about me. My oximeter readings are in the range of 96-99 when I'm awake and only a few percent lower immediately after wakening. Thus when I tried supplementary oxygen (while sleeping) there was hardly any benefit. Perhaps these reading mean that CPAP or BIPAP won't help either. But as I mentioned in my opening post, I noticed less RLS pain when "drowsing" (half awake) than when sleeping. That encouraged me to try CPAP, or perhaps soon BIPAP.

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