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Obstruction on Exhallation
#1
I have a new problem, greatly exacerbated with switch from ResMed S9 Auto to DreamStation Auto.  At the beginning of exhalation, it feels like I have airway collapse.  It idoes not prevent me from exhaling, ultimately, but it is enough to keep me from falling asleep.  It probably occurs as I start to drift/fall asleep.  It happened occasionally with prior machine, and I overcame it by intentionally taking shallower more relaxed breaths for a bit.  That doesn't work with new machine.  I had pressures set at 7.5 - 12, as per some suggestions yesterday on previous post.  I changed the Flex settings, then tried dropping the lower pressure setting to 4, all to no avail.  I'm really out of my depth here.  Is this the sort of thing that BiPap is used for? This is going to kill my sleeping.

On top of this, my wife said I was snoring through the mask this morning.  Top pressure not high enough?  Here is my data from last night..........



[attachment=3427]


Anybody have any ideas??
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#2
I would set your min to 6.5, and expect to eventually end near 7.5 cm
Because you are nearly at 5 AHI I am being somewhat conservative in my approach.
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#3
(05-02-2017, 11:02 AM)eLPete Wrote: I have a new problem, greatly exacerbated with switch from ResMed S9 Auto to DreamStation Auto.  At the beginning of exhalation, it feels like I have airway collapse.  
Anybody have any ideas??

I had the same problem when starting therapy with my S9.  I found it traced back to using the EPR setting.  I needed a backpressure to prevent my airway from closing on exhale.  I hope this may provide an avenue for you to explore.
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#4
I think this is similar to Flex setting on the DreamStation and I have set it to the max (3).  I also tried it on 1 and on 2.  No real difference.  I also used EPR on the ResMed S9 I was using.  Still had this problem creeping up on me in recent months. I wonder if I should just turn Flex off in the Provider settings???
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#5
You might as well try it. The worst thing that can happen is it not work.
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#6
Alot of folks have problems with Flex or EPR settings.
I'd say turn off the flex setting for now, and give it 4 to 5 days to see if you notice a difference.
OpalRose
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#7
For the 3 resmed s9 elite can you adjust the EPR?
I need to go in and check mine tonight.
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#8
OK.  Thanks.  I will try this.
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#9
I had this too, as bonjour said....more minimum pressure. This can be done by reducing the pressure relief or raising the minimum, or a bit of both. You need as much pressure as you need to fix this, keep increasing pressure till it stops. I found it stopped instantaneous when I got to the pressure I needed as I fell asleep. I then gave it an extra cm because when you are asleep your muscles relax more. I think you can also pick it up on sleepyhead, if you zoom in and look at the breath in.
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#10
I side with ajack in this.  in general Opal Rose and bonjour have excellent advice, but I'll throw in a curve ball.

You seem to be reacting to the fact that the pressure support reduces once inhale is over, and exhale is beginning.  part of this is a planned/programmed relief to aid in exhaling.  

One reason you are reacting is that it actually feels different and you can't nod off because you feel that and are alerted to it.  changing it back to 4 (or even starting as high as 5.5) does something to your machine.  The machine will not "relax" the exhale pressure until the inhale pressure is 6 or above.

My suggestion:

Do a ramp, starting at 5cm, and ramp time 15 minutes.  This lets the machine just give you 5 for inhale and 5 for exhale.  You will be comfortable to fall asleep.
Set you minimum back to 7.5 (or 7 is ok).  Leave your maximum at 12.

If you are awakened and feel that uncomfortable feeling, just press the ramp button, and it will get you back to 5 and start your ramp again.
by the way, to start your night, you will also have to press the ramp button once you have started the machine.
By the way, at a setting of 7.5, the inhale pressure is 7.5 and exhale pressure is 5.5, so the exhale pressure will remain as you drift off to sleep.

Your sleep brain does not care about the reduced exhale pressure.  It is just the awake brain that needs assurance.

You'll read many posters saying after a while, you'll not even want the ramp.  Great.  When that happens, just don't push it.
(and that will happen)

Sleep, Dream, Rest.

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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