Other than not sleeping well, I have no idea what I'm doing

[ironballsmcginty]

Howdy - new guy here.

The VA has issued me a ResMed S9 Autoset and originally a ResMed Mirage Quattro mask, size M. I'm not doing well with this - with the facemask, I've been waking up in a panic and pulling the mask off. That, or not waking up at all and pulling the mask off. In the first week of using it (starting the night of 14JUL15), I've either woke up holding it in my hand, or woke up with it on the floor, hissing away.

I called the VA medical center, spoke with one of the respiratory specialists, and they sent out the ResMed Swift FX nasal pillows. Everyone I know that uses a CPAP and uses the pillows swears by them. After a little while on them last night, I have to ask, "Why?" When I donned the gear, without having it hooked up to the machine, I could breathe fine - but once I hooked up to the machine and turned it on, the fight was on. I could certainly breathe in - but exhaling was a fight. And if you can't finish the breathing cycle - well, yeah, I panicked and took it off. I slept without it.

I'm out of compliance. I know that, and I don't like that, but I need to figure out what I need to do. I don't have a problem with changing settings on the machine - I've got the software, I can back it up, make changes, do whatever needs to be done. But between the sleep apnea, and the Type 1 diabetes...well, this is all part of what I need to do to be around for a while for my little girl.

Here's the settings I copied off the machine data from ReScan:
Minimum Pressure - 10
Start pressure - 5
ramp time 10
EPR level - patient
Maximum pressure - 20
maximum ramp - 20
EPR - Full Time
Mask - full face
Climate Control - auto
Smart Start - Patient
Tube Slimline
Sleep quality - usage
Ste Temp unit - F
Humidifier H5i

Will changing the mask type from full face to pillows change the machines behavior with regards to pressure? What do I need to do so I can actually breathe while I'm trying to actually sleep? Any help or suggestions would be appreciated.

[Sleeprider]

The data your machine produces can help you to answer some of your questions. If you have had any sleep on it, it will record events and tell us something about why you might feel paniced or air starved. http://www.sleepfiles.com/SH2/

Your starting pressure of 5 cmH2O is pretty low, and you might not feel like you're getting enough air. As far as being unable to exhale, that is mostly a matter of getting used to the therapy, and with nasal pillows, preventing pressure from getting into the mouth. You'd make a terrible dog, since you wouldn't be able to put your nose out the window. . Anyway, download and extract sleepyhead onto a computer and try taking a look at your data. See if you have a lot of sleep onset clear apnea, which might explain the problem. Check to see if you are using EPR (exhale pressure relief) on your machine. A setting of 3 should help.

[ironballsmcginty]

As a former aircraft mechanic, and now an IT guy - I love the SD card. I told a friend that it's like a black box - and if I were a plane, I'd be underground by this point. I've got SleepyHead and ResScan, and have looked at the data with both of them. Unfortunately, I don't know that I've got enough time on the machine (because of pulling the mask) for the data to be actually useful.

I've got EPR enabled (funny, because as an jet engine mechanic, EPR stands for Exhaust Pressure Ratio). It was set to 2, I've bumped it to 3 per your recommendation.

In the machine menu, I went ahead and changed the mask type to Pillows, just in case that makes a difference in operations. I also enabled Smart Start, just to see how that works.

I appreciate the response - I've got to make this work, that's all there is to it.

[sleepybeaver]

I'm kinda new at this myself...but I've had similar problems...I would turn the ramp off...and maybe bump starting pressure to 6 and see how that works....are you getting moisture in the tubbing or nasal pillows.

[me50]

when you look at your data, what is your pressure 95% of the time you are using it (I know you said you haven't used it much). are you having leaks? anything else that the data tells you that may be part of the problem? Maybe you open your mouth while sleeping and a chin strap might help until you learn to keep it closed. Some use the tongue on the roof of their mouth method to help with that. yes, you need to (if you haven't already) change the mask type to pillows. after you get a few more posts under your belt, it would be helpful for you to post a snapshot of your data here so we can help you more.

Welcome.

[AlanE]

SmartStart will help if you lose the mask at night. The machine will shut down instead of continuing to run up blower time.

[trish6hundred]

Hi ironballsmcginty,
WELCOME! to the forum.!
To help your body get used to the mask and machine and this whole new way of sleeping, you might try masking up and using the machine during the evening as you watch tv or read.
Hang in there for more suggestions and much success to you as you continue and get used to your CPAP therapy.

[Sleeprider]

Ya gotta love the name!

I agree turn off the ramp. With a minimum pressure of 5 you don't need it. Add some posts and eventually you can post some images of the therapy data. It wont' take much to make some sense of it for you. Meanwhile, it would be good to get a handle on this panic reaction snd figure out where it's coming from. You don't strike me as the irrational claustrophobic type. Make a point to ask yourself WTF am I doing and why? If you can do that much, you can continue to wear the mask and sleep.

[TyroneShoes]

There are two things I can provide from my experience:

1) Try the larger sizes of the NPs. I found that it is significantly harder to breathe through the mediums, and especially the smalls.

2) The Swift FX is a fine mask; I started on that. But when I switched to the P10 I found it easier to exhale, all else held equal.

I also question the choice of 20 as a top limit (which is essentially no top limit). Are these choices made by your sleep doc and based on your sleep test? Once you have SleepyHead working, try to see how high your pressure has ever gone (not including runaway responses to major leaks). That may be a more sensible top limit, or possibly even lower. Verify all of this with your sleep doc, because I am certainly not one.

[ironballsmcginty]

Ya gotta love the name!

I agree turn off the ramp. With a minimum pressure of 5 you don't need it. Add some posts and eventually you can post some images of the therapy data. It wont' take much to make some sense of it for you. Meanwhile, it would be good to get a handle on this panic reaction snd figure out where it's coming from. You don't strike me as the irrational claustrophobic type. Make a point to ask yourself WTF am I doing and why? If you can do that much, you can continue to wear the mask and sleep.

Can't help it - I'm a Steve Martin fan

Years ago, I used to spend a lot of time in a gas mask. That was a full face mask - but it wasn't pressurized, just a matter of breathing through filters. Heck, I've even slept in full chem gear more times than I care to count - so I don't know what the issue is with the little mask. Something I'm going to have to work through. I am going to go ahead and turn off the ramp.

As far as pressure levels - those were set by the doc/resp therapist at the VA. The one thing that I like is that they are open to communication and suggestions. My T1 diabetes treatment is through the VA as well, and while I'm not seeing an endocrinologist like I would like to see, the NP that I see is open to my suggestions based on my research and such. The CPAP team seems to be the same way.

Thank you everyone for the welcome - as you all already know, it's good to know you're not alone.

Bob -