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[Pressure] Pressure pulses driving me insane
Hi everyone - been lurking for a while, first time posting. Thanks in advance for the help.

I'm a few months into my CPAP treatment for OSA (AHI of 16 during my sleep study, not horrible but worth treating). It's going pretty poorly. I'm having a number of issues, none of which my clinic seems to be interested in or capable of helping me with. I'm shopping for a new clinic, but in the meantime I could use some advice...

My biggest problem is the pressure pulses. I'm using a Respironics Dreamstation & Dreamware nasal mask, and no matter the settings I choose (start pressure, ramp pressure, smartramp vs. not, etc.), I get absolutely bombarded with pressure pulses within a minute or two of turning on the machine. They always occur at the very end of my exhale - a one-second blast of pressure, then one second back at whatever pressure I was at, then another one-second blast of pressure. It makes it borderline impossible to go to sleep. It also means I take off the mask after a few hours every night because I just can't tolerate that thing blasting away at my sinuses all night. I've broken four hours only seven times since the beginning of July.

A related problem is that the machine is recording numerous events while I'm awake, making the AHI number meaningless. I'm using SleepyHead, and I always see a huge cluster of Pressure Pulses and events before I fall asleep, followed by a 40-60 minute stretch of slower breathing and barely any events or pulses at all (obviously sound asleep). Then things get interesting. It always goes back to more clusters of pulses and events, but I can never quite remember when I was awake or asleep. I've tried looking at my FitBit Charge sleep data and matching it up, but I can't really spot a pattern. The respiratory rate and tidal volume graphs would suggest I'm awake at those points, but I'm not really sure. This is important because if I'm having clusters of events while I'm sleeping, I need to raise my pressure. If I'm awake during those times, then I'm consciously breathing and likely keeping my oxygen up.

I think my answer is to buy a recording pulse oximeter. Ultimately if my SpO2% is holding up I'm probably ok and just need to focus my energy on tolerating the treatment. Does this make sense as a next step? Got any other ideas?

I'm having some other issues too (mainly mask discomfort), but I've rambled long enough and will post those under a new thread in the coming days.

Thanks again for your help.
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Welcome! As a DreamStation user, I have to say that I don't think those are pressure pulses. The Respironics machine do two things. One is a Pressure Pulse which is used to determine if an apnea is central or obstructive in nature. They are very short, not a second on and a second off, repeating. The other thing is pressure spikes to see if a higher pressure results in better breathing. These last minutes, not single seconds.

I am wondering if you have C-Flex enabled instead of A-Flex/C-Flex+. I found the C-Flex setting made breathing confused. Or you and the machine are just not getting into sync with inhale and exhale. That might feel like what you are describing. When things are right, it should feel smooth and natural. Or, perhaps, you have a defective machine. I've been through a few, though it is hard to know what is real and what is a dream and what is imagination when you are aroused from sleep. Some SleepyHead graphs might help sort it out.
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Hi blannan,
WELCOME! to the forum.!
Hang in there for more answers to your questions.

I wish you good luck with your CPAP therapy.
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Thank you for the response! I'm using A-Flex, with the Flex setting on 2. This is my second post so I'll post Sleepyhead images once I'm approved for that. Smile

If these second-long bursts I'm feeling aren't pressure pulses, then I'm not sure what's going on. I guess it makes sense that the pressure would increase at the end of my exhale, but I'm not sure why's dropping again after a second, then rising again, then dropping again. In the years before my septoplasty I certainly developed some tics and hiccups in my breathing patterns because I was struggling so much to get air through my nose. However, when I'm lying awake in bed I'm consciously, intentionally trying to breathe deeply and smoothly.

I'm still not totally sure what's going on with the events being recorded while I'm still awake. They're mostly Clear Airways and Hypopneas, with a few Obstructives thrown in.

Anyway, if anyone else has ideas for me, I'm all ears.

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(09-21-2016, 12:15 AM)chill Wrote: I am wondering if you have C-Flex enabled instead of A-Flex/C-Flex+. I found the C-Flex setting made breathing confused.

This. Exactly this. Any flex on the Dreamstation Auto for me causes that little hiccup in pressure. It seems like my breaths are longer than the machine algorithm thinks they should be. Once I turned flex all the way off, that stopped happening to me!
"I am not a Doctor, but I DID stay at a Holiday Inn Express last night.Coffee
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