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Who else has a really high max pressure setting?
#1
I'm new here, dx'd two months ago with severe OSA. My pressure settings are way high, 15-25, due to the severity. My sleep study report said I needed pressures greater than 20 to stop the OSA's.

I'm having a really hard time getting used to my machine. It's mental and emotional. I'm still in the adjustment phase where I'm attempting to take naps in a recliner with the mask on. I haven't been able to get comfortable enough lying on my side in bed with the mask on, either it leaks, or the headgear bothers me, or my neck muscles tense up and I can't relax.

I'm on my third mask, a nasal (Wisp), which I'm able to tolerate better than the two FFM's (Mirage Quattro IV and Amara) which leaked more and aggravated my sense of claustrophobia.

Yesterday I was hoping to take a nap after a 15 min. walk outside. I was a little out of breath. While I was putting my mask on the machine kicked on with a 20 cm blast of air, catching me off guard and making me feel like i was choking on air. I opened my mouth to gulp and and that made the suffocating feeling even worse. I couldn't get my breathing rhythm right and kept feeling like I wasn't getting enough air, even though I was ina wind tunnel. That ended it for me.

When I put the machine on today I'll disconnect the hose so it doesn't kick on until I'm ready.

I slept three hours or more in the treatment phase of my sleep study with a full face mask, but not at home since. I need to get used to this machine. I had 108 events/hour and worse, my oxygen saturation was below 90 for most of the time before they clapped the mask on me, actually dipped down to 69% just before I woke up. I feel like I'm on borrowed time.

Does anyone else here have very high pressure settings too? did you have a hard time as well getting used to CPAP treatment? What helped you?

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#2
Hi ellen1159,
WELCOME! to the forum.!
I'm sorry you are having such a rough start with CPAP therapy but I just encourage you to stick with it. The mask is the hardest part of the therapy so don't be afraid to try as many masks as you need 'til you find the right one for you.
Hang in there for answers to your questions. You will get lots of GREAT help here.
trish6hundred
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#3
most machines have a RAMP feature that lets you specify a lower pressure and duration for the pressure to gradually build up to your target pressure range.

so, you may set the initial pressure to be 10 and duration to 20-30 minutes and, hopefully, you will be asleep when the higher pressures kick in.

i know your feelings….. i had the same issues and the ramp solved mine.

Gene
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#4
Hi Ellen: Sorry to hear you a struggling with this. Over 95% of the time my Autoset is pushing between 19-20, and it only goes to 20. I was on a Phillips Bipap in the beginning and the pressure was even higher.
I am not an expert in this stuff, but I hope the following might help. I am sure people more knowledgeable in the technical aspect will chime in.
1. I think at such a high pressure, you need to use a full face mask. I can't imagine using a nasal mask at this setting.
2. I used to sleep on my side, but got used to sleeping on my back which greatly reduced leaks. When I first go to bed, I do sometimes lay on my side until I get sleepy.
3. When you feel like you are choking on air at high pressure, just remember that the air is helping, not hurting you. You are not going to choke and the machine will let you exhale.
4. Keep trying to keep the mask on a little more each day. That feeling of this foreign thing attached to your face does take time getting used to. I didn't like this therapy in the beginning either, but now not only am I used to it, I really like it.
Hang in there. /Jeff/
To err is human, but to really mess things up, you need a computer.
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#5
Thanks, Jeff, Gene and TRish. I think I was just having a bad day yesterday and feeling despair over not being able to get used to this machine. I'm usually able to accomplish whatever I really set my mind to. I started keeping a journal a few days ago just to bleed off the negative emotions and thoughts about where I am in my CPAP therapy (and in life in general, I've had a decade of turbulence that is just now settling down). The sleep deprivation wreaks havoc with your emotions and allows your fears to take precedence over positive thoughts.

The DME mistakenly left the provider manual in my startup kit, so I was able to adjust my ramp pressure myself from starting at 15 to 11.5 (the last time I used the machine with the ramp 10 didn't feel like anything). I'm going to do like Jeff said and wear it for longer and more frequent periods while awake and watching tv or reading, then for scheduled naps, then work my way up to wearing it to bed.
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#6
Hi Ellen.

I will also echo Jeff's advice, which certainly helped me, to use your machine while you are awake and watching TV or some other distracting activity. By convincing your subconscious that the mask and pressure are OK, you will almost certainly have an easier time falling asleep.

Don't worry about thinking that you are the only person who can't get used to their machine. MOST people take several weeks to get used to their machine. And, since you have a relatively high pressure, you have a higher hurdle than most to climb.

Others may disagree, but I am a believer in temporarily reducing pressures to below their prescribed values to have an easier time initially getting used to the machine. Just don't forget to set them back eventually.
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#7
Treasure your gift of the provider manual. If DME calls as ask if it was left in you new gear. Respond>> I've never seen it! It will be of great value later.

I second the good advice the RonWessels provided.. Start your therapy with a lesser pressure in order to more quickly get used to the breathing with the machine. Gradually increase the pressure (and only in small increments) maybe 1/2 to 1 with each increase.

BTW. I am also using the Wisp mask and so far I like it very much. It has played a part in lowering my AHI as it has no leakage for me.
Yesterday is history; Tomorrow is a mystery; Today is a gift; Thats why its called "The Present".
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#8
I approached one of the sleep doctor's assistants with a request to temporarily lower my pressures until I can get used to them (my upper palate and throat feel like they are being assaulted). She tried to dissuade me by saying that too low a pressure could lead to air hunger, where I'll be gasping for air. Thing is, I'm not getting any therapy at all right now, really, so what would the harm be in temporarily lowering the pressures so that i can at least sleep for three or four hours, then increasing them? I will ask the doc when I see him in two weeks. I'm sure the assistant can't just lower my pressure without his say-so.
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#9
True enough. The pressure is a doctor-prescribed item, so a tech that changes them without doctor approval could put themselves in significant hot water.

While it is true that, once you get used to a higher pressure, lower pressures paradoxically feel like there's not enough air, you are not yet used to the higher pressures. Aside from that, you are already doing fine on a pressure of 0 cmH2O (ie. no mask), so any pressure above that should be more air, not less. So I don't understand about the air hunger comment.

Besides, as you point out, right now you are sleeping with a setting of 0 cmH2O. Even though (say) 10 cmH2O might not be enough to curtail your obstructive apneas, I can't see how it could hurt. And, as you get comfortable with it, you can start sneaking up the pressure.

As you increase the pressure, you will probably find that the mask strap tension that worked for a lower pressure starts to allow the mask to blow off your face and leak. So you will probably end up having to tighten them somewhat.
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#10
I went up as high as 23 a few years back. It worked, but I woke up with sore ribs from it. Since my apnea was getting worse and I have a bunch of other sleep disorders, the doc sent me for surgery. They took out my tonsils and uvula, shortened my palate, and basically cut out as much as they could to widen the airway. Surprisingly, I did still need my CPAP after that, but I've needed much lower (and more comfortable pressures).

While I was up at 23, though, I found the ramp very useful. And the doc made sure to set a significantly lower exhale pressure, which is important for several reasons.

But yes, keep at it. You'll get used to it in time. Getting quality rest is so important. Sleep deprivation from the apnea alone can cause depression and mood swings, among other things.
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