Wife First Night on CPAP Advice Needed

[DoubtFire61]

Hi,

I'm been at this awhile, but my wife's first night was last night.

She's using and AirSense 10 for Her with an F30i full face mask, standard tubing (unheated). Her pressures are 4-20 (data attached)

She lasted 75 minutes before she woke up and called it a night.

When I asked how it was, she said she felt like she couldn't get any air so she disconnected.

I don't have (or know) her sleep study results, I don't think her PCP gave her a copy, so I don't know that her baseline is.

Any advice would be appreciated.

DoubtFire

   

[Crimson Nape]

Most adults require a starting pressure of at least 7 cm to overcome the suffocating feeling. The lower pressures are mainly for adolescents.

[DoubtFire61]

Thanks!

That is kind of what my thought was...i just need confirmation. 

Why would they Rx such a setting?

I have my own set of less than ideal answers to that....

[staceyburke]

That is what people do that do not really understand the autoset.  Put it on the lowest the machine will go (4) and the highest the machine can go (20) - because it is autoset.  NO you need a starting pressure that will give her enough air to breath.

It does not look like they set EPR - exhale pressure relief, probable because they set the min to 4 and EPR would do nothing at that setting.

I would suggest Min 8 and EPR 3
You can leave the max alone unless she gets runaway high pressures.

Now I will quickly explain what this does.  The min (8) is her inhale pressure.

Her exhale pressure is the min - EPR = 5

This should make the exhale easy but give her enough oxygen to breath without stuggling for breath.

[Gideon]

Why would they Rx such a setting? Because they believe that since it is an "Auto" machine it will automatically find the optimum therapy.
Nothing could be further from the truth.

The Flow Limits are at the high end of what we would like to see. BUT her settings are not designed to minimize them.

Min Pressure should be no less than 4 (machines min) + EPR (3) = 7
During her long ramp (45 minutes I believe) she is not getting effective therapy. Minimize her ramp, but since her pressures are low (nothing wrong with that) turn the ramp off.

[OpalRose]

Hi,
When I asked how it was, she said she felt like she couldn't get any air so she disconnected.

At a pressure of 4cm, she would be "starved" for air. As others have said... set the minimum to 7 with EPR set to 3.
I would turn off the ramp.

Also, be sure the mask setting is set to Full Face.

[clownbell]

I had an experience similar to yours. They started me out on 4-20 "just to see what happens." After three weeks they changed to 5-9.8. That is when I took more control. I felt starved for air, so changed ton minimum of 7 (based on the advice above), and have since changed to 8 on my own initiative. I feel much better. Give 7 a try with EPR of 3.

[DoubtFire61]

Thanks for all the help!

She went 6 hours last night with an AHI of 1.5

She's been comfortable with the 7-18 range with the RAMP and EAP settings we already had.