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New CPAP user - high pressure after events
#1
New CPAP user - high pressure after events
I'm having a very frustrating time with my CPAP experience.  Spent a few days trying the ResMed Airfit F20 and the Airtouch F20.  There's simply no way I could get them to NOT leak.  Respiratory therapist thought that my face was a little narrow to allow for a good fit (judging this from a video call).  

So now I am going with the ResMed F30i.  I'm finally able to get the darn thing to seal but I have to really adjust straps tight to the point that it's quite uncomfortable and I don't know that this would be a sustainable solution with it being that uncomfortably tight.

Even though now I am able to get the mask to not leak horribly as the other mask did, I am still woken up (times that I am actually able to fall to sleep) to crazy high pressure.  At these times - I take a look at the machine and see that the pressure level is up to 17 or so.  To me, this just feels ridiculously high and I wonder "how can anyone ever stay sleeping through this?".  As I am laying there, even with my mouth closed, my cheeks blow out from the pressure as if I were trying to blow up a balloon.  After trying to force the air out of my mouth, I close my mouth and try to concentrate on not allowing my cheeks to blow out again, but they do.  

The other thing I find curious, last night after I stopped the machine to go to the bathroom, when I hooked back up to the machine at about 00:40, I layed in bed awake and within 10-15 minutes, it ramped the pressure up again to that crazy high level of 17.  Now looking at the OSCAR data, it looks like that was in response to detected "events".  I know I was awake during the time of the report of 00:45 - 01:00.  I was probably moving around or maybe fidgeting a little with the mask trying to get it set properly.  I really find it hard to believe that within 00:45 - 0:55 that I REALLY had these events - I was laying there awake.  Could moving around (rolling side to side) be triggering these "events" to be detected?

Are others able to sleep through their machine ramping up to a pressure level of 17 or so?  

I'm just getting ridiculously frustrated by this.  If this type of thing keeps happening where it cranks up so high - I don't think that I'd be able to tolerate this.




Thanks!
   
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#2
RE: New CPAP user - high pressure after events
You are desperately trying to sleep, and you slump into it hard when you do finally fall asleep.  But that is where the trouble lies.  Your position, the one you slump into, is causing many successive and frequent obstructive events.  Look at your leak profile.  Then your flow limits profile.  Then the coloured events at the top chart. One or two large spikes in leakage, and they should be addressed to the extent possible.  But look, more importantly, at what follows when you recover from the leak.  The leak spike drops and then come all the events depicted at top.  You are quite likely tucking your chin, maybe due to sleeping on your back, or rolling onto it after you lose consciousness, and if your pillow(s) is/are too high, your body sagging into the mattress, compressing under you all the time, will force your chin toward your head.

You might avail yourself of a soft foam cervical collar.  They're available at large department stores, and at medical supplies outlets.  Also, of course, on line.  Once you get your flow limitations under control, you might find that your machine doesn't have to tractor-tire-inflate you in order to overcome the pinched off trachea that your chin-down position imposes on it.  I would experiment with an upper limit of about 15 and see if you can stand that lower maximum pressure. 

You also have many central apneas, but that might go away with some refinement of your treatment. If not, you have the wrong machine and will need an adaptive servo-ventilator (ASV).  But let's grab the reins of that horse when it goes by us.
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#3
RE: New CPAP user - high pressure after events
You might try a nasal mask or nasal pillows.  The smaller the mask, the easier it is to control leaks.  Don't assume that just because you're a mouth breather that you have to use a full face mask.  Give mouth tape a try if you haven't - even with a full face mask.  Jamming your tongue into the top of your palate helps to keep air from blowing into your mouth.

Ignore the events while you're awake.  You are so uncomfortable and unaccustomed to breathing pressurized are through a mask that there will be nothing normal about your breathing patterns while you're awake.  

You have to get comfortable in a mask with leaks controlled (not eliminated) before you can get reliable data to make adjustments.  You might consider setting EPR on full time, that will help with your comfort.  Not to question your prescription, but having max pressure set to 20 isn't going to do you any good if it's blowing the mask off your face.  You might try cranking it down a bit.  Once you get comfortable, you can start adjusting settings with advice from this forum to optimize your therapy.
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#4
RE: New CPAP user - high pressure after events
Welcome to the forum.

On masks, read the Mask Primer in my signature. I fit my masks by holding the mask to my face under pressure, the goal is to use as little pressure as possible. Being too tight is a very common cause of excessive leaks. Assuming I get a fit I repeat but lying down because gravity moves things around. Then Match the feel with the straps.

Look at your mask, seel that flap or skirt of silicon? That is what makes the seal. It is your pap pressure that holds that flap down and makes the seal, the straps only hold the mask in place so that can occur.

Now to your real problem.
See those clusters of obstructive events, that's the tell. It means that most likely you are tucking your chin in towards your chest. The first thing to try is a pillow change, use 1 vs 2, or a less firm/ flatter pillow, your grandmother's feather pillow instead of the memory foam. The idea is to straighten your neck when you sleep. If that doesn't work a properly fit soft cervical collar usually does, see the soft cervical collar link in my signature.

Additionally your flow limitations are high, the 95% FL is over the max we like to see of 0.10, ideally 0.03 or less. EPR is the tool for this, so set EPR=2, Fulltime, NOT Ramp only as yours is set. You may or may not be sensitive to your CO2 levels which may increase your centrals, if it does we will suggest a correction. But we cannot tell without trying.
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