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Hard to exhale

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Hard to exhale

Postby Maczilla » Tue Mar 20, 2012 4:27 am

Just got the following setup:

Phillips PR System ONE REMstar AUTO - DS550S / DS550HS Swift FX Mask System
Pressure is 9
I started using yet got sick and I'm back to using it. Didn't notice it before yet when exhaling it seems kinda hard and after awhile I get lightheaded and a discomfort in the upper lungs and chest. It has a 'Ramp' setting of 4 and even that sets me back. I'm waiting to hear back from my Doctor or the Tech person gives me a call back.


Call into doctor

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Re: Hard to exhale

Postby Bons » Tue Mar 20, 2012 6:56 am

Couple of questions:
Is the machine set for a steady pressure of 9, or a starting pressure of 9? Usually autos are set for a range of pressure. It could be that when the pressure increases (due to apnea events or leaks), you start having problems exhaling.

Is your c-flex (or a-flex?) set? This setting decreases the pressure a bit (1-3 mg/h20, depending on setting) as you exhale, which makes breathing more comfortable for some people.

How long have you been using the apap since you started again? Sometimes it's a psychological thing that has to be worked through.
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Re: Hard to exhale

Postby CraigB » Tue Mar 20, 2012 8:17 am

I had a heck of a time getting used to the exhaling. Turns out that there's a trick to it. You need to lay down in bed and relax a bit before putting on the mask. When you first go to bed, your breathing is ramped up and you exhale so much, you have to fight against the incoming air. As you relax and your breathing slows down, you exhale less and it becomes easier. Nice slow, relaxed breaths. That's what will work. Eventually, you get to a point where you can get into bed and put the mask on right away. You'll have trained yourself to slow everything down, immediately.

Of course, as Bons said, sometimes it's a psychological thing. I use the nasal pillows because, with them, I can't feel my breath. With a nasal or full mask, I can feel my breath hitting the inside of the mask. As soon as that happens, I find I can't breath (mild Claustrophobia?).

Regardless, talk to your doctor (ALWAYS talk to your doctor when you have any concerns, regardless of what advice you get from anyone else). I think you'll find, unless you have some sort of underlying issue, that you will be able to adjust to it within a few weeks.

Best of luck!
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Re: Hard to exhale

Postby Maczilla » Tue Mar 20, 2012 9:55 am

I have a pillow headset that fits very well, the machine starts on 9, I'm suppose to tap the 'ramp' as its set at 4. I'm not allowed to change the initial settings. The night of getting the machine I for sick so this is my second day, so I am very new at this and still learning.

My doctor is very good and knows his stuff so he is very busy he was sick two weeks ago and none of the other doctors in the office I cant see them. He is the main doctor of the clinic as well its a teaching site. Its great having the main doctor yet everyone wants the boss. I'm waiting for a return call.

I'm going to do what you suggested as to relaxing that sounds logical to me, I guess I've been fighting it in a way.
As for always talk things over with and trusting your doctor I agree.


z

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Re: Hard to exhale

Postby Maczilla » Thu Mar 22, 2012 9:35 pm

OK so I'm freaked out about going to sleep! I have an appointment with my doctor I did leave messages with the receptionist.
Its just since last Friday I've lost a pound a day
I'm so constipated
Two to three hours a sleep each night one night I had four and broken at that.
Last night I woke up three times and my mouth was bone dry and I use a mask
I called Dr office overnight Dr told me to come in the morning and I don't think I'm gonna make it that well tonight.
Not complaining not venting I just have not been through this before.

I just want to sleep get some rest, I know you're not Drs. yet I've learned more here than what I've been taught from the Techs and from the Doctor. He is good yet it took a year and a half to get a sleep test.
My wife and daughter want me to look for another doctor yet I'm now on a EPO yeah that's right EPO. Went from an HMO to that I'm a Vet yet to far from VA hospital.

Please any ideas I'm so tired of them saying in the ER its a panic attack. Great EMT folks and the ER staff know be so well yet on my chart I was diagnosed with Panic Attacks last year and its been that way for over a year. They know I have Sleep Apnea yet only a few Drs treat me with that in mind when I go in there.

Sorry I went so long.....

MacZilla.

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Re: Hard to exhale

Postby Linda » Thu Mar 22, 2012 10:21 pm

Hi MacZilla,

You did not go "so long," honest. It's ok, we understand the frustration.
I hope you get an appointment soon.

Is it that you're still having trouble with exhale? Be sure to emphasize that with the doc. Where did you get your cpap? You might contact them, so they can explain how to adjust the c-flex if your machine has it. Or they might be able to help coordinate things with your doc. Trouble with exhale needs to be resolved. You may need a bilevel machine, often called a bipap. That definitely helps resolve the exhale problems if the cpap can't be adjusted enough to do so.

Hope you get this resolved soon. Did you say that EPO is a Vet thing? So are you a Vet? If yes, you might read the military posted topics if you haven't already, you might find some advice there.

Good luck with everything and let us know how it goes. Keep calling that receptionist!


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Re: Hard to exhale

Postby Maczilla » Thu Mar 22, 2012 11:47 pm

Thank you for your response.

I just slept for around an hour an a half without the machine again, I tried it and it did it again.

As for exhale of is an issue with this unit I've mentioned it to the lady wjo delivered the unit. I received the unit from a supplier that my EPO accepts in the Chicago area. I'm on an EPO and its not associated with VA, I used to go t the VA yet I'm unable to travel the distance from our area.
As to the technician she did well in setting me up as for changing the settings I'm not allowed to do anything except from the doctors approval.

As I addressed the issues to the tech I explained I felt this weird pain on the side of my neck while using the machine, as well as the dryness and exhaling issue as well. When I took the sleep test the unit worked great and I took to it with ease. I knew my unit would not be like theirs yet I thought the settings would be close. Are the units kinda of like clothes on manufacture size is different from another, so the settings could be the same yet the units differ? Or their unit was a bipap as theirs would be a top notch setup. I didn't mention this the pollen in our area os unreal and the air we blow in with the fan makes my nose so stuffy. It has cleared up when I used the system last night at first. Then as I was sleeping deeper that's when I got the dry mouth I might have opened my mouth as I have a cough from the acid reflux going on. Didn't mention that as well.

Will try to get through the night and make it to the doctors tomorrow. Its a first come first serve basis it a clinic with my current doctor.

Thanks again

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Re: Hard to exhale

Postby robysue » Fri Mar 23, 2012 12:11 am

Maczilla,

I am so sorry to hear of your troubles. Hopefully it will get better soon when you get a chance to talk to the doc.

Maczilla wrote:As to the technician she did well in setting me up as for changing the settings I'm not allowed to do anything except from the doctors approval.
The ramp and C-flex/A-flex are patient comfort features and you should have access to changing (some) of their settings. Please talk to the tech and ask what the Flex setting is. It sounds as though you need to have Flex turned on.

As I addressed the issues to the tech I explained I felt this weird pain on the side of my neck while using the machine, as well as the dryness and exhaling issue as well.

Neck pain? Are you sleeping in a weird position in an effort to not jostle the mask? That might explain the nech pain.

Dry mouth? Chances are you are opening your mouth. Are you using a nasal mask, a pllows mask, or full-face mask that covers both your mouth and nose?

Exhaling problems. Part of this is the flex issue. But part of it is just getting used to the machine AND the fact that you've started to panic makes it even harder.


Or their unit was a bipap as theirs would be a top notch setup.
The titration unit is a special unit that can be set up in a variety of modes including simple CPAP. The tech can increase the pressure remotely based on what the sensors are saying. You may have felt "safer" in the lab knowing that if you had some kind of problem, the tech was there to take care of it. For example, if you were using a nasal mask on the lab study and mouth leaks were a serious problem, the tech could come in and fit you with a full face mask.

But at home, it's just you and the machine. For some people that's simply scary at the start. And so anxiety is probably part of your problem. Can you wear the mask when you are awake and have no intention of going to sleep without it triggering problems with exhaling?

I didn't mention this the pollen in our area os unreal and the air we blow in with the fan makes my nose so stuffy. It has cleared up when I used the system last night at first.
Breathing through the mask gives you filtered air. You can even get an ultra-fine filter that will filter out the pollen. Really helps with the night time congestion---as long as you don't start breathing unfiltered air through your mouth.

Mention the seasonal allergies to the doc when you get a chance. You may find that you are more comfortable with the mask if you are NOT congested when you first put it on. I've had to get much more aggressive about treating my seasonal allergies since starting CPAP. It helps with my comfort when I put the mask on at night.

Then as I was sleeping deeper that's when I got the dry mouth I might have opened my mouth as I have a cough from the acid reflux going on. Didn't mention that as well.
[/quote]The dry mouth is most definitely due to opening your mouth in my opinion.

Also mention the acid reflux to the sleep doc. While some people find that the PAP helps their reflux, other folks find the CPAP seems to aggravate it. Or the CPAP triggers aerophagia---air in the stomach. And the reflux problem could be related to your current problems with exhaling against the pressure.

Best of luck getting some sleep tonight.
current settings Min EPAP = 4, Max IPAP = 8 and Rise time = 3

8/1/2010 sleep study results:
AHI = 3.9 [AHI = (#OA +#CA + #H w/desat) per hour]
RDI = 23.4 [RDI = (#OA +CA + #H w/desat + #H w/arousal) per hour]
Dx: Moderate OSA
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Re: Hard to exhale

Postby Todzo » Fri Mar 23, 2012 1:36 pm

Maczilla wrote:Thank you for your response.

I just slept for around an hour an a half without the machine again, I tried it and it did it again.

As for exhale of is an issue with this unit I've mentioned it to the lady wjo delivered the unit. I received the unit from a supplier that my EPO accepts in the Chicago area. I'm on an EPO and its not associated with VA, I used to go t the VA yet I'm unable to travel the distance from our area.
As to the technician she did well in setting me up as for changing the settings I'm not allowed to do anything except from the doctors approval.

As I addressed the issues to the tech I explained I felt this weird pain on the side of my neck while using the machine, as well as the dryness and exhaling issue as well. When I took the sleep test the unit worked great and I took to it with ease. I knew my unit would not be like theirs yet I thought the settings would be close. Are the units kinda of like clothes on manufacture size is different from another, so the settings could be the same yet the units differ? Or their unit was a bipap as theirs would be a top notch setup. I didn't mention this the pollen in our area os unreal and the air we blow in with the fan makes my nose so stuffy. It has cleared up when I used the system last night at first. Then as I was sleeping deeper that's when I got the dry mouth I might have opened my mouth as I have a cough from the acid reflux going on. Didn't mention that as well.

Will try to get through the night and make it to the doctors tomorrow. Its a first come first serve basis it a clinic with my current doctor.

Thanks again

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Hi Maczilla!

Your symptoms of dry mouth and acid reflux are consistent with the kind of breathing instability that can be caused by using a CPAP. In some of us we tend to get locked into using too much air and so chronically tend to hyperventilate. Breath too much and the mouth tends to open to allow for more airflow and gets dry. The excess vacuum from the excess effort to pull more air results in acid reflux.

Even before I understood the origin of my acid reflux to be breathing instability I was able to get rid of it by raising the head of my bed a few inches, starting sleep on my left side (keeps the outlet of the stomach highest) and eating less before bedtime except of a bit of celery or similar which tends to speed through the stomach and so keep it clear.

My breathing instability I have treated by learning to breath less (more efficiently) during the day by using a pulse oximeter to find the point where breathing level brings about the lowest heart rate at reasonable SpO2 levels (a pulse oximeter's blood oxygen reading). For example, working at the computer an SpO2 of 95% is likely to bring me to my lowest heart rate while on my treadmill at 2 mph with a 6% incline the lowest hear rate is more likely to be found while the SpO2 is at 97%. You find this out by patient experience. Then I trained with the CPAP during the daytime also using the pulse oximeter. My nighttime breathing volumes are getting much better.

Right now I would suggest that you spend some quality time with your xPAP during the day and concentrating on breathing quietly. Breathing gently. Not getting into the trap of using too much air. When you start using the machine at night concentrate on breathing quietly, gently, not using a lot of air. Normal air use while laying in bed should be such that no one would be able to hear you if you were not wearing the mask. You should process about a pint of air every five seconds, breathing in for two and out for three seconds.

I have found by experience (analysis of my CPAP data every other day or so) that the following also help with this:

Eat less carbs ending intake three to four hours before bedtime. Having a lot of unused easily accessible calories seems to be a consistent trigger.

Keep hydrated.

I wear a black beanie covering my eyes to keep changes in lighting from distracting me.

Aerobic exercise helps. You might even consider doing some of this near bedtime.

Eating anti-inflammatory foods helps (e.g. salmon). It is also good to eat anti-oxidant foods.

Your doctor and technicians, if they do understand this issue (it is along the lines of Complex Sleep Apnea) they also know that getting some treatment will tend to ease your nervous system and quiet any breathing instability present. If it continues you do need to tell them about what is going on and perhaps end up with different settings or a better machine. Getting use to CPAP and getting the right treatment can be a patience building exercise.

May you find restful sleep!

Todzo
AHI=52 SpO2 Nadir=55% (!!!) Focus & Vigilance problems w/PTSD from Trauma
CPAP since 2003 Respironics REMstar Auto A-flex with EncoreViewer and SleepyHead SW
Pulse oximeter CMS-50-F, night audio recorded via Audacity or Linux “sox”. Zeo.
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Re: Hard to exhale

Postby Maczilla » Fri Mar 23, 2012 6:50 pm

I did get some sleep last night it was around four hours. The doctor contacted me and prescribed some medications for my nasal passages and my cough as well. As for seeing him on the unit that will be on Monday and in case of an emergency go to the ER.

As for the dry mouth the Tech believes I did open my mouth as mu nose was so clogged throughout the night. I'm breathing better after using Flonase and Claritin as for the acid reflux use Mucinex expectorant (The Walgreens brand). I've been using the kind that dissolves the phlegm.

As to breathing that's what I'm suppose to work on in trying to match the in with the out pressures the Tech was sure that my settings are good as the person who did the sleep study she noted I didn't use my mouth and I was able to lay on my side as well on my back. So I'm going to be trying that shortly.

I'm glad for the help and the support from here the Tech stated she hasn't seen a lot of her clients seeking and finding help like I was doing. The doctor knows I look online and he supports that as well. So Thanks Forum you've helped more than you know.

I do hope this turns around soon my wife is really getting worried she doesn't want to show it shows and know she's holding in there. What more can I say.

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Re: Hard to exhale

Postby Maczilla » Mon Mar 26, 2012 6:15 pm

I'm still having some issue of sorts each time when I'm going to sleep either with the ramp up or without. The following text is what I sent to the Tech she responds very prompt:

Ok something is going on, this makes it the fourth or fifth time wearing the nasal mask that my inner throat seems to have something stuck or touching it. Hard to explain just odd I was so relaxed last night and it was going well yet each time I dozed off, I would awake with something touching my inside.... Deep inside in the back of theoat.....whats that? It goes away the next yet it still feels like something's there.

Stop.
(I did edit edit out names and cleared out my slang texting style)

After contacting the Tech she feels I'm opening my mouth somehow and the pressure is raised trying to compensate for the lose of air, then when I shut my mouth it backs up or something like that. Recommendations are a chin strap this should stop it.
Wondering does any of this sound familiar in any way?

Added:
Should I try to film myself?

Thank you for your help

MacZilla

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Re: Hard to exhale

Postby Todzo » Tue Mar 27, 2012 12:27 am

Maczilla wrote:I'm still having some issue of sorts each time when I'm going to sleep either with the ramp up or without. The following text is what I sent to the Tech she responds very prompt:

Ok something is going on, this makes it the fourth or fifth time wearing the nasal mask that my inner throat seems to have something stuck or touching it. Hard to explain just odd I was so relaxed last night and it was going well yet each time I dozed off, I would awake with something touching my inside.... Deep inside in the back of theoat.....whats that? It goes away the next yet it still feels like something's there.

Stop.
(I did edit edit out names and cleared out my slang texting style)

After contacting the Tech she feels I'm opening my mouth somehow and the pressure is raised trying to compensate for the lose of air, then when I shut my mouth it backs up or something like that. Recommendations are a chin strap this should stop it.
Wondering does any of this sound familiar in any way?

Added:
Should I try to film myself?

Thank you for your help

MacZilla

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Hi MacZilla!

In terms of filming yourself I believe the more information, the better. Indeed, get the software for your CPAP or xPAP and use it daily until things settle down. Some of it (SleepyHead) is open source and available for download on the web anytime. Again, the more information, the better.

Your technician probably has a better idea than I of what is going on. My first guess would be that stuff is being pulled from your stomach by the high vacuum created by hyperventilative breathing instability or that you are feeling your tongue actually touching the back of your throat. If it is the first taking pictures of the back of your throat before and after sleep can reveal this, and raising the head of your bed an inch or two is a likely cure. Also, starting sleep on your left side will also help (gravity is our friend). If it is the second then sleeping on your sides may help.

It is probably a good idea to limit carb intake during the day, stop eating several hours before bed, keep hydrated, and perhaps eat a bit of celery a an hour or so before bedtime. This tends to keep the stomach clear of stuff to drag into the airway passage regardless of the breathing intensity. Less irritation, less trouble.

In your case I think it would be good to spend an hour a day using the machine during the day. Sometimes concentrating on breathing quietly, sometimes while watching TV or listening to music or whatever. You are making new reflexes and this goes better if you have an awake mind involved in the process.

I hope you find good sleep soon, you probably will,

Todzo
AHI=52 SpO2 Nadir=55% (!!!) Focus & Vigilance problems w/PTSD from Trauma
CPAP since 2003 Respironics REMstar Auto A-flex with EncoreViewer and SleepyHead SW
Pulse oximeter CMS-50-F, night audio recorded via Audacity or Linux “sox”. Zeo.
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Re: Hard to exhale

Postby Maczilla » Tue Mar 27, 2012 10:30 pm

Todzo thanks for the ideas I'm going to use them tonight. As for filming my sleep even the Tech thought it would help.

I like the idea of laying on my left (oops) side I've been doing that since you last suggested it on my first question.

Thank you again will post tomorrow.

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Re: Hard to exhale

Postby Maczilla » Thu Mar 29, 2012 6:15 pm

Alright I think I know what it is as I go to sleep the setting is at 4 then ramps up to 9. When it kicks in at 9 the pressure is so intense that's when it makes my mouth dry and I awaken. As I start it at the low setting on 4 I doze off after 20 minutes so do I try and get use to that setting or try and have them click in down. If I ask that does going so low make it not as good as its force is kinda hard on my throat and dry mouth.

Last night it was great as I was fading out and so relaxed it felt pretty good its just when it kicks into high that it does it. I'm told I have mild SA its just when on my back that I would use the higher level yet I mostly lay on my sides.

Am I off base or am I missing something or is the norm?

Thanks again for hearing me out as I'm at a lose over here.

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Re: Hard to exhale

Postby robysue » Thu Mar 29, 2012 9:59 pm

Maczilla,

Do you know exactly what your prescription reads?

I suspect that even though you have a System One APAP, the machine has been set to run in straight CPAP mode with a pressure of 9cm.

And right now you are having real problems tolerating 9cm because every time the pressure fully ramps up to 9cm you say you wake up. And the ramp is set to 20 minutes. And you wake up with a dry mouth.

And you write:
Maczilla wrote: I'm told I have mild SA its just when on my back that I would use the higher level yet I mostly lay on my sides.


Here's what I think:

1) If you don't know your prescription, you need to find that out. Think of it this way: Would you take a serious medication without knowing what the prescribed dose was? So find out if your prescription is for a range of pressures or for a fixed pressure.

2) If your current prescription is for straight CPAP at 9cm, then the machine was set to run in straight CPAP mode with a 20 minute ramp period to allow you to get to sleep. Only you wake up just as the ramp finishes. And with a dry mouth. You need to call the sleep doctor's office and report this problem. Tell them you wake up every time the ramp period ends. Tell them you wake up with a dry mouth too. See if they'll down load the full data and look at the leak line.

3) Download the SleepyHead software. (Google SleepyHead CPAP software and you should get a hit for the download site.) And then use SleepyHead to look at your own data. See if you've got serious leaking going on. The on-screen "Large-Leak" numbers for the System One machines are largely meaningless. Since you are using a Swift FX, the expected leak rate at 9cm is about 30 L/min. The System One machines report Total Leak, which includes the intentional leak rate. Leaks can certainly become problematic (and uncomfortable) when they get to be 25 L/min above the intentional leak rate. So you want to see whether you are spending a lot of time with leaks that are at 55 L/min or more. And you also want to look at whether the leak curve is bouncing up and down rapidly. If you've got a lot of times where the leaks > 55 L/min, then chances are you doing some mouth breathing. That would explain the dry mouth. It would also explain why the pressure is waking you up: When you open your mouth up with the Swift FX, you create a gigantic leak in the semi-closed pressurized system comprising your airway, the mask, the hose, and the blower unit. And the blower immediately starts pumping more air into the system to try to maintain the desired pressure level of 9cm H2O. And (as long as the mouth is open) that air rushes in through your nose and out through your mouth. And the breeze dries the mouth out rather quickly I might add.

4) LAST and MOST IMPORTANTLY: Since you seem to have a difficult time tolerating 9cm of pressure AND since your apnea is positional, it is worth asking the doctor if he'd be willing to change your prescription to an APAP range of something like 4--9cm so that you are only dealing with 9cm during the times that you are actually sleeping on your back.
current settings Min EPAP = 4, Max IPAP = 8 and Rise time = 3

8/1/2010 sleep study results:
AHI = 3.9 [AHI = (#OA +#CA + #H w/desat) per hour]
RDI = 23.4 [RDI = (#OA +CA + #H w/desat + #H w/arousal) per hour]
Dx: Moderate OSA
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Machine: PR System One BiPAP Auto
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Humidifier: System One Heated Humidif
Year Diagnosed: 2010

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