Hello all,

I am very new (1 week) to CPAP and have been reading this forum almost non-stop for a couple days now. I am really glad I found it.

I do realize that it takes sometime to get used to and see the benefits for CPAP treatment, and I am logging my hours... But one thing I keeps me concerned, I think my pressure is too high. it is set on my Philips System One at 14. I use the ramp feature, and I find myself using it in the middle of the night a couple times because when I am at full pressure it feels like its very hard to exhale, like I have to fight the incoming pressure. Also in the middle of the night it feels like my lungs are getting a good workout.

one last note, during the ramp, I do find period that become very comfortable, i see myself being very comfortable with pressure between 6-8.

I called my doctor and they said it might be too high, asked me to come in.

sroach wrote:Hello all,

I am very new (1 week) to CPAP and have been reading this forum almost non-stop for a couple days now. I am really glad I found it.

I do realize that it takes sometime to get used to and see the benefits for CPAP treatment, and I am logging my hours... But one thing I keeps me concerned, I think my pressure is too high. it is set on my Philips System One at 14. I use the ramp feature, and I find myself using it in the middle of the night a couple times because when I am at full pressure it feels like its very hard to exhale, like I have to fight the incoming pressure. Also in the middle of the night it feels like my lungs are getting a good workout.

one last note, during the ramp, I do find period that become very comfortable, i see myself being very comfortable with pressure between 6-8.

I called my doctor and they said it might be too high, asked me to come in.

Hi an welcome!

Through HS and college I played trombone and have often sang in Church. These activities use one's diaphragm well, you are constantly pushing hard to produce volume or a specific tone at the right time. If we could look in there, we would probably see well developed muscles and that the lining, lubrication systems, and tissues of my lungs are ready to handle the volume and pressures. I really do believe that this was part of what made it easy for me to use CPAP right from the first. I think anyone doing CPAP would do well to choose any of the above activities as well as public speaking and aerobic exercise. Other breath control intensive disciplines such as Yoga, Pilates, or even weight lifting could probably help as well.

Still, when the doc bumped my pressure from 13 to 15, well, there was a week or two when it kind of seemed a bit much. My lazy old lungs (I am now 57) just did not like that too well. Within three weeks I was back to just not thinking about it when I put the mask on. I have never used the ramp function.

I am suspicious that you doctor will be mainly concerned that you may be having Central Apneas. It is good to spend time with your doc. I kind of doubt he would have a problem with any of the above that I have suggested but you should ask him specifically.

Most xPAPs these days have the ability to gather data (snore rate, apneas, leak rates etc...) and you can purchase software to analyze that data. I believe it was well worth the investment of money (it us unlikely insurance will pay for that) and the time to use the software I did purchase and use with my CPAP - it has helped me find problems before they became daytime noticed problems.

From where I sit, it looks to me that you are running pretty high in the pack. Please do carry on!

Todzo

Unfortunately, you can't go by feeling when experiencing the pressure to determine what is the correct the pressure. The only way to tell if the pressure is correct is by examining the data, IF your machine collects data. Most Philips Respironics System One machines do, except for the System One Cpap Plus. If you have that machine, the only data available is compliance data. But the others do have full data that can be viewed on a computer with software (there is only limited data available on your machine's screen) and your DME and doctor can determine if the settings are correct or not and make appropriate changes.

The titration study setting your pressure was like taking a snap shot, under very artificial conditions in the sleep lab. So yes, your pressure could need to be reset but the only way to tell what the correct pressure is, now that you've used the machine for several nights in your usual sleeping conditions, is to check the data if you have any.

That said, it is difficult to breathe out against the higher pressures at first. The machine you have has a feature that should help called "flex"--cflex (or aflex if you have an auto machine). Flex has user settings from 0 to 3, with 3 giving the most pressure relief during exhalation. You should be able to change those settings yourself by scrolling over to the flex window (top right hand box) on the LED screen. Unfortunately, some DME's lock patients out of everything--if that's the case you'll need your DME to set it so you can adjust the flex setting for your comfort. Over time your muscles get used to the pressure, and you may not need so high a flex setting eventually, but it's there for your comfort as long as you need it.

Thanks Guys...

Janknitz,

I do get lots of information from the front screen of the System One, but from everything I read I need to buy and install the Encore Viewer software.

great point on the CFlex, it is disabled on mine for some reason. I do have a call in to my DME and doctor, they are going to get back to me on some changes and also switch me to a full face mask.

You should be much more comfortable with flex enabled.

DME is coming today with a full face mask and make some adjustments on the pressure. I am hopeful this will help and I can get on to my therapy.

Thanks for the comments.

If your pressure was accurately titrated to 14 cmH2O, then you do not want a lower pressure because then your apneas will not be compensated. If you are having trouble exhaling against the pressure, then enable your C-Flex as suggested to give you some exhalatory relief.

Vicki

So my DME tech came out yesterday and changed my pressure setting to 10 (after consulting my doctor) and gave me a full face mask, used it last night and it has been the first time in a very long while where I shut my eye, fell asleep and woke up 6:00am.

Is this what that uninterrupted sleep you guys speak of is like??

I am pretty excited, I think the full face mask is going to work wonders for me, only side effect is I woke up with a dry mouth.. Yuck.. I'll have to work on making sure I keep my mouth shut.

On a side note, I saw how the tech got in to the settings menu on my System One, So Vicki I could set it back to the original setting of 14 and see if it makes a difference. my C-Flex is disabled for some reason.

I've been trying a 45 minute ramp starting at 8.0cm. maybe it would work better starting at 7?

Yes, that peaceful uninterrupted sleep is what keeps us coming back for more--it's like some illicit drug we better not let on to others about, or they'd try to regulate it! (Oh, wait, they do!). On CPAP, I wake calmly, peacefully, and feeling rested--not like before when I'd wake in a terrible state of distress and fatigue. So now you know what you're aiming for. You may have some good nights and bad nights, but you now know you CAN have good nights and they will become more frequent over time. Congratulations!

The only reason to decrease the starting pressure on the ramp is if you are too uncomfortable to sleep with the pressure starting at 8. It doesn't make a difference to your therapy, except that you will soon find you don't need the ramp at all. It's a help for the first day or two, but then it becomes annoying as sometimes people don't feel like they are getting enough air when the ramp starts, or the increase in pressure keeps them awake. I would say the vast majority of CPAP users turn off the ramp altogether after a week or less.

Since you say you "shut my eye, fell asleep and woke up 6:00am" there's no need to lower the ramp at all.

I don't know I can only fall asleep with the 45 minute ramp

Using ramp isn't an indicator that the pressure is wrong. The correct pressure is the amount needed to splint the airway open.

Janknits, thank you. You are right, I know know there is hope for my treatment.

Had two more questions I wanted to ask..

1. The last two nights I had dreams, can't remember the last time I had a dream. I assume that is a good thing, does that mean I am getting good REM sleep?

2. I have also noticed I am tired in the afternoon, I was never a napper, but the last two days I have struggled to stay awake in the afternoon. Is my body trying to catch up?

Thanks.

so if you have central apnea the bipap machine doesn't breathe for you, so you could still stop breathing on bipap?