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Hot/stuffy Exhale

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05Moose +0 points · about 3 years ago Original Poster

Just started with a CPAP machine last weekend, and having trouble with only one thing. First, I'm using the ResMed AirSense 10 with AirFit N20 nasal mask (the one that just covers the nose). I'm started CPAP because I got tired of waking up from not breathing. After one evening of waking up 5 times shortly after falling asleep, I'd had enough. I actually wake up and become conscious of not breathing. I then decide to inhale and I start breathing after that. I have the same problem if I am tired during the day at work and put my head down at lunch time for a quick nap. I exhale, dose off, and wake because I never inhale. I feel too weak to inhale.

So the therapy is the CPAP set to 6 (by my doctor and not adjustable by me). I turned off the ramp up because that was useless. I have no issue with the air coming in (in fact, I think it might be set too low).

I just am used to breathing in cool air. I get claustrophobic wearing regular face masks where I exhale and the air is hot. This is what I'm having problems with regarding the CPAP therapy. I exhale which is body temp air, then I'm breathing that air back in with the CPAP air. It's bad enough that in the first 30 minutes of falling asleep, I wake up not breathing about 3 times and have to breath in my mouth to catch up on air. I also measured my blood oxygen level (wife has asthma, so we have the finger sensor), and while it was 94 with the mask off, it drops down to 91 with the mask on (probably from breathing back in my exhaled breath which isn't oxygen rich).

Any advice on whether switching to a nasal pillow removes the exhaled air more? Or could it just be that the pressure set to 6 is too low? Seems pointless if I'm going to stop breathing with it on like I do with it off.

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Sierra +0 points · about 3 years ago Sleep Patron

You have some good questions, and I don't think your experience is uncommon for new users of CPAP. Some questions for you:

  1. Do you have the AirSense 10 AutoSet model? It should say on the front of the machine, down beside where you have the humidifier water level indication.
  2. Is your machine set to CPAP mode or AutoSet mode? In CPAP mode you only have one fixed pressure. In AutoSet mode you have a minimum pressure and a maximum pressure. The machine automatically adjusts the pressure depending on your needs, up and down between those two pressures. These pressures may be shown briefly on the screen when you first start the machine.
  3. Do you have EPR turned on, and if so what is it set at? (1, 2, or 3).
  4. Are you using a heated Climate Air hose? It should be marked on the grey fitting at the end of the hose. It is darker in colour because there is a spiral wire running down the hose that is used for heating.
  5. Is your Climate Control set to Auto?
  6. Is your temperature set to 27 C or 81 F?
  7. What AHI numbers are you getting? That number should flash on the screen when you shut it off each morning.

Sorry for all the questions but all of that stuff makes a difference.

I will assume initially that your machine is set to CPAP mode which would mean one fixed pressure of 6 cm. In my opinion that pressure can be too low to be comfortable to some people. Switching your mask type should not make any difference. Each mask is designed to have a purge flow rate based on the dead space (size of the mask). A larger volume mask like a full face will have more purge flow, and a smaller volume mask like a nasal pillow style will have less purge flow. The idea is to control the CO2 level in the air so you are getting low CO2 when you breath in. For comfort purposes with the low air pressure you are using, you may be better off with a nasal pillow mask, like the AirFit P10. It is unlikely to help with the air flow issue. For that you most likely need an air pressure increase to at least 7 cm.

It is not that hard to make these changes yourself, and I can give you some instructions on how to do it, if you are comfortable in doing it. And comfortable with telling your doctor you have done it. The other option is to ask the doctor to change the pressure.

If it were me setting the machine up for a single pressure I would set it at 7 cm. I would turn on the EPR and set it at 3 cm. It reduces the pressure on exhale only by 3cm. So you would be feeling the assistance of 7 cm pressure to breath in, and only the resistance of 4 cm to breath out. Should make it easier to breath overall. Then I would turn the ramp back on, but set it to Auto with a start pressure of 7 cm, and set the EPR (exhale pressure relief) to function during the ramp time only. In auto it would only use the two pressure until you fall asleep. If you want to know how to do that, post again, with answers to as many of the questions above as you can. It is not really that hard. You just enter a special Clinician Menu which functions pretty much the same as the standard user menu. Many CPAP users adjust their own settings.

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Sierra +0 points · about 3 years ago Sleep Patron

I did some more checking on the N20 mask. It has a dead space volume of 103 ml, while the P10 nasal pillow mask actually has more dead space at 123 ml. The purge flow rate is essentially the same. So, the P10 would probably be slightly worse not better for air freshness. Purge flow does go up with air pressure so 7 cm would give more flow than 6 cm.

One further thought I had is possibility that the flow diffuser that controls the purge flow rate may be plugged. Not very likely with a new mask, but I guess possible. You manual has some instructions on how to clean it. It is located on the outside of the elbow connected to the mask. Looks like they just suggest a toothbrush using soap and water. Put your hand in front of the diffuser when you are wearing the mask with the machine on. You should feel the flow of air coming out.

Hope that helps some,

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sleeptech +0 points · about 3 years ago Sleep Enthusiast

You do not breathe in your exhaled air when using a CPAP mask. The air you exhale is blown out of the exhaust vent and you get fresh air from the machine. There is a constant flow of air through the mask to blow away exhaled air. They do a lot of engineering to make sure this works right.

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wiredgeorge +0 points · about 3 years ago Sleep Enthusiast

Not sure how engineers could design a mask that was capable of exhausting varying amounts of air from different patients. I tried a nasal mask and thought it would drown me. Just couldn't exhaust enough and the mask FILLED with moisture as a result and felt like I was drowning. I think perhaps, being a windbag, perhaps I need to exhaust more than some?

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Sierra +0 points · about 3 years ago Sleep Patron

The amount of purge air they use to keep the mask high in oxygen and low in CO2 is based on the dead volume of the mask. A larger volume mask needs more purge flow. They can't of course get rid of all the CO2, but most of it. The other issue is that the purge flow changes with mask pressure. If you use a high mask pressure you get more purge flow than if you use a low pressure. The OP seems to be using a fixed pressure of 6 cm which is very low, so the purge flow will be low as well.

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05Moose +0 points · about 3 years ago Original Poster

Hmm, never got an email that there were replies even though notifications is on. Oh well, checking back in. After speaking with two other friends on CPAP, I called my physician who had me call Apria. They sent me the P10 nasal pillow mask which arrived yesterday. HUGE difference. I slept almost 3 hours straight with only 3.1 AHI (compared to the 16 AHI earlier in the week). I can now truly say the nose masks do not clear the air as well when breathing shallow. And how could it? The purge holes are in the hose coming to the mask. A light exhale into the mask is instantly breathed right back in. I would have to exhale and push it into the tube coming to the mask to get it out.

The purge vents on the P10 Nasal Pillow are right across from the nose and apart (away) from the hose bringing in fresh air. Design is much better for clearing out exhales. In fact, with the pillow on and no hose attached (for testing fit), it still clears it out (unlike a nose mask).

So thanks for all the responses. I know the value of coming back and posting on a forum for future searches. I know this will help someone new to CPAP since I've gone through it.

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Sierra +0 points · about 3 years ago Sleep Patron

Good luck with your P10. The big issue with it is the flimsy headgear with no effective means of adjustment. I found that when you use those little adjustment clips they give you, it makes it even more susceptible to movement during the night. The solution for me has been to use a chin strap (Breathewear Halo) put on second, over top of the P10 harness. The comfort of the P10 is worth the extra hassle for me.

I would still recommend using the Auto Ramp with a start pressure of 7-8 cm and with the EPR of 3 on ramp only. It makes a big comfort difference in going to sleep. It will also keep your mask more well ventilated. And remember the Auto Ramp is not really a ramp. It is a pressure HOLD until you go to sleep. That is what makes it much better than the old timed ramp. And it allows you to use EPR on ramp only, which is really the only time you should need it.

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05Moose +0 points · about 3 years ago Original Poster

I turned the ramp off last week when I was getting too much exhale buildup in the old mask. At a pressure of 6, I really don't notice it. I agree that the only issue I may have is the strap being a little weak. I want to tighten it more because the nose piece shifts when I roll from side to side at night. I bet I can devise a solution. I'll have to think about it. Otherwise, I would never know I had anything on my face.

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wiredgeorge +0 points · about 3 years ago Sleep Enthusiast

Many head gears are not the best and are poorly designed. As I noted, the holes used to exhale are the key to the issue you had and glad you got it whipped. I wear an Amara View full face that fits up under your nose and not over it. Like the mask BUT the head gear is poor. The straps are too thin as is the broad part that rests on the back of my head. My wife makes me little cushions to go under the back part about 4x6" that fit under the large section so it doesn't cut into my skin. Makes this particular headgear wearable. Some bright innovating person will eventually figure out that most of the straps and head gear are less than optimal and will come out with a gizmo that also supplies the various hooks/fasteners to make it universal and make a fortune. They might even have to design a couple styles but it shouldn't be rocket science.

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05Moose +0 points · about 3 years ago Original Poster

My wife just sewed the strap shorter (folder a section over itself) which makes it nice and snug.

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snuzyQ +0 points · about 3 years ago Sleep Commentator

Yeayyyy! Just goes to show that simplest fixes are often the best. I'm so glad you've found a mask that you're comfortable with.

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mgratton +0 points · almost 3 years ago

I am almost having the same problem. I have an Airsense 10 with the P10 nasal mask. I have been using this for about 9 months not a single problem. But during the past 2 weeks I now have excess water(I took care of this ) and for some reason, the air I am getting is really warm. I prefer the cooler air to fall asleep and it feels like I'm suffocating when all I get is warm/hot air from the machine.

I read that the climateline might help but how cold will the air stay?

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Sierra +0 points · almost 3 years ago Sleep Patron

There is a humidity setting which can be adjusted manually if you have the standard hose. I believe all it does is adjust the amount of heat under the water reservoir.

I believe the machine has a pre warming feature as well that lets you warm up the water reservoir before you go to bed. I have never used it.

When you have a ClimateLine heated hose then the machine will detect it and switch the humidity control to automatic. I presume it adjusts the heat under the water reservoir automatically instead of manually. And you can also set an air temperature which must be controlled with the heated hose. I set mine at 27 C, and find that very comfortable.

You said you had excess water and you took care of it. What exactly did you do?

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wiredgeorge +0 points · almost 3 years ago Sleep Enthusiast

Water can condense in the hose; hang the hose over a bedpost or similar so that air from the machine goes up higher than you then comes down; this is called "rainout" and that is how you stop rainout. The heated air? Turn the humidity down or off.

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mgratton +0 points · almost 3 years ago

I just hung the hose over the door to let it drain. There is still an excess amount of moisture in it though. I think I'm going to say that is due to the 2 different temps in the room right now as it is getting colder and just haven't turned on the heater yet in the room. The humidity is set to off on my machine as during the summer it just became to hot.

I don't know if the machine is at fault anymore to be honest. It still is a little too warm for my liking but for some reason now it is like I'm having an anxiety attack everytime the air gets too warm and then I start breathing heavy and it is like I can't catch my breath with it on

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Sierra +0 points · almost 3 years ago Sleep Patron

What are your pressure settings? Sometimes the feeling of suffocating and not being able to catch your breath can be caused by having a machine set at the default minimum of 4 cm of pressure. Some find that too low.

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mgratton +0 points · almost 3 years ago

it starts off around 4.5 then ramps to 10. I recently set the ramp to auto and it seems to be helping

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Sierra +0 points · almost 3 years ago Sleep Patron

The ResMed A10 has some very good features to make going to sleep comfortable. First is switching the ramp to Auto as you have done. You can also set the Ramp Start pressure to a higher more comfortable level. I would suggest 7-8 cm. Base it on what feels like zero effort to breath in and out. I also set my EPR at 3 and for Ramp Only. That makes the breathing more comfortable before going to sleep and the pressure more effective after going to sleep.

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