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Need advice for new CPAP!

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RichZs +0 points · 2 months ago Original Poster

I've been diagnosed with sleep apnea (how bad it is I have no idea - they just gave me a CPAP machine with very little info on how to use it). I'm having all sorts of trouble with the machine (DreamStation CPAP) with a full mask. I've had it for about three weeks. I have no idea what the pressure setting is or whether the sleep doc even set it correctly. They actually gave me the machine before I had my sleep study, why I don't know. I fight with the mask all night long and wake up all the time because it leaks and is super uncomfortable. I feel like there is too much pressure inside my lungs. My sleep quality is horrible - worse than when I don't use the CPAP at all. I've hoping my doc will call me to discuss my issues tomorrow, but I feel like very little thought went into this whole thing. Now that I've done my research I see that I have a "basic" machine that can't adjust pressure as I need it, probably have a mask that's not right, that the pressure is probably too high, etc. I guess my question is should I ask if I can return my machine for a CPAP Pro, which seems to be a lot better, and a different mask, perhaps one that just goes over my nose?

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Biguglygremlin +0 points · 2 months ago Sleep Commentator

Hi RichZs

You have definitely come to the right place.

I'm not sure how you're circumstances came to be but if it is as unplanned as you indicate there are real risks.

This is really Sierra's field of expertise but if they would let you exchange then there seems to be no reason not to.

The fixed pressure is not necessarily a deal breaker but it does require effective settings and follow-up

Have you tried any other masks? Would you have the option or budget to get a different mask?

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Biguglygremlin +0 points · 2 months ago Sleep Commentator

It is important that you get the equipment working effectively and safely as soon as possible.

Can you just take your gear back to where you got it from and talk it through with them?

This forum can help you but you need a mask that works for you before you can go much further.

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Sierra +0 points · 2 months ago Sleep Innovater

A few suggestions. You should ask for a hard copy of your sleep study and your prescription for a CPAP. Down the road you will question where you were at when you got into this stuff. And if you live in the US you need a prescription if you want to buy a mask or a machine on line or at another clinic.

The DreamStation CPAP is a basic fixed pressure model. On a quick check of the DreamStation Pro it really does not have much more to offer, and is still fixed pressure. While it varies by country and jurisdiction, at least in Canada the cost of an automatic machine is as little as $30 or so more than a fixed pressure machine. So if you are going to go back for a better machine I would start out by asking for an automatic machine like the DreamStation Auto. Or better still if it is available to you, the ResMed AirSense 10 AutoSet.

As far as making the machine you have work better for you there are a few things that may help. Based on what I see, this machine should have a SmartRamp feature. This ramps pressure up and then switches to your set pressure when it detects you are asleep. You should also be able to set the pressure the ramp starts at. A pressure that is too low can feel suffocating. A start pressure around 6-7 cm usually feels comfortable to most. If you don't set it, the start pressure likely defaults to 4 cm which is low. The machine also appears to have the Flex option. It reduces pressure somewhat on exhale, which can feel more comfortable. It has a setting of 1-3, with 3 giving more relief on exhale. The issue with it is that it may reduce treatment effectiveness so then you have to increase the set pressure to get the same results, which makes it a bit of a zero sum game. The ResMed machine gives you the option of only using it (EPR) during the ramp period, which tends to work better.

Masks can be difficult. There is a DreamWear mask system which some people like that has three interchangeable inserts that make it into a nasal pillow mask, or nasal mask, or a minimal contact full face mask. What specific mask are you currently using?

And another couple of questions. What pressure is your machine set at? Do you know what AHI you are getting while using the machine? Post back, and we may be able to help you out more.

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RichZs +0 points · 2 months ago Original Poster

All - thanks for your feedback. I have an appointment with the sleep center next week to go over everything. Not sure why they didn't do this prior to giving me my machine and basically telling me "good luck." I live in the US by the way. My mask is some sort of DreamWear full face mask but I can't find it on Phillip's website. To answer some of your questions, yes, I'd gladly spend the $50 or more to get the Auto machine. I'll also try to adjust the SmartRamp feature - it's currently set to four. I can't find any setting for the Flex option, although it's supposed to be there. I think the place I got it may have limited the things I can do with the machine. I seem to have very few options. I have no idea what AHI is or what I'm getting. I'll do some research. I added the app that connects to the machine to my iPad yesterday, so hopefully that'll have some data on it when I get home from work. I remember there was something there about AHI. I'll have more info for you after I meet with the doctor next week. I really appreciate your help. I have a feeling I may need to change to a better sleep disorders clinic . . . . this one is pretty bad at nearly everything.

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Sierra +0 points · 2 months ago Sleep Innovater

Here is a link to the full Technical Manual for the DreamStation machines. Because it covers all machines it is pretty difficult to follow. However, it should be more obvious to you when you go into the machine setup. Since you have the most basic CPAP model most of the options will simply not be there. See page 4-11 for help with the User Menus. I saw some disappointing things though. If I read it right, only the Pro and Auto models give you the AHI. I don't know how you could use and adjust a machine without knowing what results you are getting. The AHI is most basic of measure. It is the count per hour of the number of events you are having per hour. Less than 5 is considered OK. Less than 1 is ideal.

On page 8-18 the section on how to get into the clinical setup starts. I would be careful if you go in there. If you are going to make any changes make sure you write down what they were at before you made a change. The Therapy menu would be the most critical, and in the absence of any information, I would suggest you not change anything there. Possibly the only item in there is the set pressure though. For now I would focus on the Comfort Menu. See page 4-21 for more help. You should be able to turn on the SmartRamp feature. I would suggest a higher than 4 cm start pressure for the ramp. 6-7 generally feels comfortable. You will not be able to set it higher than the therapy pressure though. Since you may not be able to see AHI (unles your iPad gives it to you), I would also be careful with Flex. If you turn it on and adjust it, the AHI may suffer. So, you will want to know where you are before you make any change.

But back to your original question, the CPAP model is very basic, and if possible I would try to get the Pro or Auto version. Or the ResMed AutoSet would be good too. It lets you use the Flex (EPR) on Ramp only. The DreamStation does not appear to have the ability to do that.

Hope that helps some,

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RichZs +0 points · 2 months ago Original Poster

Thanks Sierra. Appreciate your feedback. I'll take a look at the manual. I'm going to lobby my doc to get either a DreamStation Auto or a ResMed AutoSet. I'll pay the extra if the insurance won't cover it. Getting a good nights sleep is totally work a few hundred bucks, and it probably won't even cost that much. I'll keep you posted on my progress and am very glad I found this support group!!

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Sierra +0 points · 2 months ago Sleep Innovater

Here is a link to the technical manual for the AirSense 10 AutoSet. It gives you a better idea what it can do than the sales promo materials. The main difference between it and the DreamStation Auto is that with the ResMed you can set EPR to the Ramp Only part of the night, which is nice. The DreamStation uses a bit different algorithm for adjusting pressure in Auto mode. It tends to adjust pressure up and down a lot at night, where the ResMed keeps pressure more uniform. Other than that, they are pretty much the same.

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RichZs +0 points · 2 months ago Original Poster

Update: went to the sleep doc yesterday and according to him, my DreamStation automatically adjusts pressure when I'm asleep, and he showed me the data to prove it. I'm pretty sure he's right. He adjusted the pressure down a bit and gave me a new mask, a nose mask, which is much more comfortable. To keep my mouth closed, I use a bit of 3M tape, which is not a problem. I only used it one night, but so far so good. Had it on for about six hours. Only issue was a lot of water coming through the mask. The doc must have messed with the humidifier settings, which I'll have to look at tonight. I also ordered a heated hose which should arrive today, so hopefully that won't be an issue going forward.

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bobbeaty +0 points · 2 months ago

In my case, it has taken weeks to get to 7 hours with the mask on. You need professional help to config the machine as the wrong settings can be troublesome and dangerous so I am told. My only side effect so far is bad dreams, which is a result of longer REM sleep. There are two types of sleeper; those with COA and those with no COA. Make the commitment if you are the former. Get professional help and also ensure that your O2 level is acceptable. Our world has changed. Fighting it is counterproductive and possibly deadly.

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Sierra +0 points · 2 months ago Sleep Innovater

What do you mean by COA?

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Biguglygremlin +0 points · 2 months ago Sleep Commentator

Certificate Of Analysis perhaps?

Isn't that what you need to be a sleep tech?

Raises more questions than it answers though.

I could probably figure it out ..........

If only I wasn't so sleep deprived,

And if I had a COA of my very own! :)

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