Anyone else have a high pressure setting?

I have a pressure setting of 24 on my ResMed Air Curve 10 ST BIPAP machine. I find it really hard to tolerate this amount of pressure, even with the 45 minute ramp up setting. I wear the machine for up to 2 hours a night before I have to toss the mask off and go back to sleep. I know I need this BIPAP to work for me. I need to fight this in order to feel better. I just get so frustrated at times. I even have Ambien to take and it will not knock me out when the mask is on. Putting that mask on automatically wires me up like I'm on stimulants. I might try taking 2-3 hour naps (well I already take them like this) sitting upright in a chair with the mask on. I will try doing it this way and maybe I can get more acclimated to the machine. When I side sleep, the mask leaks. When I back sleep, I am not always comfortable. But I am used to sleeping upright for hours in a chair. Have any of you ever considered just having the Trech put in? I know they're not going to do it for me, because my case is only moderate/borderline low severe due to having an AHI of 30 in REM sleep. It would be so much easier though. I read that anyone needing a pressure setting higher than 24 needs to be mechanically ventilated. Thanks for the support.

J

I use the same machine in BIPAP mode with pressure settings 25/21. I found the TYPE of mask makes a huge difference. The SIMPLUS full face has the largest exhaust and I can breathe easily through the mask with the machine off. I have another full face mask made by Respironics I received initially and it leaked horribly when I first started using it. The mask is sort of like an Amara type and I can now use it because I have learned to use masks. The exhaust ability isn't nearly as comfortable when the machine isn't on but once it starts pumping, the mask works fine. The advantage is the mask is much lighter. Unfortunately, the headgear has skinny straps that bite a bit but not to where the mask is uncomfortable. I bought a nasal WISP mask thinking it would be a good idea to try this type and the mask was totally unacceptable as there was not nearly enough exhaust capability. I choked when the machine was not on and then once on, the mask filled with moisture as I don't believe it has adequate venting. At some point, I will enlarge the exhaust holes which are tiny and see if this makes the mask leak or it is just a bust for me. If you pressure is 24, the best luck is with the Simplex mask generally. I am a large person and initially thought I would need a large mask but was given a medium. The medium cushion is too wide in the nose bridge area and the mask leaked like a sieve unless I wore mask pads. I have since switched to a small cushion and the mask now doesn't leak. I also don't sleep on my sides but sleep on my back without much movement so can't provide advice as to side sleeping. I think the Amara mask would work decently for that as its smaller sized doesn't have it getting bumped (and then leaking) as much as the Simplus.

Thanks for the advice on the masks. I might try the pillow mask, but I heard it can't handle higher pressures. I might be wrong though. Your pressure is 25? That is pretty high as well. I wonder why my pressure is so high when my apnea is considered moderate? I have to keep on trying. I will be trying every night until something gets better. I will also look into something to seal around the mask like you suggested. What happens with me is I swallow a lot because of excess saliva. When I try and pause breathing to swallow when the pressure level is high, the machine forces me to gulp a huge amount of air. I then have to burp and can't burp with the machine trying to do it's thing. I have to stop the machine and then burp and start all over again. Maybe a nose only mask will prevent this. Thanks for the support.

I would think a full face mask with LARGE exhale holes would be where you might want to consider going. Doesn't matter what your AHI is, the amount of pressure is what the sleep study found that would keep your airway unobstructed. There isn't a real correlation between AHI and pressure I think so much as some people need more pressure to achieve a clear airway. Maybe size of neck? Maybe size of chest? Maybe a lot of things but the pressure needed is what the pressure prescription is. I have never tried nasal pillows so I can't say if high pressure is something that type mask can accommodate. I have seen some masks that have specifications and recommended pressure ranges. In fact, I don't understand how you can exhale through your nose with nasal pillows but the exhaust-ability must be restricted due the size of those things... just not sure.

Thanks. All good advice. I figured with the nasal pillows it would be easier. There was a guy in my class we had to go to who had the nasal pillows and his pressure was 20. He could not tolerate the face mask because of claustrophobia. I never thought about how hard it would be to try and blow air out of the nasal pillow type masks. It makes sense that it would be quite difficult to do so. I wish this therapy was easier than it is. I wish it was like taking a blood pressure pill, but it's not. I have never had such a hard time with anything other than this mask. I will keep on pushing forward though. My symptoms are bad today. I napped three hours yesterday. Then I had 10 hours of sleep, with two of them being off and on with the mask on. I'm slamming diet mountain dews like crazy just to stay awake. I could probably sleep 3-4 hours right now if I allowed myself. My cognitive function is really bad. I feel like I'm dreaming walking. Thanks for the help.

Therapy shouldn't be as hard as it is. It is made hard by the dearth of information presented in a coherent manner and lack of good medical support. Not criticizing anyone, just my subjective observation. Why a mask can't be fitted is based on your medical supply place and mine took no interest in getting it right. I suspect I now know far more about fitting a mask than the gal who was supposed to be an expert. I received NO follow up from the doctor who wrote the prescription from the sleep study nor anyone in his practice. I had to get hard with them to get a copy as they didn't seem willing to give me a copy; only send along a copy to my PCP who admitted she knew little about the subject of sleep apnea.

Based on what I have encountered on this site, many are in this position and adrift in medical jargon and mumbo jumbo and only cursory support from the medical professionals and associated medical support system. Only two ways to go from that point; either stay adrift and rely on the the support system who may not give your conditions their full attention or self educate. Get copies of all studies and prescriptions and search out all the numbers and facts. You will be better able to target specifics when talking to doctors and make sure they talk to you as they have been paid to do so.

After awhile, you will be able to begin to discern the truly beneficial information you take in here and elsewhere since you now have context for what is being advised or discussed. You have to be able to separate the wheat from the chaff but the good info is out there!