Newbie issues w Dreamstation Autopap

[emmagoldman44]

Hi Everyone,
I've benefited a lot over the last couple months from reading your posts but now I have an issue that I haven't seen addressed anywhere, and hoping to get some feedback.

I am on my 2nd cpap trial on PR Dreamstation Auto cpap and it's not going so well. My prior trial period ( a few months ago) was on a PR System one, and I got to the point where everything was good (AHI wise) except I could not solve the mask leakage problem. I tried 6 different nasal and FF masks but the leaks kept waking me up and causing eye irritation. My RT was so difficult to work with that I thought I would try another company so now I am on the Dreamstation, using nasal pillows most of the time, which solves the mask leakage problem. But now I have machine problems!

My pressure setting btw starts at 4 and my 90% is only 6.5

The problems I have now are 2 things: #1) As I am inhaling, the machine starts to blow harder into my lungs as I come to the end of the inhalation and also just at the point when I want to begin the exhalation. This only happens about 1 out of 3 - 5 breaths, but enough to interfere with going to sleep.
#2) Although the new RT says the flex setting is at "3", still when it is time to exhale, so much force is required, it's like I have to "huff" into the tubing and try to overpower the resistance, which also interferes with going to sleep. I don't experience any reduction in resistance like I am supposed to, even at 4 cm with this 3 flex setting. After I eventually fall asleep, when I wake up, I can tell that I am breathing in this way, with very forceful exhales.

Is this normal?

My new cpap agency tells me the PR system one is no longer available, but I am thinking maybe I should just buy it on ebay or something.

Please excuse any stupid oversights or mistakes in my post, I am dazed and sleep-deprived. Amazingly, still a net gain compared to before cpap
Thanks so much.

[palerider]

turn off flex and see if the annoying pressure fluctuations cease.

[Pugsy]

Flex relief can't even kick in at 4 cm because the machine can't go below 4cm. There's no where for it to go in terms of down when at 4cm.

[palerider]

Flex relief can't even kick in at 4 cm because the machine can't go below 4cm. There's no where for it to go in terms of down when at 4cm.

true, but he didn't say when he was having those perceived pressure problems, maybe it's after the machine has raised pressure some...?

[emmagoldman44]

Hey thanks a lot, you guys (btw I am a woman).
Definitely it would be the case that I am starting out at the lowest possible pressure of 4, and so of course the pressure cannot drop any further! Yes it is at the outset, when I am first trying to go to sleep.

On one hand, I wonder about starting out at a higher pressure so that there is somewhere lower to drop to for the exhale, but then again, the 4 level is still difficult to exhale against. This may be a factor related to being a lifelong asthmatic, and although I don't have asthma symptoms right now, my lung functions are probably a lot weaker than the average.

I have found the air pressure much easier to tolerate with a nasal mask/full face mask, but there again I have the damned leakage problem. I was really hoping to make the nasal pillows work. The RTs at the cpap agency say that the air pressure should be experienced the same whether I'm wearing nasal pillows or a full face mask but I haven't found that to be true. I haven't utilized everything this forum has to offer in the project of solving the mask leakage, so going back to FF masks may still be an option.

[palerider]

Hey thanks a lot, you guys (btw I am a woman).

shoulda filled out your profile

The RTs at the cpap agency say that the air pressure should be experienced the same whether I'm wearing nasal pillows or a full face mask but I haven't found that to be true. I haven't utilized everything this forum has to offer in the project of solving the mask leakage, so going back to FF masks may still be an option.

perception aside, pressure's the same. if you want to go back to the ffm, look into mask liners to tame the leaks.

[Pugsy]

Couple of ideas to try...try while awake with no pressure to try to go to sleep

1. Try the next size larger nasal pillow if you can. Believe it or not but that little bit of extra room in the next size up can make the exhale easier. It seems to let the air move better/easier...both inhale and exhale.

2. Try setting the minimum from 4 to 5 or even 6 so that Flex relief (try all the settings and not just the highest and choose which feels best, even off) can actually work its magic. Believe it or not but a starting point of 5 or 6 with appropriate exhale relief can actually be easier to work with than the setting of 4 with nothing.

A word about Flex relief...while the amount of relief or reduction is what we think about with Flex relief there's another part that we don't immediately think about but since I have used Flex relief I noticed that there's also a timing thing involved. Timing of the changes from inhale to exhale and that can be just as important as the amount of reduction so I always suggest that people try all the Flex settings (even off) to see what feels best to them in terms of their own natural respiration. I found that the setting of 3 made me feel like I was having to breathe too fast to get in tune with the machine. The setting of 1 to me felt like I was dragging up the rear and it was too slow but the setting of 2 was a perfect fit for my own respiration pattern. So try them all and choose what "feels" the best no matter what that setting ends up being. The idea is to have a respiration rhythm that is as close to your natural breathing as possible.

Do you know how to get into the menu where you can play with these settings? If you don't you can find the instructions here. If you don't have the clinical/provider manual for your machine go ahead and request it here (instructions down near the bottom of the page) as it has more information in it than the user manual does.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

[stephennic]

Hey thanks a lot, you guys (btw I am a woman).
Definitely it would be the case that I am starting out at the lowest possible pressure of 4, and so of course the pressure cannot drop any further! Yes it is at the outset, when I am first trying to go to sleep.

On one hand, I wonder about starting out at a higher pressure so that there is somewhere lower to drop to for the exhale, but then again, the 4 level is still difficult to exhale against. This may be a factor related to being a lifelong asthmatic, and although I don't have asthma symptoms right now, my lung functions are probably a lot weaker than the average.

I have found the air pressure much easier to tolerate with a nasal mask/full face mask, but there again I have the damned leakage problem. I was really hoping to make the nasal pillows work. The RTs at the cpap agency say that the air pressure should be experienced the same whether I'm wearing nasal pillows or a full face mask but I haven't found that to be true. I haven't utilized everything this forum has to offer in the project of solving the mask leakage, so going back to FF masks may still be an option.

I bought a dreamstation auto a few weeks ago and I find at such low pressure of 4 I felt starved of air. I have it set to at least 6 or 6.5 and its much better. Also I don't think exhale relief really works at around 4 but you do feel the affect more at 6 onwards. I use an amara view face mask. Also do you have it at the right setting for the mask?
All the best
Cheers
Steve

[emmagoldman44]

Palerider - those mask liners are definitely something I will check out, thanks. Will get to my profile soon

Pugsy - great suggestions. I did already move up from the small nasal pillows to the med and doubt my schnozz can take anything bigger
I'm going to try an increase in my start pressure to see if that helps - "believe it or not" definitely being the operative phrase here!

stephennic: Re "at such low pressure of 4 I felt starved of air." One thing I have learned from this forum is a lot of this is just specific to each person. For me, as I feel the amount of air rushing out of the tube at 4 cm, I know it is more air than I would normally be inhaling as part of a resting breath and that's enough for me. I tend to breathe slow, long breaths so a less intense airflow is normal for me anyway.

Here's my latest insight: one thing I couldn't understand is why I DID NOT have this problem with the PR System One. I mean, I didn't like the resistance against my exhale but I could live with it okay and go to sleep. Now I just discovered that tubing size affects the actual pressure coming out at the "patient end" of the tubing, and I am pretty sure that I had the larger size tubing, which according to the PR manual, brings down the actual pressure to 3.6 . So I used to have 3.6 actual pressure vs. 3. 8 for the smaller tubing that I now use with the Dreamstation.

I am going to discuss this with my cpap RT and see if I can try out the larger size tubing if there is any compatible with the Dreamstation.

This board is great

[palerider]

Palerider - those mask liners are definitely something I will check out, thanks.

they were a game changer for me when I was wearing a full face mask. the lady that runs padacheek.com is really nice and cares more about helping people than making a buck.

Here's my latest insight: one thing I couldn't understand is why I DID NOT have this problem with the PR System One. I mean, I didn't like the resistance against my exhale but I could live with it okay and go to sleep. Now I just discovered that tubing size affects the actual pressure coming out at the "patient end" of the tubing, and I am pretty sure that I had the larger size tubing, which according to the PR manual, brings down the actual pressure to 3.6 . So I used to have 3.6 actual pressure vs. 3. 8 for the smaller tubing that I now use with the Dreamstation.

there's a tubing setting. just make sure that it's appropriate for the tubing you're using. the machine adjusts pressure to compensate for the greater resistance in smaller tubing. if you use large tubing but have it set to slim, you'll end up with more pressure.

I bought a used machine, hooked up my hose, and thought it was defective, pressure seemed way too high, until I remembered I was using standard tubing but the default setting on the machine was for slim tubing... after changing that, it felt fine.

For me, as I feel the amount of air rushing out of the tube at 4 cm, I know it is more air than I would normally be inhaling as part of a resting breath....

this is a *common* mistake people make. they take the mask off, and there's all this huge amount of air blowing out of the mask, and they start freaking out. some engage in hyperbole about "gale force winds" "leaf blower" "blow the mask across the room" crap.

the *fact* is, the machine has a pressure sensor right at the outlet, it measures pressure typically in centimeters of water. ie, how much pressure it takes to push down that many centimeters of water. you can feel *exactly* how much pressure that is by sticking a straw in a glass of water, and blowing. four centimeters is slightly over 1/2 inch. so, stick a straw 1.5 inches in a glass of water, and blow.. if you got bubbles to come out, you've just blown harder than 4cm/h2o pressure.

now, as to that rush of air, like I said, the machine is set to create a specific pressure. pressure is the result of resistance to flow. when there's no resistance (or very little) like when your mask is off... the machine creates MORE flow, to try and get pressure. but there's no resistance, so the air just blows out, so the machine tries harder, spinning the fan faster, and faster, till it's at full speed, trying to make some pressure, pushing against nothing.... so you get a huge amount of flow with no pressure. it's like turning on the garden hose and letting all the water run out, it doesn't go very far, big flow, low pressure, but if you put your thumb over the end, the flow goes way down but the pressure goes up, and the water shoots a much longer distance.

as soon as you put your mask on, the machine senses the the increasing pressure, and slows the fan down. (it checks maybe a hundred times a second, maybe more, depending on the model.) it slows the fan down till there's only that very gentle 4cm/h2o of pressure, that you blew bubbles with. and none of it is blowing up your nose... where would it go? if it was actually blowing up your nose, you'd eventually explode! no, the air, and that gentle pressure, is just sitting there, until you do what you normally do, until you inhale, THEN air goes up your nose, into your lungs, giving you the oxygen you need to live. then you exhale and the air comes back out your nose, against that tiny bit of pressure... and flows out the vent holes in the mask.

[emmagoldman44]

Wow palerider, you rock! That explanation about the meaning of the cm of pressure totally made sense to me, I always wondered what exactly that referred to. So I just tried it out, and it did feel very close to breathing out against my 4 cm setting.
Can I get a continuing education unit for this?

For better or worse, for me it was okay to not understand the mechanism of air flow when I first started cpap, because the increased air blowing that happened as the tube is removed from the face caused me to feel reassured that I would have no trouble getting enough air to inhale though that long tube.

So here's my question, is there a way to get the machine to deliver me lower pressure than the 4 cm setting (3.8 actual), by either using the larger tube size or by monkeying with the settings some other way?

Thanks so much!

[palerider]

Wow palerider, you rock! That explanation about the meaning of the cm of pressure totally made sense to me, I always wondered what exactly that referred to. So I just tried it out, and it did feel very close to breathing out against my 4 cm setting.
Can I get a continuing education unit for this?

For better or worse, for me it was okay to not understand the mechanism of air flow when I first started cpap, because the increased air blowing that happened as the tube is removed from the face caused me to feel reassured that I would have no trouble getting enough air to inhale though that long tube.

So here's my question, is there a way to get the machine to deliver me lower pressure than the 4 cm setting (3.8 actual), by either using the larger tube size or by monkeying with the settings some other way?

Thanks so much!

not effectively, though you *could* set it for a normal tube and use a slimline... that would give you lower pressure when you breath in, further reducing the effectiveness of the treatment.

and I'd take those numbers you got with a grain of salt, unless you're sticking a digital manometer on the output and measuring it yourself (they're about 30$ on ebay).

my recommendation is that you just *use* the machine, you'll get used to that tiny pressure, and more, in much less time than you think, once you start using it. comments from people along the lines of "I thought all that pressure would kill me when I started, now I have to check to make sure it's even working!" are common.

[emmagoldman44]

Hmm, using a larger tube setting is something I should definitely try.

I appreciate your points about getting used to the pressure but, remember that I didn't have this problem at this same setting on my PR system one with the larger tube, and also, it has been 4 weeks now on my current machine and it hasn't gotten easier for me in the last few weeks.

Now, starting at a super low pressure - below 4 - could be just the thing if it would allow me to go to sleep alright, then it could ramp up to a higher pressure for the rest of the time. Fortunately, even when my average cpap pressure is only 5 - 5.5, my AHI is usually around 3, according to my daily report. Some nights, the pressure average is only 4.8 with an AHI of 2.5 So obviously I need a lot less pressure than some folks.

One factor in my low AHI success at a low pressure is probably that I additionally use a tongue retractor - I forget the brand name but it has the look of a pacifier and helps to keep my tongue out of the back of my throat. By itself however, it was inadequate.

[palerider]

Hmm, using a larger tube setting is something I should definitely try.

I appreciate your points about getting used to the pressure but, remember that I didn't have this problem at this same setting on my PR system one with the larger tube, and also, it has been 4 weeks now on my current machine and it hasn't gotten easier for me in the last few weeks.

perception is a fickle thing, also, you're older than you were then(though obviously not much), and probably in a bit worse health from untreated apnea. while these things are unlikely to be major, they do add up... there may also be other issues. the point is, how something feels "now" and memories of something in the past.... it's hard to objectively compare. do the best you can.

One factor in my low AHI success at a low pressure is probably that I additionally use a tongue retractor - I forget the brand name but it has the look of a pacifier and helps to keep my tongue out of the back of my throat. By itself however, it was inadequate.

that may be the most significant thing.

[sgcpapuser]

When I was testing the FF mask vs the Nasal mask at the doctor's, my initial impression is it seems easier to adapt to the pressure in a FF mask.

I too had some leakage issues, but they are usually solved once i made microadjustments as and when needed.

Now I'm trying out nasal pillows. Nasal pillows are easier IMHO since lesser of the face is covered. Its easier to scratch your nose when required. When ur nose itches, and u could not relieve the itch when u start to scratch plastic, it really turns u off at night.

Take ur time to get used to it. I used to find 4cm a bit too much to bear on the start, now I'm ok with 6cm after using it for 1 month