New user advice greatly appreciated

[BungleBear]

Morning all,

I was diagnosed with OSA with AHI of 42.8 some months ago. To cut a long story short, I became frustrated at the wait for a NHS CPAP machine I have just bought the Resmed Airsense 10 AutoCpap machine from Intus (great service by the way!).

Friday night was the first night and in some respects it was far too easy, no leaks, it wasn't too powerful and my machine showed a AHI of 0.7, pressure was 15, however last night was a pain, no matter what I did I couldn't get a seal when running the leak test on the machine - always a red sad face. Eventually (not sure how, think it was literally holding the mask on my face for a few minutes before letting go, but it worked), I got a green face and slept. I woke up to a AHI of 1.7 so as I believe anything less than 5 is good I am happy with that, here are where the questions/request for advice start.

• The network bars on my device are full but always grey, they don't go green(is the device faulty), there are no signal strength issues and it is connected to Vodafone, I have created a MyAir account, how do I get the bars to go green so I can access MyAir?
• On the first night, although the pressure got up to 15, it didn't really blow my face off as I expected. Is there an issue?
• After struggling to get a seal last night, when I eventually did, I then was conscious of my breathing being noisy (inhale only I think) on the tube next to me. Is that normal? it may have been like that the night before and I didn't recognise it, presumably if there was something wrong the setup/tube - the machine would tell me?
• My pressure is showing 14.9 after two nights - that seems high to me as its not having the impact on me I expected (see blowing face comment above) - is my pressure too high, do I need to drop it based on the fact my AHI is less than 5?
• If I have EPR on, will that aid the user experience and help me to settle down quicker, but still deliver the right amount of air to prevent apneas (I had read that reduces the overall pressure by the setting on the EPR), I wouldn't want there to be an issue?

Many thanks in advance.

Paul

[Reno]

Hi Paul,

I do see what you mean, 15cmH²O seems like a lot. I do vaguely think ResMed algorithm is notorious of ramping the pressure up too high on auto. I’m not sure though.

Masks are so unique. Each one has its quirks, in my opinion. I don’t know what mask you are using but here’s an example of the quirks on the AirTouch mask. Make sure your mask and face are clean. That can help. You could also consider mask liners. Biggest help for me, though, was reading the mask manual and making sure it was fitted properly.

Never used ResMed machines so I’m no help there, but intus should pop by tomorrow, and may be able to help.

If your AHI is really low, it doesn’t mean you need to change the pressure. But if it’s low and you want save power when traveling or current pressure is causing issues, it does give you wiggle room to look into lowering it.

Some people like EPR, but I cannot stand it. EPR drops the pressure when the machine senses you’re exhaling. Usually this is no more than a 3cmH²O reduction, depending on your settings. For me with EPR on, it takes too long to get used to the pressure as it changes depending on whether you inhale or exhale. For me, with EPR off, I cannot tell if the machine is turned on after 30 seconds. I literally need to put me hand in front of the vent to see if its on. (And mine is locked at 12cmH²O) You need to do what makes you feel the most comfortable so you stick with your therapy.

The results of your therapy so far look excellent. Keep up the good work.

- Reno

[Kelly @ Intus]

Good Morning,

Thank you for your post.

In response to your questions

1. Connect ResMed Machine to Myair website - for this you would need to contact Resmed directly

2. Pressure - The auto CPAP machines are set with a lower pressure of 4cmh20 and an upper pressure of 20cmh20. You need to pop your mask on and then turn the machine on. The machine will start at a pressure of 4cmh20 and stay at this pressure until you are asleep. One you are asleep the pressure will increase an decrease as and when you need it. So you do not need to do anything apart from use the equipment and go to sleep. The machine does all the work for you. Everyone's expectation of high pressure can different, depending upon what you are used to. If you turn the machine on without the mask on your face, this will give you high pressure as there is no resistance. Some people require a high pressure for their CPAP therapy than others. It is purely dependant upon the individual using the CPAP equipment

3. conscious of my breathing being noisy - you are more aware of the noise when using a CPAP machine as it will sound and feel abit different for a while until you get use to them.

4. My pressure is showing 14.9 after two nights - as per my comments above, everyone's CPAP therapy requirements are different. Some people require a higher pressure than others during their CPAP therapy. As long as the requirement is comfortably within the pressure range, then this is fine.

5. AHI - You mentioned your AHI was 42.8 per hour before using the CPAP machine. The target AHI with a CPAP machine is an AHI of 5 of under. This is achievable, the time frame it takes depends upon the individual and the equipment being used. If you AHI is has decreased from 42.8 events per hour to anywhere need 5 events per hour or under then this show that the CPAP machine is working well for you.

6. EPR - This is a personal preference so may be something that you can try for a few nights to see how you get on with and can adjust if required. The ResMed AirSense 10 has four EPR settings: 0-3. At 0, pressure relief is turned off. At 3, air pressure is reduced by 3 cm H2O. For example, if a patient’s CPAP is set to 10 cm H2O with an EPR of 3, the air pressure during exhale is lowered to 7 cm H2O. Once an inhale is detected, air pressure increases back to 10.

I would give yourself abit of time to adjust to using the CPAP machine and mask. Once you have the MyAir account linked to your machine, then you can review your CPAP therapy data and send us a copy to look at should you have any queries.

The idea is to reduce your AHI and keep any mask leaks to a minimal. Try using your equipment for a month and see how you get on.

If you have any queries or if we can be of any assistance then please either message me on here or email us at [email protected].

Kelly

[Reno]

Kelly did a much better job explaining EPR than me.

Some people require a higher pressure than others during their CPAP therapy. As long as the requirement is comfortably within the pressure range, then this is fine.

This is true, but the majority of people don’t need to go above 10 and there could be reasons to reduce pressure, as long as it’s safe to do so. Comfort is one, and also lower pressure means it would be less likely to leak.

Auto machines are very good, but not perfect. My Dreamstation auto would go as high as 16 on some nights, most nights had a high of 14, but now I’m on a fixed pressure of 12. On auto I went 1-5 AHI a night (average around 3.2), but on fixed it’s 2.5-3.0. My AHI has never gone above 3 at the fixed 12cmH₂O, despite the auto algorithm thinking it should be higher.

Just because your machine went that high doesn’t mean it needed to be that high.

But…

I don’t see a need to change the pressure unless you have a good reason to do so. If there are benefits to a lower pressure in your circumstances, you could try gradually reducing it night-by-night and watch out that your AHI doesn’t go too high.

[BungleBear]

Thank you, greatly appreciate the responses. I think it was the Amara view mask, now have an Airfit F20 and it feels much better. I don't seem to have an issue with getting a seal like the other. I have started to lower my maximum pressure exactly as Reno suggested, it helps make it more comfortable and less leaks. I am still under one now for my AHI so it's working, I am going to keep lowering it until I see what works therapeutically at the lowest pressure.

Thanks again, will keep you posted but hasten to add, the change in mask has already made me question whether the mask and machine were switched on, so I must be getting comfortable already?

Paul.

[Kelly @ Intus]

Good Afternoon

Thank you for your post. I am pleased the ResMed Airfit F20 mask is working well for you, and that you are getting better nights.

Please do let us know how you get on.

Take Care.

Kelly

[Reno]

That’s fantastic news! Glad the airfit is working for you and an AHI under 1 is such a good result.

Keep up the good work!

- Reno

[Mark]

Hi, have just had my diagnosis through a private company and am about to circumnavigate the NHS waiting list and purchase my first machine, mask etc.... I have a beard am a side and back sleeper and am not really sure if I'm a mouth or nose breather.
If anyone has any advice/experience I'd really love your help.
Mark

[Reno]

Firstly, don’t buy a Philips machine. The masks are fine, though and I actually quite like the dreamwear collection.

If you’ve never done CPAP, you will need to buy an auto machine. Biggest players in CPAP equipment are Philips (which has a safety notice on at the moment) and ResMed. The other players are DeVilbiss, which I personally like a lot but their app is a little buggy, and Fisher&Paykel, which I know nothing about.

Secondly, most people aren’t mouth breathers, even those that claim they are. This is usually because untreated OSA means you need to gasp to get the extra oxygen you need. When on CPAP, the need to breath through your mouth goes away for most people. The only way you will know if you are a mouth breather is to use a nasal mask and it doesn’t work. because of this, a lot of private buyers buy a full face mask to “play it safe” as they don’t want any further expenses if the chosen mask doesn’t work out.

Gold standard of masks is nasal pillow. They leak the least and because the seal is under the nostrils and not on your face, fantastic for beards, assuming you don’t breath through your mouth. Your nostrils may feel a little sore for the first few nights, though, until your skin toughens up.

Next is the nasal mask (not to be confused with nasal pillow) which also is good at not leaking, but not as good as the nasal pillows. These may be more comfortable than nasal pillows especially at higher pressures or if your nostrils are sensitive.

The worst mask is the orinasal/full face mask. It leaks so easily, can be the most irritant and leaks would be worse with a beard. You should use this mask if you are a mouth breather. There are beard users that use this style of mask. They often use mask liners to help get a better seal. Resmed do have a full face mask with a kind of memory foam pillow which some beard users like. I’m pretty sure the foam need replacing each month, so probably a more expensive option. I confuse the Resmed masks up, but I think the foam one is the ResMed Airtouch. Could be wrong though.

Most people that use nasal or nasal pillow masks like to also have a full face mask as a spare for when they’re ill. You cant use the nasal kind if you’re congested. Another reason why some opt for full face.

What did I do?

I bought a nasal pillow mask because I had a beard. I decided if I did turn out to be a mouth breather, I’d try a boil and bite mouth guard to encourage my mouth to stay closed or use a chin strap before moving to a full face mask. (these are techniques even full face mask users sometimes need to do as opening the mouth too wide will also cause large leaks ) Luckily, I don’t open my mouth enough during my sleep to impact my therapy, so didn’t need to buy them. I did later on buy a full face mask to have on hand in case I get a cold/flu, but I use the nasal pillow every night.

- Reno

[Mark]

Thanks Reno, I'm pretty in the dark so your info is gold dust to me. Will keep posting my progress as and when they happen

[Kelly @ Intus]

Good Morning,

If you would like to email us a copy of your sleep test results at [email protected], then we would happily walk you through the different CPAP machines and masks available to help you purchase the right ones for you to get you started.

Kelly