CPAP Functioning Problem

Ginim - I am trying to picture what you are describing…and from my guess, it might be a cpap pressure issue - not a default in the mechanics of the machine.

Can you tell me exactly which machine you are using? Brand / style and also is it a cpap or an autocpap and what are your pressure settings? Do you have ramp enabled? expiratory pressure relief enabled?

let me know, I may have some solutions for ya!
looking forward to hearing back…
tracy

I have the ResMed S9 and it's an auto CPAP. I do have the ramp enabled and expiratory pressure relief enabled as well. I don't know my pressure settings and whether or not I need to call my pulmonologist or CPAP provider. Would you know if it's possible to find my pressure setting on my machine myself? I checked the handbook, but it's of no use. It's very difficult to describe this issue. I tried explaining it to an Apria respiratory therapist, but was told I was hearing things. You can imagine my reluctance in having to call them to find my pressure settings. Thank you in advance for any help you might provide.

Hi again - here are my thoughts
You have an auto cpap - it is set using a high and low range. The machines has the ability to detect what you need at any given inhalation breath and it then delivers - the EPR is then set to cut back 1, 2 or 3 points lower to ease exhalation.

So depending on your sleep position and what stage sleep you are in, your machine may deliver higher pressures during the night and also, should you have any mask leak from changing sleep positions, this MAY cause the machine to detect an apnea and deliver a higher pressure. Sometimes when the pressure is a bit high, it can cause a puffing of the nostrils or cheeks - I think of it more as a sensation than a noise - but it could be a noise. I am not over sensitive to noises but some people are and this type of thing could cause arousal from sleep - such as in your case. So, when this happens, I would not turn off the machine - I doubt its a machine problem, I would guess that the delivery of a higher pressure at that breath might have awakened you.
So how do you fix this? Your machine has a data collection card which shows all usage of your machine. You should be taking machine in to Apria so they can download this info, and show it to you - and discuss your data. It will show minute by minute use - including mask leak and apnea episodes. I think you will get to the bottom of your issues sooner, if you are able to talk with the respiratory therapist at Apria with your data right there in front of you both.

When you are aroused in to wakefulness from the nostril puffing…do you recall what sleep position you were in? Remember that for most of us, back sleeping causes the greatest number of apnea episodes, so if you are waking on your back, you might consider breaking that habit and side or stomach sleeping. Remember too that if your arousals are caused from mask leaking - your mask fit and adjustment is DIFFERENT for side/stomach vs back sleeping. In otherwords, if when you first retire to sleep, you adjust your mask for side sleeping - THEN sometime during the night you roll to your back, chances are you will get mask leak - a sudden incurease in delivered air from the auto machine and if you are sensitive to noise or sensation - this might also be a reason for your awakenings.

Lastly - if Apria is not giving you the customer service and friendly hand holding you deserve to resolve these issues - ask for another resp therapist OR find another healthcare provider! You deserve the best in customer service -
let me know if any of this makes sense to you - I hope it will be helpful. Keep asking questions, I'm here for ya!
tracy

Hi Tracy-
Thank you once again for your detailed reply. I just received a copy of my sleep study and my pressure is set at 6. Is this high, moderate or low? And yes, this nostril puffing does seem to occur when I move although I am a side sleeper. However, while I'm lying there awake , it continues no matter how often I adjust the nose pillows. At one time, it continued for forty-five minutes, hence my reason for turning the machine off for a minute or so before turning it back on. Unfortunately, when calling Apria, one is only allowed to speak to whomever happens to be there at that time. I did bring the machine in, the therapist checked the chip and said it was fine and that I was imagining it. I actually have an appointment with a new pulmonologist in hopes of getting some help with my accompanying insomnia-something I've dealt with for many years. One last thing-according to the doctor's notes, he felt that I didn't tolerate CPAP well and might need a desensitization program or alternate therapy. He never mentioned that to me! I thought I did very well for the first ten months when the nostril puffing never occurred or at least, didn't wake me up. My apologies for how fragmented this reply is! In summary, is a pressure setting of 6 high and is it possible that I'll never return to the success I had initially? You can't begin to imagine how much your support means-thank you again.

A desensitization program probably means CBT - cognitive behavioral therapy - of which I am a big supporter of. The psychologists who provide this are sleep trained. Depending on your needs, it could mean one session or possibly more. In your case, since you also have an insomnia issue it might be more. Is your insomnia related to sleep onset? Or is it more of an issue of maintaining sleep all through the night. If the latter…it could be apnea related and a CBT doc might be very helpful.
Don't give up, you still have many options - but being surrounded by a medical team that really wants to help you achieve a successful therapy is KEY - make sure you let the new pulmonologist know that you WANT to make this all work.
hugs
tracy

Here is a link to learn more about CBT http://www.sleepconnect.com/sleep-disorder-ar...

Hello Tracy, I cant sleep through the night and when morning, its hard for me to get up. I have tried hot green tea, soup, but seems like since im try n to get sleepy by eating have caused me to gain weight. So its really a struggle for me to sleep.

so I know you had the home study - are you now on cpap? if so, how is that going?
tracy

Your auto cpap has the ability to deliver pressure between 4 and 20. 6 is a very low pressure. Remember that an auto is preset by prescription to deliver within a RANGE - so your machine should be set at 2 pressures. My guess is that 6 is your low range. during the titration part of your sleep study, you were trialed on different pressures. I am guessing, but its possible that 6 might have been your average pressure, yet it might have been noted that you needed higher pressures during deep REM sleep or when sleeping in the supine position ( on your back) so this MIGHT be why you were prescribed autocpap. Your downloaded data would provide the actual pressures delivered and at what times during the night. Often a patient is sent home with an autocpap to better determine one best cpap setting.

Also know that ones cpap pressure is not indicitive of sleep apnea severity…meaning one could have severe apnea and be on cpap at pressure of 15 or 6. Each of us needs a distinct air pressure to keep the airway blown open and/or the tongue held down all with the goal of keeping the airway unobstructed.

There is a solution for you to make a success of CPAP! Much has to do with patience AND working closely with your medical professional team to use all tools available to you properly.
Here is a link to an article I just wrote about attitude and expectations.
http://www.sleepconnect.com/sleep-disorder-ar...

I am not suggesting you have a poor attitude, in fact, you seem very proactive and wanting to make it work. The article may be helpful to you as an overview.

I am really happy to hear you have an appt with a new pulmonolgist - make sure you tell him all, and especially about the flip attitude of Apria. You may want to visit another cpap supplier, discuss with him.

Hi Tracy…I finally met with my new pulmonologist. He feels my nose puffing issue is the result of congestion and suggested I try Afrin just before bed. Since I've had a bad reaction all my life to nasal sprays, I decided to try Clariton with much success thus far. He also felt Ambien CR was a better choice for my insomnia as it has a time release aspect. As a result, I've been able to sleep approximately five to six hours each night. Unfortunately, we were so involved in our discussion that I forgot to mention my problems with Apria. I'm seeing him again August and will put Apria at the top of my priority list. I do have another question, though. How often should the microchip be checked each year? Mine hasn't been checked since early December. Upon reflection, I realized there was no rhyme or reason as to how often Apria asked for it. Thanks again for all your support and help. Ginim

the data that is downloaded on our machines is used as a tool for the doctor and cpap provider to help you become compliant on cpap. it shows usage, snoring, links etc. so if a patient is struggling, checking the data often is one way of helping resolve certain issues. checking that data depends on how the patient is doing, so in your case, i think it should be checked often!
btw, I see I did not answer a previous question from you about pressure - 6 is VERY LOW. but since you are on autocpap, it may in fact be delivering a higher pressure…this again, is something your data would show and WHY YOU should have that data checked- to know for sure what pressures you are actually receiving! example, it may show you receive lower pressures in the early hours, but higher when you reach deep REM sleep or when you change positions…
tracy