Replies to This Discussion

Permalink Reply by lia deneau on March 30, 2010 at 11:44am

Jim,
if you are still snoring with your cpap and its up to 20cmH20 at times you most likely need higher pressures, but with mask blowouts and over inflation and most likely some issues with gas... you may need bipap... perhaps a retitration is needed

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Permalink Reply by Sam Berger on March 30, 2010 at 12:18pm

Thanks Mary. I use the FitLife as well, but not the one covering the eyes and perhaps your advice on the ear plugs may help me as well. I typically use the Hybrid with nasal pillows, but once they start to irritate my nose, I switch to the other for a while. Not as comfortable, but an alternative.

Sammy

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Permalink Reply by Carl on March 30, 2010 at 2:03pm

Pat,

You ask a good question. I seriously doubt you will get a reasonable answer because they were made to pretty much take care of all circumstances. Once they work, they work. You really wouldn't NEED to go back for followup visits unless something had changed. These guys, like many medical people, make their money on visits that are quick, easy, and pretty much just "checkoff" visits. When they have tough cases they actually have to sit, think, and do some research and they don't like doing that.

I have also asked.. why do these medical equipment company RENT you the equipment for such a LONG period before you "purchase" it (with insurance money). For example - an O2 Concentrator (typical 1-6lpm unit) rents for between $300-400 a month. They want you to rent one for 10 (TEN) months before you purchase one. Funny thing is - these units really only cost about $700 to purchase, and that's for a Respironics with a 5 yr warranty - cheaper ones can be had for as little as $425... so you can see the scam they have going.

There are lots of medical things that are like this if you look carefully. I'm actually fairly surprised that the insurance companies let them get away with this.

Carl

Patricia A Davis said:

I've only been using the CPAP for two months but what you have is what I had, blowing so much air it blew the mask off my face, nearly. I went back and talked to the store where I got mine and she reset it. Mine was set at 5 and then at 45 minutes ramped up to 18. Then she changed it to go from 5 to 14. Using the ramp button, I was constantly ramping it back to 5. That didn't help that much either, so I knew that there is a "titration" CPAP and you can get it with heated humidity so I asked if I could get that and I'd be willing to pay for it out of pocket. Well, they actually switched it out for me and now I have the auto-matic titration where you get only the amount of air that you need at the moment you need it.

The funny part about it was that I thought I was getting too much air but as it turns out, I actually get that higher number of 18.9 several times throughout the night for for a duration of about 1 minute or less. Sometimes I wake up during the night and look at the pressure and it's only 7 or 8.9 or 11 and one time I saw 18.1.

If you haven't had a sleep study repeated since you've been on it, you might want to have that done or ask for the "auto-titration" CPAP. Losing or gaining weight can change your needed pressure amount too.

I don't know why they don't just make them ALL auto-matic. Seems to me it would beneftit the patient a lot more.

Hope this will help you.

Pat

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Permalink Reply by RD on March 30, 2010 at 3:05pm

Howdy,
When I first started using my mask (quattro II with a ResMed Elite II machine, set at 14lbs/cm) I had the same issue with snoring in the mask. What I've reasoned is that the ramp time took too long and that I was falling asleep before I reached my prescribed pressure. As I got comfortable with my system, the ramp times became less until I reached 5-minutes. Now it's all easy. Occassionally, I do get 'high pressure' leaks on the mask. I turn wrong, I lost 3#s last week and now my cheeks aren't as plump, I don't know. What I did find was a product that is helping me reduce the number of leaks. This may be bad ju-ju but the name of the product is REMZZZ. It's essentially a gasket I place between my skin and the silicon seal of the mask. I think it helps because it helps to fill in those gaps caused by a flexible, unevenly shaped face and a rigid, non-conforming, flat mask. I've even been able to lighten up on my mask harness a bit which makes for an even more comfortable wear. So that works for me .. check their website to see if they still have their free trial offer going on. If it works for you -- Masel Tov!

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Permalink Reply by amott1973 on March 30, 2010 at 11:04pm

Hi,
I was having a similar problem with snoring into my mask and starting to feel crappy again during the day. This was last spring. After a lot of troubleshooting and a re-titration (that was screwed up because I was sleeping with my head elevated at the titration) I found that my pressure needed to be increased as I'd gained a good 23 lbs since my last titration. Once I bumped it up from a 10 to a 12 I stopped snoring and was able to sleep again. So if you've had a weight change, maybe you need a new titration. (Just don't do it propped up! My titration came back as needing a pressure of 8, which I did try, but was waaayyy too low for normal sleep. Apparently I only need 8 if reclining, but 12 if lying down.)

Now, I suppose aging could also do things that would change your pressure needs, but I'm blaming mine on weight. ;)

Here's the thing though, I don't have an APAP, just a CPAP, so it blows at a constant pressure. It sounds like yours is ramping up and up when you snore and I have heard that when a pressure is too high for you it can cause apneas too (hence me giving the pressure of 8 a try, just in case). So maybe it ramps up too high, and then you're still having apneas due to too high a pressure and it maxes out. Just an idea. I haven't had an APAP myself.

I would say a trip to your sleep doc is in order. Maybe a new titration too. That way you can be all hooked up to their machines with your settings and they can see what's really going on. Might just be that your range needs adjusting.

Oh, and I'm guessing your mask isn't really 2 years old, but if it is, or if you're due for a new one, do get one! I'm thinking of marking my computer calendar with the dates I need to ask for new supplies. I could have a lot more masks and stuff if I'd just ASK! But I tend to forget.

Good luck!

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Permalink Reply by Candice Craig on March 31, 2010 at 2:10pm

I am a Respiratory Therapist.
The first thing I want to know is, when was the last time you changed out your mask. If it has been over a year. This could be the biggest issue. Cushions on the mask wear quickly and need to be replaced at least once every 3-6 months. Most insurances will allow you to replace the cushion once per month (headgear every 6 mo., filters monthly, mask frame every 3 mo., tubing every 3 mo.). Leakage in mask will also cause the machine to give a higher than usual or needed pressure. This leakage disrupts the flow that the machine is trying to deliver to you. Office visits are necessary usually when symptoms for OSA return (daytime sleepiness, fatigue, restlessness, snoring returning).

Also, when you are sleeping on your back -- the airway is more obstructed than when you are on your side (this is why snoring is worse when sleeping on the back). Most physicians will encourage side sleeping to prevent the airway from complete closure. In your case, it does not matter, because the machine will automatically adjust to any changes in the airway.

So......to sum everything up. You need a new mask :)

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Permalink Reply by Carl on March 31, 2010 at 2:43pm

Candice,

Can you provide a reference for your statement from a credible source, such as a manufacturer's web page, document, etc.

"Leakage in mask will also cause the machine to give a higher than usual or needed pressure. This leakage disrupts the flow that the machine is trying to deliver to you."

The reason I ask is that the first sentence makes absolutely no sense. Leakage should cause the pressure in the mask to be lower than the set point - I see absolutely no way for it to make it higher. A GOOD explanation is needed here - not one with any hand waving, but one that shows a real master of how the CPAP device actually works. And I also fail to see how "This leakage disrupts the flow that the machine is trying to deliver to you." It may allow some of the air to leak OUT of the mask, but AFAIK, it certainly does not DISRUPT the flow. Please explain this as well - in detail.

I am curious if anyone knows the answer to this question... How exactly is a CPAP Titration performed? I am very familiar with how a titration is performed when it refers to a chemical titration.

Carl

Candice Craig said:

I am a Respiratory Therapist.
The first thing I want to know is, when was the last time you changed out your mask. If it has been over a year. This could be the biggest issue. Cushions on the mask wear quickly and need to be replaced at least once every 3-6 months. Most insurances will allow you to replace the cushion once per month (headgear every 6 mo., filters monthly, mask frame every 3 mo., tubing every 3 mo.). Leakage in mask will also cause the machine to give a higher than usual or needed pressure. This leakage disrupts the flow that the machine is trying to deliver to you. Office visits are necessary usually when symptoms for OSA return (daytime sleepiness, fatigue, restlessness, snoring returning). Also, when you are sleeping on your back -- the airway is more obstructed than when you are on your side (this is why snoring is worse when sleeping on the back). Most physicians will encourage side sleeping to prevent the airway from complete closure. In your case, it does not matter, because the machine will automatically adjust to any changes in the airway.

So......to sum everything up. You need a new mask :)

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Permalink Reply by Rose Marie Holt on March 31, 2010 at 3:01pm

I have a simple mask. The machine delivers a flow to give a certain pressure. If the mask leaks the pressure goes down. There has to be a pressure regulator of some type to maintain a pressure despite leaks. This would keep the pressure the same (as long as the machine could deliver it) but increase the flow. It wouldnt INCREASE the pressure. I dont know if fancier masks have pressure regulation. As far as I can tell my simple set up doesnt adjust the flow for leaks. It presumes a seal. So if I have a leak I dont get increased flow despite decreased pressure. Unless I increase the "pressure" on the machine.

Cleaning the silicone seal really makes a difference for me - the remZZZ might also help. Good tip about the ear plug silicone "patch."

As a fellow chemist I believe the reference is to another sleep test with mask and pressure experiments to see if your settings are different.

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Permalink Reply by Kristen on March 31, 2010 at 9:11pm

Hi Carl.
All machines compensate for small leaks (i.e. minor mask leaks), meaning the CPAP pressure INCREASES to compensate for the leak the machine is sensing. Newer machines will show you a 7 day average leak in your menu, depending on the machine you have. Any leak <30 lpm is OK (<10 lpm is optimal, but pretty rare with anyone that moves at night! lol ). Any user manual provided with your machine should (SHOULD!, not will) inform the user of acceptable leak values. Or... Google it, or look at your machine's manufacturer's website. But, don't take your leak value as gospel! If you get up at night to go to the bathroom and leave your machine on, this will affect leak values!

You can test this "increased pressure based on leak" by turning your machine on and not being hooked up to it. You may notice that the air is blowing significantly more than if you were all hooked up and wearing it. This is audible proof that the machine is trying to "make up" for the leak. Of course, it can't, not with that large a leak, but with small ones - like minor mask leaks - it's capable of making up the difference.

A CPAP titration is done as follows, (very simply put): Regular PSG hook-up, of course. After the patient falls asleep at lowest pap pressure tolerated (no lower than 4 cmH2O), the pressure is increased by 1-2 cmH2O, approx. every 1/2 hour or so, until respiratory events are eliminated - with the exception of mild snoring, in some cases. For BiPAP titrations, the EPAP is used to eliminate obstructive apneas, IPAP to eliminate all other obstructive events/ oxygen desaturations. Remember - VERY simply put, but mostly in English, I think :)






Can you provide a reference for your statement from a credible source, such as a manufacturer's web page, document, etc.
"Leakage in mask will also cause the machine to give a higher than usual or needed pressure. This leakage disrupts the flow that the machine is trying to deliver to you."

The reason I ask is that the first sentence makes absolutely no sense. Leakage should cause the pressure in the mask to be lower than the set point - I see absolutely no way for it to make it higher. A GOOD explanation is needed here - not one with any hand waving, but one that shows a real master of how the CPAP device actually works. And I also fail to see how "This leakage disrupts the flow that the machine is trying to deliver to you." It may allow some of the air to leak OUT of the mask, but AFAIK, it certainly does not DISRUPT the flow. Please explain this as well - in detail.

I am curious if anyone knows the answer to this question... How exactly is a CPAP Titration performed? I am very familiar with how a titration is performed when it refers to a chemical titration.

Carl

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