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I was issued with my machine and started using it in September this year, I've just had my review, and it looks like I'm stuck with it for a while, I'm currently messing with a few different masks, I have the normal full face mask, which I'm iffy about, main use seems to be the Mirage FX nasal, but I'm having problems with the machine or mask, not sure yet, and I have just got the N20 nasal mask which has a truly awful head mounting arrangement, I think the part which goes over the nose is good, but the rest is like a bridle and no good if you like to sleep on your side.

My reason for coming on here is I am getting conflicting info from Resmed, and also my sleep clinic, which is in St James Hospital in Leeds, West Yorkshire. The problem I have is the machine ramps up the air pressure and this wakes me up so defeating the purpose, Resmed say this should not happen, the clinic says it is a response to the mask leaking, which if it was I'd accept, but once awoken I press the mask onto my face, but the pressure does not drop, I have to turn off the machine for a few minutes (go to loo) then fire it up again, then it's fine again, I noticed that when turned off in the morning that the machine carries on blowing at a reduced pressure for several hours, Resmed said this should not happen, I forgot to mention this at the clinic.

I'm unsure how to proceed so any advice will be welcome.

Cheers Kev.

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Welcome Kev.  It's not unusual to get different advice which can cause more confusion.

Firstly, I'd comment about the fact you've had both a full face mask and a nasal one.  If you're a mouth breather and you're using a nasal mask, this could be causing the machine to ramp up if air is escaping from your mouth.  If you are a mouth breather during sleep then you need to revert back to a full face mask or use a chin strap to keep your mouth closed.

St James' Hospital are very good, and Resmed are a reputable manufacturer, but still differing advice can be offered.  The clinic are correct in that mask leaks could be causing you to wake up, which coincides with the pressure raising due to the mask leak.  However, there are also people who get disturbed sleep without mask leaks, just when the pressure starts to raise to treat their apnoeas.  Auto pressures are not for everyone - sometimes people get better therapy on fixed CPAP pressures.

Resmed are correct that the machine shouldn't continue to blow for several hours, so I'd book in an appointment with your clinic to find out what's going on and to discuss whether you need a chin strap or use a full face one.  Once you're getting good therapy things will start to improve.

Thanks Kath, that all makes sense to me, well it will do when I've read it a few more times :) :)

During the day I breathe through my nose, so I assume the same at night, so I shall perhaps give the full face one another try for a few days, although I find it cumbersome to wear.

As for Auto, I'm sufficiently competent to change any of the Resmeds settings if need be,it has a warmer which I need to get to grips with, only had that a week, not getting quite as much dry mouth, but would I still get a dry mouth if it remained closed throughout the night?

CheersKev

Yes see how it goes Kev, as if you can nasal breathe at night with a nasal mask it's certainly healthier for us.  Unfortunately, I can't and need a full face mask.  If you've got the humidifier on and you're not opening your mouth you should find the dry mouth eases, although there are some medical conditions and some medications that can cause dry mouth as well.  If you're still struggling the Xylimelts are a great solution http://www.hope2sleep.co.uk/xylimelts-dry-mouth-discs.html



Kev Behr said:

Thanks Kath, that all makes sense to me, well it will do when I've read it a few more times :) :)

During the day I breathe through my nose, so I assume the same at night, so I shall perhaps give the full face one another try for a few days, although I find it cumbersome to wear.

As for Auto, I'm sufficiently competent to change any of the Resmeds settings if need be,it has a warmer which I need to get to grips with, only had that a week, not getting quite as much dry mouth, but would I still get a dry mouth if it remained closed throughout the night?

CheersKev

Hi Kev,

You didn't say what machine you have.

The ResMed machines have an Smart Start function that will run if you do not turn it off at the mains.

If the pressure rise affects your sleep, you can change it to a soft response which raises the pressure slower, but this will affect treatment slightly.  You might not notice though, but it might stop it waking you up.  It is in the Clinicians settings.

You can also disable Smart Start in there as well.  Not sure if you have an S9, but it uses much the same software, so in theory it should have the same settings.

The Airsense10 comes in a few forms, but some of the controls are still there.

The clinics do not like you adjusting the settings and they will know if you do, however, sometimes they will let you do it if you know what you are doing.  Turn Smart Start OFF and put it onto SOFT if the machine wakens you up when it rises in pressure.  It is also better if your low pressure is 90% of your needs, or taken nearer the pressure the machine gets up to.

It is easier if you can read your data yourself to know what is going on.  Sleepyhead is the best for this, but you do need to get used to it.  Be very careful if you do this not to delete your data, it is easy done.  Clinics also do not like you doing this, but if you want to see what is going on you have no option as the clinic will not show you.

Once you get used to it you can read the data and tweak the machine to give you the best treatment.

I just got a new machine and they didn't know what setting to set it at, so they set it at 10 and left it wide open and on APAP, they were supposed to set it on EPR, but only set it for the ramp time, then they said they would set it to ramp (I hate this) so I am glad they didn't do this either.  I said to them that I would adjust the machine later to a storm of protest.

I only see them every 5 years, so a lot can happen between times, so I want to keep an eye on things.

If it is an Airsense10 the manual has all the instructions in it, if you don't have the full manual you can download it:

http://www.resmed.com/assets/documents/product/airsense_10_autoset/...

If it is an S9 you have the manual is here: 

https://www.resmed.com/ja-jp/dam/documents/products/machine/s9-seri...

Both have the clinicians setup instructions in them and are freely available on the Internet.

If it is any other machine just google for the clinicians manual.

A climate line I am told will help a lot more with dryness.  I have not used one, but everyone I ave spoken to that used one has a great belief in them.  Even with a chin strap, air can escape through your lips and your mouth will dry out, plus, the chin straps stretch a bit and it is still possible to open your mouth with a chin strap on, try it, no matter how tight it is you can still open your mouth.

Hi, thanks, I don't think I breathe through my mouth much, but I'm asleep so who knows :) :) 

I have been through and changed a few setting (photos of original first of course) nothing seems to help me, it becomes very noisy when it ramps up even on the auto setting, it is ultra quiet where we live.

Thanks for the manual URL, always prefer the PDF to paper, easier to search for things.

Machine is the airsense 10 

These machines should not be noisy at all, my one is so quiet, I wake up wondering if it is still running!

The other half complains it is far to quiet!

It is not that you might be breathing through your mouth, it is tha air under pressure escaping out your mouth, it does not take much and it starts to dry out your moth, then it is much harder to keep the air from leaking past your lips.  I have woke up and tried to stop this happening, had to give up and take a sip of water, to add moisture, then I can stop it leaking.  Even with a chin strap it can still leak.

Also make sure you have EPR on, it does help some people get a seconds relief from constant pressure when breathing out.

That looks like a CPAP and not an Auto machine?

The dry mouth seems better with the reservoir, if you look at the right hand side you can see what it is, mine is the same, and yes it is a CPAP.

What is EPR please.

And is there a way to deregister the machine from Resmed, I don;t care for the way they score you, perfer Sleepyheads detail.

Kev

EPR = Exhale Pressure Relief.

If you want some relief when breathing out, the higher the number the more the machine drops pressure when you breath out.  It helps you to breath out against the pressure of the air coming the other way when you breath out.

Though this is good if you are not used to breathing out against the pressure of the machine, it does sometimes affect the fit of the mack due to the drop of pressure, however, it can also affect the results of treatment (slightly) though I wouldn't worry about it affecting this, if you need it you need it.  It takes the machine time to build the pressure up when you breathe in again, thought it is only dropping it one pressure point for every number.  It does affect your treatment, the guys on another forum that are well up on Sleepyhead Software say to increase the normal pressure it you use it.  But I have found it affects it so little under normal use I would ignore it unless you get more AHIs if using it.

To find out how you are doing with your therapy, press both the big round knob and the long one at the bottom for a few seconds, the display will change, go to Sleep Report, click the big round knob and turn the knob to go down to see what AHIs, Centrals, etc you are having. (Note what setting it is on (1 Month, 6 Months, 1 Year, remember this as you will have to return it to this setting) then select 1 day.  It will now tell you how you did last night.  Take a note of Ahi and Centrals etc, now return it to what setting it was at. i.e. 1 Month, 1 Year etc.

If your machine has a data card in it you can Download Sleepyhead and read the data if you really want to see how well you are doing, you can zoom into see every breath if you want.  You can fine tune your treatment using Sleepyhead, however, you need to know what you are doing, but with some advice you can try better settings and see how it affects your treatment.  You should note that if you have an NHS machine they will not be amused at changing settings.

However, if you have your own machine and treated by a private clinic there is nothing stopping you.

But please ask advice form others that have fine tuned their equipment.  At this point, I should tell you that by doing this you could make things a lot worse and by changing it you might even come into bother with DVLA as you might be breaking the conditions of getting your license back.

It wouldn't stop me as I could show I had improved things by keeping the graphs to show treatment had improved.

What the Americans have found however, is that a 0.0 AHI is not always the best sleep you get and not always results in you feeling the best next day.  However, you should be aiming to get it as low as you can.

I got a new machine just lately, it was set to 10 to 20 (wide open) it could go up to 20 if it wanted to. however, even with leaks when I first got it (I got a new mask as well) it didn't go up to 20, it would shot up trying to maintain pressure (there is a difference between pressure and flow (though they are linked).  It detected that the pressure was not being held, it also detected that the flow and leak rate had gone up, so it raised the flow to see if it could stop the leak, then when it couldn't it dropped back down to try to maintain some sort of pressure near what it had been at.  I had a red angry face in the morning, but the mask was still just in contact with my face, but air was going everywhere.  After a few nights I got to grips with the new mask (Nasal Pillows and a Chin Strap) and now I am getting 0.0 most nights, but not all, sometimes I get a 0.1 Ahi which is still very good.  When I first started with this new set up I had a central as well, which still shows up in the total results, but this is what the machine thought I was having when the mask came adrift, it could not detect me breathing so it said I was not breathing, which of course I was.

EPR is just the machine dropping the pressure when you breath out on a normal CPAP/APAP machine, it just helps you breath out against the pressure if you are not used to it.

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