At the 3 week mark with some questions

[courtney123]

Hi folks -

I got my first CPAP machine 3 weeks ago and then swapped for a better data capable one 2 weeks ago.
I've got just enough time on CPAP to have some questions about the way forward. None earth-shaking, just curious.

1) My setting is 11 and I use the RAMP because that's a lot of puffing to start out with while trying to get to sleep. Yet, when I wake in the morning I don't feel any pressure while breathing at all. Sleepyhead shows steady pressure all night.
Did I just get used to it over night? If so, wow, good for me!

2) C-Flex and A-Flex are turned off. Should I have one of them on? If so, what's the recommendation and how come?

3) In your experience, if I drop weight will the need for CPAP stop or does the doc just drop the pressure? I realize this may be a life-long thing but it's a question worth asking. I'm about 60 pounds on the plus side.

4) About every 3rd morning I wake up with dry mouth. I suspect that's because I'm opening my yap while sleeping. The chin strap is something from the dark ages so I'm trying to "train" myself to keep it closed. Anyone been successful at that?

Thanks - again nothing all that important but it would be a shame to let the wealth of knowledge here go untapped.

MrCourtney

[SPOUSE]

I think the dry mouth is probably from sleeping with your mouth open. Seems that chin straps do work for some people on here but it may also just be an adjustment period for you.

I am a spouse, not a hosehead, and I don't know the answer to your first question but it sounds like you are just getting used to it by morning. And I don't know about your second question.

But your third question was asked at my husband's recent six month checkup. He lost 15 pounds in the first six months of CPAP (mostly from a diet change) and we asked the sleep doctor if he thought that losing more weight might mean he would not have to continue the CPAP. Got sort of a "wait and see" answer but he did not rule that out as a possibility. I think I read here that for most people it is a lifetime thing. I am OK with that, of course, but I don't have to wear it!

Sounds like you are doing well and I am glad you have joined this group - you can learn a lot. Do keep asking questions, earth-shattering or not!

Hi folks -

I got my first CPAP machine 3 weeks ago and then swapped for a better data capable one 2 weeks ago.
I've got just enough time on CPAP to have some questions about the way forward. None earth-shaking, just curious.

1) My setting is 11 and I use the RAMP because that's a lot of puffing to start out with while trying to get to sleep. Yet, when I wake in the morning I don't feel any pressure while breathing at all. Sleepyhead shows steady pressure all night.
Did I just get used to it over night? If so, wow, good for me!

2) C-Flex and A-Flex are turned off. Should I have one of them on? If so, what's the recommendation and how come?

3) In your experience, if I drop weight will the need for CPAP stop or does the doc just drop the pressure? I realize this may be a life-long thing but it's a question worth asking. I'm about 60 pounds on the plus side.

4) About every 3rd morning I wake up with dry mouth. I suspect that's because I'm opening my yap while sleeping. The chin strap is something from the dark ages so I'm trying to "train" myself to keep it closed. Anyone been successful at that?

Thanks - again nothing all that important but it would be a shame to let the wealth of knowledge here go untapped.

MrCourtney

[courtney123]

Thank you!

[pgw78]

1) My setting is 11 and I use the RAMP because that's a lot of puffing to start out with while trying to get to sleep. Yet, when I wake in the morning I don't feel any pressure while breathing at all. Sleepyhead shows steady pressure all night.
Did I just get used to it over night? If so, wow, good for me!

Yes, it sounds like you're adjusting to the pressure. It can take a while, which is exactly what the ramp is for. To let you ease into it and adjust more gradually.

2) C-Flex and A-Flex are turned off. Should I have one of them on? If so, what's the recommendation and how come?

C-Flex slightly lowers your pressure whenever the machine senses that you're exhaling. It's mostly a comfort issue, so that you don't have to work as hard to exhale. It can feel strange, though, and it can take some getting used to.

At higher pressures (I'm at 15, and I've been up to 23), it's not uncommon to go to full BiPAP. The machine actively lowers your pressure by a set amount whenever you exhale. (For me, it drops from 15 to 11.) It can make things easier on your lungs and help you maintain the rhythm of your breathing. Depending on the patient, it can sometimes reduce the number of apnea incidents.

3) In your experience, if I drop weight will the need for CPAP stop or does the doc just drop the pressure? I realize this may be a life-long thing but it's a question worth asking. I'm about 60 pounds on the plus side.

It depends. I didn't have apnea until I gained weight (due to my thyroid condition getting out of control for a while), but I've needed it ever since. My optimal pressure, however, has gone up and down over the years, which is why it's good to have it checked periodically if you can and to keep an eye on how you're feeling. You may also want to learn how to access the clinical menu on your machine, so you can see your apnea index from day to day. People here on the boards will be more than happy to help you with that if you want.

But, to actually answer your question: Yes, it is possible that if you lose weight your pressure will decrease, or that you'll no longer need CPAP at all. On the other hand, it's possible that your pressure will actually go up.

To understand why, you need to understand what apnea is. When you go into REM (dream) sleep, your body releases chemicals which temporarily paralyze you. That's to keep you from thrashing around and hurting yourself in your dreams. Almost every muscle in your body is frozen. Unfortunately, that includes your rib muscles. So you're breathing entirely with your diaphragm. If anything happens to make breathing more difficult, that may not be enough. If you can't draw enough breath, your body starts to wake up. You come out of your dream, at which point the paralysis is released and you can start breathing normally again. Often, you're completely unaware of this because you only wake up enough to come out of your dream. You don't come fully awake. This happens to some degree to everyone, but for most people it doesn't happen enough to actually leave them feeling unrested.

What CPAP does is pressurize the air, forcing the airway to stay open and making it easier for you to fill your lungs.

Gaining weight can cause obstructions and make it harder to breathe, so it makes apnea more likely. Particularly as you develop more fat around your neck. Losing that weight can cause your needed pressure to drop.

However, as you gain weight, your skin stretches and your whole body gets bigger. As you lose weight not everything contracts tightly. You can end up with loose flaps of skin, for example. Now, snoring is caused by what amounts to a loose flap of skin at the back of the roof of your mouth (your soft palate). If you lose weight, that flap can end up looser and proportionately bigger, enough to become an obstruction. (This can be surgically corrected if it becomes a major problem.)

Which is the long way of saying that it really depends on you as an individual. What's causing your apnea? What effects does gaining or losing weight have on the shape of your body?

If changes are happening, you and your doctor will want to keep a closer eye on your apnea. (By reading your machine more frequently, having another sleep study, and/or using different settings on the machine.)

4) About every 3rd morning I wake up with dry mouth. I suspect that's because I'm opening my yap while sleeping. The chin strap is something from the dark ages so I'm trying to "train" myself to keep it closed. Anyone been successful at that?

You can train yourself in time, yes. (Just try to remember to keep your mouth closed in your sleep and you can probably get into the habit in time.) Or you can try the chin strap. Or use the chin strap to help you train yourself. Personally, I clench my teeth at night, so I wear a nightguard.

You may also want to adjust the settings on your humidifier.

Thanks - again nothing all that important but it would be a shame to let the wealth of knowledge here go untapped.

It's what we're here for. And, believe me, getting comfortable, restful sleep is very important. So is understanding your own body and its needs.

[courtney123]

I appreciate your well thought out answer. I'm using SleepyHead so I'm tracking all the various numbers.

You mentioned BiPAP. Is that the same thing as A-Flex?
My prescribed pressure is 11.

The only adjustment I've made is to begin the RAMP at 6 instead of 4. Cracking the settings change menu was the first thing I did :-)

[pgw78]

Your machine has three modes. The PAP stands for Positive Airway Pressure - getting pressurized air to keep your airway open.

Right now, you're on CPAP (Constant PAP). The machine pressurizes your air to 11. (The units, if you're curious, are cm of water. Which is ridiculous, but it's the industry standard.) That's a steady, constant pressure.

I'm on BiPAP (Bi-level PAP). The machine normally keeps my pressure at 15. When I exhale it drops it to 11. At the end of my exhalation it returns the pressure to 15.

Others are on APAP (Auto PAP). The machine adjusts the pressure within a preset range. If it detects frequent apneas, it will raise the pressure. If it detects few apneas, it will lower the pressure. It will continually adjust over the course of the night as it senses you need it. For some, this works well. For others (including me), you actually end up with a higher apnea index than you would on a steady pressure. APAP can work with either CPAP or BiPAP. (In the latter case, the machine will raise and lower both your inhale and exhale pressures as needed.)

But the machine also has a flex option, which can be used with any of those modes. So you have C-Flex, A-Flex, and Bi-Flex. With C-Flex, the machine lowers your pressure slightly when you exhale. Not as much as it would with full BiPAP, but enough to make breathing a little easier and more comfortable. With Bi-Flex, it softens the drop in pressure, so that the transition is a little more gradual and natural. A-Flex is the same thing, but with the machine adjusting your inhalation pressure over the course of the night.

[courtney123]

Thanks. Best explanation I've seen. I'm sure a lot of newbies like me will find it helpful.

[iSnooze]

You got several wonderful answers. I'll just add my experiences.

1) My setting is 11 and I use the RAMP because that's a lot of puffing to start out with while trying to get to sleep. Yet, when I wake in the morning I don't feel any pressure while breathing at all. Sleepyhead shows steady pressure all night.
Did I just get used to it over night? If so, wow, good for me!

This is exactly what happened to me. There are some times I wake up in the middle of the night or morning and have to put my hand over my exhale vents to make sure the machine is still on. Congrats on adapting.

3) In your experience, if I drop weight will the need for CPAP stop or does the doc just drop the pressure? I realize this may be a life-long thing but it's a question worth asking. I'm about 60 pounds on the plus side.

pgw78 gave an incredibly detailed and wonderful answer. I want to share the story my sleep technician told me. Both he and his wife were about 50 pounds overweight and on CPAP. They both lost the excess weight. She no longer needed CPAP but he did, but at a slightly lower pressure. He said it was obvious that her sleep apnea was caused by the excess weight but not his. Everyone's different and your doc's attitude of "wait and see" is a good one for this situation.

[courtney123]

Thank you for your answer. This is an incredibly supportive forum.
I'm glad I found all of you.