[CPAP] First night of CPAP was bad- help please

[rodea24]

Good morning.
I was recently diagnosed with obstructive sleep apnea with AHI of 16. I am not overweight but have lost 75bs from my heaviest a couple years ago. I have snored bad my entire life regardless of my weight. I was given a ResMed S9 Autoset with humidifier and my mask is the least intrusive wiht nasal pillows and a basically a rubber band. I used it for the first time last night and failed miserably. I had to remove it after about 30 minutes of staring at the ceiling. The pressure was uncomfortable which I expected would be for a few days to a few weeks but what really made me feel almost closterphobic was having to keep my mouth closed. I normally breathe through my mouth so it felt like I was breathing through straws. My therapist told me that I probably breathe through my mouth because of the apnea and 90% of apnea sufferers get used to the nasal pillows.

Is this true? How long should I give the nasal pillows a chance before going for a bigger full mask. I'm reall hoping is just my adjustment period but not sure if I'm spinning my wheels without just going for the mask (which may be equally as uncomfortble- I haven' tried one yet) . Would it be easier of an adjustment to start with full mask to get used to CPAP and then give the nasal pillows a shot or should I carry on as is and push through. Any feedback, advise, guidance and help would be greatly appreciated. Thanks

[Galactus]

Hi there, we feel your pain. the mask is the first step in adaptation. Do not give up on nasal pillows because if you feel constricted now you don't even want to imagine a full face mask.

First, you say pressure is bothering you, so what pressure are you set at? Are you using ramp? Is there too much pressure, is there too little air? Give us the details.

Next, try the mask on while awake, sit there for 10-15 minutes with it on you while in a comfy chair watch some tv read a book, try and get yourself acclimated to begin with, it is something new take some time to get used to it.

We're here to help and support you you 'll get through it like we all did, just be a bit patient.

[PaytonA]

Welcome to the forum.
It may be that you will need a chin strap to help in keeping your mouth closed while you are asleep. Chin straps should be available from your equipment supplier or online at any of the suppliers on our supplier list at the top of each page.

Best Regards,

PaytonA

[PsychoMike]

Hi Rodea24 and welcome to the board,

Pillows are a common choice as they do provide the least invasive treatment when compared to other styles of mask. They are not the only choice, though....give them a go and if they don't work, well, they don't work

Do you know what your pressure setting are? You have it stated as "auto" but that doesn't provide a lot of info. Do you know if you are using the ramp feature?

Sometimes, a well meaning shop will set up a new patient with a low pressure (4 cm H20 is the lowest the machine does) and let the machine "auto adjust: itself to the right pressure or will set the machine up with a long ramp-up time. Typically, the S9 starts its ramp at 4 cm of H20 then builds up to whatever the minimum pressure is set at. If your starting pressure is too low, you will feel suffocated...especially since you are used to all the air that you can move through your mouth.

If you watch the display when the machine starts, down at the bottom it will show you the pressure number...let us know what that is. It may also show you a triangle symbol...the symbol for the ramp...let us know if that is there too. Alternately, you can request the clinician's manual for your machine and can go into the menus that tell you directly what the settings are (and will allow you to change them if you need to).

Let's see if we can't help you get set up better with the pillows first, so you can give them an honest try, before swapping to a different mask....if the pressure and/or ramp settings are wrong, you'll have just as much trouble with the next mask....it's part of the reason some folks quit CPAP therapy really early in their treatment. Sometimes, the folks who provide us with the CPAP machines (durable medical equipment suppliers or "DME's") are not the greatest at setting them up well...they make sure they function, hit you with a lot of information and then basically rush you out the door. That's part of the reason for boards like this one....so hang in there, try to provide us a little more info, and hopefully we can help you to get your therapy to work for you

[trish6hundred]

Hi rodea24,
WELCOME! to the forum.!
CPAP can take some time to get used to but be patient, it will get better.
To help you get used to your mask and machine, try this.
As you are watching tv or reading, wear the mask and use the machine. Just keep trying with this mask a bit longer since it was your first night. If, after a while you find that the mask you are using now just won't work for you, there are many of them out there, don't give up.
Hang in there for more suggestions and best of luck to you with your CPAP therapy.

[rodea24]

Thank you all. The therapist at the supply company did set up the "ramp" feature for 15 minutes. I am not sure what the initial setting is? It did feel like I had labored breathing a bit or at least I was very cognicent of every breath in and out. That may very well be a mindset and being very used to sleeping and breathing through my mouth. I will not give up as I am so anxious to experience a full nights sleep.
Should I not use the "ramp feature" as I get used to the equipment? When watching tv should I turn off the ramp so I am used to the pressure? I do think that will help if my mind is on something else other than focusing on not sleeping.

I may be getting ahead ofmyself but has anyone heard of a new procedure that is not surgery but a device is implanted and acts similar to a pacemaker is for a heart patient? This sounds terrifying to me but wondering inf anyone knows anyting or has good or bad results from it? Thanks again

[retired_guy]

Hi Rod!

Welcome to our world!

It does sound like the machine is set to it's default values of minimum 4, maximum 20. That's what I call the 4 and 20 blackbird setting. Fine, if you're baking a pie, but not so good for cpap therapy.

4 is too low for most people to feel like they're getting enough air. So if the min pressure is 4, and just as bad, if the ramp starts at 4, you're not going to be happy for a few minutes. You can sit on the edge of the bed for a little while until the machine gets over it's silliness, but that's not all that much fun either.

So. Now comes should you make the changes yourself, or call the guys that set it up? You'll need to decide that. If you want to make changes yourself, and by the way it IS your body afterall, then ask for the Clinician manual from the link at the top of the page.

The settings I would change if it were mine would be to set the minimum pressure to at least 6, the maximum pressure to no more than 15, and the ramp to "off." You might like to turn the EPR on, and set it to perhaps 2, which allows for a little easier exhale against pressure. Some people like that, some don't, I do.

Then I would download the Sleepyhead software and begin monitoring my results daily to see what's going on.

[Galactus]

Ok so you're using ramp, but we still need the pressure. If you look at the screen when you turn it on it should say a number, is that 4? If so you will struggle to breathe, there's just no air at 4 imho, needs to be somewhere between 6 and 8 depending on you. Try shutting the ramp off, or wait till ramp is done and look again at that number to see what the level is when ramp is done.

You could just also call them and ask what the settings are as you will need to know anyway, this will help us help you better and faster.

RG is right 4/20 is a bad setting, called machine default for a reason.....

[Ghost1958]

Min pressure with an auto is the most important for me. Anything under six min Im having to pull air instead of just breathing. Smothering. Top pressure on an auto needs a max but its not that important to me because the machine will only go as high as it needs to. Unless of course it goes so high as to cause you problems. Mines capped at 18 now by the doc but it never goes that high or over the 15 max I was orginally titrated at. Normally doesnt even go close to the 15 max.

I may be going the opposite direction of others advise but its just based on how it went for me. I had to a fitlife at the hospital which is a total face mask. Nasals blew out my mouth even with a chin strap. Regular full face wouldnt seal.

After using the Fitlife which pretty much kept my mouth shut and reading some here for awhile about tongue postion etc I was given a nasal by a friend and lo and behold I could use it. Its abit to small so for now I still mostly use the FFM. Moral to the story is the FFM helped teach me to use the nasal after about a month. Thats just my experience though I Lord knows Im probably not the typical case. Never was at anything else either LOL

[rodea24]

Thanks everyone. I have an update. I did have the ramp feature set to on for 10 minutes. The initial pressure was 4 as many here assumed it would be. I did watch the machine for the 10 minutes and the pressure was on 4 the who time. Is this a flaw in the machine and/or progaming? Im concerned I was at 4 all night but the machine turns dim so its hard to say.

On the positive side, I did sleep 6 hours with the nasal pillows only remembering waking up twice. I really wanted to lay on my side but that was difficult so I continued to lay on my back. I did wake up after 6 hrs to use the bathroom. I wasn't sure how to temporarily turn off the machine so I just took it off and slept another hour fifteen without it. I felt more rested this morning but this afternoon I had to go back to my coffee like usual. I wonder if I need several days of good sleep after years of bad to feel the rest that so many experience? Or perhaps if the setting remained at 4 (not sure if this is possible) the whole time, it may not of prevented my apneas? Any thoughts or guidance on where to go from here? Thank you