[CPAP] New user - looking for some advice please

[SleepyBug]

Hi everyone,

So I was diagnosed with mild sleep apnoea a few months ago, and have only recently received my CPAP machine from the hospital on a trial basis. Initially I was given pillows but I found this impossible to deal with (every time I opened my mouth I felt like I was suffocating due to change in pressure, couldn't cough/yawn/speak etc.) - I read some advice here about getting used to wearing it and staying calm, but after several attempts the most time I managed was about half an hour (even trying to practice whilst distracted watching tv or reading). For me I knew the second I started to drop off my mouth was going to pop right on open and I'd be woken up, so I got in touch with my doctor who suggested I try a full face mask.

So far this has been a massive improvement for me - the fact I can keep it on and open my mouth if need be has really helped relax me whilst wearing it - but it's causing some other minor issues and before bothering my doctor again I figured I'd pop on here and see if anyone has any general advice for easing these issues. I'm also hopeful that some / all of these issues may resolve or ease off on their own after a little while using the machine (I've only done two sleeps with it on, and these were around 4-5 hours both times).

* First issue - epic dry mouth - like I haven't had a drink in ten years and all the tissue wants to stick together (sorry to be dramatic but I don't know how else to properly convey just how dry my mouth is within even an hour of using my machine). Now - some brief history, I am long term sick with various issues - one of which being suffering with GERD (I have been treating this for near on a decade with lansoprazole on prescription, and mostly food and drink choices mean that reflux is rarely an issue these days) - but I did read that this can contribute towards dry mouth anyway, as well as some other prescription medications. I certainly can't see a practical way of having a sip of water every time I wake up. I initially thought all the waking up was because of apnoeas, but now it seems to be because my mouth is so dry. Is this something that will ease on it's own? Or is there anything else I can do to help it? I read about keeping the air in the room warmer but this really isn't an option for me (I'm on benefits/very low income and simply can't afford to run my electric heaters all night every night). I also saw something about heated tubing? Is this something my doctor would be able to provide? Has anyone any experience with this? I do believe my machine has a filter in it, but I'm not entirely up on the equipment being so new to it all.

Second issue - nosebleeds - is this because of how sensitive the lining of your nose is? Will it get used to the pressure over time or can I expect this to be an ongoing issue? They are only mild bleeds (nowhere near as bad as I had them as a child) and clot pretty quickly, but there's a general soreness to my nose that is quite unpleasant.

Third issue - headaches - one of the main reasons my doctor wanted me to trial the CPAP was due to the large number of headaches I wake up with (and migraines), saying that it could well (and should) reduce them. Instead after my first 4 hour stint I woke with an awful headache that radiated from behind my nose round one side of the back of my head, and lasted all day. I'm not sure if it's sinus related, and maybe partially due to my over tightening the mask the first time. Any suggestions?

Fourth issue - specifically a mask question really - getting my mask seal to stay sealed. The second night I tried using it I wore it a lot looser, and I'd say a good two hours or so of my sleep it seemed to be well sealed and everything was comfortable. Then when I started waking it would be to a bit of air leak in varying areas (mostly round my chin, sometimes the bridge of my nose/into my eyes). Sometimes I couldn't accurately find where the leak was coming from (obviously you can feel air coming out where you exhale) but there was a high pitched squeaking sound that disappeared the moment I adjusted the mask ever so slightly, suggesting to me there was a leak somewhere. Now, I've avoided sleeping on my back for many years (not just because of apnoea before diagnosed, but because of sleep paralysis), so even though I felt this could now be an option I just can't relax (even though back sleeping seems to sort out any leaking issues). I'm very much a side sleeper, and I turn over a lot during the night due to pains caused by my other conditions (M.E/CFS, fibro). Any tips on how to keep a nice seal whilst sleeping on your side or moving about a lot? Am I tightening it too much or not enough? Is there any sort of tape you can get to really hold it in place or should it not come to that?

Fifth issue - bloating/feeling sick when I get up - is it possible I'm getting air into my stomach, and if so are there any ways of reducing this? At the moment I think it's probably only mild, as I'm not in pain with it, just uncomfortable mostly.

Looking forwards to hearing from others with much more experience, and hopefully becoming more comfortable with using CPAP.

My machine is a Resmed AirSense10 autoset, and my mask is AirFit F10 for her. The range of pressure reads 4-20 (I've observed it hanging around 9/10 whilst in use, the highest pressure being 13 ish which I found uncomfortable but was told it would auto adjust to my needs so I just tried to stay calm).

Thanks in advance for any help and advice!

[Sleepster]

For the dry mouth try Biotene. For the nose bleeds try raising the humidity level on your machine. The ClimateLine tubing (also known as a heated hose) will allow you to get even more moisture.

I had chronic headaches for decades and when I started CPAP therapy they finally started to go away. It may take a while. I'm pretty much headache free now.

Adjusting the mask is a bit tricky. You don't want it too tight and you don't want it too loose. You will just have to experiment. But keep the surface that touches your face clean. Wash it with hot soapy water or use a CPAP wipe to remove the face oils. That will help with the leaks.

The bloating is called aerophagia. Try turning up the EPR setting. You can also try lowering your pressure. But to really tell what's going on you will need to download the free OSCAR software so you can look at the data on your computer. You can then post screen shots here so people can make better judgments as to your pressure and EPR settings. This is something that tends to subside as we adapt.

[SarcasticDave94]

Welcome to the Apnea Board,

I'd like to suggest a bit of homework and a helpful hint or two.

Get the free report tool OSCAR so you can look at your data in a lot greater detail. It's safe to use. It does need an SD card in the APAP slot on the top left under a rubber door. If you're PAP doesn't have one, get one locally at your electronics type store or a digital camera store. It's a Standard SD slot that can take SD or SDHC cards of 2-32 GB of any brand. Leave it unlocked when using, and it must be in the PAP overnight for OSCAR to find the detailed data.

I'd suggest for the dry mouth 1 of 2 actions, increase the humidity on the PAP, and the heated hose may need turned up to combat rainout, or look for Xylimelts at pharmacy.

Next let's try editing the pressure a bit and add a comfort item called EPR, which is exhale pressure relief. OK hold the Home and click the dial in for 5 seconds to enter your clinician setup menu. Edit your Min pressure of 4 to 7 and then turn on EPR to 3 full time. This needs both edits to work the best. Min 7 gives EPR room to drop pressures if on the lower end.

Give that a try and tell us how it worked.

[sheepless]

dry mouth: as long as you breathe through your mouth you'll have this problem. humidity settings and xylimelts can help. otherwise if you're physically able to breathe through your nose it's a matter of keeping air from your mouth. I use a soft cervical collar for this purpose. others tape over their lips, use a chin strap that pulls up not back and/or learn to keep their tongue pressed up against the roof of their mouth.

I see your min pressure is 4, too low for most adults. you may be feeling air starved and there's a small chance you're gulping air in the additional effort you make to breathe. you also need to raise your min to take best advantage of epr, suggested below. incrementally bump your min up while assessing impact on breathing, bloating, leaks and ahi. and post oscar charts so folks can provide more informed responses to your questions.

nosebleeds: cpap pressure doesn't amount to much so unless you're really really sensitive, it's most likely from airflow drying out your sinuses. the machine humidifier should do the job; if not, consider a room humidifier.

mask fit: the most difficult part of papping. the only thing for it is to try messing with adjustments; failing that, many people have to try many mask types and brands before finding one that's comfortable and doesn't leak too much. as for keeping the mask from moving around during the night, a) use some kind of hose hanger, one designed for cpap or anything you have around that will hold the hose up over your head (hooks, string, from the ceiling, wall, headboard), and b) use a pillow you can easily hang your face and mask off the side (I use a buckwheat pillow for this purpose).

bloating or aerophagia: probably due to your mouth breathing. solve that problem, you might solve the bloating as well. otherwise, you can try increasing epr (exhale pressure relief) and/or start out at lower pressure and work your way up to more therapeutic pressure as you acclimate.