First Post after 6 days

[eBoof]

Thanks to everyone for your comments. I note the repeated advice re the importance of a suitable mask. I visit the clinic today for my review so I'll also be guided by them.

I don't have a problem keeping my mouth shut. Not while sleeping anyway. I did the Buteyko course and trained myself to sleep with my mouth closed. I wake when I'm forced to open my mouth. Concerning the sinuses, I use a nasal douche most nights.

The suggestions that the mask might be too tight strikes a chord and as so many have suggested I might not be suited to the Nasal mask. It is a pillow but I don't know enough to tell the difference.

Thanks again for all your helpful responses. I am determined to stick it out Lasted 2.4 hours last night.
Cheers
Rob

[robysue]

eBoof,

I'm inclinded to agree with retired_guy:

Except for usage, your numbers look good---the leak numbers are excellent and if you were doing significant amounts of mouth breathing during the time you have the mask on, there's be some evidence of leaks in the form of higher leak numbers.

So as far as the mask is concerned, I'd start by asking this question: Do you find your current mask comfortable?

You may be overtightening it, and that might be part of what's going on.

Or it might just not be the mask for you.

Now some other stuff in response to things you've said:

The problem is I can only keep the mask on for a short time. The first night it was 3hours 56 min. But since then it's been closer to the 2 hour mark. I try very hard to keep it on but it either forces my mouth open or makes me feel so uncomfortable I have to take it off.

I want to tease apart what you mean when you say the mask makes you feel uncomfortable. It's important to figure out what kind of discomfort you are dealing with because different causes of discomfort have different fixes. And the fixes for some causes make other discomforts even worse.

So try to answer the following questions:

1) When you say the machine "forces" you to open your mouth, is it the pressure that is forcing your mouth open or is it more of a feeling of suffocation? In other words, is the problem that there's too much air getting inside your mouth? Or is the problem that there's not enough air coming into the mask for you to breath comfortably so you open your mouth to breath in more air? [The "fixes" for these two distinctively different problems are very different from each other. And the "fix" for one of them is likely to make the other problem feel worse.]

2) Do you have more problems with exhaling against the pressure or with inhaling comfortably? Or are they about the same?

3) If you keep your mouth closed when this feeling starts, do you get chipmunk cheeks?

4) Is there any discomfort from the straps of the mask? Is the mask pressing awkwardly on your nose?

5) Do you have any problems with air getting into your stomach? Do you have any problems with air getting into your eyes?

Last night I took it off waited for an hour to relax and put it back on again but this time I lasted only about an hour.

Is mask anxiety becoming an issue? (You won't be the first if it is.)

Did you fall back asleep after you put the mask back on and then wake up after only an hour? Or did you lie in bed fighting to get to sleep with the mask on for an hour and then you gave up, took the mask off, and went to sleep without the machine?

Each morning when I wake I feel like I've done 3 rounds with a drunken possum. So far I haven't had a feeling of having a good night's sleep.

Well, lets see, you've only gotten between 2 and 4 hours of mask time each night, but you've been trying each night. So at best, your sleep is highly fragmented right now because of the fact that you are struggling with learning how to sleep with this alien on your face.

In other words, given your difficulties, it's quite understandable why you havent had a feeling of having a good night's sleep since you started.

Time for a morale talk: It takes time to adjust to CPAP. And it takes some of a lot of time to adjust. It helps to remember that very few people experience a miracle of suddenly waking up one morning feeling fantastic with boatloads of energy and emotional bliss that lasts the entire day. A few people start to feel noticeably better in a few days or a week or so. But for many of us, it takes several weeks to a few months just to work out the logisitics of sleeping comfortably with this alien on our face. And then it takes several more weeks to a few more months of sleeping well with the mask all night long, every single night before we start feeling better---the damage the untreated apnea has caused your body takes time to heal.

So right now you need to understand that figuring out what it is about the CPAP and/or the mask that's causing all the discomfort is your number one priority. Fix the comfort problems you are currently enduring and you'll increase the probability that you'll be able to keep the mask on all night with only a minimal amount of waking. And that's the start of getting good, restorative sleep. But if you have sleep issues OTHER than apnea, be aware that you'll have to address those issues (eventually) before you'll really be getting the high quality sleep you want.

I like putting the mask on and going to sleep with it but wake in distress.

My body feels OK but my head feels really heavy.

Back to questions for you to answer so that we can figure out what's causing your discomfort.

1) When you put the mask on at the beginning of the night, do you have trouble falling asleep? Or is the discomfort only an issue after you wake up after 2 or 3 hours of sleep with the mask on?

2) When you wake in distress, what are the first things you notice that are wrong? Do you have too much air in your mouth? Too much air in the stomach? Or are you waking in a panic because it seems like there's no air coming through the mask?

3) When you wake in distress, is the distress worse when you are inhaling or when you are exhaling? Which is more painful---inhalation or exhalation?

4) When you wake in distress, are you noticing physical discomfort somewhere? Is the mask making your head hurt? (If so, where does your head hurt?)

5) When you wake up in distress, do you feel like you are waking up from a disturbing dream?

I suffer from chronic asthma and sinus problems.

1) Is the asthma well controlled?

2) Are the sinus problems allergy-related? If so, do you treat the sinus problems in any way? Taking any sinus-related medication in addition to your asthma drugs? If so, what?

3) Do you often breathe through your mouth in the daytime?

4) Does wind bother your asthma or your sinuses? Does sleeping under a fan bother you?

The sleep test revealed atrial fibrillation during sleep.

1) Is it possible that the afib is causing some of the waking with distress?

2) Any evidence of afib during the daytime?

3) Anything been said to you by the sleep doc about whether the night time afib might need to be treated with drug therapy? Or is the hope that CPAP will control the apnea and that the afib will diminish once the obstructive sleep apnea is under control?

Again, I'm sorry about the long list of questions, but until we understand what exactly is making you so uncomfortable, we're all just shooting in the dark and telling you what worked for us, but our problems may not be the ones that you are facing.

[robysue]

I don't have a problem keeping my mouth shut. Not while sleeping anyway. I did the Buteyko course and trained myself to sleep with my mouth closed. I wake when I'm forced to open my mouth.

Then chances are a full face mask is NOT going to make you feel any more comfortable and it could make things worse.

Concerning the sinuses, I use a nasal douche most nights.

Do you use anything else?

And when you first put the mask on, does the congestion get better, get worse, or stay about the same?

[eBoof]

Whew and wow thanks for the response.

Ill' try to answer your Qs in order

1. Pressure opens my mouth to expel air
2. More difficult exhaling
3.Not aware of Chipmunk cheeks
4. No discomfort from straps but mask is hard up against my nose
5. Not aware of air in stomach but certainly not in eyes.

1. I have no trouble falling asleep but my breathing isn't normal and I feel I'm forcing exhalation. Distress only after a couple of hours with mask on.
2 Hard to remember but in line with the other Qs most likely to expel air. Certainly when I was aware of it one night it was forcing my mouth open to expel air.
3. 4. and 5 are all No

1. My asthma is controlled I'm on a management plan. I don't wake with asthma.
2. Yes both A and S are allergy related.
3.No I don't usually breathe through my mouth during the daytime.
4. No not unless it's a westerly carrying dust and pollen. No problem with a fan


Atrial Fibrillation was diagnosed some years ago. It was exercise induced and is being controlled by medication
I'm not aware of it during this CPAP trial.

Sorry I didn't reply in the lovely way you did with quotes but I'm afraid I haven't figured out how to do that yet.

Cheers
and thanks for your help.

[robysue]

eBoof,

Since the asthma and sinus stuff is under control, they're probably NOT significantly contributing to your CPAP adjustment problems. Since you aren't normally a mouth breather, switching to a full face mask might not provide any relief from your problems with too much air in your mouth.

Since your problem seems to be too much air rather than too little air, the question becomes how can you minimize the pressure while still having enough pressure to properly manage the OSA?

Obviously using your machine in APAP mode is part of the answer. But of course, you've already got it set in Auto mode with the pressure range of 6-18cm.

We'll start with the obvious: According to the data you posted, your EPR is currently set to 2cm. You might be more comfortable with EPR set to 3cm. So try changing the EPR for a few nights and see if that's any better.


Second: The fact that you feel like there's too much air in your mouth may mean that air is leaking into your mouth, but your mouth is NOT opening up in your sleep. And you wake up once the amount of air reaches a critical amount. One thing that can allow air to leak into your mouth is tongue placement. The natural place for your tongue should be with the tip of the tongue touching the roof of your mouth right behind your top incisors. When the tongue is up there, little or no air from your nasal passages will be able to get into your mouth. But if the tongue drops down from that position, an opening from the oral cavity to the nasal cavity and upper airway is created. And the CPAP air can blow throw that opening and fill up your mouth.

If you don't believe what I say about tongue placement, try this experiment: Put your tongue up there, pinch your nostrils, and open your lips and even your jaw and try to breath through your mouth while keeping the tongue parked on the roof of your mouth. It should be much harder to breath through your mouth with your tongue parked up on the roof of your mouth than it is if the tongue is NOT up there.

So it's worth practicing becoming aware of where your tongue's natural resting place is. And train the tongue to get up where it should be and stay there. If you can keep the tongue up on the roof of your mouth, that should minimize the sensation of air leaking into the mouth and accumulating there. And that in turn will make exhaling feel more normal.


Third: Your data shows that your 90% pressure level is up around 12cm on average and your maximum pressure is about 13.5 cm. That extra 1.5 cm between the 90% pressure level and the max pressure level may not sound like much, but it could feel really significant if you are physically sensitive to pressure, which you seem to be.

My guess is that when you are waking up in distress, the pressure is probably at or above your 90% pressure level. One really easy "fix" for this is to simply turn the machine OFF and back ON as soon as you wake up. That will lower the pressure back down to your minimum pressure of 6cm, and the difference in pressure should be noticeable. And if you cycle the machine OFF and ON before you give yourself a lot of time to focus on the distress, that may be enough to prevent some of your discomfort, which in turn may help with the anxiety issues.

If turning the machine OFF and back ON doesn't provide enough relief from the sensation that there's so much air coming into you that you need to open your mouth to fully exhale it all, you may want to take your mask off for just a few minutes and breath normally and get all the excess air sensation dealt with before putting the mask back on and turning the machine back ON. Don't look at the clock and try not to focus on your discomfort when you do this. Simply dislodge the pillows from your nostrils and take maybe 5-10 nice sized relaxing breaths and then pull the nasal pillows back on and turn the machine back on. If the machine is easily reached from your bed, you can do all this without turning on a bedroom lamp.

Since your pressure seldom gets above 13.5cm, you might also consider reducing the maximum pressure down to something between 12 and 13.5 for a while. If you lower it to 12 or 12.5, you might see a bit higher of an AHI, but at the same time, it might get you over the hump of learning how to sleep with the machine. Once you're sleeping more soundly, you can always increase the max pressure back up if need be.


Fourth: Exhaling against the pressure does take some effort, and that work feels pretty strange and even disturbing for a lot of newbies. But over time you start to become accustomed to your pressure and your chest muscles and diaphragm develop the strength needed to exhale fully against pressure. So it may just be a case of sticking with PAP long enough to start getting more comfortable rather than giving up right away.


Finally: I'll mention a couple of other things that might be aggravating the sensation you are having: The heated humidifier setting and the heated hose if you are using it.

Some people's noses like lots and lots of moisture. Other people's noses can't stand even a bit of extra moisture. Too much moisture can make the air feel "heavy" and that can increase the perceived difficulties and discomfort of exhaling against the pressure. So if you've got the humidifier set at its maximum, you might try turning it down a bit to see if that helps. Conversely, if the humidity is too low, that can irritate the airway and nasal passages, which in turn can make breathing feel strange and "funny". So if you've got the humidity set rather low, turn it up and see if that helps.

Same thing can be said about the heated hose option: Some people's noses really appreciate some extra heat and other people's noses find the heated air oppressive. So if you're using the heated hose, you may want to adjust the temperature. Try going both colder and warmer: Sleeping in hot humid "jungle" air can make everything feel "heavy", but sleeping with air that is chilling your airway can also irritate the airway.

And if you are using a heated hose in "auto mode" where you simply set the temperature, you need to know that the relative humidity in the air in the tube is 80%. If that's too humid (or not humid enough) to suit your particular nose, you can opt to use a "manual mode" where you set the temperature of the hose and the desired humidity level separately.

[eBoof]

Good morning and thanks again for the help.
I thought I'd give you a quick update.

I visited the clinic yesterday and they replaced the pillow with a nasal mask. My breathing doesn't seem as forced. I managed to sleep with it on for 5:25 last night. This was interrupted by a brief fight I had with the mask which resulted in it coming completely apart. I managed to put it back together and then woke in sunlight with everything still intact. I took this top be a good sign.

Here are my reading from last night:-
Avge Hrs per night 5:25
Compliancy 100%
AHI is 4.61
OI 0.92
HO 1.29
CAI 2.40
Av Leak 6.51
90% Leak 14.4

Av Pres 9.54
Min P 6.00
Max P 14.06
90% 12.46
Av EPAP 7.54
Min EPAP 4.00
Max EPAP 12.06

I really don't understand a lot of this just that AHI < 5 is good and leaks <24 is also good.

Cheers and thanks again Rob

[retired_guy]

Good job Rob...

Your numbers look great. The CAI will probably come down a little on its own bringing your AHI even lower. Leak rate is great! Keep up the good work!

[eBoof]

Thanks retired_guy!

[Galactus]

Hi there, Just to chime in, I note no one has suggested a chinstrap and you do not mention you are using one despite a breathing through the mouth issue at times. A chinstrap could help you in that area.

I have learned to keep my tongue positioned as suggested in the above threads and this has ended my mouth breathing. I also saw a test described above to show you how the air gets through into your mouth. Another test I have used is to put the mask on while awake, close your mouth, put the tongue where it belongs, turn on the machine, then open your mouth and slowly let your tongue down, and you will feel the air rush through.

You should be aware as everyone has said this takes some adjustment, almost a month for me before I was sleeping through the night and not waking trying to claw the mask off my face immediately. Hang in there it will get better.

[eBoof]

Thanks Galactus. I don't have a problem with mouth breathing. I trained myself when I did Buteyko to only breathe through my nose while asleep. The only reason I was opening my mouth was to expel air.

I'll let you know how I go. The clinician gave me a chin strap to try if I need it. I hope I don't though 'cos I found it absolutely horrible.

Cheers
Rob