New CPAP user

[mountainbird]

Hello,

I've just started CPAP therapy.  This is from my 5th night and I am still getting used to it (amount of time sleeping 45 min, 25 min, 90 min and 3 hours on the first four nights).  It looks like I need to get a chin strap as I was mouth breathing for part of the night.  

Any other advice.  I have lifelong insomnia and I am struggling to sleep with the mask.

[SarcasticDave94]

Hi mountainbird,

Welcome to Apnea Board.

I see you already can post screenshots via SleepyHead, so congrats there.
If you haven't got the clinical manual for your machine, I suggest doing so via the "CPAP Setup Manuals" link at the top of the page. Look for your specific make/model of CPAP. This has more detailed info than a standard user manual; it also will show you the access method into adjusting settings.

I suggest you access the settings and edit your pressure to 6 instead of the 4 it's at now. Most everyone complains that there "isn't enough air" at 4. Another setting to consider, and I'm basing this on the machine model info found on the SleepyHead screenshot, you can set your machine to have a range of pressures similar to a BPAP. This would take action on your part to change the operating mode from CPAP to Auto or APAP. From there, you can input a range of pressures like the above mentioned 6 to something a bit higher like 8-10. This may assist in catching events if they need additional pressure than the single CPAP pressure that's normally available. There's also available the "for her" setting which could add comfort if you don't require pressures above 12.

To help get used to wearing a CPAP mask, you can try wearing the mask with CPAP turned on while reading, watching TV, or etc. This is to help get accustomed to wearing a mask. You can also spend that time trying to adjust the straps to minimize leaks.

Bottom line: other more GURU status (read smarter as I'm limited-track-minded ASV user and coffeemaker boy) members will chime in soon enough. If they come up with better, or more informed advice, I defer to their suggestions. Even so, have a great Friday.

best to successful apnea treatment and stop to enjoy a

[jaswilliams]

There is no issue with your leaks anything less that 24 L/M is great your max in this screen shot was less than 17, and nothing over the Large Leak Line no need for a chin strap yet.

[Walla Walla]

Something is very wrong about your charts. None of the times match up with each other and your AHI is showing 0.11 while you also have a smiley face which is suppose to mean zero AHI. It looks like two days of charts have been merged. You might want to delete those days and reload them from your SD Card.

[Ron AKA]

Hello,

I've just started CPAP therapy.  This is from my 5th night and I am still getting used to it (amount of time sleeping 45 min, 25 min, 90 min and 3 hours on the first four nights).  It looks like I need to get a chin strap as I was mouth breathing for part of the night.  

Any other advice.  I have lifelong insomnia and I am struggling to sleep with the mask.

Wow! I've never seen a SleepyHead chart that good before, or the happyface! Are you sure you need a CPAP?

You obviously need no changes to improve your AHI number. That is about as good as it gets. You may be able to improve the comfort factor though. You indicate you are using it for fairly short periods of time. Is there a particular reason for that? What is making you take it off? Do you feel short of air, or a suffocating feeling?

My suggestion for basic improvements would be similar to Dave's. Go into the Clinical Menu and make the following changes. Press and hold the Home button and the round knob button for 3 seconds. That will bring up the clinical menu.

1. Set the mode to AutoSet instead of CPAP
2. Set the minimum pressure to 6 cm
3. Set the maximum pressure to 10 cm
4. You can turn the auto ramp off, or put it in Auto. I would suggest Auto
5. If you have the auto ramp in Auto, then set the Ramp Start pressure to 6 cm

Exit back out of the Clinical Menu

The small advantage in using the Auto ramp is that it will keep the pressure fixed at 6 cm until you fall asleep or 30 minute passes. It will not bother you with any pressure changes until after you are asleep. I find that more comfortable That's about it. Post your chart after a night with those settings, and it will be more obvious what changes if any are required.

[mountainbird]

Thanks for the thoughtful advice.

I've attached a screen shot of the entire day/night as the numbers did not line up when I only included the time I was in bed.  The sessions earlier in the day were practicing with the CPAP while working on the computer.

I am seeing a sleep pulmonologist at a medical school.  He recommended the setting of 4cm.  I had a sleep study done with mild apnea overall but severe apnea during REM sleep.  I took Benadryl to sleep for the study not realizing that it causes respiratory depression in me similar to that caused by opioids.   My readings with an overnight pulse oximeter show ODI rates of 1.8-5.6/ hour when I have not taken antihistamines.  The rates increase as the dose of one of my asthma meds decreases.  My SDB may be nocturnal asthma.  My doctor wants me to try CPAP at a very low setting.  

For the first four nights I spent many hours in bed but was only able to sleep for 45, 25, 90 and 180 minutes.  

Questions

How loose/snug should the mask straps be?  Should there be slack in the straps or should they be snug on the cheeks?  I keep feeling the air from the diffuser and think the mask is leaking.  How big a leak should I worry about?

I don't feel air starved at 4 cm but my right lung is sore when I breathe in deeply.    

Thanks again for your advice.

[Walla Walla]

Leaks-Anything under 24l/min is acceptable and won't affect your treatment. As far as the straps loosen them to the point where it stars to leak. Than tighten using very small adjustments until the leaks stop. You want it loose enough to be comfortable but not loose enough to leak. Check the link below for Mask primer. There's more information about masks and leaks in there.

[cate1898]

Welcome mountainbird! Sounds like you're well on your way to better health!

[Ron AKA]

A couple of things to consider. First is that most machines have a default minimum of 4 cm. Somewhere I read that the reason a pressure of 4 cm is used is that most CPAP machines on average lose about 4 cm pressure through the hose and mask when typical flows are consider. It is flow loss pressure. So effectively a 4 cm pressure is zero pressure. That is why many people find it a problem getting enough air when it is at that setting. But if it works for you that is what counts. I adjust the minimum or the ramp start pressure so it feels to me like the mask is not there. In other words I feel no effort to inhale air.

The second thing is just a SleepyHead trick I learned from Crimson Nape. If you do mask fitting or take a nap in the afternoon, and only want to see the night sleep the individual sessions will be recorded in the lower left of the screen. There is little switch beside each session that you can click on to turn it on and off. By defauilt they are all green, but you can turn the ones off that you want. That way you can eliminate bad data from your display. Also it lets you expand the session you are interested in to the full screen width.

[Walla Walla]

4cm of pressure is just that. It is Not zero pressure. The reason I heard for 4cm minimum was to ensure enough air is exchanged to replace the CO2 in Full Face Masks.