New User Having Trouble Staying Asleep and more

[SnoreGalore]

Friends,

After many years of extreme snoring, which led to poor sleep quality for both me and my wife, I took a home sleep test and was diagnosed with mild sleep apnea.

Since this was all out-of-pocket, I accepted a CPAP setup as a gift from a friend:

ResMed S8 AutoSet II with humidifier
ResMed Quattro FX headgear and mask (M)

I've had no assistance in setting up the machine, so it presently is using factory AutoSet settings 4cm MIN and 20cm MAX

Observations after about two weeks of use:

I generally fall asleep easily by 10 or 10:30 PM on my back.

I generally wake up (wide awake) between 1 AM and 2:30 AM and remove the mask (at which point I just get up, because I cannot fall back to sleep). After a couple of hours awake, sometimes I can fall back to sleep for an hour or two, without the mask.

I cannot sleep on my side as the mask is easily jarred loose if anything bumps it.

While falling asleep with the mask on, I typically breath with my mouth open. I notice that my mouth is being "blown" and held open by the machine, i.e. my cheeks and lips are puffed out like a balloon.

In general, my mind is much more clear in the morning than it was pre-CPAP, even with the shorter number of sleep hours.

I like having a clearer mind, but I'm very distressed to be waking up so abruptly after a short sleep. Something does not seem right.

Any ideas here would be greatly appreciated. I am happy to provide further information if requested.

SG

[Rcgop]

It takes time to get used to the setup. Hang in there. It does get better. I have been on it for 8 months and still not to where I want to be but still better and getting better all the time. Patience, patience, and more patience.

[DeepBreathing]

G'day SG, welcome to Apnea Board.

It's very common to have difficulty adjusting - the great majority of people go through the same sort of teething problems. So you're not alone, and your situation is not unusual, nor any cause for alarm.

Mask fit and comfort is key to successful CPAP treatment, and it may be that the Quattro doesn't suit you. It is a full face mask, and a lot of people prefer a nasal mask or nasal pillows, which can be less intrusive. You mentioned that you're doing this therapy without medical assistance, but do you have a local supplier / DME who can help you with mask choice? If you're in the US you will need a prescription (any doc can provide one). But it's important to try different masks until you find "the one".

Side sleeping is better for apneacs if you can achieve it. A different pillow might be the answer here. I use a duck feather pillow which I can just pummel into shape, and a lot of other people have had success with (I think) buckwheat hull pillows. You can shape them to avoid stress on the mask if you sleep on your side.

You mentioned that you have a ResMed S8 but your profile says S9. This is an important distinction as the two machines handle their data quite differently. The S9 uses a standard SD card (like you'll find in any camera) but the S8 has a proprietary card which needs an expensive and hard-to-find card reader.

It's important to be able to read the data in order to optimise the therapy and help identify the cause of any problems. Your wide open setting of 4 - 20 is not optimal and may be part of the problem you're experiencing. Without data it's difficult to be sure. However many people find that 4 is too low and they feel smothered, while 20 is way too high for most people.

In the absence of data, and based purely on what many people find works for them, I'd suggest you look at narrowing the pressure range. Increase the minimum to maybe 6 and bring the maximum down to 16. This is a good general purpose range which suits many people.

But do look at you data options and try to read your data into #sleepyhead - this would give a firm basis for any advice.

Hope this helps. Just remember that adjustment does take some time and a lot of patience and it really does get better over time.

[Sleepster]

While falling asleep with the mask on, I typically breath with my mouth open. I notice that my mouth is being "blown" and held open by the machine, i.e. my cheeks and lips are puffed out like a balloon.

There are two main categories of masks: Those that cover both your mouth and nose, and those that don't cover your mouth.

Those that don't cover your mouth are called nasal masks. If you have one of those and what you report is happening then you probably need to switch to the other type, called a full face mask.

Getting a good fitting mask can be a trial-and-error process.

Waking up often is normal behavior for a lot us. Fortunately it fades as we adapt to the therapy.

[SnoreGalore]

Thanks very much for your thoughtful reply. My mask does cover both mouth and nose. The "chipmunk" cheek effect is happening inside the mask! Does this indicate that settings are incorrect, or is this a common side effect of the pressure being delivered?

[SnoreGalore]

G'day SG, welcome to Apnea Board.

It's very common to have difficulty adjusting - the great majority of people go through the same sort of teething problems. So you're not alone, and your situation is not unusual, nor any cause for alarm.

Mask fit and comfort is key to successful CPAP treatment, and it may be that the Quattro doesn't suit you. It is a full face mask, and a lot of people prefer a nasal mask or nasal pillows, which can be less intrusive. You mentioned that you're doing this therapy without medical assistance, but do you have a local supplier / DME who can help you with mask choice? If you're in the US you will need a prescription (any doc can provide one). But it's important to try different masks until you find "the one".

Side sleeping is better for apneacs if you can achieve it. A different pillow might be the answer here. I use a duck feather pillow which I can just pummel into shape, and a lot of other people have had success with (I think) buckwheat hull pillows. You can shape them to avoid stress on the mask if you sleep on your side.

You mentioned that you have a ResMed S8 but your profile says S9. This is an important distinction as the two machines handle their data quite differently. The S9 uses a standard SD card (like you'll find in any camera) but the S8 has a proprietary card which needs an expensive and hard-to-find card reader.

It's important to be able to read the data in order to optimise the therapy and help identify the cause of any problems. Your wide open setting of 4 - 20 is not optimal and may be part of the problem you're experiencing. Without data it's difficult to be sure. However many people find that 4 is too low and they feel smothered, while 20 is way too high for most people.

In the absence of data, and based purely on what many people find works for them, I'd suggest you look at narrowing the pressure range. Increase the minimum to maybe 6 and bring the maximum down to 16. This is a good general purpose range which suits many people.

But do look at you data options and try to read your data into [url=http://OSCAR Official Download Page ----> CLICK HERE ./]SleepyHead[/url] - this would give a firm basis for any advice.

Hope this helps. Just remember that adjustment does take some time and a lot of patience and it really does get better over time.

Thanks very much for this helpful information. Glad to hear I'm not the only one with these problems!

I've not yet found a local supplier, but I will be arranging an appointment with a local sleep doctor soon. Hopefully, she can assist with the mask issues.

I do indeed have an S8, and I did notice the proprietary card. Ugh. Not sure that I'll be able to do anything with data in the short term. Long term, I may get another machine.

I'm a bit confused by the settings, as I thought an "auto-set" machine would automatically set to the ideal pressure settings. I will adjust them as you suggest and see what happens.

I truly appreciate your assistance.

SG

[DeepBreathing]

An Autoset machine will indeed try to find optimum pressures by adjusting the pressure in response to apneas, hypopneas or precursor events such as flow limitations and snoring. Later machines have more sophisticated intervention algorithms.

They generally try to run at the lower end of the range you have set and only increase pressure when necessary. This means that they may be running too low for comfort, which many people describe as a suffocating experience. They also take time to respond to events, so if the lower limit is set too low, a lot of time is wasted getting up to therapy pressure.

On the other hand, autosets can also get stuck in a situation where they increase pressure more than necessary. This causes discomfort and is almost guaranteed to wake you up.

For these reasons we recommend you determine a narrower range and let the machine work within that range for optimal results. I don't know off hand what sort of data the S8 gives on its front panel display - it might give the max, min and 90th percentile pressures. If that is the case, try setting the lower limit a couple of cm below the 90th and the upper limit a couple of cm above. That should give you a good range to start with, and you can adjust from there based on your AHI and how you feel.

[DeepBreathing]

I just did a quick search - Supplier #1 is advertising the Resmed S8 card reader (but not the cards) and also a USB adapter.

[Elaine TC]

Hi,

I'm fairly new to CPAP as well.

I had a similar problem with " chipmunk cheeks".

The respiratory therapist from the durable medical equipment provider gave me a mask that let's her adjust it over the internet to release some pressure on my expiration. This solved the problem.

Regarding not being able to sleep on your side, again you may need a different mask.

It was also recommended that i get use to the mask by wearing it around before I go to bed just to get adjusted to having it on my face.

hope this helps.

[SnoreGalore]

Thanks very much for all of your replies. Still having trouble getting more than about 3 hours on the CPAP. I've got an appointment with a local sleep doctor in February (earliest I could get). I'll report back when I've got an update for you.

I really appreciate your support and suggestions.