Overwhelming exhale resistance - is this normal ?

[Fox66]

Excellent tips, i will start experimenting, adjusting, as soon as possible, and i also think diving into Oscar with all the details directly might not be the best move, based on my psychology. Also, i can only imagine the 20-30 years of disastrous nightly breathing, needing to perfect everything fast seems highly illogical. 

Also, i have figured out starting/testing with full mask might be good, but since i have already spent so much on bed, mattresses, pillows etc. i just figure i can order a nasal pillow mask also (did that today), and i have the full, half/hybrid (with nose bridge) and nose pillow, the whole family. 

The funny thing is that i have quite an extensive experience with diving (scuba diving instructor) in my earlier years, i guess i have to channel a bit of that, imaging myself taking a challenging dive every night ;-).

I´m starting to understand it´s normal to really feel like you can breath out at all, initially. And, based on previous experiences lately, i didn't have much hope at the "sleep doctor", but i had no idea it would be so bad, but hey, this forum seems like the right place to be, for sure. Tackar för tipsen!

[Fox66]

I get the Oscar also, of course, absolutely. I realise only way for you experienced guys to really help. I think i have a good grasp now of the steps to take not to get overwhelmed, still provide needed charts etc. for help. The biggest help right now is the feeling that this actually might be possible to get going.

Also, i have a background as a chemist at a huge pharmaceutical company where i did nothing but tinkering with machines, settings and chart (in the 90s) so... i fully realize the not flying blind thing also, for sure. It's A funny mix of having i guess on paper better abilities than most are fortunate to have, based on previous work, but also i think worst than many, due to many years of, let's say pretty severe "mental health" stuff (won´t go into everything, but we are talking legit diagnosis, extreme OSD is one of them, that is leading to to early retirement, unfortunately). So, thank for all the tips.

I ordered a good CPAP memory foam pillow today, i have had disastrous sleep set up for så many years. And i have a brand new bed, mattress, side table for machine set up to assemble, then i will be back here with more actually "getting CPAPing going charts, questions etc.

[SarcasticDave94]

Be assured we'll try to keep the experiments on you to a minimum.

[PeaceLoveAndPizza]

As a fellow scientist we both know the value of using data in research. Without it we are merely guessing. Amateurs guess, then apologise afterwards. 

It is your therapy, so do what is right for you. We will be here to help when things go off the rails.

[Fox66]

Well i guess feeling like a lab rat might not be that uncommon in all this ;-). Would have been great if i had the capabilities i used to, but i guess there are many non scientists that have made this work also. I'm quite sure the actual process, that i have gotten so many good tips on, getting used to the breathing with mask, the resistance etc. will be the big thing/hardest for me, due to my many issues, but it is what it is. Well, let's see how it goes.

[40plus]

The thing is, without OSCAR charts we're not going to be able to assist in setting pressures up in an informed manner, hindering both the struggling user and Apnea Board members trying to help. We try to avoid blindly guessing at pressures, but without OSCAR that's what you'd be asking us to do.

It's not to hinder a new user that we'd want OSCAR included from the beginning but to assist better. The burden isn't on the new user to even understand the data at the beginning but to display it and let those that know what it says to interrupt and guide. As the new user learns about the suggestions and the why that corresponds with it, they'll learn to understand it themselves.

Ofc and i myself got a lot of help here.

But he is a very new cpap user and his question was about the struggles of adapting and getting used to breathing under pressure. He is not a user that have bad ahi or bad sleep and needs help, atleast not yet. Diving into oscar and analysing things in detail before you even had a chance to adjust to the treatment to know what works for you might not be the best option.

The fact is that there are people who will do just fine with good sleep quality and low ahi on apap with a wide range. Others need a tight range and others like many of us need a lot of time to dail in the best seetings for us.

I myslef fell into the oscar abyss and over analysed every minute of breaths every night for months and months changing settings every day, sometimes even in the middel of the night in my insomia dispair of not getting restful sleep.

This forum is amazing and without it i would be completley lost as sleep techs in sweden is like elsewhere meaning ahi low = treatment good and thats the end of it. But there is no reason to dive into all the details for someone whi is completley new at this. Apap might give him amazing results. He should absolutley atleast try to get used to the treatment and look at the sleep quality and ahi first.

And if he has issues he should absolutley come back here and ask away. Oscar is very powerful and will almost always find a solution with you experienced guys as help weather it be tweaked settings, bipap or whatever.

[Fox66]

40 plus, extra thanks for this reply, I really feel, due to my extreme "mental health" problem, especially catastrophic thinking, extreme fear for all "medical" doctors etc. and not the least kind of "freeze" very hard getting thing going, in combination with, well even more stuff, very, VERY, scared, intimidated, and frankly terrified. The combination of fully knowing the absolute necessity of getting things going (have severe OSA, and frightening low dips oxygen) with all this, is very hard ( and a couple of the other "diseases that this can lead to, already). I really had hoped to get some form of help from sleep doctor place, even another doctor and shrink, than understand all of my issues, called in advanzed, and explained, but to no use. I fully understand all that have replied mean all well, want to point that out, and of course I realize I unfortunately am a really special case in severity of other issues that hinder optimal process here. I have intellect enough from previous life, but... almost childlike fears, putting head in sand behaviour. I'm very very scared of failing getting this to work, at all, to just start. It's hard to explain, and i don't want you experienced guys to care, the process, with data, Oscar etc. you have helped so many, it's me that have to overcome my very uniquely humongous amount of extra problems with all this. I´m very appreciative, very, since this forum is now my only "lifeline" (I really have no living Friends, left, either, to even went anything with).

Well, last 24 hours it has just been to mush, very much to mush. Again, no point with details, but i guess i will have to take a break for a day or two (have only "slept" i.e. dying in my sleep about 3 hours, the last 72, not falling asleep, headaches etc. which is bizarre).

I just hope this illustrates better (I know it's hard to convey "tone" in text) that i appreciate all relies/support, both the experts and others. Also, as you can probably tell, i have a strong thing of always se catastrophic outcome, of everything. I was a fairly normal guy, up until the pandemic, since then everything have gone, well to sh*t frankly. 

I have no idea, despite the excellent advice here, after the terrifying first choking with mask and pressure, I am unfortunately way weaker than i would say most here, but  i guess, testing slowly, awake, trying to relax etc. all that. I thought I could fix everything around this, bed, pillows etc. but realize it's just a way to "avoid" thing (subconsciously). To be honest, right now, i just feel like it's a huge mountain almost impossible to climb. I'm afraid I will do something stupid/wrong, interpret advice here wrong and accidentally suffocate/kill myself in sleep. 

If this is to mush psycho stuff, I apologize, but i recon best to be transparent. All I want i to overcome all my other thing enough to start, to just actually get some therapeutic effect going. I have a thousand questions, but as i said even if i intellectually still function with relative high intelligence, all of my rationalles is kind of "overruled" by fear (rational, and a lot irrational/exaggerated), fear of failing etc. I have extra problems with everything related to basically "caring for myself" at this stage, which, of course, is the basic premise for the CPAP thing.

Just unpacking the machine now, the thought of that, is a problem, am at that level. Again, i really don't expect you guys to "adapt" you advice to this mess, not at all, just illustrating why my journey might be even more problematic, at early steps, than most (if at all possible). If i don't reply in a day or two, I will have to try to "reset" and start again then. I just have to be honest, i'm still very much, mentally, in complete denial phase i think, it has not really sunken in, the consequences of it all. I´m just so tired, and loss for hope, after extreme struggles the last 4-5 years. Thanks to all, will be back.

[Fox66]

My absolutely worst fear (I hope the home test was wrong), and I'm just too afraid to get an O2 meter, is as i now realize reading threads, my extreme low o2. I can't even share, right now, but much lower than people in thread needing oxygen supplementation, more advanced machines etc. I was under 90% half of the time, but the dips, was, very very low. I can´t understand i have not even had any head acher, not falling asleep in all the years, it make no sense. Well I'm spinning away, and of course i should stop reading other treads for now, but the first ear throat doctor just said it was very low, and the CPAP people didn't say anything. I'm just way too afraid to get a o2 meter. It feels like ever since diagnosis, even before starting, it just gets worse and worse. IS it possible that CPAP/APAP, in itself, will get even very very low o2, up to acceptable ? (realizing need to get CAPAP going, and measure with o2 meter). Sorry, will try to not post for a bit, but hard, i have no other outlet for this mess, right now, at all. I just can't imagine even CPAP might not be enough. My AHI was very much worse on my back (about 4 times) than on side so i guess the worst dips etc. was on my back. I thought you should try sleeping on back for study, so everytime i woke up, i started on my back (where as i would normally start on side), also with very bad kink in neck (bad pillow). I realize Oscar etc. will explain a lot, just so terrified for "the results", so ill equipped handling more "bad news". I hope you don´t throw me out of the forum for panicking posts like this, will try to minimize them, but, as you can probably tell, I´m kind of spinning into full panic mode here (which happens for all the other easons, like 7-10 times a week anyway). This is all so very scary.

[40plus]

My AHI was 69 and my blood oxygen dropped to 74% at the lowest, but this was tested on only one night with not much sleep at all. Its safe to say i have dips far below the 74% sometimes. My median oxygen level was 90 %. And i know i had this for atleast 15 years untreated and im not dead yet.

The cpap machine brought this up to normal range which is like 95-98 % with maybe one or two dips to around 90 %.

Some if not many of your mental issues could very well start to lessen as the treatment gets going. Lack of sleep can do terrible things to your mind and well being.

Also you will not choke to death by sleep apnea. Thats not how it works.

Try using the machine while awake at first. Try knowing that you are exhaling and breathing just fine even though you feel like suffocating. If needed use beta blocker like "Inderal" or sleep meds like "Imovane" that is also a general sedative and will calm you down. If you can only use the machine at 30 min every night you start there. Whatever you can tolerate is what you start with. Then you build on that.

It took me about 6 months to get used to breathing under pressure and i had to use meds for months to tolerate it. Still now sometimes my heart start to race when i lay to sleep or i feel that my breathing is difficult even though it isnt.

[Fox66]

40Plus, I can't even express how much I value your response. I have this bizzare state with the last years hell, I am kind of intelligent and intellectual, but it just gets pulverised most of the time, right now, with all other issues. Since we seem to have very similar values (AHI, O2 etc.), and based on your experience, and it's crystal clear i somehow need to narrow my focus to, looking at the machine, setting up, awake testing etc. get from now, to trying to actually sleep. I will have no big problem waking up, only getting little sleep etc. I have slept max 4 hours, waking up multiple times, desert dry mouth, hyperventilating, pee brakes etc. as it is now. (I just thought it was because the mental stuff all these years, but i guess, as you point out, I'm now getting the chicken and the egg situation, the actual physical have definitely exaggerated the menat), not scaring myself with other treads (I have way too much tendency to fear instead of learning, right now but if/when that changes, if I get things going, i will be able to switch), no Oscar immediately ets (not before actually starting using, and understanding more). Even if i realized that before, your replies especially really made that click harder. I'm kind of like a scared 5 year old ;-), repeating same things over and over, get´s carried away etc. (add a 5 and you have my actual age). Hope you and other will be patient with me ;-). I have to understand how little i really understand right now, and be fine with that. My English is usually relatively O.K but the combination of wrecked keyboard and panic mode makes it a bit shaky ;-)

Again, i really want to add that I still very much appreciate all other welcoming and supportive tips, and beneath my mental block fully understand, the more advanced thing, what actually can dile in stuff later, for sure.

Again, i really really want to thank you, and wish you a good day. /Regards