First night with CPAP - Full face mask

[FranckDG]

Hi all,

Last night was my first night at home with a cpap machine. My machine is pre-set on a pressure of 14 but there is a button that sets it to 4 and it gradually goes to 14 over 45 minutes. I have a full face mask. My night was - as you can imagine - crappy. In some ways, not as much as I thought it would be because I did get some sleep, it was just very fragmented. Once I got the hang of breathing through the device, that was not much of a problem. My top problems were these:
- air leaks: that's what was constantly waking me up... It's not a problem at low pressure but as I fall asleep and reach 14, it's air leak galore and I wake up instantly. Later in the night, I tried putting it at 14 then setting up the mask so that there would be no leaks then back to 4 and fall asleep but it would end up leaking anyway.
- nose pressure: That mask (it's a blue-gel full face mask, supposedly good but honestly my DME seems to be a scam) hurts the bridge of my nose. After a few hours it becomes painful enough to contribute to keeping me awake as well
- air/gas: In the later part of the night/morning, I felt full of air. My belly felt bloated and it was fart galore. Maybe it was unrelated but after all, I did feel like a balloon with that air pressure on my face all night.

How do you deal with all this? Is it better with a nasal-only mask? 14 is the pressure they came up with during the sleep study but maybe a lower pressure would be a better compromise even if it means a few AHI events per hour instead of 0?

Any advice appreciated!

Franck-

[tedburnsIII]

I can only give you my first impressions, and I am a relatively newbie, but successful at this thing so far:

Impressions

The 4 to 14cm is known as the 'ramp' 'comfort' feature where one gradually and automatically titrates up to 14cm.

Straight 14cm is a high pressure to deal with for many. 14cm may or may not be your optimal pressure while supine (on your back).
You need to find that out, and also, whether it is a good or adequate pressure pursuant to clinical guidelines contained in first link, below.

Suggest that you read the following, but not first:

http://www.aasmnet.org/Resources/clinic ... 040210.pdf

IMO it is worth reading because, inter alia, you may be borderline a different type of machine it you can not
tolerate straight 14cm or auto-CPAP.

There IS A LEARNING CURVE but keep in mind that after your sleep study, if in an approved lab, all the results were analyzed by someone usually different
from the technologist and thereafter further analyzed by a board-certified sleep doctor. I would get the sleep test results and ALSO the doctor's summary or report on the test and give it considerable weight.

With that in mind, that was apparently your prescribed pressure, and if you can adapt to it, you are probably better off.

You may be okay to go on AUTO CPAP where your pressure might settle lower yet cover your back sleeping as well.

Notwithstanding, I would highly recommend that you first read this- I just found it and it is relatively easy and fun to understand:

http://www.daveburrows.com/cpap/sleepst ... pstudy.pdf

Best wishes,

p.s. I am sure that others will contribute re your monitoring your data, etc. I guess the first step here is to list your machine and mask, etc., pursuant to the drop-down menu in your Profile. That will be helpful to others here who will likely assist you with the monitoring of your data.

[FranckDG]

Thanks for the tip. I have also been using a pillow to sleep on my side and it's been pretty successful (no more snoring and I felt more rested in general) so I am thinking that if I combine the pillow with the cpap machine, I may be able to lower the pressure. But I guess I need to get an adjustable cpap that is data-capable first.

[tedburnsIII]

Thanks for the tip. I have also been using a pillow to sleep on my side and it's been pretty successful (no more snoring and I felt more rested in general) so I am thinking that if I combine the pillow with the cpap machine, I may be able to lower the pressure. But I guess I need to get an adjustable cpap that is data-capable first.

That sounds good.

My 2 cents- don't start playing with the pressures for some time, if at all. Known as 'dial-a-winging'. Remember that 14cm must be the prescribed, optimal pressure. You are not supposed to adjust pressure yourself (but you likely will, eventually).

Here is what I mean: I finally got my sleep doctor's report. I had obtained the sleep study first, did not even know at that time that a doctor wrote a report on that study.

12cm was apparently the optimal pressure (and what I suspected from the study).

Cardio for some reason prescribed auto-CPAP 6-15cm range. Minimum pressure WAY BELOW recommended pressure but supposed to cover it other end. I felt some shortness of breath and saw pulmonologist about it. But before I saw him I had been doing that pressure for a while and overall felt great. He increased for various reasons to 9-15cm-no reason to go into collateral reasons, don't want to confuse.

Bottom line- After 2-3 months on auto I know in my heart of hearts that if I can adapt eventually to straight 12cm that is probably for the better, though it is likely OVERKILL for sleeping on my side. But I am also MORE COMFORTABLE and SLEEP LONGER on auto, at least for now.

Remember this- an auto-CPAP, (or APAP) can be set to straight CPAP at any time. So, I indeed, switched from auto 9-15cm to 12cm and tested for a while, but the pressure was a bit much for me to adapt to. I will get there, and some people actually prefer straight CPAP to auto, anyway, as pressure is consistent all the time.

I believe that my cardio prescribed auto 6-15 due to lack of knowledge (he was first to admit he was parroting the report-NOT REALLY, but I appreciated his candor) and/or wanting me to be able to satisfy compliance requirements and not be a 'drop-out'- that I be 'successful' at it, and I can assure you that your going on auto-CPAP or, in your case, possibly BPAP, in contrast to straight 14cm will be more comfortable for you- however, in your case, it may be imprudent or even ill-advised. You need to speak to the sleep doctor, your doctor, the lab, etc.

[FranckDG]

however, in your case, it may be imprudent or even dangerous.

What do you think is dangerous about it? After all I have been sleeping without a CPAP all this time and I am pretty sure now that I've had sleep apnea for 7 to 10 years just because of the symptoms. Would it be more dangerous than sleeping without a CPAP?

[Pugsy]

The "prescribed" pressure isn't always the "optimal" pressure. I have first hand experience with that myself.
It might be a worst case scenario pressure based on a sleeping position that someone never sleeps in that position or it may be based on what works for 15 minutes and they ran out of time to test anything else.
Sometimes it is spot on and just as many times it isn't...but it's a starting point that is usually fairly close but not always. I know people prescribed 18 cm but they found out they only need 9 cm....big difference.

[palerider]

however, in your case, it may be imprudent or even dangerous.

What do you think is dangerous about it? After all I have been sleeping without a CPAP all this time and I am pretty sure now that I've had sleep apnea for 7 to 10 years just because of the symptoms. Would it be more dangerous than sleeping without a CPAP?

bear in mind that tedburnsIII is very new at this and thinks he knows a lot more than he actually does. (like misusing the term "titrating")

now, pugsy on the other hand, HER advice is GOLDEN

there are a lot of ways to make your treatment more effective, and more tolerable.

the best suggestion of teds is that you fill out the equipment section of your profile, so that people can see what kind of machine you have, and what mask you're using.

finding the right mask is perhaps the most challenging aspect of cpap therapy.

yes, there are many nasal masks that just fit over your nose, and there are many nasal pillow masks (the style I mostly use these days) that just rest against your nostrils. the resmed p10 is one of the most popular ones these days, very minimal, very light. they can be found for about 40$ on ebay... though it's not permitted to sell full masks, some vendors will sell, for instance, "p10 cushions and headgear + bonus"... the bonus turns out to be the mask frame... so it was a never opened complete mask package.

do fill out your equipment.

if you choose to keep using that mask, get a mask liner, Karen from Padacheek is a member here, she's a really nice lady who cares, and helps people all the time, her website is padacheek.com mask liners won't prevent leaks, but they'll tame them down to the point where they probably won't bother you anymore.

[tedburnsIII]

The "prescribed" pressure isn't always the "optimal" pressure. I have first hand experience with that myself.
It might be a worst case scenario pressure based on a sleeping position that someone never sleeps in that position or it may be based on what works for 15 minutes and they ran out of time to test anything else.
Sometimes it is spot on and just as many times it isn't...but it's a starting point that is usually fairly close but not always. I know people prescribed 18 cm but they found out they only need 9 cm....big difference.

Good point, Pugsy, as always. But in my case 9cm clears almost all aps/hyps but according to the titration study in the lab my oxygen saturation was not enough at 9cm as it was below 90% SUPINE. That is what concerned me in particular and led me to conduct my own overnight oximeter monitoring. If I could get by at auto 9-15 or whatever with adequate oxygen sat I will stick with that setting, for a while. I may even test straight 9 or 9.5cm and see how that goes.

[Pugsy]

Right now Frank has a brick...but is getting educated on his options for acquiring a full data machine. See his other thread for that discussion.

As for lowering the pressure from 14 in an effort to be able to maintain a better seal and get some sleep...hey, it's better than no sleep or sleeping without the cpap machine.
It's quite possible that the 14 cm RX was a worst case scenario pressure for REM stage sleep and letting a few events slip by in REM isn't the end of the world. We won't/don't know for sure until he gets a copy of his sleep studies and/or gets a full data machine.
There's nothing wrong or dangerous about working up to whatever pressure is needed...any pressure is better than no pressure and not using the machine at all.

[tedburnsIII]

Right now Frank has a brick...but is getting educated on his options for acquiring a full data machine. See his other thread for that discussion.

As for lowering the pressure from 14 in an effort to be able to maintain a better seal and get some sleep...hey, it's better than no sleep or sleeping without the cpap machine.
It's quite possible that the 14 cm RX was a worst case scenario pressure for REM stage sleep and letting a few events slip by in REM isn't the end of the world. We won't/don't know for sure until he gets a copy of his sleep studies and/or gets a full data machine.
There's nothing wrong or dangerous about working up to whatever pressure is needed...any pressure is better than no pressure and not using the machine at all.

Everything of a clinical nature that I've read seems to mandate or at least try to titrate SUPINE during REM, and to actually turn the patient over to his back if not compliant during the lab titration. They mandate the worst-case scenario to apparently come up with the optimal setting- e.g., SUPINE and DURING REM, and I can understand the reasoning behind it, so that one who sleeps on back only is 'covered' during 'REM'.

Good idea to sleep on side as much as possible, and 'get away' with lower setting, assuming everything else (including, but not limited to, Spo2 adequacy) is satisfied.

[Pugsy]

But in my case 9cm clears almost all aps/hyps but according to the titration study in the lab my oxygen saturation was not enough at 9cm as it was below 90% SUPINE. That is what concerned me in particular and led me to conduct my own overnight oximeter monitoring

You need to understand that what was done in your situation is not something that is commonly done.
Your situation and your doctor's choice to treat your oxygen desats in this manner is rather unique. Most people will have their O2 stabilize with effective apnea/hyponea prevention and won't have a need to use higher pressures past effective AHI pressures for O2 reasons alone. Meaning the majority of cpap users would end up with a RX pressure of around 9 cm.

We tend to assume that everyone is like we are and a lot of situations we are correct but your situation is something that isn't all that common and most people won't be in the same boat as you are and won't have the same concerns that you have and there's no reason to assume that since it is that way for you that it is in turn that way for the next person.

Before we go down that road we need a lot more information than is available here right now....like the sleep studies themselves and some data from a full data machine which unfortunately Frank doesn't have right now.
So based on how the majority of people are treated and respond...lowering the pressure right now and maybe increasing it slowly if needed once the leaks are better managed or a new mask is tried...some pressure is better than no pressure and while not ideal....not necessarily dangerous.

[tedburnsIII]

But in my case 9cm clears almost all aps/hyps but according to the titration study in the lab my oxygen saturation was not enough at 9cm as it was below 90% SUPINE. That is what concerned me in particular and led me to conduct my own overnight oximeter monitoring

You need to understand that what was done in your situation is not something that is commonly done.
Your situation and your doctor's choice to treat your oxygen desats in this manner is rather unique. Most people will have their O2 stabilize with effective apnea/hyponea prevention and won't have a need to use higher pressures past effective AHI pressures for O2 reasons alone. Meaning the majority of cpap users would end up with a RX pressure of around 9 cm.

We tend to assume that everyone is like we are and a lot of situations we are correct but your situation is something that isn't all that common and most people won't be in the same boat as you are and won't have the same concerns that you have and there's no reason to assume that since it is that way for you that it is in turn that way for the next person.

Before we go down that road we need a lot more information than is available here right now....like the sleep studies themselves and some data from a full data machine which unfortunately Frank doesn't have right now.
So based on how the majority of people are treated and respond...lowering the pressure right now and maybe increasing it slowly if needed once the leaks are better managed or a new mask is tried...some pressure is better than no pressure and while not ideal....not necessarily dangerous.

Note that my cardio admitted to me that his knowledge may be a bit more than most cardios but substantially less than that of a sleep technologist.

Of course, and I wish I were like other people in that sense. And I have lung/breathing issues, though my awake Sp02 is 97%.

We don't have the reports and study, but a prescribed pressure so high might indicate similar issue, and I emphasize the word 'might, be an issue with OP. Curious, OP, what your oxy sats/desats were at the lower pressures. My understanding is they only titrate up to optimal (in contrast to 'good' or 'adequate' pressure) where not only <5 RDI but also >90% minimum SaO2. It is reasonable to conclude that that is the optimal pressure supine for this OP where above is satisfied. And following that reasoning, either he was having too high RDI with too many aps/hyps/RERA at lower pressure settings or his Sao2 was too low- one or the other, or both. There may also be other factors beyond my limited knowledge.

Here is an example of why in my particular case the pressure titrated to by the sleep lab and recommended by the board-certified sleep doctor apparently came to 12cm:







mmmhhhhmmm...so, my cardio prescribes auto 6-15cm?!?

It is likely that if your doctor were mine, doc would've prescribed me straight 12cm, and I might have been the OP instead of you!

In any event, stick with the program, whatever!

So a reasonable conclusion could be that the optimal pressure is the 'cover all' pressure, and may not be absolutely necessary. 'Optimal pressure' is clearly defined in the first link in my first post here. But it may not be the best pressure for you; however, it's a good starting point.

[FranckDG]

This all makes sense to me. I know for a fact that they asked me to go to supine position on purpose to get that worst case calibration. I asked my doctor about it and she said that they have to assume supine position because nothing can guarantee that you will stay on your side. I've been using a sleep bump pillow and it's true that a couple of times I took it out in my sleep but most of the time I sleep on my side now. I was using this while waiting for my brick (which took two months of back and forth) and I already felt less tired and better in general (and no snoring which made my wife happy:)

Anyway, I am going to get a good machine with data capability first and a nasal mask then run some tests (side pillow/no side pillow, full face mask/nasal mask, recommended pressure, lower pressures, etc...) until I find the sweet spot!

[tedburnsIII]

Sounds great, Franck!

Do you have a link to the pillow that you purchased?

[FranckDG]

It's this one: http://www.amazon.com/SlumberBump-Snore ... ump+pillow

Be aware that they have different sizes!