Easing hubby into CPAP

[nvanderhoeven]

Hi all! My husband was diagnosed with severe sleep apnea last week, which was good in one sense because we finally have an answer for why he's so tired all the time, but it's also bad because I know how serious it can be. My father died because of complications caused by sleep apnea, so I want to get this right, and I want to get this right as soon as possible.

My husband has a total AHI of 31 (OA: 17.9). We immediately got a trial machine (a Phillip Respironics Series One auto) which we will have for the next month. I have a few questions that I'm hoping you can help me with.

1. He has yet to sleep the entire night with the CPAP. The longest he's gone with it is 2 hours at a time (last night). He says he has issues with a blocked nose. I increased the humidity to max (he was at 2, now at 3) and hose temperature (he was at 3 and is now at 5) but he said he felt it was worse. He also noticed some condensation in the mask. Am I correct in assuming I should try to reduce the humidity to 1? Does the hose temperature need to change?

2. The pharmacist that has conducted the sleep study said he initially wanted my husband to try the auto setting, but he said that he has personally seen better results when the pressure is fixed. However, after some research online, it seems that there is an ongoing debate on this issue. I have downloaded SleepyHead and imported my husband's data. His AHI last night was 2.53 (2 hours on, 2 hours off, and 2 hours on again). This is a substantial difference, which is great. His pressure was a min of 8 and a max of 14. The 95th percentile pressure was 10.30. Should I consider setting the machine to fixed, or should I leave it on auto? If I should try fixed, how do I know what to fix it at? Is the 95th percentile pressure a good start, or is it still too high?

3. I'm already starting to look at buying a CPAP after our trial is over. How do I go about choosing one? Is there a model that is above and beyond the rest? Should I buy an auto just for the flexibility of switching to fixed if we want it? Or with the price difference, is it better to buy fixed (if it turns out the hubby responds well to it)?

4. The mask we have is a Phillips Wisp nasal mask. The pharmacist started us off on it because he said it's the least obtrusive. My husband, however, has complained a few times that he still likes to breathe through his mouth. He has already removed the nasal mask a few times because he doesn't like having it on his face too long. Should we try a full face mask as well, or would the added bulk only exacerbate his current inability to sleep with the mask on the whole night?

While I'm not the one with sleep apnea, all the research falls to me, and so I feel a little overwhelmed. Thank you all for contributing to this forum, and for the many tips I've already read on it. I've looked through several threads: tutorials on SleepyHead, Pugsy's Pointers and just general words of encouragement. They all help. This is all pretty scary for me, and it's nice to know there's a community here of people who understand.

[ThePrincess&ThePea]

Hi there, I'm pretty new to this myself, so I can sympathize with you there! Did your husband have a formal sleep study done? I know usually they observe part of the night and then start therapy the second part so they can probably titrate the machine and figure out the right pressure for him. I didn't do it that way... My insurance wouldn't pay for a real sleep study, so I had to do an at-home one. Then my doctor's office connected me with a local supplier and they set me up with an auto machine at the request of my insurance company. I don't know if there's a brand that's above the rest, but if you have insurance they will probably decide what they're willing to pay for. From what I understand, the gold standard is to have a sleep study / titration, which means more sleep studies down the road to see if he needs adjustments later. The auto machines are more expensive, but my insurance company opted for that over having to pay for periodic sleep studies.

Sorry I'm not more help! There are a lot more people on here with more experience. I know it's scary and overwhelming, but you're doing all the right things, so just hang in there!

[kteague]

1. ...He says he has issues with a blocked nose. I increased the humidity to max (he was at 2, now at 3) and hose temperature (he was at 3 and is now at 5) but he said he felt it was worse. He also noticed some condensation in the mask. Am I correct in assuming I should try to reduce the humidity to 1? Does the hose temperature need to change?
The best humidity is trial and error and very individual. Considering he did worse when increasing it and had condensation, I would turn it back down unless you see reason to do otherwise. There are hose covers that can help with condensation, but unless he needs more humidity I wouldn't focus on that yet. Also, placing the machine a bit lower than mattress level can help prevent droplets from running down to the mask. Routing the hose overhead can help prevent the same, either by running it over a headboard or hanging it. But hopefully with the humidity dialed down none of this will be needed.

3. I'm already starting to look at buying a CPAP after our trial is over. How do I go about choosing one? Is there a model that is above and beyond the rest? Should I buy an auto just for the flexibility of switching to fixed if we want it? Or with the price difference, is it better to buy fixed (if it turns out the hubby responds well to it)?
Auto may not be necessary, but it may give more data points. And you can always set an auto on a fixed pressure, but not the other way around. If money is not at issue, I would suggest getting an auto. But if it can't happen, I doubt it will make or break your hubby's treatment. Some really NEED auto, but we can't say if he's one of those or not. I can use either mode equally effectively.

4. The mask we have is a Phillips Wisp nasal mask. The pharmacist started us off on it because he said it's the least obtrusive. My husband, however, has complained a few times that he still likes to breathe through his mouth. He has already removed the nasal mask a few times because he doesn't like having it on his face too long. Should we try a full face mask as well, or would the added bulk only exacerbate his current inability to sleep with the mask on the whole night?
It may cause more trouble if it's leaky, or the bulk bothers him, but it could help his sleep if he needs it because he really needs to mouth breath. If you go that route, a mask liner might help it be more tolerable.

This is all pretty scary for me, and it's nice to know there's a community here of people who understand.
You're not the first spouse here who has successfully guided their loved one in this treatment. They are blessed to have you.

[LSAT]

What country are you in where the pharmacist does the sleep study?

[bellab]

I can comment on the stuffy nose issue:

You may want to have more than one mask- a "daily driver" mask and then a full face mask for when you just want to mouth breathe or you're stuffed up. I generally switch to my hybrid mask (nasal pillows and a mouth cover) when I'm feeling stuffed up- but last night I tried something new that did the trick-


Essential oils!

When I want to relax I've been dabbing some orange or lavender essential oil on a cotton ball and placing it near the air intake- last night I was stuffed up so I tried eucalyptus oil. Eucalyptus oil basically smells like vicks vapor rub so it really seems to open up your sinuses. I slept just fine with my nasal mask & eucalyptus oil as opposed to switching to the face mask.

[lilly747]

Essential oils!

When I want to relax I've been dabbing some orange or lavender essential oil on a cotton ball and placing it near the air intake- last night I was stuffed up so I tried eucalyptus oil. Eucalyptus oil basically smells like vicks vapor rub so it really seems to open up your sinuses. I slept just fine with my nasal mask & eucalyptus oil as opposed to switching to the face mask.

I too use Esseniail Oils but be careful of the brand. Do some research about using them and buying them. I put mine in the tank, 1 to 3 drops depending. Good luck with Hubby

[Julie]

Lilly - you're going to ruin your tank - never, ever put anything in it besides water, preferably distilled. The oils or anything else should be put on a cotton ball in front of the air intake of the tank - outside of it - and that's all.

[nvanderhoeven]

Thank you everyone for the answers!

LSAT-- I live in Australia. We do have sleep specialists, but for years I couldn't convince my husband to go to one of them because he knew they would do a sleep study and he thought it was too much trouble for nothing. I took what I could get and we saw a pharmacist last week. Now that he knows he has the issue though, we've gotten a referral from our GP for a sleep specialist. He has not had a titration study done; it was just a test at home.

ThePrincess&ThePea - Thanks! No, he hasn't had a formal sleep study done; he was just given some wires and a machine to sleep with one night and it was enough to diagnose him. Should I look at getting a real one done? I'm not sure what that would accomplish. Is it to understand what settings he needs? We only have hospital insurance, so we have to pay for all of this out of pocket-- but we will gladly pay it to get him some decent sleep!!

kteague - Last night we tried a level 1 humidity setting and he said it was worse. We're going to try out a full face mask for him as well, but tonight we're going to give the level 5 humidity setting a go, just because we haven't tried it yet! I'd love for him not to need a full face mask because he's already finding the nasal mask quite cloying. Thanks for the advvice on the auto. I'm inclined to agree. At least if we decide later that auto is better, we'll have the option to do that without buying a whole new machine!

[Julie]

While plain obstructive apnea can be diagnosed at home with a good Auto machine, software like Sleepyhead and some education, an in-lab study can also look for other related problems such as complex apnea, UARS, RLS, etc. that can't be diagnosed at home, so if you can afford, at least one time, a lab study, I'd do it if only so your doctor will have 'baseline' and worst scenario stats for future follow-up, etc.