Length of time using mask at night

[Mamie05]

I saw the heart doctor a week ago and he asked how long I was wearing the full face mask at night. I told him 4-5 hours. He said at least I was getting some benefit. What I forgot to ask is, after 5 hours, are you still at risk of dying in your sleep if you're not wearing the mask. I'm confused. Does it work for you for the 5 hours and then after that it doesn't? Dumb question but its on my mind.

[Pugsy]

If you are sleeping for any amount of time without the mask...your OSA is untreated for that length of time.
You don't buy 3 hours of no OSA after using the mask 5 hours..
5 hours is better than no hours or 3 hours or whatever but not nearly as good as never sleeping without the mask.
It works when you use it but if you don't use when sleeping part of the night you are putting yourself at risk during those hours asleep without it.

[Drowsy Dancer]

I saw the heart doctor a week ago and he asked how long I was wearing the full face mask at night. I told him 4-5 hours. He said at least I was getting some benefit. What I forgot to ask is, after 5 hours, are you still at risk of dying in your sleep if you're not wearing the mask. I'm confused. Does it work for you for the 5 hours and then after that it doesn't? Dumb question but its on my mind.

You are always at greater risk when you are sleeping without CPAP. There is no "protective dose."

It is true that you are better off wearing it some of the time than not at all, but the goal of everyone on CPAP should be to wear the mask 100% of the time that you are sleeping. Even naps.

[2 B Sleeping Soundly]

I completely agree with Pugsy and Drowsy Dancer. I will try to say the same thing they said just slightly different using a food example. If you have a diet that consists of primarily convenience/fast foods and take a occasional multi-vitamin, or eat a occasional salad, or some vegetables, would that then counteract all of the convenience/fast foods that you eat? The addition of the multi-vitamin, salad or vegetables will certainly help (be of benefit), but could not be expected to undue/correct the negative effects of the convenience/fast food diet.

John

[Otter]

He said at least I was getting some benefit. What I forgot to ask is, after 5 hours, are you still at risk of dying in your sleep if you're not wearing the mask.

Untreated apnea is more slow degeneration than sudden death, but yes, if you are already at risk for a heart attack, working your heart hard without enough oxygen could cut the thread you're hanging by.

Also, being awake won't keep you safe from the damage untreated OSA does to you. It grinds you down, and that makes you more vulnerable 24/7. Stroke, heart attack, diabetes, or infection could just as easily take you during the day. As much fun as it is to wake up feeling like you've been fighting for your life for three hours, it's just not worth the wear and tear.

Dumb question but its on my mind.

The only dumb questions are the ones you don't ask. For instance, if you need help with whatever is keeping you from using your machine all night, and you haven't asked about it yet, that's a dumb question. But it will stop being dumb the instant you post it here.

[Mamie05]

Thenks everybody. My pressure is at 17 and I try to think I'm on an ocean cruise (not the Carnival) with the sea breeze coming in but it ends up feeling like a dog with his head out a car window. The ramp time is 45 minutes so hopefully I can fall asleep in that time. One thing I like about the CPAP, my restless leg syndrome went away. I was off CPAP for a month because of gum surgery and my legs started up again. As soon as I continued, I haven't had them since.

[Otter]

Thenks everybody. My pressure is at 17 and I try to think I'm on an ocean cruise (not the Carnival) with the sea breeze coming in but it ends up feeling like a dog with his head out a car window. The ramp time is 45 minutes so hopefully I can fall asleep in that time.

Actually, you want the pressure to ramp up before you fall asleep. If it doesn't, then when you first fall asleep, you won't have effective therapy. And if you go straight to REM, as some sleep-deprived people will do, you'll either have clusters of events or you'll wake up because you can't breathe. Ultimately, you're probably better off without the ramp, but if the pressure is too intimidating at first, you can use the ramp to keep from freaking out while you get relaxed. Try shortening it, though. Eventually, you'll probably want to turn it off completely. Believe it or not, you will get used to this.

[Pugsy]

At a 17 cm starting pressure...that's going to take a lot of getting used to. Those of you who think all you have to do is set your mind to it and "get used to it"... crank your machine up to 17 and see what it feels like. It isn't easy at all.
In fact she went past a common pressure need to qualify for bilevel pressures a few cms ago.

If it had been me I would have been pushing for a bilevel machine. That's what they are there for.
So Mamie...there are machines designed for people who have to use high pressures like yours and they would make your life a whole lot easier and might even allow you to get more than 4 or 5 hours of sleep each night.
They are called bilevel pressure machines...BiPap is a common term but actually refers to the Respironics model of bilevel machine.
There are plain bilevel machines and bilevel machines that get real fancy and cost a lot of money.
Unless you have a lot of centrals you would only need the plain bilevel machine.

Up to you if you want to pursue it but you do have options.

What machine are you using? Maybe there is some exhale relief on it that you aren't aware of?

[Otter]

At a 17 cm starting pressure...that's going to take a lot of getting used to. Those of you who think all you have to do is set your mind to it and "get used to it"... crank your machine up to 17 and see what it feels like. It isn't easy at all.

I didn't say it would be easy. And I don't think it's the mind so much as the body. At first, all this machinery triggers our fight/flight response. "Help! A leaf blower is trying to eat my face!" But eventually that primal self learns that the machine does no harm, and even helps, and the rush of air becomes relaxing rather than threatening. It's a bit like training a horse.

Until that beast is trained, though, ramp or even lower pressures make some sense. But don't most people get used to their therapeutic pressure eventually, even if it's high?

Bipap is a good idea. I actually wish I had one. Then maybe I could sleep on my back.

[STL Mark]

My sleep study titration was 18. In the past I used a S9 Autoset with settings at 16/20 with a EPR of 3 and no ramp. My 95 rate on my APAP data is 17.9. I picked up a used BiPap for a great deal and asked a few questions here and consulted with my doctor to determine proper settings.

There are machines that can make it easier to sleep through the night with your mask on. The APAP machines are great. The Bi-Pap machines are a dream at these higher pressures. If your insurance company does not agree and you have the funds you can buy out of pocket. Register here and join us. We don't bite.

[hyperlexis]

Yes. I guarantee 100% you will die. Eventually.

You're not alone. I forget to mask up before bed all the time. I doze off with the tv on, wake up at 2 am and then do it. Not proud of it and am working on being more compliant, but at least I havent thrown the machine in the closet like a lot of apnea patients do.

No one is perfect, just try your best to connect yourself before bed. Worry about death tomorrow. Because tomorrow is another day.

[Pugsy]

In an ideal world yeah...they get used to it but it is far from an ideal world.
In reality no, people don't always get used to high pressures.

Mamie admitted to her doctor she was only using the machine 4 to 5 hours a night and instead of "what can we do to make it better for you so you can use it all night"...she gets "well that's better than nothing" and then comes here and says 17 cm is hard to get used to and we tell her to keep trying that "she will get used to it" when in reality we don't know what is going on with her. Maybe there are physical reasons for additional difficulty. I have a friend that has to use 16.5 cm cpap (doesn't do well with APAP) and has COPD..and her doctor said "hey, I can't do anything to make it any easier"...Bilevel was never mentioned. Duh....
For people with COPD the act of exhaling with normal breathing can be very difficult let alone exhaling against cpap pressure at any range. Add in the really high pressures and it is just often very, very difficult.

Ever wonder why there are so many people who toss their machines in the closet? People like Mamie and my friend...that's how it happens. Now if all options are exhausted sometimes we do have to suggest "try harder" but until those options are used up I am not going to tell someone to keep sticking their head out the car window going down the freeway at 70 MPH that eventually she will get used to it.

So we don't know all of Mamie's history and don't really need to know for us to be able to offer her additional ideas that go beyond "work harder...most people get used to it" because that simply isn't always the case.

We can't assume that because something is easy for us to do that the rest of the population would also find it easy to do and they will "get used to it". This is how people slip through the cracks. They don't/can't get used to it and it's a damned shame when there are additional options available that might help.

[DEXSUZ]

mamie05:

Had my "slumber party" at the hospital on January 17 and was instantly judged as being a CPAP candidate. Got my gear 2 1/2 weeks later
(F-F Quattro FX and a reading of 10 on my gizmo) but had a few bad nights and then decided I'd ease myself into wearing it. At first I used it only for afternoon naps when no one was home, phone off the hook, etc. After I got accustomed to that, I kept going to bed without the mask but started putting it on during the night when I'd be groggy after inevitably waking up around midnight or 1 a.m. Last Sunday night I decided I was totally comfortable with the gear and went from bedtime to morning with it on. Happy to say that last night was my first uninterrupted, sustained sleep in DECADES as I retired at 11 p.m. and awoke at 7 a.m.

Corny as this seems, when I see the machine, hose, and mask, I now look at them as friends. Together, they and the doctors and technicians have helped me do something that I thought would never be possible. Time frame for this: exactly 40 days and nights.

Best of luck to you. REMEMBER: ease into it.

[Otter]

So we don't know all of Mamie's history and don't really need to know for us to be able to offer her additional ideas that go beyond "work harder...most people get used to it" because that simply isn't always the case.

We can't assume that because something is easy for us to do that the rest of the population would also find it easy to do and they will "get used to it". This is how people slip through the cracks. They don't/can't get used to it and it's a damned shame when there are additional options available that might help.

I know you mean well and you really believe that people can get used to it and some people do....but not everyone.
It's a cold hard fact of life and part of the reason cpap failure rate is so high.

Pugsy, you're going way beyond anything I actually posted. I didn't say anything about working harder, and while I didn't think of BPAP myself, I agree that it's a great idea. I did wonder whether any sort of exhalation relief was part of the picture, but not even knowing what machine Mamie is using, and being rather tired, I decided to leave that for other posts or other posters. You aren't seriously suggesting that I am somehow blocking anything that doesn't immediately occur to me, are you? I'm really not even sure if you're responding to my posts at all, but you start by quoting them so maybe you think I said all the things you're going on about. I did not actually say 90% of what you are refuting, and I'm not going to argue with you because I agree with a great deal of what you've said.

I discussed the downside of ramp and suggested that Mamie use it if her pressure is physically intimidating, but to try to keep it short so that she doesn't get hit with apnea as soon as she falls asleep. If you've ever experienced sleep onset apnea, it's no more fun with CPAP than it is without. Startling awake unable to breathe immediately after falling asleep is not going to help anyone get used to wearing a mask. Even though the mask actually helps you breathe, if it's unfamiliar, it may seem that the mask is what cut off your air. I suppose, just to make a point, I could berate you for 10 paragraphs for suggesting Mamie put herself through that, but I know that's not where you're coming from, and I don't think either of us wants to hijack her thread.

Yes, I did say, "Believe it or not, you will get used to this." You are correct that that is not certain. You are wildly incorrect that I was dismissing Mamie's difficulties. My intent was to be encouraging. Mamie, if I seemed that I wasn't taking the problems you are having seriously, I apologize. That was as far from my intent as anything could be.

What I actually meant was that she would get used to sleeping blown. I didn't intend to exclude any options for the blower, mask, etc. I didn't even suggest that her pressure had to stay the same. But from what I've seen here, most people do get used to the pressure they need provided they can get their masks to stay sealed. Well, at least people who come here and get help. And yes, people do sometimes require a machine with greater capabilities. Some people need BPAP or ASV even at relatively low pressures. Finding the right combination of equipment and settings is part of getting used to having a machine hold your throat open with air pressure. Obviously, if something isn't right, you fix it.

I'm currently running APAP at15-18cm H20 with EPR set to 3, but I have run higher. When I first started, 12cm freaked me out. But after about six months I experimented with the highest pressure my S9 can manage and it didn't bother me as long as my mask didn't blow off (BIG if), and as long as I could have my EPR. BPAP adds even more flexibility, so I wholeheartedly agree with that suggestion. Whether or not it actually addresses the problem, we don't know yet. But sometimes it's not clear what the problem is, and having the greater flexibility of BPAP to play with could prove very useful.

As for me being the personification of unhelpfulness and insensitivity, Pugsy, you can yell at me all you want, but I want a paycheck from whatever DME you think I work for.

[Pugsy]

Otter I wasn't attacking you.
I was only pointing out that there perhaps your statement

But don't most people get used to their therapeutic pressure eventually, even if it's high?

wasn't/isn't something that happens all the time.

The rest of my statement was general information so that everyone could maybe understand that "most" people is not necessarily the best adjective and I went on to share some personal experience why sometimes "most" people can't manage what "most" of us take for granted.

If you feel I was personally attacking you...no..that was not my intent and if I have that impression then I apologize.

I just get so tired of the "suck it up buttercup" and "if you try harder you can make it work" and "most people manage....." when someone is having a problem that sometimes I can't stay off the soap box.

In an ideal world yeah...they get used to it but it is far from an ideal world.
In reality no, people don't always get used to high pressures.

This is the part I wished to address to you....the rest of it was to the whole world in general.