Nights 1-4 with CPAP, having trouble

My Resmed AirSense 10 Autoset with heated tubing and Resmed AirFit F10 Full Face Mask was delivered yesterday by a very helpful DME tech who unpacked everything, helped me fit the mask, and showed me how the machine works.

My first night went pretty well. I had some issues, but I should be able to resolve them:

• No humidification - I didn't have any distilled water, so for the first night, I used the CPAP with the humidifier turned off. My nose got dry, and my throat is a little hoarse this morning, but I plan on buying a gallon today and I shouldn't have this problem anymore.
• Sleep onset - It took me longer than normal to fall asleep, though it really was not too bad. I'm sure that will improve as I get used to CPAP.
• Repeated waking - Ok, so I have UARS, not OSA, and repeated waking is what I do. Most of them I don't remember, but I always have a few total awakenings each night. Last night there were more than usual, but most were caused by mask leaks (see last bullet). One was caused by a neighbor's domestic dispute (yes, loud yelling, outside, at 3 in the morning, sheesh!) I am confident that with time I will grow more acclimated to CPAP, and awakenings will taper off.
• Itchy nose - Several times my nose got itchy and I had to pull off the mask to scratch it. This sent air blowing, and made noise. (I hope it didn't bother my husband too much.) Obviously, it only happened when I was awake, and I am hoping that as I grow accustomed to the CPAP, that I won't wake as often. The itchy nose may also have been another side effect of no humidifier.
• Mask leaks - I had several leaks. Mostly I could fix them by adjusting the mask a bit, but the last one I couldn't get right. By then it was only an hour until my alarm was supposed to go off, so I just took off the mask altogether and slept the last hour without CPAP. I will spend some more time adjusting the straps before I go to bed tonight, and see if I can cut down on leaks. The DME has a comfort guarantee, so if I can't get this mask to work for me, I can call them and try another one. So, while it was troublesome, this issue should be one that I can overcome in time.

So, how do I feel? I know that it can take weeks to notice any results, but I have to say I feel pretty rested. I have to get up by 5am to catch my morning vanpool to work, and I'm usually pretty groggy when I drag myself out of bed. I was still tired this morning, but my head felt clear, and I think I have more energy than usual. It could be a placebo effect. The real test will come this afternoon. I usually hit what I call my "energy wall" around 1-2 in the afternoon on workdays, when fatigue hits me like a freight train, and meetings become almost intolerable. Of course today happens to be the last day before a holiday, and we're allowed to leave an hour early, which means I'll be out of here by 1:45 today. Maybe I won't feel like napping on the ride home? We'll see!

Other things to do:

• Clinical Menu - One thing I noticed is that the tech turned the machine away from me as she entered certain settings, like my prescribed pressure, what kind of mask I have, and how much exhalation relief to provide. I want to be able to control those myself. So, this morning I looked up online how to access the clinical menu. My insurance rents the machine and requires compliance with therapy for one month before purchasing it outright, so I'll leave the settings alone at least until then in case modifying them would influence the insurance at all. But after that, I own the machine, so I'm taking charge. CPAP machines can't accurately measure RERAs, so the auto setting may not work for me like it could for someone with OSA. I want to be able to set the pressure according to my symptoms, not just according to some algorithm in the machine. (I'm a computer scientist - I know the limitations of software!)
• Software - This is another thing I have to do. I plan on downloading the software for reading my own sleep reports.

So, that's about it. So far, so good. I'm optimistic that the therapy will improve my symptoms, and I can resume some of the activities I've abandoned due to fatigue. Yay!

I am also new and have been on the hose a week. I haven't felt different or better at all yet. My apnea level was 23 per hour, but that was a home study because my insurance wouldn't pay for lab review. The doctor said the home study is not as detailed and I probably had more Apneas. He said the lab study overnight is more detailed and maybe at some point my insurance will pay for that.

I tried a chin strap last night because I use a nose mask and was waking with really dry mouth. I thought I must be mouth breathing and losing pressure, yet the machine showed AHI as 1.7. Weird. But I woke way earlier than usual today and had to get up. Now four hours later I'm feeling tired.

I hope you feel better soon. Me too.

For my self, I was having problems with nocturia and multiple trips to the bathroom at night. When I started using my xPAP that immediately stopped and was the only benefit I saw for a few months. I was happy for just this, but still tired.

It wasn't until a late night trip when it was my turn to drive that I realized, I wasn't as tired as I had been in the past. It was a gradual thing that happened while I wasn't watching. The day before this trip if asked, I would have told you that I was only getting some benefit. Now I know how much better I feel and I am afraid of what would happen without my xPAP.

MamaGeek wrote: My insurance rents the machine and requires compliance with therapy for one month before purchasing it outright, so I'll leave the settings alone at least until then in case modifying them would influence the insurance at all.

"compliance" (I hate that term) is only concerned with usage, the insurance company (and by extension, the dme) don't give a crap if your treatment is *WORKING* only that you've got the machine on your face for at least 4 hours a night, 70% of the time (typically).

I've never heard of an insurance company saying anything at all about changed settings, if it lets you use the machine more, they're happy.

your DME may get their nose out of joint, but you can just tell them to piss off.

palerider wrote:your DME may get their nose out of joint, but you can just tell them to piss off.

Excellent!

I'm four days in now, and having some problems:

1. Sore throat - I upped the humidification to 6, which seemed to help. Is that the recommended way of dealing with a sore throat?
2. Swallowing air - sometimes I swallow a lot of air, and end up very bloated, with all the air coming out later in the usual (embarrassing) way. How can I prevent this?
3. Mask leaks - I feel like I'm fighting with the mask all the time. It either leaks, or it's too tight and hurts my face. I can't get a happy medium. It seems like it needs to be seated just right, or it leaks, which means I can't sleep more than 2 hours before I turn in some way that knocks it off kilter. I'm thinking of calling the DME about a different mask style. My nose was broken when I was younger, and I have a bump right where the mask sits. That means it's painful if the mask is even a little bit tight there. I am a nose-breather. I requested the full face mask because I started breathing out my mouth towards the very end of the in-lab titration study, which was uncomfortable and woke me up. I'm thinking now that maybe I should ask to try a nasal pillow mask? There is a FFM I saw on Cpap.com called Simplus that purports to put no pressure on the bridge of the nose. Anyone else use that?
4. Headaches - now this could just be me. I get migraines - a lot. It could be some other thing that is triggering them, and there are other triggers present at the moment, so that may be it. Or it could be the CPAP. I just don't know.

I made a couple of adjustments to the settings on my machine. Besides the humidity (as mentioned above), I did the following:
A. turned the exhalation relief to the lowest setting - I didn't like the "gust" of air that I felt inhaling due to the high contrast between the two.
B. turned off the ramp up completely - I would get my mask seated and comfortable at pressure 4, go to sleep, then it would ramp up to 8 and start leaking. I find I can go longer without a leak if I adjust it for the higher pressure to begin with.

So far, I can't make it the whole night with CPAP. I'm keeping up the "compliance" requirement of at least 4 hours a night, but I want to truly benefit from the therapy, and I feel like I won't until I can use it more consistently.

Any suggestions for my mask problems (see #3 above)? Thanks!

I have the F10 also and after a while, I experience similar problems as you. Do you use a mask liner like this one?http://www.padacheek.com/PACAirFitSeries.html. It can help with leaks.

The F10 is a little narrow for my face, so I prefer the Quattro FX, which is very similar, because it fits my face a little better. You wear it about the same. I like the mask in one size larger than I measure for because I like for the bottom of the mask to ride at the lowest part of my chin instead of under my lip. This allows for more facial movement without causing leaks. YMMV

At my sleep study, I used a nasal mask, and I tried on a few different ones. The only one that didn't hurt my nose hat a hard plastic piece that went up from the mask to a forehead strap. I think I'll ask for one like that. It seemed to keep the mask off my nose better than the one I've got now.

Liners - Padacheek.com - take a look.

I also have the F10 mask. When my nose itches, I don't take the mask off. Instead, I keep a stack of straws in my nightstand drawer. I disconnect the hose and use a straw to scratch it, I disconnect it when I need to get up during the night as well. There's another liner available as well, called RemZzzs, available from many DMEs and from our hosts at cpap.com. I had a terrible time with leaks when I started this journey, and liners were a game changer for me! I tried the Pad-A-Cheek liners and the RemZzzs, and prefer the latter as they are of a different fabric, but have started making my own from old t-shirts based on the RemZzzs style. Many people here use one or the other of these liners. At Pad-A-Cheek you can also get strap pads if the straps bother you. I do have have those straps for the hard cheek straps.

If the F10 cushion is comfortable for you and fits your face, you could try Quattro Air FF mask; it uses the same cushion as the F10, but has a forehead strap, with the same hard plastic going up to your forehead... as you suggested, that could put less pressure on your nose. I started this journey with the Air, and when I switched to the F10, I found freedom without the forehead strap, and I keep the Air as my backup mask. As another poster mentioned, you might also try nasal or pillows, but if your mouth opens when you sleep you might be happier with a FF.

Regarding distilled water - it is recommended because otherwise you get lime scale deposits in the humidifier. It is perfectly ok to use tap water that is good to drink for a week or so. You just have to remember to clean the tank more often and use vinegar to dissolve the deposits.

The sore throat is usually due to Mouthe breathing - since you already have a full face mask try a chin strap.

Oh, I have distilled water now. I just went without the first night. My husband pickup up a gallon for me the next day.

I am a big proponent of DIY, so maybe I'll try cutting a homemade liner out of some cotton flannel to try using tonight. It's free, and it can't hurt. If it doesn't work, it doesn't work. I'd rather try something like that before spending money on a manufactured product. I'm the kind of person who darns my socks up to 4 times before I replace them.

I've also scheduled a mask fitting appointment with my DME. That won't be for two weeks, though, so I'll try the liner in the meantime.

Thanks for all the thoughtful suggestions!

Does your jaw drop during sleep?

tan wrote:Does your jaw drop during sleep?

I don't think so, but I couldn't say for sure. Why?

I'll try cutting a homemade liner out of some cotton flannel to try using tonight. It's free, and it can't hurt.

A knit works best because it stretches into those odd shapes. I used an old pair of cotton "big girl" panties. Polar fleece works too. Cut any holes smaller then needed and adjust - fabric stretches on the diagonal surprising amounts.