First night with a CPAP....ugh

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Westfalia
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First night with a CPAP....ugh

Post by Westfalia » Thu Feb 08, 2018 11:33 am

Hi All - first post here! I was diagnosed with sleep apnea a few weeks ago, and just got my machine and was fitted with my nasal mask yesterday. Last night was my first night...and oh what a night! I felt like had trouble getting enough air and it was near impossible to exhale without opening my mouth. It was tolerable when I first started the machine, but was pretty bad once it ramped up. I eventually fell asleep, but woke 45-60 minutes later with air shooting out of my open mouth, and the machine pumping at 16-17 (it was set 5-20 by my Dr.). I also had a very sore area under my nose. Humidity was set at 4 - heat was off. I ended up ditching the mask...

I typically sleep with my mouth open due to restrictions in my nose/sinuses, so I think a full face would work better for me (don't want to try chin strap or taping my mouth shut). However, I have a beard, and the therapist that fit me said I could not get a good fit with a full face, thus fitting me with nasal mask.

Should I experiment with different sleeping positions, humidity levels, heat? Or, shave my beard and get a full-face?

I was so hoping that this would be easy....

Thanks for any and all replies!

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Pugsy
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Re: First night with a CPAP....ugh

Post by Pugsy » Thu Feb 08, 2018 11:42 am

There are a lot of full face mask users here who sport beards...one guy even has a big bushy Santa Claus bear and his leaks are very well managed.
So it can be done...not without some challenges but it can be done.

Force them to give you a full face mask...if you can't keep your mouth shut you will need it.

Play with the machine and mask while awake watching TV or reading...when you aren't under the gun to "get to sleep".
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Re: First night with a CPAP....ugh

Post by Julie » Thu Feb 08, 2018 11:49 am

Do you know for sure if you need that much humidity (given whatever your local climate is and/or central htg needs are) or could that possibly contribute to your nasal issues - i.e. cause congestion at that setting?

mesenteria
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Re: First night with a CPAP....ugh

Post by mesenteria » Thu Feb 08, 2018 12:03 pm

I had the same horrible first TWO nights. I called the supplier/monitor folks the next day and said that I thought I'd have to switch to a full face mask from the nose mask (Airfit). She told me to persist, and that my horrible first night was somewhat typical. She also claimed that I should be able to train myself to sleep with my mouth closed over time if I persisted in doing so. I have lived long enough to know that it would not be the case...when I sag into sleep, my jaw sags at the same time...period.

She pointed out that I could come by and get a chin strap, and that some just tape over their mouths. I opted for the tape method...............................................and haven't looked back. I had some sports tape on hand which worked passably, but I ended up using waterproof surgical tape that is more effective at both staying tightly affixed to my skin and lips, but also it doesn't leak through the material, even slightly. The results: AHI typically 1-2 per night, zero leaks, and I could get by with a reduction in pressure from 10 to 8 at max sustained pressure. But, for a new person like you, the really important thing to keep in mind is your compliance. You must persist, learn to relax, and do what seems intuitively right to improve comfort and effectiveness (minus tweaking the pressure yourself unless your health care providers know and agree to it. Later, with more education and experience, you can do this yourself).

Your life is never going to be the same. The hope is that it will be a 'better' same. Don't lose sight of the potential benefits and longevity that will be due to you if you do this well.. It's a somewhat crusty and dry pill to swallow, but a person can get used to anything. I have extensive military experience and got used to living under a full-face gas mask, including learning how to eat with one and how to sleep in one. Entire face, even below the chin....fully covered by thick rubber.

Try some tape. It's worth it for even one night. HOWEVER, you will have to get by that oxygen-starved feeling when you first put on the mask. Not me....you. My mask and pressure don't seem to have made me go through a panicky time, so I felt comfortable trying to tape the only other safety escape I had for breathing...my mouth. I have yet to awaken feeling oxygen starved and forced to yank off my mask or to claw at the tape.

Finally...nobody is forcing this on you. This is YOUR therapy. You run it. You decide when you have to shut off the machine and try to relax for another hour of lie-in. You run the show, and you get to call the shots. It's your body. It's your reckoning. It's your therapy.

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Pugsy
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Re: First night with a CPAP....ugh

Post by Pugsy » Thu Feb 08, 2018 12:11 pm

What kind of nasal issues do you experience that cause you to need to mouth breathe?
I assume that these are issues you had prior to cpap...so it's unlikely that your humidity setting caused congestion (if that is what you have a problem with) prior to adding cpap therapy since it pre dates cpap use.

Now the humidity setting may impact nasal congestion issues after adding cpap into the mix.
Some people the added moisture helps clear up the congestion and some it doesn't help and some it can actually make things worse.
This is something that is highly individualized and you will have to sort that part out yourself with trial and error.
Does a hot steamy shower clear up your nose and make breathing easier or worse?

If it is just congestion...try varying the humidity setting to see if anything helps or hurts the congestion side of things.
If it is something else like a badly deviated septum causing significant problems moving the air and causing you to actually have to mouth breathe...then that's a different story and humidity (more or less) is unlikely to impact things.

So first thing is why the need to mouth breathe and if you can't fix that problem and you just have to mouth breathe...get a full face mask.
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Re: First night with a CPAP....ugh

Post by Janknitz » Thu Feb 08, 2018 2:02 pm

That feeling of not being able to get air in is related to the low starting pressure and not being able to get out is partly about learning to breathe out against pressure and partly to adjust the exhalation pressure relief features of the machine for your comfort.

Is your machine set to ramp up the pressure? That's usually why people don't feel they are getting enough air at first. The ramp setting can easily be turned off, and when you use Sleepyhead to download your data so you can see what's happening, you may want to increase your lowest pressure to a more comfortable setting.
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RogerSC
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Re: First night with a CPAP....ugh

Post by RogerSC » Thu Feb 08, 2018 6:04 pm

One more suggestion to add to the excellent ones above...I used Ambien for my first week of cpap, and that really helped me. The first night I could not get to sleep with all the gear and noise going on. The next night I had Ambien at my disposal and things were fine. When I got to the end of the first week, stopped using the Ambien, and again, everything was fine.

Oh yeah, at my first sleep study I hardly got enough sleep to get the data that my sleep doctor needed. Just had a second sleep study a week ago or so, and used Ambien during that. I was actually able to get to sleep after a few minutes, as opposed to lying awake for 5 hours before dozing off. They had to wake me up to tell me to sleep on my back so that they got that data as well, since I've trained myself to sleep on my side. And I got back to sleep...so the Ambien really helps in a pinch.

Anyways, it's a thought *smile*.

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Re: First night with a CPAP....ugh

Post by LSAT » Thu Feb 08, 2018 6:11 pm

Westfalia wrote:Hi All - first post here! I was diagnosed with sleep apnea a few weeks ago, and just got my machine and was fitted with my nasal mask yesterday. Last night was my first night...and oh what a night! I felt like had trouble getting enough air and it was near impossible to exhale without opening my mouth. It was tolerable when I first started the machine, but was pretty bad once it ramped up. I eventually fell asleep, but woke 45-60 minutes later with air shooting out of my open mouth, and the machine pumping at 16-17 (it was set 5-20 by my Dr.). I also had a very sore area under my nose. Humidity was set at 4 - heat was off. I ended up ditching the mask...

I typically sleep with my mouth open due to restrictions in my nose/sinuses, so I think a full face would work better for me (don't want to try chin strap or taping my mouth shut). However, I have a beard, and the therapist that fit me said I could not get a good fit with a full face, thus fitting me with nasal mask.

Should I experiment with different sleeping positions, humidity levels, heat? Or, shave my beard and get a full-face?

I was so hoping that this would be easy....

Thanks for any and all replies!
Your machine has a feature called EPR (Exhale Pressure Relief). Be sure it is on. It can be set to 1,2,3 to reduce the pressure for exhaling. I would set it at 2.

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Bons
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Re: First night with a CPAP....ugh

Post by Bons » Thu Feb 08, 2018 8:04 pm

You should have a 30 day window to do a mask exchange. Make an appointment to go the the DME and try out different full face masks using their machine set to the higher end of the pressure range. Put a pillow in your car so that if they don't have one you can test the mask with you head against the pillow (set on a desk if they don't have a bed or gurney).

I would be nervous about trying Ambien if you sleep alone. Many people have problems with it, especially males. My husband was given one in the hospital. He tore out his IV lines, stripped off his gown and went running naked and bleeding like a stuck pig down the hallway of the hospital. Others eat, walk and even drive on Ambien. Maybe a mild anti-anxiety medication would be better if you sleep alone.

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Re: First night with a CPAP....ugh

Post by SarahB » Fri Feb 09, 2018 3:07 pm

Westfalia wrote:Hi All - first post here! I was diagnosed with sleep apnea a few weeks ago, and just got my machine and was fitted with my nasal mask yesterday. Last night was my first night...and oh what a night! I felt like had trouble getting enough air and it was near impossible to exhale without opening my mouth. It was tolerable when I first started the machine, but was pretty bad once it ramped up. I eventually fell asleep, but woke 45-60 minutes later with air shooting out of my open mouth, and the machine pumping at 16-17 (it was set 5-20 by my Dr.). I also had a very sore area under my nose. Humidity was set at 4 - heat was off. I ended up ditching the mask...

I typically sleep with my mouth open due to restrictions in my nose/sinuses, so I think a full face would work better for me (don't want to try chin strap or taping my mouth shut). However, I have a beard, and the therapist that fit me said I could not get a good fit with a full face, thus fitting me with nasal mask.

Should I experiment with different sleeping positions, humidity levels, heat? Or, shave my beard and get a full-face?

I was so hoping that this would be easy....

Thanks for any and all replies!
Hi Westfalia

I don't know the answers but just wanted to identify with your first night as I am just one day behind you and experiencing similar problems. (Not the beard thing - I'm female! :lol: ) Last night was my first night with the CPAP machine. I too was fitted with a nasal mask yesterday, I also felt like I wasn't getting enough air and had to open my mouth and gasp occasionally to relieve that panicky feeling. I also ended up sleeping with my mouth open and after two hours of listening to the air hissing out of my mouth my husband woke me up. Then I had difficulty breathing in through my nose when lying down - in fact, I couldn't, and had to abandon the mask. Like you, I have decided that the full face mask is probably more suitable for me.

Wishing you a speedy journey to restful nights. :)
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Westfalia
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Re: First night with a CPAP....ugh

Post by Westfalia » Sat Feb 10, 2018 10:18 pm

Thanks for all the replies and suggestions! I didn't realize how restricted my nose breathing was until I wore the nasal mask. i bet I have a deviated septum or similar, and that is the cause of my mouth breathing.

Regarding the EPR, it doesn't seem like it is something I can adjust...it is not listed in the options I can change settings on?

I requested a mask switch and my full face comes on Tuesday. I hope it does the trick.

Thanks again!

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tedtomato
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Re: First night with a CPAP....ugh

Post by tedtomato » Sun Feb 11, 2018 2:45 am

Westfalia wrote: Regarding the EPR, it doesn't seem like it is something I can adjust...it is not listed in the options I can change settings on?
You would need to go into the clinical menu of your machine. Press the home and round button at the same time for a few seconds.

EPR should be listed, as well as whether it's only during ramp up time or full time.

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Cowboy Casey
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Re: First night with a CPAP....ugh

Post by Cowboy Casey » Sun Feb 11, 2018 9:50 am

We have all been in the same exact place, it does get better.. it took me 2 years, most take a shorter time to get everything working normal... I was the same as you, turned my machine on and my mouth would open and air escape... It took a couple weeks to train myself to close that flap in my throat to stop air from escaping (sorry, I do not know the name for that flap) its the same thing as breathing from your nose or mouth....

Here is how I did it: start by breathing through your nose, then through your mouth every other breath.. that is the mechanism your going to use, now Put your mask on while awake, open your mouth and air comes out, tell yourself to stop the air with your mouth open... it can be done and at first it feels weird.. once you train your brain to do it all the time your good to go... I can now hold my mouth wide open with IPAP at 25 and pressure support at 17,just did it last night :)

hope this helps :)
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Ray-zer
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Re: First night with a CPAP....ugh

Post by Ray-zer » Sun Feb 11, 2018 3:39 pm

I'm only a month ahead of two of you in this thread and have had some of the same experiences. My first piece of advice (even as a newbie) is to hang in there! I've been working through some issues and probably will have to work through more. But I'm determined to make this work because I imagine I've already done damage to my body for many years of having undiagnosed sleep apnea, so I want to repair that or at least not continue a downward path.

I also gasp for air and feel like I'm not getting enough oxygen when I first put on the mask. It seems strange to me since it seems like I should be more easily getting air into my lungs with the mask on. So I'm not sure why I feel this way. It happened during the 3 weeks I was on the nasal mask, and it has happened every time with my full face mask as well. But the feeling only lasts a few minutes, during which time I just remove the mask slightly so I can take some deep breaths to get oxygen into my lungs.

When it's time for me to get a new mask (at the 3 month point), I'm going to switch back to the nasal mask. That way I'll have both types of masks to use. And I'm definitely going to try the technique mentioned here of trying to close the flap in my throat and/or using some tape when I go back to the nasal mask.

I hope the OP ends up being able to use a nasal mask even with the nasal issues, but if not, I'm sure the full face mask will work well for you.

Ray

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Westfalia
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Re: First night with a CPAP....ugh

Post by Westfalia » Wed Feb 14, 2018 7:23 am

Hi All - just wanted to give you an update.

I got fitted with a full face mask yesterday (ResMed AirFit F20), and it is exactly what I needed! I can inhale and exhale with ease...I even got a sleep scope of 96/100 last night. I woke up a few times and had to readjust the mask, but I think that is just part of dialing the system in.

I think the problem for me was that the nasal mask pressed on the dorsal base of my nose, which for me almost completely restricts my nasal airway. The full face mask has a slightly larger footprint and presses/seals a bit further out of the dorsal base of my nose. So, I can inhale and exhale through my nose freely with the full face, but not with a nasal mask. See this pic for what I mean by "dorsal base".

Image

Just posting this up there so it might help others.

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