APAP Newbie

Hi everyone,

It's good to be part of this community! I'm very thankful that this forum is here to provide guidance and support to the newbies and the experienced CPAP users alike.

I was diagnosed with obstructive sleep apnea a little over a week ago. I'm 24 years old, female, generally healthy though a little bit underweight, and I've been dealing with chronic fatigue for many months. It's hard to pinpoint when the sleep apnea started, but I remember having way more energy about 8 years ago. Around that time, I got rhinitis medicamentosa from Afrin (even though I only used it a couple of times for allergy congestion), so my turbinates were enlarged constantly. Nasacort helped relieve it somewhat, but I still had to mouth-breathe a lot of the time, and it was very uncomfortable. Then I got a radiofrequency turbinate reduction, which helped immensely, but the congestion started to return, and I got a 2nd reduction about 2 years later.

In that time and after, the fatigue had started to become noticeable in the mornings. That slowly turned into feeling tired all day. Thankfully, I haven't fallen asleep in class or at work, but the feeling has resulted in a lot of anxiety and appointments with different doctors that couldn't find anything wrong. A doctor did find sphenoid sinusitis a couple years back, which healed thanks to strong antibiotics, but the relief from healing it hadn't lasted long before the fatigue settled in again. Finally, I did some research online, and asked the doctor directly if I could have a sleep study done. The home test was inconclusive, and I came in for a study in the lab. The technicians said I didn't snore, and I felt like I woke up only about 3-4 times total.

It was kind of shocking to hear in the results that I had an average of 30 sleep disturbances per hour! My oxygen didn't drop below 93%, but these disturbances were enough to disrupt the sleep significantly. The doctor has prescribed an APAP machine, and I have an appointment soon to receive it. They won't be doing another overnight test, since it's auto-titrating, and I'll get to try out different masks to find a suitable one.

I'm kind of nervous, because I got to try nasal pillows and a nose mask before my in-lab study, and it wasn't a comfortable feeling... It felt like the air was flowing too fast and not letting me exhale fully, especially with the nasal pillows. The nose mask worked better, but then I felt the urge to take a breath through my mouth. It's like when you know you can't stretch your legs fully in a plane seat, and suddenly all you want to do is to stretch them. Trying to open my mouth just flooded my nose with air, and I quickly took the mask off. I think maybe a mask with the option of mouth-breathing will be worth trying out.

Also planning to see an ENT specialist in a month or so. There's still some blockage in one side of my nose despite the 2 reductions, and I'm trying to see if that's contributing to the apnea.

Sorry for the long intro! I really needed to write this all out - I'm still somewhat in a daze after the diagnosis, and writing helps make it more logical and real somehow. Looking forward to participating in the forum!

~WinterLily

WinterLily wrote:I'm kind of nervous, because I got to try nasal pillows and a nose mask before my in-lab study, and it wasn't a comfortable feeling... It felt like the air was flowing too fast and not letting me exhale fully, especially with the nasal pillows. The nose mask worked better, but then I felt the urge to take a breath through my mouth. It's like when you know you can't stretch your legs fully in a plane seat, and suddenly all you want to do is to stretch them. Trying to open my mouth just flooded my nose with air, and I quickly took the mask off. I think maybe a mask with the option of mouth-breathing will be worth trying out.

That feeling should subside as you get used to the mask and breathing with the machine. But then it depends on the machine setup and pressure settings.

But typically speaking any pressure is more than we are used to.

You might try just breathing thru your nose with mouth closed and w/o a mask for a timed minute or two to see if you get the same feeling. You could still be having trouble there getting enuff air and if you are I would not see that same surgeon again for anything.

Guest wrote:

WinterLily wrote:I'm kind of nervous, because I got to try nasal pillows and a nose mask before my in-lab study, and it wasn't a comfortable feeling... It felt like the air was flowing too fast and not letting me exhale fully, especially with the nasal pillows. The nose mask worked better, but then I felt the urge to take a breath through my mouth. It's like when you know you can't stretch your legs fully in a plane seat, and suddenly all you want to do is to stretch them. Trying to open my mouth just flooded my nose with air, and I quickly took the mask off. I think maybe a mask with the option of mouth-breathing will be worth trying out.

That feeling should subside as you get used to the mask and breathing with the machine. But then it depends on the machine setup and pressure settings.

But typically speaking any pressure is more than we are used to.

You might try just breathing thru your nose with mouth closed and w/o a mask for a timed minute or two to see if you get the same feeling. You could still be having trouble there getting enuff air and if you are I would not see that same surgeon again for anything.

Thank you for your reply! I really hope to get used to the APAP without too much discomfort- it's reassuring to read the success stories on the forum The nose seems to be doing OK- looks like I'll need to work on un-learning the mouth-breathing habit (which will be a good step to take in general!)

Try the Innomed/Respcare Hybrid mask which accommodates nose and/or mouth breathing without compromising your therapy. Great mask, comes with 3 sizes of pillows and 3 sizes of oral cushions. Our host sells it. You can buy return insurance in case it doesn't work out.

O, is it the one in your signature? It sounds like a good type of mask for the situation - thank you for letting me know about it! When my APAP arrives on Monday, I'm planning to ask for a couple different masks to keep, to give each a thorough test. Hopefully they'll have the hybrid available, but if not, ordering online with insurance would be another good option.

Muse-Inc wrote:Try the Innomed/Respcare Hybrid mask which accommodates nose and/or mouth breathing without compromising your therapy. Great mask, comes with 3 sizes of pillows and 3 sizes of oral cushions. Our host sells it. You can buy return insurance in case it doesn't work out.

Update for anyone who is curious: I got fitted with the AirFit P10 nasal pillow mask. Proves that things can change after the first impression! I tried a full face mask, but it was the least comfortable of all types I've tried. There was an over-the-nose type mask that was ok, but the nasal pillows were the best. I think the first time I was given the wrong size and air pressure, and now that everything is set (mask size XS, machine pressure 5 and auto-adjusting over time, humidity at 2-3), the experience is a lot better.

I'm wearing it right now as I type. The sensation is a little weird, and there is some smell of plastic, but I like how warm and humidified the air is. It definitely feels like the inside of my nose is being stretched a bit. I'm trying to wear it for some time while watching Netflix or browsing the Internet, to pay less attention to the new sensations. So far so good!

Couple of things to try.

Maybe your congestion could be lessened with less humidity - try it for a night or two.

Also when you lie down start by breathing through your mouth until you are comfy, then close your mouth and take 10-12 deep breaths through your nose and see if your nose actually clears.

englandsf wrote:Couple of things to try.

Maybe your congestion could be lessened with less humidity - try it for a night or two.

Also when you lie down start by breathing through your mouth until you are comfy, then close your mouth and take 10-12 deep breaths through your nose and see if your nose actually clears.

Thank you for the tips! It feels a lot better after the deep breathing There is also less congestion after I've worn the mask for just an hour or so- maybe the APAP pressure helps it (if so, that will make the device double useful!)

Curious to see how the first time wearing it overnight will go tonight

Humidity setting at 2 to 3 on the PR S1 machine isn't a very high humidity delivery unless you are using a heated hose with it.
Have you been okay with these settings so far? How's the congestion now?
Or is this the first night?

I know Mr England does well with his low settings but he isn't using the machine you are using and not everyone does well with minimal to none humidity. I have used the machine you are using...it doesn't crank out massive amounts of moisture at a setting of 2 without the heated hose.

Just be aware that humidity needs or preferences vary widely among individuals and some need more and some need less.
Google cpap rhinitis and see what I mean.
You may be like me (need lots of added moisture) or you may be like Mr England and be totally happy with not much at all.

The nasal mucosa are weird little things....they respond to both too much and not enough moisture in the same manner...congestion, drainage and misery. You will have to figure out which makes your nose the happiest.

Pugsy wrote:Humidity setting at 2 to 3 on the PR S1 machine isn't a very high humidity delivery unless you are using a heated hose with it.
Have you been okay with these settings so far? How's the congestion now?
Or is this the first night?

I know Mr England does well with his low settings but he isn't using the machine you are using and not everyone does well with minimal to none humidity. I have used the machine you are using...it doesn't crank out massive amounts of moisture at a setting of 2 without the heated hose.

Just be aware that humidity needs or preferences vary widely among individuals and some need more and some need less.
Google cpap rhinitis and see what I mean.
You may be like me (need lots of added moisture) or you may be like Mr England and be totally happy with not much at all.

The nasal mucosa are weird little things....they respond to both too much and not enough moisture in the same manner...congestion, drainage and misery. You will have to figure out which makes your nose the happiest.

It will be the very first night. I've had the APAP on for an hour or so while awake, and was able to breathe through the nasal pillows. There is a heated hose that comes with the equipment- the more moisture, the warmer it gets. Looks like it will be a trial-and-error process to find the right balance of the heat and humidity (and hopefully avoiding cpap rhinitis!)

Actually with your machine and when using that heated hose the humidity settings are in the clinical setup menu and the only change you can do from outside that menu with the little knob is adjust the air temperature.
So with the heated hose you have 2 settings available that are independent of each other.

Settings in the clinical set up menu for humidity are 1, 2 and 3..and those reflect humidity chosen that the machine will deliver on a constant basis no matter what temperature you end up using..so you can lower the air temp and not sacrifice humidity.
Setting of 1 is 70%, 2 is 80 % and 3 is 90%.
Temperature control is settings 1 through 6 with 6 being the highest...it starts with adding 4 degrees to whatever your bedroom air temp is and goes up with each setting and the highest of 6 adds 16 degrees to the room air temp.
See this link
https://www.cpap.com/productpage/pr-sys ... ifier.html

I think the default humidity setting with the heated hose attached is the setting of 2 which is 80% humidity.
80% is also what ResMed's S9 machine defaults to with its heated hose. That's because that is what the majority of people find works well for them.

If you want to change the humidity delivered you will need to go into the clinical setup menu and if you don't know how to do that the clinical manual will explain how to get to that setup menu.
You can request it from this website. Just be sure to request the correct manual for your machine...
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

or the short version is explained here
http://www.apneaboard.com/pr-system-one ... structions

Do get the clinical manual if you don't already have it because it explains a lot more about what your machine does and what various things mean than the user manual that came with your machine.

I find that often with the cpap machine and its humidity I might go to bed with a tiny bit of congestion and wake up breathing far better than when I went to bed. But then a hot shower also makes me breathe better.
I have done the "turn it down thing" and also have forgot to fill the water chamber and have the tank run dry for most of the night and the congestion I had from the nasal mucosa being too dry was horrible and took days to fix.

I am glad you are doing better with the nasal pillow mask...once you get used to it I imagine you will be sold on it. It's about as next to nothing as a person can get when it comes to wearing these cpap masks. I am currently using the P10 myself.

I thought I had CFS until I found out that I had a severe case of OSA. CPAP has changed my life - it wasn't instant, but I have far more energy now than I did 10 years ago.

Pugsy wrote:
I find that often with the cpap machine and its humidity I might go to bed with a tiny bit of congestion and wake up breathing far better than when I went to bed. But then a hot shower also makes me breathe better.
I have done the "turn it down thing" and also have forgot to fill the water chamber and have the tank run dry for most of the night and the congestion I had from the nasal mucosa being too dry was horrible and took days to fix.

It looks like I'm the same way! Woke up this morning with some swelling in the nose, and it feels kind of dry (no discharge though). The odd thing with the temperature dial on my machine is that if I turn it to 0, so that the heat of the hose is totally off, it will automatically turn the humidifier to 0 too. I saw it in the Setup menu after the discomfort woke me up in the middle of the night. For next time, I guess I've got to change humidity from 2 to 3 and keep the hose somewhat heated.

Pugsy wrote: I am glad you are doing better with the nasal pillow mask...once you get used to it I imagine you will be sold on it. It's about as next to nothing as a person can get when it comes to wearing these cpap masks. I am currently using the P10 myself.

It was the most comfortable one for sure! At night, the straps were annoying, but once actually falling asleep it was possible not to feel the mask. I've ordered a CPAP pillow to prevent the sore cheeks and marks on the skin.

Thank you so much for your tips!

The night was a mixed-feelings experience overall. I got a total of maybe 5 hours of sleep, and feel very tired right now (full day of work ahead... ugh..). On the other hand, the time when I was asleep was nightmare-free and restful.

Some good tweaks that helped were to turn the ramp feature off completely and let the machine adjust the pressure as needed right away, and to turn the A-flex feature down. That one was weird- it lowered the pressure to make breathing out easier, but it made the in-breath feel incomplete, as through the pressure cut off too early. I found it easier with a more steady flow.

Nick Danger wrote:I thought I had CFS until I found out that I had a severe case of OSA. CPAP has changed my life - it wasn't instant, but I have far more energy now than I did 10 years ago.

That's really good to hear! Knowing that it will be possible to feel better over time makes it easier to stick with the treatment.