I'm new to CPAP - need advise please?

Hello!

I just got my CPAP-machine 5 or so days ago, and I've tried using it every night with various success. I'm a 36 year old man weighing 115kg, 178 cm tall. (Sorry but I don't know inches, feet and pounds). My machine is the ResMed AirSense 10 Elite Autoset (or something along those lines). My mask is the Quattro Air (Medium size). I live in Norway, and the CPAP system was handed to me after a sleep study at the local public hospital. They have given me a new appointment 1 month after I started using it, to bring the equipment back in so that they can read the SD card and figure out how it's working for me.

So I have a few comments and questions:

The sleep study showed that I had an AHI of 33. The doctor didn't go through a whole lot with me, they showed a 30 minute video of sleep apnea problems, and the sleep technician spent maybe 5 minutes with me explaining how to use the machine and fitting my mask. She gave me 15 minutes time to test the mask before I was sent home.

I strongly suspect I have more of a central apnea problem than an obstructive sleep apnea. I live by myself, and have nobody to check if I'm snoring or anything like that. The reason I suspect central apnea is because I often wake up in panic just as I fall asleep, and then take a long deep breath, feeling I have no air. The problem gets worse if I've taken sleeping pills or anti-anxiety pills or something like that. I sometimes feel like I don't get enough air throughout the day as well. I take 10mg Stilnoct sleeping pills just before bed time, because I have a big problem falling asleep at all. I'm bipolar type 2, with all the sleeping issues that comes with it.

I've watched a ton of Youtube videos, read a lot of forum posts in various forums to try to figure out the CPAP machine and it's options. I've had issues with mask leakage that I was unable to fix, but it's only on high pressure. My machine was set to 4-15 pressure from the doctor. In the beginning I felt like I didn't get enough air, so I turned off Ramptime. I also increased starting pressure to 6, and I've experimented with how much pressure I can handle without the mask leaking too bad. So now it's set to 6-11 in pressure. I've figured out how to reach the Clinical menu, and checked my AHI which only says 0.7 on average now, and it says CI is 0.5. I've set EPR setting to 3.

So the machine might be working for me, but I still wake up feeling really exhausted and tired, and I need 2-3 cups of coffee to be able to do anything at all. I also struggle a lot with headaches and migraines, and high blood pressure. I'm taking Candesartan 8mg in the morning for the blood pressure and for limiting the migraines. It's too early to tell if the CPAP helps me a lot.

I don't know where to get different masks, or equipment that could help me. Healthcare is mainly supplied by the public where I live, but I have to wait another three weeks to get back to the hospital so they can check my SD card data and maybe fit a different mask. I suspect the Quattro Air mask is okay, but maybe a size too small.

Does anyone have any tips or advise for me?

How many hours of sleep are you averaging?
Are those hours fragmented with many wake ups? If so, approx how many and do you go right back to sleep or does it take a while?

Do you take any meds for the BiPolar thing?

Look up all your medications for potential side effects that could be a factor in how you feel when you wake up.
The 10mg Stilnoct will/can cause drowsiness and fatigue like symptoms the next day...might be part of what is going on with you.
The other part is that it has only been 5 days and while some people are lucky and get that overnight miracle we read about...most of us it was a very gradual improvement that took some time before we really could tell much improvement.
You may just need to give it time. While giving it time it hurts nothing to investigate other potential factors that might be affecting how we feel during the day.

Can't help with the mask question. I have never used that mask but if you are waking often during the night just fiddling with the mask...that alone can cause you to feel like crap during the day because your normal sleep cycles aren't progressing as they should for optimal benefits from restorative sleep. It's poor quality sleep. The best AHI in the world doesn't mean anything if we aren't sleeping so great.

I believe I found this link on this site earlier when trying to get a Quattro Air to seal The Quattro Air does not have number settings for the upper headband, but they just loosened it all the way.
https://maskarrayed.wordpress.com/tamin ... e-quattro/

I think the Mask Test setting is not full prescription pressure, but full 20 cm. Do not be discouraged if you do not get it sealed all the way with the test mode. Just get close and you will likely find a huge difference.

In fact I received a another Quattro Air yesterday had had a horrible leakage issue. I am going to take my own advice before tonight to improve the situation.

Pugsy wrote:How many hours of sleep are you averaging?
Are those hours fragmented with many wake ups? If so, approx how many and do you go right back to sleep or does it take a while?

Do you take any meds for the BiPolar thing?

Look up all your medications for potential side effects that could be a factor in how you feel when you wake up.
The 10mg Stilnoct will/can cause drowsiness and fatigue like symptoms the next day...might be part of what is going on with you.
The other part is that it has only been 5 days and while some people are lucky and get that overnight miracle we read about...most of us it was a very gradual improvement that took some time before we really could tell much improvement.
You may just need to give it time. While giving it time it hurts nothing to investigate other potential factors that might be affecting how we feel during the day.

Can't help with the mask question. I have never used that mask but if you are waking often during the night just fiddling with the mask...that alone can cause you to feel like crap during the day because your normal sleep cycles aren't progressing as they should for optimal benefits from restorative sleep. It's poor quality sleep. The best AHI in the world doesn't mean anything if we aren't sleeping so great.

Thank you for taking time to answer!

Last night I slept continiously for about 7-8 hours without getting up or waking up (that I'm aware of), and still felt really tired and exhausted when I woke up. Sometimes I do wake up for a little trip to the bathrooom, but I usually have no problem getting right back to sleep. The first four days of using the CPAP was a mess though, as I woke up with lots of mask leaks and ended up removing it before turning over and sleeping further. Now I feel like I've dialed in a good pressure at 6-11, which is hopefully enough. The AHI looks okay so far. As a curiosity I can mention that my machine only said I slept for about 4:30 hours, but I Googled it and found out that the machine zeroed out at noon. My sleeping pattern is all over the place, so I sometimes sleep in the day and is awake at night.

You're right about the Stilnoct, it does have a long hangover effect, so it could explain some of it. But without taking it, I don't fall alseep for hours and hours even if I'm very tired.

My medication is the following:

Morning:
40mg Somac (almost like Nexium, proton pump inhibitor)
8mg Candesartan (for lowering blood pressure, and preventing migraines)
10mg Zyrtec (modern anti-histamines)

Evening:
300mg Seroquel Depot (Quietiapine, for stabilizing bipolar disorder/anti-psychotic. Gives me drowsyness after 1 hour too, and helps with sleep. Has some sideffects: Blocked nose, restless legs)
300mg Magnesium (For canceling restless legs syndrome caused by Seroquel)

When going to bed:
10mg Stilnoct (When not using CPAP I can get away with 5mg, but then I wake sometimes during the night)

As far as I understand, the machine I'm using is good at detecting central apneas.. but when the sleep report only says 0.5 central apneas, should I trust that? Maybe I don't have them.

I appreciate any advise! Thank you.

prodigyplace wrote:I believe I found this link on this site earlier when trying to get a Quattro Air to seal The Quattro Air does not have number settings for the upper headband, but they just loosened it all the way.
https://maskarrayed.wordpress.com/tamin ... e-quattro/

I think the Mask Test setting is not full prescription pressure, but full 20 cm. Do not be discouraged if you do not get it sealed all the way with the test mode. Just get close and you will likely find a huge difference.

In fact I received a another Quattro Air yesterday had had a horrible leakage issue. I am going to take my own advice before tonight to improve the situation.

Thanks for taking time to respond!

I've read through the advise you linked to, it seems like it's written for the Quattro, not Quattro Air.. but most of it still applies. So thank you!
I've used the Mask Fit function of my machine, and I could not get it sealed at 15 (doctor prescribed max pressure), but I could get it to be fairly sealed at 11-12. So that's why I've dialed down to 11 max pressure for me. Hopefully it's enough, I'm paying attention to the AHI number of the sleep report after every night.

One issue is that even though I managed to seal it at 11-12 pressure, the straps are too tight in my neck. I know the mask is designed to "float" on the air cushion seal around the mask, and that works fine up to 6-8 pressure.. but any more than that, I really have to tighten it uncomfortably. I think I should try a different size mask, or a different mask - but I don't know where to get them where I live. But I'll try to investigate further.

Thanks for the reply!

Hold your breath for 10 seconds. That's pretty much what a central apnea is. The airway is open but no air is moving.
These machines are pretty good at detecting and naming the reduction or cessation of air flow but what they aren't good at is figuring out if you are awake or asleep. It can't measure sleep status...it only measures air flow.
Sometimes the irregularities of awake/semi awake breathing can fool the machine and sometimes it will flag centrals when it really isn't anything more than a pause in awake breathing.
So some of that central index could be awake/semi awake breathing flags by mistake.

Also...it's normal to have some real centrals during the night. Sleep onset or sleep stage transitional centrals are normal and not usually a problem unless present in unusually large numbers or causing oxygen level drops or bouncing a person out of sleep all night long.

Even if all your centrals were the real deal you aren't having enough of them to worry about. Less than 1 per hour average...not anything to get concerned about. Now if you were having 5 per hour...every hour all night long and every night...then we worry.

Remember the cpap machine can only fix problems related to sleep apnea. It can't fix problems caused by meds or other health issues. No matter how much we want to dump all our problems in the sleep apnea basket and have the cpap fix them....the truth is not everything wrong is caused by sleep apnea.
It's only been 5 nights and the first 4 you admittedly had some mask fit issues. There's a lot of stuff for us to get used to with all this "stuff" on our face. I think it took me a month to not just wake up to feel the darn mask on my face....several times a night.

And yes...sometimes meds cause some unwanted side effects the next day...and with your sleeping meds that includes that morning hangover effect.
I sort of have to deal with that myself. I take some meds for arthritis pain at night (because if I didn't take them I wake a bunch of times with the pain) that cause a bit of a morning hangover. That morning hangover is less than the hangover I would get from from the gazillion wake ups with the pain and that poor sleep. About a year ago I tried for 3 months just going without those meds...slept less in terms of hours and felt worse than I did with the morning hangover from the meds.
I just come to accept that this devil with meds is not as bad as the no meds devil.

Give yourself some time to adjust to this new therapy and maybe later talk with your doctor about reducing and/or maybe eliminating the sleeping pills. Maybe once you get used to this therapy your sleep quality will improve and you won't need the sleeping aid to go to sleep....or you may end up like me...the with meds devil is less annoying than the no meds devil.

If you broke your arm do you think that it would be healed immediately with the cast application? Of course not, yet we want the cpap to fix years of damage done to the body overnight. I understand the desire...I experienced it myself but other than a couple of typical OSA symptoms (nocturia and low oxygen headaches) that went away within the first couple of weeks of therapy, I didn't have that miracle either. It took me several months to have some improvement in daytime energy levels and I still am not a morning person. But then I never have been a morning person and why I thought the cpap would make me into something I have never been...I don't know what I was thinking.
I tell people that while I don't wake up ready and rearing to go run a marathon at least I don't wake up feeling like I just ran a marathon and got run over by a bus at the finish line.

Republic3D wrote:Hello!

I just got my CPAP-machine 5 or so days ago, and I've tried using it every night with various success. I'm a 36 year old man weighing 115kg, 178 cm tall. (Sorry but I don't know inches, feet and pounds).

For those in the US who don't do metric measurements:

178 cm = 5' 10"
115 kg = 253.5 lbs.

You've gotten some good advice from Pugsy so far.

It does take time to get used to sleeping with a CPAP machine, particularly if you have sleep issues other than sleep apnea. And it sounds like you've got some other issues, including the insomnia that you manage with the Stilnoct and the sleep issues you say come with the Bipolar 2 diagnosis. So you will need to give it some time.

My machine is the ResMed AirSense 10 Elite Autoset (or something along those lines). My mask is the Quattro Air (Medium size). I live in Norway, and the CPAP system was handed to me after a sleep study at the local public hospital. They have given me a new appointment 1 month after I started using it, to bring the equipment back in so that they can read the SD card and figure out how it's working for me.

Install SleepyHead and/or ResScan on your computer, and you can then read the data on the SD card for yourself.

I don't know where to get different masks, or equipment that could help me. Healthcare is mainly supplied by the public where I live, but I have to wait another three weeks to get back to the hospital so they can check my SD card data and maybe fit a different mask. I suspect the Quattro Air mask is okay, but maybe a size too small.

I don't know how your public health care system works in Norway, but if you are struggling with your current mask, you should call them SOONER and ask whether switching to a different size or a different mask is possible. Here in the states, most CPAP suppliers will swap out the first mask for free during the first 30 days of use.

Pugsy wrote:Hold your breath for 10 seconds. That's pretty much what a central apnea is. The airway is open but no air is moving.
These machines are pretty good at detecting and naming the reduction or cessation of air flow

I've tried this experiment more than once while using my BiPAP.

What I've noticed is that if I inhale deeply and then hold my breath for 10 seconds, the dang machine often doesn't score anything at all.

If I exhale deeply or normally and then manage to hold my breath for 10 seconds, it usually scores an OA instead of a CA. I've wondered if I close my epiglottis over my windpipe when I hold my breath, and if I do, if that's why the machine usually scores an OA when I do the "hold your breath for 10 seconds" experiment.

robysue wrote: I've tried this experiment more than once while using my BiPAP.

What I've noticed is that if I inhale deeply and then hold my breath for 10 seconds, the dang machine often doesn't score anything at all.

If I exhale deeply or normally and then manage to hold my breath for 10 seconds, it usually scores an OA instead of a CA. I've wondered if I close my epiglottis over my windpipe when I hold my breath, and if I do, if that's why the machine usually scores an OA when I do the "hold your breath for 10 seconds" experiment.

I could sometimes fool the ResMed with the fake central...sometimes I couldn't but now the machine I have won't even flag centrals so I can't test it.
I use the 10 second hold your breath more for an example of what a central apnea is...not so much as a test to see if the machine will be fooled or not. So that people won't get all in a panic with "OMG a central apnea" thing.
We haven't seen any software reports from the OP here so I don't know when the centrals are getting flagged. They might be awake breathing SWJ or they may simply be sleep onset after a REM cycle maybe.

One of these days I will get my PR S1 760 out and see if I can fool it. It's been a long time since I used it to see.

I do remember a guy with a huge number of SWJ centrals...all in a panic with AHI of 20 something primarily central and come to find out major insomnia was going on and once he quit laying in bed fighting the machine and sleep for hours his AHI dropped to 2.0. So I know there was an awful lot of SWJ centrals getting a flag.
Not sure why we can't duplicate them when we want to but isn't that just the way things go sometimes.

I used to play oboe (hautbois for cross word puzzlers). There are around 50 tiny adjustment screws to assure proper function. If you adjust one, that may effect 3 or 4 others.

The point is DO NOT GIVE UP OR BECOME DISCOURAGED! Fix one thing like minimum pressure and you may still need to systematically work through 3 - 10 other variables before you wake up one morning saying, "Ah ha! So that's what rested feels like."

My strategy was to keep coming back to this virtual community issue-by-issue until that "ah ha" moment occurred..

All the best,
Don D

Sent from my SAMSUNG-SM-G900A using Tapatalk

Thanks for the nice replies!

I feel like I'm becoming more friendly with the machine every night - or maybe it's the other way around. It seems like I'm tolerating it better. But regarding central apneas, last night I woke up in panic two times.. feeling I had no air, but the morning check of the sleep report still said 0 AHI. On average it says 0.7 AHI, and CI is 0.5. So it doesn't seem like it registers all central apneas, or maybe I'm just worrying too much. Like some of you have mentioned, it's normal with some central apneas with obstructive apneas.

I downloaded an app for my phone that records snoring, I live by myself and nobody can check on me. The result was a big graph that I'll have to look closer into.

I've heard about the SleepyHead software, but it seems a bit daunting to try to figure it out right now. I'm a person who worries a lot, and maybe I see something that will scare me in the analysis. I probably will check it sooner or later though.

I've also experienced that my teeth or gums have started hurting a bit during the day after using the CPAP. My machine didn't come with humidifier or anything like that, so when I wake up my mouth is completely dry and icky. When I got the CPAP machine, they said that I maybe could get a humidifier if I needed it - but the appointment is in three weeks time. Do you think there's a connection between my gums having started to hurt, and the dry mouth?

Republic3D wrote:Thanks for the nice replies!

I feel like I'm becoming more friendly with the machine every night - or maybe it's the other way around. It seems like I'm tolerating it better. But regarding central apneas, last night I woke up in panic two times.. feeling I had no air, but the morning check of the sleep report still said 0 AHI. On average it says 0.7 AHI, and CI is 0.5. So it doesn't seem like it registers all central apneas, or maybe I'm just worrying too much. Like some of you have mentioned, it's normal with some central apneas with obstructive apneas.

Waking up in a panic can happen after an OA or a H as well as a CA. But it's also possible to wake up in a panic because your brain is still learning to trust the equipment. One thing that a lot of new PAPers are not aware of is that you do get used to the airflow during the night time, and so if you wake up after several hours of sleep for any reason, it can seem like there's no air coming through the mask even though there is a lot of air coming through. Just hold your hand in front of the exhaust vents OR pull the mask away from your face for a tiny little bit and you'll feel that there's still plenty of air coming through the mask.

I downloaded an app for my phone that records snoring, I live by myself and nobody can check on me. The result was a big graph that I'll have to look closer into.

That may help you figure out whether you're (still) snoring with the PAP on.

I've heard about the SleepyHead software, but it seems a bit daunting to try to figure it out right now. I'm a person who worries a lot, and maybe I see something that will scare me in the analysis. I probably will check it sooner or later though.

I would encourage you to install SleepyHead sooner rather than later. My guess is that the data from your machine may help you understand that it IS working in the sense of doing its job of preventing the OSA stuff from happening. And knowing that the machine is doing its job may help you relax enough to do YOUR job, which is get comfortable enough to sleep soundly with the machine WITHOUT worrying about the CPAP, the hose, the OSA, your breathing, and the (occasional) CA that may slip in when you're going to sleep. Slapping a CPAP mask on seems to make a lot of us over aware of our own breathing. And that's when we might notice and allow a perfectly typical and normal sleep transitional CA to bounce us back into being WIDE awake.

I've also experienced that my teeth or gums have started hurting a bit during the day after using the CPAP. My machine didn't come with humidifier or anything like that, so when I wake up my mouth is completely dry and icky. When I got the CPAP machine, they said that I maybe could get a humidifier if I needed it - but the appointment is in three weeks time. Do you think there's a connection between my gums having started to hurt, and the dry mouth?

Yes, the teeth and gums may be reacting to your mouth getting completely dry and icky at night. I think you should call the people who set you up with the machine and report that problem NOW. Politely, but firmly tell them that you don't think you can deal with the super dry mouth for another 3 weeks and that you NEED a humidifier NOW. They should be willing to get you one.

They gave you the AirSense 10 Elite. It has a humidifier already built in. They probably didn't include the water chamber and used the plastic side cover instead of the water chamber. All you need is the water chamber because the humidifier is already there ...it's just covered up right now.

This is the side cover plate that is use when no water chamber is used.
https://www.cpap.com/productpage/resmed ... cover.html

This is the water chamber that needs to be added.
https://www.cpap.com/productpage/resmed ... amber.html

The heated hose is optional...you don't have to use a heated hose with the humidifier you can use your regular hose but you get more control over humidity delivered with the heated hose (delivery is more consistent) plus the heated hose will likely come in handy when temperatures cool off and chances of condensation in the hose increase.
I use a heated hose year round. I increase the hose air temps in the winter when the house is cooler and lower the temps in the summer when the house is warmer but the humidity I get stays consistent year round and I don't have to go changing the humidity all the time.

Your equipment supplier should be able to get you that water chamber easily enough. Don't wait...call them now.
The heated hose you may or may not want or need now but you might want it later and it isn't that critical right now.

I understand the worries about "worrying too much" if you use the software but I am with RobySue...I think that if you learn what all your machine can offer you in terms of details that it will help reduce your worries and not increase them.
Your machine will flag the apnea events if they meet criteria...and one important criteria is duration ....they must all meet the at least 10 second duration criteria to earn a flag. A 9 second duration apnea event....doesn't get a flag. So yeah..it's possible for the machine to not flag a central apnea but only if it lasts 9 seconds or shorter. It it lasts 10 seconds it's going to get a flag.
Hold your breath for 10 seconds...that's sort of like what a central apnea is. The airway is open but no air movement. It's not hard to do for 10 seconds and no real stress is placed on the body. Even less so with a central lasting less than 10 seconds.
The problem with centrals (or really any apnea event) is when we have a bunch of them happening back to back in close proximity to each other then the cumulative effect can be detrimental to the body even if they only last 10 seconds.

Your CI index is 0.5...that's low...that tells me that you can't be having a large number of centrals during the night. Real or not..there's not very many of them.
Your AHI is low...that tells me that you aren't having very many of any sort of apnea event during the night.
What you can't see on the machine LCD screen are some other detailed data that your machine gathers. If you have a "panic" attack and wake up and turn off the machine you can use the software and look at the air flow immediately preceding your turning off the machine and see if anything looks weird or if there was an apnea flag right before the turning off of the machine.
So it might explain the reason for the "panic" or it might reassure you that nothing really happened worth worrying about. Either way you learn something that can help a person who admittedly tends to "worry a lot" be reassured that there's no reason to worry.