Help - first time was horrible

Hey everyone - Last night was my first time using the CPAP. I'm using one my healthcare system gave me for the week as a trial to confirm it's the right grade and then I'll be buying my own since my insurance doesn't cover it.

Any tips on how to adjust? It was horrible to be honest and I wasn't expecting it to be. I felt like I was suffocating last night. I realize some of it is psychological but I couldn't comfortably blow air out, didn't feel like enough was coming in, and didn't feel the pace of the machine matched my natural pace of breathing. I like the pillows more than the over the nose mask (I tried both and had more success with the pillows) but overall it was not a pleasant experience.

It took me finally propping myself up on a wedge pillow for the first couple hours of sleep to actually get comfortable and then I was able to lay down later. But I didn't prop myself up until after over a couple hours of intense discomfort. I keep reading how people take to it immediately and don't know what I should be doing to set myself up for success...

I could really use some words of encouragement that it'll get better... I'm feeling pretty disappointed, anxious, and hopeless about the whole thing (which I'm sure is in part due to the lack of sleep but still)

ETA: I'm using an AirSense 10 AutoSet - I don't think the nasal pillows I have are the ones that normally come with it just by the little research I've done. I'm curious about learning more about size of nasal pillows making a difference and more information about ramp and pressure and if that could be contributing to things... but I know very little about any of this obviously.

First thing, you need to fill in your profile to let us know your equipment. Second, you might have something that says exhale relief, or c-flex, or a-flex, or something - this is a feature that shuts off the air blowing while you are exhaling and some people find it more comfortable.Try wearing your mask and let it blow while you are watching tv so you won't be thinking about it so much. Trust me, it will get better.

herefishy wrote:First thing, you need to fill in your profile to let us know your equipment. Second, you might have something that says exhale relief, or c-flex, or a-flex, or something - this is a feature that shuts off the air blowing while you are exhaling and some people find it more comfortable.Try wearing your mask and let it blow while you are watching tv so you won't be thinking about it so much. Trust me, it will get better.

Thanks for your reply!

Oops - I'll get on that profile thing... didn't realize.

Since this is a trial for the week and not the machine I'll be keeping, my healthcare system disables my ability to make any adjustments to anything - but that's great to know the exhale relief/c-flex/a-flex feature is something I should look out for when deciding which one I want to purchase!

And I'll absolutely wear it tonight while watching TV - thanks!

Which mask and what pressure are is ramp turned on?
Go here and read up on how to get into the clinical setup menu where you will find out if ramp is turned on or not and what pressures were being used.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

Typically DMEs/equipment suppliers dispense the auto adjusting machines set pretty much to factory defaults so it can "find the right pressure" and unfortunately that minimum factory default is 4 cm and a lot of people find that they feel like they are suffocating at such a low pressure.
Some masks can make it feel even worse. We won't suffocate but it sure feels like it and really hard to go to sleep when we are that uncomfortable.
Ramp....usually starts out at that 4 cm even if the minimum setting pressure is higher....so again something that is supposed to make it easier often causes suffocation feeling.

Exhale relief...called EPR on ResMed machines...even if it is on and set to drop a bit during exhale if the machine is only putting out 4 cm pressure the exhale relief won't engage because it can't go below 4 cm during exhale because 4 cm is as low as it can go period.

So figure out what your settings are...like
Mode...is it auto or cpap?
Is ramp on?
What are the settings...if auto mode there will be a minimum and maximum
Is EPR turned on? at what setting?
If cpap mode...what does it say for pressure setting?

Once we have this information from you we can offer more specific ideas on how to make this easier for you.
What you have described is fairly common and actually very easy to fix.

Welcome, Berks. I've only been using CPAP myself for several months, still learning and adjusting, so I'm not qualified to be making technical suggestions. I'll leave that to the veterans here. What I can do is offer my empathy and moral support, strictly from a perspective of commiseration. My first couple weeks of therapy were rough. The first few days were the worst. I very seriously considered quitting, but resigned myself to stick with it. I continue to struggle with various aspects of the treatment, but I have become more or less used to sleeping with things on my face. And I'm sleeping much more, and much better than I had been for many years prior. From my own personal (and somewhat harrowing) experience, recent enough to still be fresh in what's left of my poor memory, I can tell you that it became easier for me pretty quickly. Try to "tough it out" these first few nights and see if the same doesn't apply to you. Follow the advice from other members here, which has been instrumental for me getting to the place I am.

On a side note, I'm fairly certain the vast majority of professionals who prescribe, dispense, and advise us on this kind of therapy have never tried this kind of therapy. Unless you're very lucky, one week is probably not long enough to really establish whether the machine and interface are right for you.

-Russ

Pugsy wrote: So figure out what your settings are...like
Mode...is it auto or cpap?
Is ramp on?
What are the settings...if auto mode there will be a minimum and maximum
Is EPR turned on? at what setting?
If cpap mode...what does it say for pressure setting?

It's an airsense 10 autoset. It's on a ramp setting that starts at 4 (and I believe 4 is the min and 20 is the max) and I believe the EPR is turned off but I can't be sure since my healthcare provide I believe has turned off my ability to adjust the settings while in the trial. I'll play around with it tonight to see if I can change anything but it may be something I just have to deal with for this first week and then adjust to my needs when I purchase my own.

I think based on your PM I am really looking into the airsense 10 autoset for her to use when this trial is over.

angryquaker wrote:Welcome, Berks. I've only been using CPAP myself for several months, still learning and adjusting, so I'm not qualified to be making technical suggestions. I'll leave that to the veterans here. What I can do is offer my empathy and moral support, strictly from a perspective of commiseration. My first couple weeks of therapy were rough. The first few days were the worst. I very seriously considered quitting, but resigned myself to stick with it. I continue to struggle with various aspects of the treatment, but I have become more or less used to sleeping with things on my face. And I'm sleeping much more, and much better than I had been for many years prior. From my own personal (and somewhat harrowing) experience, recent enough to still be fresh in what's left of my poor memory, I can tell you that it became easier for me pretty quickly. Try to "tough it out" these first few nights and see if the same doesn't apply to you. Follow the advice from other members here, which has been instrumental for me getting to the place I am.
-Russ

Thank you for the warm welcome and commiseration! Last night was one of the most miserable experiences I could imagine but I don't have much choice but to power through it and hope that once I have my own machine and can make sure it's a really good fit for me that things start to improve. I realize that in the grand scheme of things a couple weeks of "rough" are nothing compared to the potential benefits but it's hard to keep that perspective when you feel like you're getting even worse sleep than you were without the machine.

Pugsy wrote:Which mask?

I'm not positive but I think it's the Philips Respironics Nuance Gel Nasal Pillow Mask with Headgear based on a quick google search. Again - I'll need feedback when I get my long term mask but any advice on getting me through this first week would be great.

That 4 cm starting point if often a problem for many people. There's simply not enough air moving to be comfortable and it feels like we are suffocating.

Read that manual and you will find how to get into the clinical setup menu and change that minimum from 4 to say 5 or 6. Make sure ramp is off.
Just play with 5 or 6 while awake just to see if it solves the suffocation feeling. I suspect it will. Might need 7 but 6 seems to be where a lot of people can be comfortable with.

What size nasal pillow? Sometimes moving up a size will help with that suffocation feeling but I really think that the minimum pressure would be where I would start first.

Welcome to the forum. You can find a lot of good information and help here. Not sleeping well the first night with the machine is common. Very few people are able to put that alien thing on their face and sleep well the first night. When I started, I could only stand the mask for two hours. After that, I took it off so I could sleep. It took about three nights before I got the place where I could stand that alien thing on my face all night long. It does get easier after a few nights. I have been on my machine for almost three years, and my wife has been on one almost one year. She took to it easier than I did.

Pugsy wrote:That 4 cm starting point if often a problem for many people. There's simply not enough air moving to be comfortable and it feels like we are suffocating.

Read that manual and you will find how to get into the clinical setup menu and change that minimum from 4 to say 5 or 6. Make sure ramp is off.
Just play with 5 or 6 while awake just to see if it solves the suffocation feeling. I suspect it will. Might need 7 but 6 seems to be where a lot of people can be comfortable with.

What size nasal pillow? Sometimes moving up a size will help with that suffocation feeling but I really think that the minimum pressure would be where I would start first.

Thanks! Fingers crossed I can access the set up menu...

the nasal pillow is a small - is there a rule of thumb for how to determine if the fit is right or is it just personal preference?

Berks wrote: Thanks! Fingers crossed I can access the set up menu...

the nasal pillow is a small - is there a rule of thumb for how to determine if the fit is right or is it just personal preference?

Hello and welcome, I assume that you had two nights in the sleep lab, one for the study itself and then one for the titration to determine what pressure you need. Or they may have done both in one night.
Most people have their minimum pressure range set either at or around their titrated pressure and the a few cm above that for the maximum. For example I was titrated at 7cm so my minimum is 6cm and my max is 10cm.

Regarding the nasal pillow the rule of thumb is whatever pillow gives you the lowest leak rate. Once you get your pressure changed your next task will be to work on your leak rate (if that is even an issue).
You will also need to obtain the software for your computer so that you can transfer and analyze your sleep data from the machines SD card in order to make progress.

To access the Resmed autosense 10 clinical menu hold down the home button and round selector button at the same time for 3 seconds. You can then change the settings.

CPAP therapy can be a bit of a challenging journey but well worth it. The first thing to learn is that you are your own best therapist and that there are plenty of kind people here to help you. Congratulations on finding the forum.

Good luck

~UB

Full Disclosure: I have not read the other replies

Berks wrote:It was horrible to be honest and I wasn't expecting it to be. I felt like I was suffocating last night

When I went in for my first sleep study, the Sleep Lab Tech let me try on the mask before laying down to go to sleep. I experienced the same sensation - that same panicky feeling of "How am I supposed to breathe??". Just try to remain calm and remind yourself (even if you have to make it a mantra of sorts) that you're doing just fine, that you can breathe, that it's all going to take an adjustment period.

Personally, it's also about playing with masks until you find one that works for you. I started out with the Dreamwear mask (it rests under your nose), but as a mouth breather, it didn't work. I moved on to the AirFit F10, which is a full face mask (covers nose and mouth), and have done much better. It might be something for you to explore, if you can.

Thanks for the welcome!

My diagnostic test was one night at home with a monitor that was a watch attached to a finger monitor. Based on that they gave me the machine to take home which apparently has fixed settings for anyone (starting at a 4 and going up as needed based on your breathing or lack thereof).

I called to ask if there’s a way to adjust this and was told no. I explained I felt like I was suffocating and she kinda sounded surprised like there was no way I could feel that way because even at a 4 it’s more air and pressure than I’d be breathing without it. I was also told I shouldn’t be able to breathe out as that’s part of the point - but wouldn’t that mean I’m just rebreathing carbon dioxide??

Berks wrote: I was also told I shouldn’t be able to breathe out as that’s part of the point

Sigh....that person doesn't have a clue what is going on.

You can change the pressure and try it yourself and see if it is easier with 5 or 6 minimum. I am betting it will be.
Either that or try a larger size nasal pillow.

You can easily get into the clinical setup menu and make the changes. It's not difficult at all.

OH good... just what you want from a respiratory therapist... someone who doesn’t know what they’re talking about. I just got into the settings and you’re right I can adjust them it seems. I’m going to try that. I’m also going to just sit around with it on while I watch tv and such.

Fingers crossed today goes better. I’m honestly having some significant anxiety around the prospect of repeating the misery of last night but the only option is to tough it out.

Also... how do I figure out if I’m a mouth breather?