1st Post, 1st Night on CPAP

[gdpeck]

Hi All,
I've suspected that I may have sleep apnea for some time, but have never done anything about it. About two weeks ago I visited a P.A. because I lost my voice. During the exam, the P.A. commented on the fact that I still have my tonsils, and mentioned that my throat is small. He then asked if I snored (yes), if my sleep partner ever noticed that I stopped breathing at night (yes), and offered to schedule a sleep study for me. I believe this was what is referred to as a split study. I spent about three hours sleeping with a bunch of leads and wires, then the sleep technician fitted me with a mask and I spent the rest of the sleep study with a CPAP machine. I slept incredibly well with the CPAP machine on and woke up feeling very refreshed. The sleep technician told me that it would take 4 days or so to get the sleep study to my Dr., and that they would discuss the results with me.

During the time between the sleep study and last night, I did a little bit of research, mostly looking at machines and reviews on CPAP.com and manufacturers web sites, and talking to friends who already were using CPAP therapy with varying degrees of success. I also spent some time reflecting on how I've been feeling, and how I felt the morning after the sleep study. I knew that there was a big difference, and as I waited to hear from my doctor, I began to realize that I'm probably sleep-deprived, and that it really is negatively effecting my life. I also began to get very excited that this could all change. I couldn't wait for this process to start.

After a few days of waiting I called my doctor's office and asked them about the results. Nothing yet, but they would call me back. I waited a couple of days then called again. They said they still didn't have the results, but a couple of hours later a rep from a local DME called to set an appointment for a respiratory therapist to set me up with a CPAP machine and mask. I asked a few questions, including what type of machine they would be bringing and got some pretty vague answers. I went ahead and made the appointment, but was unsure of what was really going on. I did call back one other time to ask a little bit more detail on which machines they were actually going to bring out. They mentioned Fisher & Paykel machines and specifically mentioned the Respironics SleepEasy. I did a little more research online and realized that neither of these machines were designed for travel (I travel weekly for work), I also decided based on a online research and a friends recommendation that the machine that was going to meet my needs was either the ResMed S9 Elite, or the ResMed S8 Escape II.

Because the DME had not mentioned either of these machines, I decided that the next step would be to have my prescription sent to a different DME. I called the other DME and got much better answers from them, including the fact that they had the machines I was interested in in stock. I called my doctor's office and they agreed to look into it. A few minutes later I got a call from the original DME asking why I wanted to move my prescription. I explained it to them, and they asked me if they could check to see if they could get one of the machines I wanted. I said fine, and they called me back a few minutes later and told me they could get the ResMed S8 Escape II. Since I already had the appointment, I agreed.

Yesterday, the respiratory technician from the DME showed up at my house with a ResMed Escape (not Escape II). I was disappointed since the Escape II was a re-design with a much quieter specified noise level (25dB for Escape II v. 31dB for Escape), but I didn't say anything since what I really wanted at this point was to get started with the therapy. We went over the results of my sleep study which showed an AHI of 57.9 before CPAP and an AHI of 6.4 after. Also we discussed that the prescribed pressure for me was 7cm H20. The RT, did bring a few different masks with him, and so I tried on a Respironics Comfort II Classic, a Respironics EasyLife, and a Fisher & Paykel Opus 360. I didn't think to try the masks on while lying down (delayed duh), and the RT didn't mention it either. I decided on the Respironics EasyLife.

Last night I got ready for bed, got the machine set up with the humidifier set to 2.5 and the Ramp time set to 30 minutes, and put the mask on. Normally I'm a side sleeper, but every time I tried to sleep on my side the mask would start leaking. So I spent most of the night trying to sleep on my back. I had great difficulty falling asleep, and eventually took a Melatonin based sleeping pill (SleepMD). This didn't help. I wasn't comfortable on my back, the noise from the machine was bothering me, and the mask would start to leak everytime I moved. It was also hard to breathe, against the air pressure in the mask. I eventually got frustrated and took the mask off. After an hour of fitful sleep, I put the mask back on, determined to sleep on my back . I also put a pillow under my knees which helped me be a little more comfortable.

From that point on things went a lot better. I was able to fall asleep and had some very vivid dreams. However each time, I would suddenly wake up from the dream. All in all it was a rough night, but I also realize it was the first step in a journey that might take some time. I'm encouraged by the results, although not as encouraged as I was after the sleep study.

That's my long experience to this point. I have a few specific questions and would also like to solicit any general advice the group may have.

1-I'm really disappointed with my DME, and specifically with the machine they sent me. It wasn't what I was told I was getting and I'm not sure what I should or can do about it. The noise level also bothered me quite a bit. It wasn't loud, but it had a high pitched whine that kept me awake. Fortunately my wife didn't notice it at all. From my research it looks like the Escape II which they said they were bringing has two advantages over the machine I have. First it has Easy Breathe Technology which may help initially with my exhaling difficulties. However, at a pressure of only 7cm, this may be a short term benefit. Second it is quieter, at least according to the specifications. Do you think I should try to get the DME to bring the machine they originally agreed to bring based on those to factors, or is this just a something I will get used to as I adjust to the therapy? I'm blessed to have very good insurance coverage, so this was a straight purchase that required no out-of-pocket expense from me. The DME mentioned a 30 day one-time exchange policy for the mask but not the machine, so I'm not sure what my options are.

2-Both the machine I have and the machine I was told I would get do not gather ongoing data such as leakage, AHI, etc. How important is getting that data?

3-This morning there was some condensation inside my mask. I never noticed any discomfort or felt like I was breathing overly damp air. Is this a problem? Or is it only a problem if I notice it while sleeping?

4-Any suggestions for side sleepers? I'm open to trying different masks, although I have a lot of difficulty with the two nasal pillow masks I've tried so far, and I dont' see the need for a full face mask. I used to mouth breathe, but with a nasal mask, every time I open my mouth the air coming out makes me very uncomfortable, so I don't believe I'm prone to mouth breathing with a nasal mask.

5-I'm a little concerned by the fact that during my sleep study I was only able to get to an AHI of 6.4. Is that concern justified?

That's it for now. Thanks for reading my long post.

Best,
George

[harry33]

welcome george

for side sleep simply tighten the mask straps, all CPAPs are OK for travel, generally the smaller and lighter weight ones are popular

[mdintx]

1) Sounds like you got the all too typical shaft from the DME. If it were me, I would consider raising a stink about the machine.
2) Data is important in order to fine tune your therapy. Your machine is like a glucose meter that only verifies that you've drawn blood.
3) A bit of condensation is not unusual. Just find the balance that's right for you.
4) Some people (like myself) are prone to leaking therapy from the mouth. I used tape to keep it sealed. If you notice dry mouth and fatigue upon waking, then you are mouth leaking. Some nasals for side sleepers are the Activa and Activa LT. I'm a side sleeper and haven't had a problem with any of the nasals I've tried. I keep my head at the end of the pillow so the mask sits off the side.
5) You can do better than 6.4 and data would help your progressively fine tune your settings. The main thing is to keep the AI (apnea index) at 0 and have the AHI be composed of as few hypopneas as possible.

Welcome to the fold...er, the hose!

[KatieW]

1-I'm really disappointed with my DME, and specifically with the machine they sent me. It wasn't what I was told I was getting and I'm not sure what I should or can do about it. The noise level also bothered me quite a bit. It wasn't loud, but it had a high pitched whine that kept me awake. Fortunately my wife didn't notice it at all. From my research it looks like the Escape II which they said they were bringing has two advantages over the machine I have. First it has Easy Breathe Technology which may help initially with my exhaling difficulties. However, at a pressure of only 7cm, this may be a short term benefit. Second it is quieter, at least according to the specifications. Do you think I should try to get the DME to bring the machine they originally agreed to bring based on those to factors, or is this just a something I will get used to as I adjust to the therapy? I'm blessed to have very good insurance coverage, so this was a straight purchase that required no out-of-pocket expense from me. The DME mentioned a 30 day one-time exchange policy for the mask but not the machine, I'm not sure what my options are.

I would not settle for any Escape cpap. While I believe you can get some info from the lcd screen of the Escape II, you cannot download data except for hours of use. Talk to your insurance company and your doctor to find out what your options are. What does your RX say?

2-Both the machine I have and the machine I was told I would get do not gather ongoing data such as leakage, AHI, etc. How important is getting that data?

In my opinion, it is absolutely essential to be able monitor your therapy.

3-This morning there was some condensation inside my mask. I never noticed any discomfort or felt like I was breathing overly damp air. Is this a problem? Or is it only a problem if I notice it while sleeping?

Read in the Wicki (yellow light bulb at top of page) about rainout and how to deal with it. If that is a problem for you, know that the S9 has climate control. In 3 weeks, I have not had a drop of rainout, and it was an ongoing problem for me prior to that.

4-Any suggestions for side sleepers? I'm open to trying different masks, although I have a lot of difficulty with the two nasal pillow masks I've tried so far, and I dont' see the need for a full face mask. I used to mouth breathe, but with a nasal mask, every time I open my mouth the air coming out makes me very uncomfortable, so I don't believe I'm prone to mouth breathing with a nasal mask.

Without data, you have no idea what your leaks are, whether from your mouth or mask.

5-I'm a little concerned by the fact that during my sleep study I was only able to get to an AHI of 6.4. Is that concern justified?

Get a copy of your sleep report. I think the purpose of titration is to find the optimal pressure where you don't have any events. All the more reason for you to have a data capable machine, so you can monitor your results.

Welcome to the forum, keep reading, so you can be a informed consumer.

[Julie]

Why are you trying to sleep on your back? It's the worst position in terms of aggravating apnea production and most of us try our hardest to sleep any other way if we can. The sleep study techs may have insisted you do it because they wanted to see a worst case scenario in terms of stats, but that would be the only time you should do it.

[bob007]

gdpeck,

I've just started (21 days into it) and I just want to encourage you to keep with it. My wife's cousin was very helpful and through her efforts and her relationship with other members of this board I had my doc prescribe the S9 with the H5i humidifier. From what I read it is one of the best and newest machines going but like anything brand new their may be some tweaks needed after people have a chance to use it. I would highly recommend the S9 system but what do I know, it's the only machine I've used LOL.

I use a pillow mask and find it easier to adjust to than the nasal originally supplied.

Bob

[RipVW]

Hello & Welcome, gdpeck! Glad you found this forum—SO much useful info and everyone here is so willing to help! You're lucky to have found this forum as you begin CPAP—took me almost year before I found this place and, with the help of folks here, got my CPAP therapy working as it should. Regarding the machine, everyone here agrees that a data capable machine is a must have.

"You are getting sleepy . . ."

[gdpeck]

Thanks for all of the responses. I can tell I've got a lot to learn, but it sounds like I really need to get a data capable machine.

Why are you trying to sleep on your back? It's the worst position in terms of aggravating apnea production and most of us try our hardest to sleep any other way if we can. The sleep study techs may have insisted you do it because they wanted to see a worst case scenario in terms of stats, but that would be the only time you should do it.

I was only trying to sleep on my back, because every time I moved to my side, one or more or all of the following happened: Mask started leaking, Hose would either tangle or tug, or pillow would cause uncomfortable pressure of the mask onto my face. At the time it seemed like the best course of action was to chose a sleep position that wouldn't bother the mask fit. I'm definitely not planning on training myself to back sleep.

[kteague]

Hi. Sounds like your 1st nite wasn't a total failure, just not everything it will one day (night) be. I'm a huge data machine advocate. Why should anybody have to guess if their treatment is therapeutic when the technology is there to know? Getting a mask that is comfortable and not leaky can take some effort, and learning to position oneself on the best pillow style in the familiar sleeping position can take time too. I too am a side sleeper. I feel that getting used to this treatment can be nerve wracking in itself, so why add changing ones sleeping position to the mix? Best wishes as you sort thur the coming nights. You're off to a good start.