Introduction from a Newbie

Good Day,

I am a probable sleep apnea newbie who will potentially be prescribed xPAP in the near future. When my diagnostic sleep study was scheduled, I did an Internet search to find out all I could about the process, possible results, & etc. and the best resource I found was cpap.com and this forum. First, I want to thank you all for providing such great information.

A little about me – I’m a 34 year old male, 5’ 6”, 145 pounds, medium build. I don’t snore. Given my physique, age, and lack of snoring I’m fairly bummed out I may have sleep apnea as I don’t fit the traditional risk group from what little I know. I’m married, have a 7 month- old daughter, and live in Maryland. I’m with the Federal Government.

My father, age 65 and overweight, does have sleep apnea, so I suppose it may be hereditary?

I must admit I have had sleep apnea-like symptoms for many years and, given my father had it, was afraid to mention it to my doctor because I didn’t want to be diagnosed with it. As young as my mid 20s, I’ve had to get up, usually twice a night, to use the lavatory. Thinking about it now, it isn’t that I woke up to use the lavatory, but that I was awakened by something else, and went and used it since I was already up. I had my prostate checked several times, and even took medication for over active bladder, with no appreciable results. Year by year since my 20s, I’ve be more fatigued when I get up in the morning, and I can’t remember when the last time I actually felt rested was. I don’t remember dreaming, and haven’t slept through the night in 10 years. Sometimes I wake up with a headache and I always wake up groggy. I may mouth breath in my sleep as I always wake up with a dry mouth, I do have a slight deviated septum and one side of my nose is usually not up to par. My wife tells me that sometimes I will make “chomping” or “gasping” sounds. Most scary of all for me, I will rarely jolt awake not briefing at all, feeling like I am suffocating, and have to force myself to start breathing again.

I was able to put up with this until my daughter came in January. With the multiple times up a night feeding, changing, & etc., I was naturally getting less sleep. However, I started having fatigue more than I thought appropriate for this as I would fall asleep watching TV at night, and recently fell asleep on the Metro train coming into work in D.C. and have had a hard time concentrating at work because I’ve been so tired. There were a few mornings I probably shouldn’t have even driven. So anyway, I finally mentioned it to my primary care doctor and she ordered a sleep study, which I had Saturday night.

They were very nice at the study and the room was pleasant enough. I was as comfortable as one could be while doing a Borg impersonation all hooked up. I didn’t think that I slept at all, but when I asked the next morning, the technician told me that I sleep for a couple hours, enough to get the readings they needed. The doctor at the sleep diagnostic center is analyzing them today and will send them to my primary care doctor by Wednesday. I asked the technician if there was any activity during the study, and he said yes, there was some, and that after the results were analyzed by the physician they would probably call me back for CPAP or BiPAP.

Given all that, I’m fairly sure there is a mask and a hose in my future.

Any words of wisdom? Beyond what jewels you have to share from your experience, I have a couple questions that probably seem common sense to you, but I am unsure of.

I’ve read that while using nasal masks, many people either have to use a chin strap or tape their mouths to prevent mouth leakage. This seems like an unpleasant prospect to me. I’m not claustrophobic, and I know that my nose is often clogged up and given the dry mouth I’m probably a mouth breather. Is there any reason not go to a full face mask first and skip the nasal ones if I can convince the folks at the sleep study? Are the nasal ones any clinically better than the full face?

I gather the difference between CPAP and BiPAP is that BiPAP has two different pressure levels, one for inhaling and one for exhaling. Is the BiPAP easier to use, especially for someone new, since there is less resistance breathing out?

Are the straps that go on the forehead / crown of the head strictly necessary? Looking through cpap.com, I saw a few nasal masks and full face masks that do not have forehead straps.

Any advice on dealing with your partner? When I mentioned to my wife I was going to the sleep study, she said that she hoped I didn’t have a problem since the cPAP was decided not sexy in bed. While I certainly agree with the statement, I was a little hurt by it too. Also, a picture a few years down the road, my daughter running into our bedroom at night or in the morning, and me having to divest myself of the darth vader gear in order to interact with her. It’s a bummer. That said, if I can sleep through the night and know what it feels like to be rested, to remember dreams, I’ll give anything a go for that.

Thanks for reading.

I'm too new to this to offer much advice except for the kid thing. I have a 2 year old and a 5 year old and they couldn't care less about me using the CPAP. I've had them sleeping in my bed while I had the CPAP on, I've seen them play with the buttons, play tug of war with the hose, throw my mask in the bathtub. The whole world it a big question mark for 5 year olds. Once they find an answer they move on to something else. And the mask has never stopped them from coming to wake me up in the middle of the night (although I wish they would wake their mother first).
And think of all the extra energy you will have to put into "play time!"

Mask2sleep wrote:Good Day,

I am a probable sleep apnea newbie who will potentially be prescribed xPAP in the near future. When my diagnostic sleep study was scheduled, I did an Internet search to find out all I could about the process, possible results, & etc. and the best resource I found was cpap.com and this forum. First, I want to thank you all for providing such great information.

Hi, Mask2, and welcome to the forum.

<snip>

I have a couple questions that probably seem common sense to you, but I am unsure of.

I’ve read that while using nasal masks, many people either have to use a chin strap or tape their mouths to prevent mouth leakage. This seems like an unpleasant prospect to me. I’m not claustrophobic, and I know that my nose is often clogged up and given the dry mouth I’m probably a mouth breather. Is there any reason not go to a full face mask first and skip the nasal ones if I can convince the folks at the sleep study? Are the nasal ones any clinically better than the full face?

IMO, no. From what I've read, medical professionals say that we're better off breathing through our noses than our mouths, so nasal breathing is encouraged. You can work on that with a FFM, knowing that you're "covered" (literally and figuratively) if you still need to mouth-breathe. FWIW, I used to be a mouth-breather. When I used a nasal pillows mask, I had to tape my mouth or use a chinstrap; neither were effective enough for me. I now use the Hybrid mask (mouth cushion and nasal pillows combo). The chinflap works to keep my mouth shut, and I almost exclusively now breathe through my nose.

I gather the difference between CPAP and BiPAP is that BiPAP has two different pressure levels, one for inhaling and one for exhaling. Is the BiPAP easier to use, especially for someone new, since there is less resistance breathing out?

Not necessarily. It depends on one's pressure needs.

BiPAP is usually prescribed when a person has high pressure needs or when pressure-induced central apnea occurs on CPAP. Central Apnea is so-named because it involves the central nervous system (i.e., when you're physically able to breathe but the brain is slow to send the signal to the lungs). There's also APAP, which works within a range of pressures.

Are the straps that go on the forehead / crown of the head strictly necessary? Looking through cpap.com, I saw a few nasal masks and full face masks that do not have forehead straps.

Forehead, no. But nearly every mask has headgear that holds it in place (over the crown of the head). The CPAP-PRO (or No-Mask) is held in place by the teeth, with no headgear at all.

Any advice on dealing with your partner? When I mentioned to my wife I was going to the sleep study, she said that she hoped I didn’t have a problem since the cPAP was decided not sexy in bed. While I certainly agree with the statement, I was a little hurt by it too. Also, a picture a few years down the road, my daughter running into our bedroom at night or in the morning, and me having to divest myself of the darth vader gear in order to interact with her. It’s a bummer. That said, if I can sleep through the night and know what it feels like to be rested, to remember dreams, I’ll give anything a go for that.

Thanks for reading.

There have been many discussions here about this issue. Personally, I find it terribly sad that such a shallow view is taken by a partner (or even by the user, themselves) that the loss of "sexy" is more disturbing to them than good sleep and good health. How sexy are we when we're sleeping, anyway? Obviously, adjustments on all levels are necessary when we become a hosehead, including our priorities.

Be well, and keep us posted on your sleep study results.

Mask2sleep wrote: Any words of wisdom?
Thanks for reading.

Your story is my story.

Doc:"....well, you don't fit the profile,
but let's do a sleep study."

It's the beginning of your new life.
A life that will allow you to witness your daughter be and
accomplish all those things that you wish for her.

There are many threads here about dealing w/the spouse,
the kids, the pets. Your daughter will grow up seeing
you in your mask and you will teach her about it,
and it will just be the way her daddy is.
Your mask may or may not be sexy in bed.....
guess that's up to you and your wife.....
could go many different ways.

Ain't no big thing.
Given that in time, it will give you your life back...
it's really pretty easy.

It's your life.
It's my life.

Welcome! It's a journey.

Hi and welcome to the forum! Using a cap is not always easy but it is worth th hassle. Here is a video blog that may help you get started.
http://WWW.sleepnation.tv

Hi and welcome. Seems there's a good number of younger users on here so some of the things you are dealing with will be a shared experience. Being informed in advance can help one navigate new user issues, but there may be some restarts no matter what. Each experience is as unique as we are, and one person's dream mask may be another's nightmare. One time I posted about a horrid mask I was given at a sleep study, and someone rplied that they credited that mask with their success. Go figure! It's hard to know if your ability to nose breathe will improve with cpap. Some do, some end up with nasal surgery to allow them to use the nasal or nasal pillows masks. Others do fine with a full face mask. You are a step ahead in preparing yourself to make informed decisions.

About your wife's remark... Who of us hasn't made a remark at some point that we later realize wasn't the best thing to say? Once she sees you feeling better (and thus sexier) she'll likely see it differently, especially once she is educated about the health hazards of untreated apnea. If it was put to her as to if she'd rather you wear a mask or become increasingly debilitated, I doubt she say the wrong thing. Spouses of snorers are very aware there's a problem. It's a little harder to grasp when the signs are less blatant. You two will sort thru it easier if you don't make it an issue based on one offhand remark. About the little one, when picking a mask, consider the vent direction. One that goes outward or down may be an interference with smaller babies, but at your baby's age, the air may be "fun". Appearance - they don't care. At least my grandkids didn't. One that blows upward might be better, but some with little ones can better speak to that.

Hi Mas2sleep and welcome,

I am new to the mask my self and I have 4 kide the oldest is 19 and youngest is 13 in 2 months. they kind of think it is weard and teased me a bit but thay know that I need it and still love me. your daughter is young and will grow up knowing you with your mask and she will think it is normal. As far as the mask not being sexy well my wife is glad that I have stoped snoring and am breathing better at night. She just comented last night that i look peaseful sleeping with my mask. I am sure your wife will love you no mater if you have the mask or not.

Welcome, Mask2sleep! I'm glad that you found this forum early in your sleep study/CPAP journey. You will learn a lot here!

BleepingBeauty wrote:

Mask2sleep wrote:

I gather the difference between CPAP and BiPAP is that BiPAP has two different pressure levels, one for inhaling and one for exhaling. Is the BiPAP easier to use, especially for someone new, since there is less resistance breathing out?

Not necessarily. It depends on one's pressure needs.

BiPAP is usually prescribed when a person has high pressure needs or when pressure-induced central apnea occurs on CPAP.

That is an excellent description of when a BiPAP is needed. I also want to point out that some regular CPAP (set pressure) and APAP (varying pressure) machines have an exhalation relief feature. In the Respironics machines, it's called C-Flex or A-Flex. In the ResMed machines, it's called EPR (Expiratory Pressure Relief). I'm most familiar with the ResMed machines myself. ResMed's EPR can be set to decrease exhalation pressure by 1, 2, or 3 cmH2O, so that makes it easier to breathe against the therapy air.

Most of us here prefer machines that are capable of reporting full results data, such as AHI (apnea-hypopnea index), leak rate, etc. That data can help if there are any adjustments needed to therapy settings or problems with leaks. Here's a list of machines, showing their data capabilities: viewtopic.php?p=307168#p307168. The machines typed in blue are preferable. Pay attention to the model names, as some are very similar.

Please let us know how things go for you. And be sure to ask questions if you can't find the answers by searching past posts and searching the CPAP Wiki (at the top of the screen). We're here to help each other!

Good Morning,

Thanks for all of the great replies, I appreciate the warm welcome.

I suppose your right, my daughter won't know the difference, it is simply how her father is, but it is still weird, embarrassing even. It isn't even a rational feeling to be embarrassed over it, but for some reason I am. That and probably having to wear a mask to bed for the rest of my life is pretty daunting.

I am sure my wife didn't mean to be hurtful by her comment, that it was just casual and offhand, but it still stung a little. Who knows, if there is a mask in my future, maybe we'll invent a new form of bedroom role-playing? LOL.

Would anyone have any opinions on which FFM to try to get? I know everyone is different, and what works for you won't work for me, but there's so many varieties and brands, I frankly don't know where to start experimenting when the time comes.

While I have trepidation about the whole thing, I also want to get going on therapy ASAP. I'm so tired of being tired! For the first time ever last night my daughter slept through the night, but I still woke up 4 times for no external reason.

I have read that CPAP has a unique sound to it? I had assumed it was sort of a constant hum of air, like an air conditioner, but it sounds like there is a definite inhale - exhale sound rotation, ala Darth Vader?

Thanks for the information about CPAP vs. BiPAP. Regarding the machines that are capable of reporting results, does that take special permission to get? Can the Dr. just do an Rx for them? I imagine such machines are the cadillacs of CPAP.

Thank you, have a good day.

mask2sleep said:
Thanks for the information about CPAP vs. BiPAP. Regarding the machines that are capable of reporting results, does that take special permission to get? Can the Dr. just do an Rx for them? I imagine such machines are the cadillacs of CPAP.

My data capable machine was per scribed to me but when i got it i had to switch it from usage the the data capable mode. Also the software for my machine, although you can get, I think it is meant for the doctors only but as stated to me and i agree that it is needed in order to get control of your own therapy.

Mask2sleep wrote:
While I have trepidation about the whole thing, I also want to get going on therapy ASAP. I'm so tired of being tired!
I have read that CPAP has a unique sound to it? Thank you, have a good day.

Zen of the Mask-the rhythm

Zen-direct experiential realizations toward obtaining an awakening.
The practice to discover, through daily, or in this case, nightly,
experiences that will lead one to ultimate enlightment.

All things are brought to each of us, for a reason.
Why OSA???

In OSA therapy, the mask, is everything.

rhythm-a regularly recurrent quantitative change in a variable biological process
<a circadian rhythm>

the rhythm of expectations-
My confidence in cpap is confirmed, I no longer question, "is it working?"
I know that each night and the next morning, I will be better.
I feel the change on my bike. Pushing bigger gears up familiar hills.
Pushing my mileage, pushing my endurance, pushing my enjoyment,
confident that each nights rest will bring the blessed recovery.
I hear it in my music. My guitars are fun again. I remember the old songs,
I learn new songs and remember each of them, and improve on them, daily.
....ah, to remember, I can remember, slight details, again.
I don't question if it is going to happen, I expect it to happen.

the rhythm of breathing-I go to sleep, listening to and feeling,
the rhythm of Grace, my machine.
It is the rhythm of life. I welcome the sound, the sound of my breathing,
in sync, w/a machine, in sync w/my new life, flowing through a hose.

the rhythm of routine-I live in the rhythm of the routine of cpap.
The care and feeding of Grace each evening.
Slipping into my Papcap and mask, plug in my hose, hit the blue light,
feel the rush of 12.5cm......
The morning routine of mask cleaning, data recover and analysis.

the rhythm of life-In response to my first Zen of the Mask chautauqua,
someone suggested that I "become the mask."
Good suggestion. I have become one w/the mask.
Sometimes I wake and don't feel or realize I'm wearing the mask or
breathing through it. I don't think I could sleep now without the mask.
I had a dream, where the actions in the dream were coming through the
hose and out of my mask. Sometimes when the stresses of the day
clog my brain and I can't seem to let go of all that "noise", I let myself
go into my mask to see all the things, the mask,
is going to bring me the next day....the next day of my new life.
Zen of the Mask

Yin/Yang of life-
MY choice to embrace or reject, the mask, and in so doing,
chose quality of life.

I have chosen quality of life.

Mask2sleep wrote:I have read that CPAP has a unique sound to it? I had assumed it was sort of a constant hum of air, like an air conditioner, but it sounds like there is a definite inhale - exhale sound rotation, ala Darth Vader?

I don't know. I heard that Darth Vader thing when I first started on CPAP therapy, but now I can't hear it any more. In the beginning I was very aware of my breathing and every little thing that was different.

Now I'm so used to it that I actually have to check to make sure the machine is on. I can't even tell that there is no pressure without lifting the mask to create an intentional leak!

Your brain has to get used to all this new stuff. Once it does, it will start to filter out or tune out sounds it doesn't think are abnormal any more.

As far as noise goes, most of the newer machines are very quiet. I can barely hear my ResMed S9! Some masks are noisier than others. I have several masks that are very quiet, but my favorite mask (AEIOMed Headrest nasal pillows) is quite noisy on inspiration (a bit Darth Vaderish). Most of us tend to concentrate on our breathing more intensely when we first start CPAP. I know that I did. But, over time, I came to find that breathing sound to be more comforting than annoying.

The most important thing with masks is to get the proper size. Have the DME fit you while the machine is at full pressure, preferably lying down. Move around and make sure the mask seal doesn't leak. Two of the most popular full-face masks seem to be the Quattro and Ultra Mirage. A lot of people like the Innomed/RespCare Hybrid mask, which has both nasal pillows and a cushion that fits over the mouth. You're right that mask preferences are a very individual thing. I've probably tried on at least 15 different masks, and only found a few that work for me! Hopefully, you'll find a good one right away.

You and your wife will probably have a few laughs over the mask, etc., but you'll both get over the foreignness of that. Having a sense of humor about it can help. You mentioned that you don't snore, but your gasping sounds as you're struggling to breathe probably wake your wife up sometimes. I'm sure she'll welcome not hearing that. It's rather frightening to hear someone stop breathing. I think that we all go through a period of emotional adjustment when we're diagnosed with any medical condition. It makes us feel vulnerable. Our loved ones have to adjust to that too. Sometimes the equipment itself conjures up frightening images of hospitals and ventilators. I had never known anyone who used a CPAP machine, so I didn't know what to expect. Once we understand how the machine works, and enjoy the benefits of feeling better, those fears tend to go away. Knowledge is power, so educate your wife about sleep apnea and the equipment too.

Mask2sleep wrote:Regarding the machines that are capable of reporting results, does that take special permission to get? Can the Dr. just do an Rx for them? I imagine such machines are the cadillacs of CPAP.

You will probably be sent to a durable medical equipment provider (DME) to purchase your equipment. The same insurance billing code (E0601) is used, regardless of whether a machine is fully data capable or "dumb" (just reports hours used). This same billing code is used whether the machine is a CPAP (set pressure) or APAP (varying pressure) machine. So what this means is that the insurance company is going to pay the DME the same amount, whether you get a CPAP or APAP, data capable or not. BiPAP machines use a different billing code.

Some DMEs are very good and recognize the value of having full data capability. But many are trying to maximize their profit, so they try to sell you the most basic machine. If you want an APAP machine, it would be best to have that specified on the prescription. APAP machines can be used in either Auto or CPAP mode, so they are more versatile than a CPAP machine. If you have decided on a particular machine, you could ask the doctor to specify that by specific make and model, writing "dispense as written" or "no substitutions" on the prescription. The idea is to give the DME as little choice as possible in what they will be selling you.

I don't recall if you have insurance. If you don't (or even if you do, depending on your coverage), you may want to consider purchasing a machine from cpap.com (they sponsor this forum). You can purchase any CPAP or APAP through them with just a CPAP prescription. Local DMEs may not be as liberal. I think that many require an APAP prescription if you want that type of machine (even though an APAP can be run in CPAP mode!). If you have insurance, you may want to get a list of in-network DMEs from your insurance company, so you can call around and see which would be willing to sell you the specific model you want. Be sure to get a copy of your prescription and sleep study results when you meet with the doctor too.

You mentioned BiPAP as an option in your initial post, so I'm not sure if your pressure needs are high and/or you had a lot of central apneas, or if you were just asking about that because of the differing inhale/exhale pressures. As I explained earlier, some of the CPAP and APAP machines do have exhalation relief (up to 3 cmH20 in the case of the ResMed machines). Anyway, some insurance companies require that you "fail" CPAP/APAP before they will pay for a BiPAP machine. Just thought I'd mention that. I guess your doctor will be advising you regarding that.

Let us know how it goes!

I'm supposed to find out my results today... is there anything specifically I should ask them when they call? Like any kind of stats on number of apneas, information about titration, & etc?.

It seems like the Autoset S9 is very popular with folks here, when the time comes I will ask specifically for that one. I like the idea of tracking how it is going, and from the little I know the APAP feature seems like a good idea. Does that come with a humidifier too?

I like the Zen, thanks!

I'm not so concerned about the sound bothering me, but more of my wife. I suppose there are always ear plugs!

I get the nasal masks and the full face, but just looking at them, the pillows seem fairly uncomfortable. Big prongs in the nose, and I guess you need a chin strap? I suppose I will want the best of both worlds, the best therapy possible plus the least amount of extra stuff needed besides the mask itself, like a chinstrap. I suppose part of that is vanity too. I have seen reference to a papcap - what is that? It looked almost like a dew rag.

Thanks for the advice, DreamOn. I have Federal Government Blue Cross Blue Shield Standard. I perused their website but I couldn't find anything specifically about CPAP supplies.

Thanks all for the support.

Mask2sleep said
I'm not so concerned about the sound bothering me, but more of my wife. I suppose there are always ear plugs!

The S9 is a very quit machine, when i turned on my machine for the first time my wife looks at me and said " is that all the noise it makes, i cant here it now i have to keep sleeping with a fan". She has slept with a fan now for 15 years to off set my snoring.