Best Night Of Sleep Ever (CPAP)? Not Even Close (SUPER LONG)

Hello, Im brand spanking new and I posted this on another board. It was recommended that I post this here also...So here goes. All advice appreciated."



"So...many people report that their first night with CPAP was their best night of sleep ever. I too suffer from day time groggyness, lack of energy, headaches from lack of oxygen at night, restless sleep, frequent bathroom trips and the like. So why hasn't my CPAP machine helped reduce even ONE of these issues? In fact, instead of extinguishing some problems, it has added the following problems

CONSTANT (no fewer than 8x) waking in the middle of the night attempting to remove the mask.
CONTINUALLY dry, stuffy, inflamed nasal passages and
CONTINUALLY dry throat-to the point where I wake up to drink SEVERAL times throughout the night and have a sore dry itchy throat and burning, dry nasal passages during the entire day.

So I end up taking the mask off in the middle of the night when its not tied down with pantyhose.. I have tried nasal decongestion sprays, neosporin in my nasal passages, tying the mask to my head with pantyhose (advice from a friggin doctor) and taking sleep aids to assist in deeper sleep so as to not be as aware of the annoyances of the sleep machine.

I have had CPAP machines FOR YEARS (since 04). I have swapped my masks, varied the water temp in the humidifyers, I have skipped using the humidifyers. I have even gone so far as to raise and lower the temp in my home to compensate for the warmed air coming from the CPAP machine. It is to no avail. I read a thread on OH where a guy had the same issues. Extreme drying of the nose and throat to the point where it got unbearable. He said that he had his study repeated and learned that his setting on his machine was too high. While Im happy for him, I don't think thats the issue here for mine because my machines have been based from two different sleep studies done at two different facilities. It was because of the extreme difficulty I was having with the first machine that the second study was ordered.

I have been attempting to use this machine for over 2 years and not only does it not help me, but every night that I use it, I feel much much worse the next day with the addition of a sore throat and inflamed nasal passages. I am also waking up SEVERAL times a night attempting to take the mask off. So that makes for some miserable sleep.

I have talked to my doctor, and to be honest, her responses seem ridiculous and unreasonable. I listed some of her advice above. But essentially her first response is basically saying there are a gazillion machines on the market all working a different way so I should apparently sit and try them all along with the gazillion masks available. Soooo in total thats an infinte amount of mask/machine combos. But while trying all that I should take sleep aids NIGHTLY, use Neosporin in my nose NIGHTLY, Tie the mask to my head NIGHTLY and I guess just screw the dry throat. I have tried that stuf and IT DIDNT WORK. The only result in her stupid suggestions was a nose clogged with neosporin(super gross)

I have seen an ENT doc who basically says that I had pretty bad sinus issues, and while they aren't signifiacnt enough to operate, they are definitely bad enough that CPAP is gonna be a huge pain to use. He prescriped me singular (pill), flonase (nasal spray), and advised me to use a netti pot. Does anyone else see the sorta ridiculousness of it? I dont mean the treating of the apnea, I mean the steps I should take to stay on CPAP versus BI PAP or whatever other machines are out there. Am I really supposed to try every CPAP machine and mask out there? My insurance makes me rent the machine for 3 months. So I can only swap machines every three months. So in a year I can only try 4 machines. IN order to try 10 machines I would have to wait 2 and a half years. Please, please help..

So do I need another study? A different doctor? A different sleep apnea treating device? Can a mask make THAT much of a difference? Why do doctors seem so dead set againat any other treatment aside from CPAP? Why are they so reluctant to prescribe Bi Pap or whatever? What can be done....My issues with CPAP have never been how I look in it, or the cleaning issues with it. In all my bitching, I am not complaining about the comfort of the mask hile sleeping. Thats sooo not my issue. I have no issues cleaning it and using it. My ONLY issues have been the fact that the darned thing doesnt help and in fact makes stuff worse. This turned into a rant, and I apologize. But I seriously hate that the stupid machine isnt helping. I have to use it for surgery and I would like for it to actually HELP ME recover...SO although its a rant, I really do need some advice!"


I would like to add that I do not wake with these issues. I never really get to sleep in the first place. I did a search for nasal pain, stiffiness etc. And I think my issue is a bit different than what I found. Seems those people got to sleep and WAKE UP like this. I never really get any sleep.


Thanks

Definitely use a humidifier. It doesn't matter that the air that comes out is warm, all that matters is its moisture content. Want to know why? All the air that enters our lungs, by the time that gets there, is warmed up to near body temperature and close to 100% saturated with humidity. Not using a humidifier because it heats the air up (and thinking that that will dry you out more) makes absolutely no sense as it is the moisture content not the temperature that is the most important. Now using a humidifier with no water in it would be a bad idea. In fact if you can get a machine with a heated hose (to prevent rainout) so that you can really crank up the humidity it might help. I wouldn't trade my S9 for anything (the heated hose/other features really are that good).

As your issue is dryness and not pressure intolerance BPAP will do no good. Your doctors seem correct on this.

The excessively dry throat makes me think you might be leaving your mouth open thus diminishing the amount that the CPAP works and also drying out your throat. Have you tried a chin strap or a full face mask? I know full face masks kinda suck and are hard to get used to, but you might just have to suck it up and adjust to one.


So in summary:

Make sure air isn't blowing out your mouth (have your leak data examined). I really, really think this might be your issue.
If it is switch to full face or use a chin strap. Since your sinuses have issues, a full face/mouth breathing might be your best option.
You want as much humidity as possible without rainout. If you can get an S9 series CPAP with a heated hose next cycle I would

A BPAP isn't likely to help as your issue appears to be nasal dryness and not anything to do with pressure. What is your pressure setting anyways. If it is less than 14 cm/H2O and you don't have a lung/neuromuscular disorder/no central apneas I don't think anyone would prescribe a BPAP. There are all sorts of ideas on the horizon to treat OSA without CPAP. There are already oral appliances (mouth guard type things) that have some success in some people. There is also a lot of research on implants that would electrically stimulate (mildly shock) the muscles of the soft palate to keep them firm/prevent OSA as well. Surgery is also an option in some people.

Unfortunately, the electrical implants are still in the testing stage.
I have a lot of dryness; but it is lots better with a full face mask;
or with nasal pillows and a combination of Poli-grip and a little tape--all easily removed.
I could not do this without my full data machine.
I find my pressure needs vary depending on many factors, including the mask I use,
and I need to change masks when my leaks get too bad. Not possible without full data.
DEMAND full data--AHI, leak, (and pressure if machine is automatic).
Waveforms are very useful, too; though I find I do not need them at present.
They are available, though, should they become necessary.
Good luck. You need good sleep. Hope you get it.

Wow, you left yourself wide open when you said

"All advice appreciated."

Warning, I often have a little different perspective on things.

The first thing you need to do is tell us how you really feel. Leave nothing out. Unlike your experience with your medical professionals, we will not only listen, but we will try to comprehend.

The people here have experienced a wide variety of issues and between all of us there may be some solution that you can incorporate.

But first, you need to get all of this frustration and other garbage out of your system.

You don't have to limit your discussion to us, you can also air your frustrations on friends and family and anyone else that you have a trust relationship with that is able to just listen and not pass judgement.

OK, now that you have that out of your system, let's see if we can fill the empty spot with something constructive.

One thing that often helps is mental training.

If you pose a question to yourself just before you go to sleep, your subconscious brain will try to answer it while you sleep. Use care when putting your question together. If you ask yourself how many times am I going to wake up tonight, you may find yourself waking up repeatedly. However, if you ask yourself what can I do tonight to sleep all night without waking up, you will end up with different results.

Mental gymnastics will only go so far, but it is a good place to start.

When I started my xPAP journey, I noticed that I seem to have some congestion. I was able to eliminate this by adding a very small amount of sea salt to my humidifier water and when I go to sleep I visualize that I am down at the ocean beach sleeping on the shore. Some people notice that breathing salt air helps with congestion and dry throat and sinus issues. I don't know if the small amount of salt that I am using provides enough concentration to be therapeutic, or if my visualization provides a placebo effect, but I don't care. It works for me.

Caution, if you thrash your machine at night and it frequently ends up overturned, you are better off not adding salt to the water. Salt water can do more damage the regular water to electronics.

The neti pot and gargling frequently with salt water may also help.

There will be many other suggestions from others, so I will cut this short. You need to come to terms with your mask. Wear it during the day for awhile so you can become aware of it. You may be waking up because it is too tight, or too loose. Daytime adjustments may help you figure this out.

Another thing to consider is hydration. Check the color of your urine. If it is dark, you need to drink more water.

I hear what you are saying and I hate your machine too.

Thanks for the replies...I am taking notes. BELIEVE ME I am taking notes. The other place I posted suggested that with a pressure of 16, that BiPap may provide some relief. But to make a long story ever friggin longer.I have been diagnosed with Apnea since 2004. I was "diagnosed" by a while hospitalized for pnumonia. The doctor came into my room and instantly knew it was apnea. The next night she ordered a machine to be put on me. Now that machine, was like heaven. As I recall, it went over my mouth and seemed to force air in. I loved it and wanted one immediately. But when it came for the sleep study, they INSISTED that I wouldn't like the machine I had in the hospital. Even though I was telling her that I did in fact like it. She insisted that for everyday use, I would not want a mask over my mouth and I ended up with the nasal pillows. As such, my very first mask was the nasal pillows type. I worked nights at the time and those nasal pillows kept me awake all day. I was waking up several times a day (I slept during the day) with extreme burning and dryness. I can't stress enough, the CPAP was waking me up and keeping me awake. I don't remember if the machine had a humidifier or not, but I know for a fact it did NOT have a ramp. I NEEDED to be rested for work, so the CPAP machine and its nasal pillows went into my closet where they could never harm anyone ever, ever again. Out of sheer misery and desperation I tried to revisit getting Apnea treatment and it's been a nightmare to say the least....

I presently have a full face mask, and I have used the humidifier on the maximum setting (6) and still experienced dryness. I get what you guys are saying, that throat dryness is because of my mouth opening at night. But it seems like it's easier to change the machine??? Than to strap the mask to my head AND use a salve for the interior/exterior portions of my nose AND essentially take decongestants every day for life, to ensure that my nasal passages are clear enough to use CPAP, AND have to use salt waterin the machine AND to have to essentially retrain myself to sleep in a way that increases the efficacy of the CPAP. It seems like the issues MAY, MAY be solved with a different type of machine verses adding about 4 medications/products etc to my routine. Please don't consider this response hostile or rude. But it honestly baffles me that when a device isn't working and there are other options, my doctor would rather have me buying salt, pantyhose, neosporin and claritin for the rest of my life. While she has swapped out my machines, I can tell by the tutorials that I get when I pick them up or get them delivered that the machines essentially function the same. She has yet to prescribe a machine that isn't the "set type" or that titrates etc etc...

Thanks for responding

Hi, not sure if I can add anything useful, but if you could please go to the User ctl. panel at the top left (small writing!) and then click on Profile, fill in the text (not icons please) name and model of your machine and mask, with software if you use it (it could be a big help to you) it'll help us to help you.

For most of us, having the right mask in the right size, with or without having to also use something like Pad-a-cheek liners is EVERYthing... can make all the difference to your therapy... it's rarely the machine that's at fault unless you were prescribed something really inappropriate...

And I do understand that you've had a hard time, but I also think that even if it's now 2012 there's room for improvement as equipment's improved over the years, people here can really help you with everything, and if you give yourself and your Cpap Rx a chance, looking at each variable for at least a few days at a time so you have a better idea of what's working and not, plus get the software, you might just be surprised that you end up feeling good for a change, but your username tells me that you might be ready to give up on it all .. don't do that, just remember it's not about being persecuted by the equipment or that doctor who sounds a bit lost for answers, but about saving your life, and you need to stop 'hating'...Good luck - hope you find some answers.

I'll second what Julie said - if you have your equipment listed in your posts, it will gather you a whole lot more help because we'll know exactly what you're dealing with. It does make a difference. Also, anything you can recall about the machine that gave you relief in the hospital might help.

Also other things - as Hosecrusher says, it all matters. For example, with that much thirst and no other info to go on, I'd be wanting to know if you'd been checked for diabetes, and whether you drink much coffee or other dehydrating beverages; but maybe you've thought of those and have eliminated those possibilities already. We don't want to add to your frustration by suggesting things that don't pertain. Tell us everything you can.

And stay with us.

Remind us what decongestants you are using? Most decongestants have a "rebound" effect that may make congestion WORSE. When my nose is stuffy and I open my mouth to breathe (in my FF mask), I experience a wicked dry mouth, even though I'm using a FF mask. You still need to be able to keep your mouth closed and breathe through your nose if at all possible.

You did say your doctor prescribed Singulair which should help--it's an allergy med, not a decongestant. Flonase is a steroid nasal spray that should help as well, but needs to be used regularly. And a neti pot often helps people, but overuse can lead to nasal irritation. You might try a saline only nasal spray to hydrate your nasal tissues, in the morning and a few hours before bed. Drinking plenty of water during the day will also help hydrate your tissues.

These MAY help with the dryness, but then the next thing is to take a look at your EFFICACY data to see what else might be going on IF your machine has EFFICACY data. That's why we need to know what machine make and model you are using.

A good machine with full efficacy data including waveform data will help us sleuth this out. Hang in there, you have the persistence to make it work--now you will have some PRACTICAL ideas of what to try.

HateMyMachine,

Others have addressed your problems with the nasal congestion and the painfully dry mouth. I want to look at this comment:

I would like to add that I do not wake with these issues. I never really get to sleep in the first place. I did a search for nasal pain, stiffiness etc. And I think my issue is a bit different than what I found. Seems those people got to sleep and WAKE UP like this. I never really get any sleep.

You've identified a very real and very serious issue here: You have to be able to get into a good deep sleep with the mask on before it can help you AND right now you feel as though you never really get to sleep in the first place.

In other words, you've got some CPAP-induced insomnia going on. The insomnia seems to be triggered by the intense discomfort you are experiencing with nasal dryness AND some understandable resentment of all the hoops that you are seemingly going through every night just to keep the mask on. Adding to all that resentment is the fact that you don't feel even marginally better when you use the machine and you probably subjectively feel a whole lot worse.

And adding to your angst is this series of questions that are at the forefront of your mind:

So do I need another study? A different doctor? A different sleep apnea treating device? Can a mask make THAT much of a difference? Why do doctors seem so dead set againat any other treatment aside from CPAP? Why are they so reluctant to prescribe Bi Pap or whatever?

So let's look at these questions first and I'll return to the issue of insomnia (at length) in a separate post.

Do you need another sleep study? Probably not---you've had two sleep studies done in two different facilities with basically the same results. But if your insurance will pay for one, then you could bring up the idea with your sleep doc. However, you need to be clear to yourself about what you hope a new sleep study will accomplish.

Do you need a different sleep doctor? Probably---you don't seem to trust the current one and it's hard to work with a doc you don't trust.

Do you need a different method of treating the sleep apnea? and Why are doctors so dead set against other treatments besides CPAP? We're not doctors so we can't definitively answer the first question. But these two questions are closely related to each other.

It is true xPAP in its various forms is the "gold standard" for OSA---that means it is known to be highly effective at treating even the severest cases of OSA as long as the patient complies with therapy. However compliance is a significant issue and you are far from the only person who has critically thought about whether CPAP is working in their case and whether they will ever be able to fully adjust to therapy.

As for other non-xPAP treatments, the answer is that there are some other alternatives, but how effective they are and how risky they are wind up being significant issues.

If your OSA is mild (a diagnostic AHI < 15) or on the mild end of moderate, it might be worth investigating whether an oral appliance might work "good enough" for you. Oral appliances are usually considered "successful" if they reduce the AHI by about 50%---so for folks with mild apnea, that usually results in clinically effective treatment, but in practice "Good enough therapy" often means that (a) you tolerate the device holding your jaw in an unnatural position for your whole sleep period and (b) the device manages to reduce the number of apneas enough for you to feel a positive difference. In other words, "good enough" may simply mean that "some therapy" with an oral device is better than "no therapy" with a CPAP machine. For some folks who are unable to tolerate their presribed CPAP pressure, using an oral appliance in conjunction with a CPAP allows the pressure to be reduced to a low enough level so the patient can tolerate CPAP AND still have effective therapy. One huge problem with oral appliances is that not all insurance companies will pay for them. And most insurance companies will not pay for them if your OSA is in the severe category.

And then there are surgical "solutions" that you could consider. The three surgical options for sleep apnea surgeries are called uvulopalatopharyngoplasty (UPPP), maxillomandibular advancement, and tracheostomy. Google them for details. Most folks on this board and many sleep doctors are very reluctant to mention surgery for sleep apnea for the very good reasons that (a)all of these surgeries are highly invasive and irreversible, (b)any surgery comes with real medical risks, (c)surgery for sleep apnea is particularly painful, (d)except for getting a trach, sleep apnea surgery does not have a particularly high success rate, (e) the definition of "success" for UPPP and maxillomandibular advancement is described as a 50% reduction in the number of apneas and hypopneas and for folks with severe OSA a "successful" surgery can still leave you with clinically significant OSA, and (f)except for the trach, surgery is seldom a permanent solution---within 5 or 10 years the apnea often comes back and CPAP can be even more difficult to adjust to after UUP surgery. As for tracheostomy, yeah, it's effective, but it also leaves you with a lifelong commitment to learning how to properly take care of the trach, which is not exactly easy.

Can a mask make that much difference? The mask is the intimate connection between you and the machine. Until you find a mask that fits you well, that you are comfortable sleeping in, and that does not leak too much, the mask matters a great deal.

The main problems you complain about:

• "CONSTANT (no fewer than 8x) waking in the middle of the night attempting to remove the mask.
• CONTINUALLY dry, stuffy, inflamed nasal passages and
• CONTINUALLY dry throat-to the point where I wake up to drink SEVERAL times throughout the night and have a sore dry itchy throat and burning, dry nasal passages during the entire day."

all point to serious issues with the mask you are using. And the fact that you are likely mouth breathing,which creates a whole set of mask-related issues. In order for us to help you with mask issues we need to know what mask you are using right now---the full model name is best. I'm under the impression that you've tried a number of masks and it's clear that you tried and did not like nasal pillows. But I cannot determine if you are currently using a full face mask that covers both your mouth and nose or just a nasal mask that covers your nose only.

I know you say you've tried lots of masks. But finding the right mask for you is a bit like finding the perfect pair of shoes: You can get lucky and love the first pair you try on OR, more typically, you have to try on a dozen pairs of shoes before you find the pair your feet actually like and want to wear. Same thing with masks: You can get lucky and love the first one you try on OR, more typically, you have to try using 6-12 (or more) masks before you find the one your nose actually likes and wants to wear. It would help us if you could tell us more about what masks you've tried and why you did not like them. Because sometimes the problem with a particular mask can be addressed by making sure the mask is correctly fit to your face. And there are a lot of DMEs who know nothing about how to properly fit a mask. (Just like there are plenty of shoe salespersons who know nothing about how to properly fit a pair of shoes.)

Why are docs reluctant to prescribe BiPAPs (or whatever)? The short answer? BiPAPs are twice as expensive as the most expensive APAPs.

The longer answer? Some docs are more likely to switch a person to BiPAP in light of (mere) adjustment problems than others are when a CPAPer is struggling with issues that are clearly related to tolerating their prescribed pressure setting and switching to APAP has not helped. After struggling mightily for two months of straight CPAP (at 9cm) and APAP (with a 4-8cm range), my sleep doc and his PA (who was providing my care) talked about my case and did decide that it was worthwhile to do a BiPAP titration and I was switched to BiPAP. My adjustment problems, however, were not mask related nor were they related to mouth breathing. Even at low pressures I was struggling with significant aerophagia issues and air was getting into my eyes via my tear ducts. Even with EPR turned on, I was struggling with exhaling against the pressure. And EPR itself was triggering the sensation that the machine was rushing me to inhale before I was done exhaling. I am grateful that the PA brought up the idea of a BiPAP trial to me since it has proved to be a major help. Even so, it took another two or three months of BiPAP before I was starting to sleep more comfortably with the machine.

Would a BiPAP help you? My guess is probably not as much as you think it would help. You are not complaining of things that sound like they are pressure related. You are complaining of things that sound like they are related to mask, leak, and mouth breathing issues.

That said, I will add that the instant and complete drop from IPAP to EPAP at the start of each exhale can increase many people's comfort level with breathing with the machine. Add in the fact that the drop can be set to more than 3cm (the max EPR drop) and that can make the machine even more comfortable for some folks to breathe with.

However, it's also important to add that some folks who are prescribed bi-level machines do not particularly like them: Some people find that their BiPAP (or VPAP) doesn't track their breathing pattern very well and so they find themselves either exhaling against IPAP pressure OR struggling to inhale with EPAP pressure. In the first case, it feels as though the machine is trying to rush you to inhale before you are ready. In the second case, it feels as though there's not enough air coming through the mask to satisfy your needs on inhaling. Both can make you miserable.

HateMyMachine wrote: "I too suffer from day time groggyness, lack of energy, headaches from lack of oxygen at night, restless sleep, frequent bathroom trips and the like. So why hasn't my CPAP machine helped reduce even ONE of these issues?

You already know the answer to this question: In order for the CPAP to help with these issues, you actually have to be sleeping when using the CPAP.

And right now you're stuck in a stage where the "sleep" you're getting with the CPAP is highly fragmented and simply doesn't feel like sleep. I know the feeling: That's what was going with me for the first 3-6 months (or more) of xPAP therapy.

So we need to help you figure out how to start solving the problem of your sleep being fragmented by the use of the CPAP.

You've written two things I'd like more information about.

First you write:

I would like to add that I do not wake with these issues. I never really get to sleep in the first place. I did a search for nasal pain, stiffiness etc. And I think my issue is a bit different than what I found. Seems those people got to sleep and WAKE UP like this. I never really get any sleep.

and you also write:

CONSTANT (no fewer than 8x) waking in the middle of the night attempting to remove the mask.
CONTINUALLY dry, stuffy, inflamed nasal passages and
CONTINUALLY dry throat-to the point where I wake up to drink SEVERAL times throughout the night and have a sore dry itchy throat and burning, dry nasal passages during the entire day.

I have a series of questions that I'd like you to answer to try to tease apart whether you are managing to get to sleep in the first place or not. Because if you are having problems right from the instant you lie down AND these problems are keeping you from getting to sleep night after night, then that does indicate you've got a problem with sleep on-set insomnia.

1) If I recall correctly, the doc has given you a prescription for Ambien. Do you take it? If so, how often? Does it make you drowsy at all? Does the drowsiness wear off before you feel like you get to sleep? If you don't take the Ambien, then why not? Does it cause problems with side effects? If so, what side effects?

2) How long do you lie in bed at the start of the night "fighting" the mask and "fighting" to get to sleep? Do you have a clock beside your bed? Do you find yourself constantly looking at the clock while fighting the mask?

3) How long do you lie in bed with the CPAP on before "the dry throat-to the point of needing to get out of bed to drink some water" sensation starts to be noticeable? And how long do you wait to before you get up to get the drink of water? And do you have to get all the way out of bed to get the water or do you have a water bottle handy on your nightstand?

4) How long do you lie in bed before the urge to remove the mask becomes overwhelming and you "wake up" realizing that you are attempting to remove the mask?

5) Do the nasal passages feel any less dry, stuffy, or inflamed during the daytime? If your nose feels ok during the daytime, how long does it take for the nose to start feeling dry, stuffy, or inflamed after you lie down with the mask on? Also, how does your daytime congestion react to a long, hot steamy shower? Does the nose feel better or worse during and after a long, hot steamy shower?

6) You describe a whole lot of things you've been asked to try by the sleep doc and clearly some of these suggestions have lead to a rather elaborate set of "requirements" for you to deal with before you can lie down to try to get to sleep. But I'm confused about the actual steps you have to go through before you can lie down and start trying to go to sleep. Could you outline your bedtime routine for me AND if possible give me an idea of how long each step takes? In particular, what steps do you have to complete each night to be "properly" masked up in the sense of the chinstrap, the pantyhose, and all the other whatnots you are currently doing.

7) When's bedtime? When's wake up time? Do these vary a lot from day-to-day or are they pretty much at the same time seven days a week.

8) You say you are waking up repeatedly either finding yourself attempting to remove the mask or in order to drink some water. How long does it take you to settle back down after one of these wakes? Do these wake ups seem to be pretty random? Or do they occur at a somewhat fixed frequency ("I tend to wake up about every hour needing a drink," for example.) Or do they occur in clusters ("Once I wake up, I wake up two or three more times in the next 30-40 minutes, but then I'm ok for about two hours ....")

While you think about your responses to these questions, here are some suggestions that may help you get a bit more sleep.

Suggestion 1: Start a basic sleep log. A good model for a basic sleep log can be found at

http://www.sleepmedicinecenters.com/fil ... %20LOG.xls

Keep in mind that time to sleep, number of wakes, and total sleep time should be estimated. There is no reason to try to keep written records in the middle of the night. Fill the log in every morning when you first get up. If you want to make notes, they don't need to be very long: "Woke up four times needing to get a drink" is plenty of information.

Suggestion 2: Read up on sleep hygiene. A decent link to the basics of sleep hygiene can be found here:

http://www.sleepmedicinecenters.com/fil ... HABITS.doc .

Critically evaluate whether some of your lifestyle habits and sleep habits are aggravating the situation. Sometimes making one or two small changes in your life can help.

Suggestion 3: Learn some things about mouth breathing, nasal breathing, nasal congestion, and how all this fits into tolerating CPAP. Two good web based sources for this are:

Nasal Breathing Video Series, from Dr. Barry Krakow's web pages
Unstuff your stuffy nose, from Dr. Stephen Y. Park's web pages

Both of these sites may have suggestions you've not already tried. But more importantly, both of these sites will give you some understanding about why starting CPAP has triggered the problems you are having AND why some of the things you've tried have NOT worked out.

Suggestion 4: It's counterintuitive, but try turning the humidifier down a notch---particularly if hot steamy showers tend to make your daytime congestion worse. Not all noses like the humidity cranked up all the way and some of them become stuffy (and inflamed feeling) when there's too much humidity. And once your nose is stuffed up, you open your mouth and start breathing through it, which leads to the bone-dry and sore throat.

Suggestion 5: If you are taking decongestants on a daily basis, wean yourself off of them. The decongestant nasal sprays are particularly bad about triggering rebound congestion. The OTC decongestant pills are bad about aggravating insomnia in some people.

Suggestion 6: Try to simplify the "CPAP regime" as much as possible. If you are using a FFM and you can't tell a dimes' worth of difference in the morning between how dry your throat is when you wear a chinstrap (or pantyhose) and how dry your throat is when you DON'T wear the chinstrap (or pantyhose), then ditch the chinstrap for a few days and see if your misery level is any better. In other words, if it's easier to get to sleep without the chinstrap AND if using a chinstrap really doesn't make the throat any less sore in the morning, there's no good reason to torture yourself with the chin strap. Get the machine all put together well before bedtime. Put water in the humidifier well before bedtime Wash the face a good couple of hours before bedtime so that it has a chance to be nice and dry before masking up.

Suggestion 7: Give yourself at least 30 minutes or so before bedtime to do something quiet and relaxing to unwind and distract you from the CPAP stuff. Try to NOT think about the CPAP and the nighttime battle to come. Dwelling on the CPAP before bedtime can lead to self fulling prophecies: If you go to bed dreading the sure fact that you will wake up 8 times with mask issues, you probably will wake up 8 times with mask issues. If you go to bed each night with the hope that tonight you might not wake up (as much) then slowly the number of wakes will start to drop. The number of wakes may never get to 0, but it should get down low enough where the remaining wakes are few in number and short in length and don't really disturb you all that much.

HateMyMachine, there's a lot of good advice here to help you unsnarl these problems you're having and get them solved. One additional thing caught my eye just now: you're taking Singulair, yes? Troubled sleep is a known side effect of this medication, as are stuffy and excessively dry nasal passages and throat.

Maybe an easy first thing to check on with your doctor is whether you would actually do better with, or without, the Singulair. Do talk with your doctor about that - don't stop it on your own, especially if you have asthma as an underlying issue.