One month in: tired, desperate, and under a lot of pressure

I apologize in advance for writing this post, as it's not really asking for help nor is useful. However, today, my feelings today are the worst since I started CPAP, and I feel I really need to vent.
To give you a background, I am a graduate student in a chemistry program in a very prestigious university in US. I am at the beginning of my 3rd year. Despite being almost half-way in, I've not made a lot of progress in my research, mainly because I have been too tired to keep up with my work consistently. While I tried my best to work hard, the results are often bad and my effort ended up begin unproductive. I am mostly to blame for this, as in fact, I was diagnosed with sleep apnea (AHI = 40) in 2009 and never took CPAP seriously. I did explore and try other options such as oral appliance, but I never really follow through with it.
At the beginning of this semester, I realized (somewhat too late), that I can't keep doing this and pretending everything will be fine anymore. In my condition, it is very likely I will not finish my PhD. Not to mention that sleep apnea has taken so much from my life. When I was an undergraduate, I barely had any social life, and while I got good grades, I did not really learn the materials (but I did get lots of help so I got through). I was determined to make CPAP work for me, in hopes that I will get better soon enough to be able to do research efficiently.
I've tried CPAP for a month. I was unable to sleep in the first week and in the rare cases I did, I took the mask off. This got better in the second week, but then, my old Resmed S8 EliteII started making whooshing sound that really disturbed my sleep. I decided to buy a new S9 autoset, out of my pocket, and hoped that it would not do the same thing (I also was interested in its data capability). Contrary to my expectation, S9 autoset DID make the same sound and even worse, even after I checked all the humidifier and filter). In the past few days that I have been using the machine, I can barely fall asleep. I would like to exchange it for a new one (I bought it new online), but then I heard that a number of people that got their machine replaced still have the same problem. The best way would be that I have to find a way to live with this, but so far I've been very unsuccessful with it
The machine noise is only one of the problems. So far, my sleep has been very fragmented and I keep waking up with different situations. Sometimes, my mask seal would become loose at night even though I fit it well before I went to sleep. Sometimes, I would feel a rush of air pressure from the machine into my nose and I can't explain why. Sometimes, I would wake up with excessive drooling on my face. A few nights ago, I even woke up with aerophagia. And if I can't sleep well, I cannot take a nap during the day either because somehow I cannot fall asleep.
With such poor sleep, I can't perform well in the lab. I would be able to stay awake 2 hours in the morning (starting at 11 am), and even with constant stream of caffeine, I would feel very sleepy by 6 PM. And even while I am awake, my brain is so fogged that I can barely critically think about papers I read or experiments I perform. However, I can't slow down because my advisor is thinking I am on a slow track right now, and if I don't work hard, I wouldn't be able to finish in time. I am also in a contract with the government from my country so I have 7 years as the maximum to finish my PhD. Now, without knowing when I'll get better, I feel I am wasting yet another semester away.
At this point I don't really know what to do anymore. I know I can't abandon my CPAP as it is probably my only chance of getting better. However, dealing with all of this at the same time is very torturing for me. I am thinking maybe I should take a next semester off and go home to recover, but then there's no guarantee that I'll have recovered before I come back to resume my study.
I thank you very much for anyone reading up to here, even though my writing must have been quite confusing. I'd appreciate any input. Thanks.

The S9 is an extremely quiet machine. Be sure that there is no leak in the humidifier seal or the hose connection. A hissing sound may becoming from the mask exhaust. I have an S8 and the S9 is MUCH quieter which makes me believe that the hose/mask is your problem.

Well, I've heard that some S9's DO make more noise than they're supposed to, and while I can't explain the situation properly as I'm not up on it, wait for Pugsy (or someone else knowledgable about it) to come in and do that. You should not have to put up with it - I believe it's some kind of random glitch - and I would certainly ask the dealer who you bought the machine from to look at it and if necessary replace it. Just be sure the noise isn't from e.g. something like the mask cushion retainer plastic not being seated properly (has happened to me), or that the vent holes have not somehow become enlarged beyond what they should be, but if the machine itself is noisy, something is wrong and we'll try to help you get it fixed.

May I ask what country you are in? It might matter in terms of what help you have there.

Julie wrote:Well, I've heard that some S9's DO make more noise than they're supposed to, and while I can't explain the situation properly as I'm not up on it, wait for Pugsy (or someone else knowledgable about it) to come in and do that. You should not have to put up with it - I believe it's some kind of random glitch - and I would certainly ask the dealer who you bought the machine from to look at it and if necessary replace it. Just be sure the noise isn't from e.g. something like the mask cushion retainer plastic not being seated properly (has happened to me), or that the vent holes have not somehow become enlarged beyond what they should be, but if the machine itself is noisy, something is wrong and we'll try to help you get it fixed.

May I ask what country you are in? It might matter in terms of what help you have there.

I'm from Thailand. Doctors are pretty knowledgeable but I might have a little difficult time finding CPAP supplies. I'm thinking about stocking from here before I go back

CardinalPalmz wrote:I've tried CPAP for a month. I was unable to sleep in the first week and in the rare cases I did, I took the mask off. This got better in the second week, but then, my old Resmed S8 EliteII started making whooshing sound that really disturbed my sleep. I decided to buy a new S9 autoset, out of my pocket, and hoped that it would not do the same thing (I also was interested in its data capability). Contrary to my expectation, S9 autoset DID make the same sound and even worse, even after I checked all the humidifier and filter).

There's a chance that the whoosing noise you're hearing is the sound of your own breathing and the sound of the machine being magnified by the hose and then conducted into your inner ears through your skull. How are you running the hose from the machine to your nose? Does the hose touch the top or back or side of your head at all? Does it lie on the pillow near the side of your head? If so, moving the hose may help with the noise problem. It may help to put the hose in a hose cozy. It may also help to hang the hose overhead.

There's also a chance that the whoosing noise is caused by the exhaust flow from the mask hitting the covers or your pillow. Moving the covers or pillow around may allow you to find a sleeping position that minimizes the chance that the noise is caused by the exhaust flow bouncing off the covers.

The machine noise is only one of the problems. So far, my sleep has been very fragmented and I keep waking up with different situations. Sometimes, my mask seal would become loose at night even though I fit it well before I went to sleep. Sometimes, I would feel a rush of air pressure from the machine into my nose and I can't explain why. Sometimes, I would wake up with excessive drooling on my face. A few nights ago, I even woke up with aerophagia.

My deepest sympathies. I had a rough adjustment period and remember all of these problems (and more) from the early, dark days of using my PAP.

It's not a magic bullet, but sometimes the best you can do it to try to tackle one problem at a time. And some things do become easier with time and practice.

Mask losing its seal during the night
It's not uncommon for a mask to fit "differently" late in the night than it does earlier in the night. The longer the night goes on, the more our facial muscles relax, and the more the facial muscles relax, the more likely it is that the mask or its seal will become loose.

So let's start with mask fitting: It takes some real practice to get to where you can slip the mask on at night with little or no effort and have few or no problems with it moving around during the night. It's also true that as you get more experience, the time and effort to "fix" a mask problem in the night becomes much less. At the start, any nocturnal mask adjustment can require the new CPAPer to come to full WAKE just to diagnose what the problem is, and then it takes a while to figure out how to fix it, and then it takes time to get back to sleep. But after a while, you learn to fix certain common mask problems without fully waking up. At which point, "mask fiddling in the middle of the night" no longer is as big of a disruption as it was at the start.

Your signature shows you are using a Swift LT nasal pillows mask. The seal is obtained and maintained through the use of an "air" cushion---that's why there are double cones for each nostril. If the mask is not fully inflated OR if one of those inner cones collapses, the seal is much, much more fragile. And as you move around in your sleep and as those facial muscles relax, it's possible to roll into a position that slightly jars the mask and breaks the seal. The fix is simple enough (once you get it into muscle memory): A slight tug on the pillows to get them OFF the nostrils allows the nasal pillow to fully inflate and then you can let it settle back into position against your nostrils. The gentle tug and release can usually be done in any sleep position, and as long as the inner cones are not collapsed, that's usually all it takes to fix a problem with the Swift nasal pillows masks. With time and practice, you'll be able to train your body to do the tug and release without waking all the way up.

Drooling
Some people believe that drooling means you must be opening your mouth. I know better. I drool out the corners of my mouth when sleeping and it's both amazing and disgusting just how much drool there is on my pillow sometimes. One thing to keep in mind about the drool: It's more likely to happen when your body is fully asleep and is in a good, deep sleep and your muscles are fully relaxed. If you never drooled before CPAP, it could be that the excess drool is indicating that your body is learning how to relax into a deep sleep, but you just aren't staying asleep all night long (yet).

About the only thing I've ever found for dealing with the drool is (1)ignore it as much as possible (and NEVER show my naked pillow to anybody), (2) keep a good old fashioned hanky handy if I wake up and want to wipe my mouth, and (3) stick the hanky by the offending corner of my mouth on really bad nights.

Rainout
Depending on where that "excessive" drool on your face actually is, it could be that what you're thinking is drool, is in fact rainout. Rainout occurs when moisture in the hose starts to condense and form water drops. There are two basic causes for rainout problems:

(1) The heated humidifier allows too much water to be absorbed by the air and then the hose (typically an unheated hose) is exposed to the relatively cold room temperature air. The air inside the hose starts to cool down and the excessive moisture starts to condense. If the lowest point in the "system" is the mask end of the hose, all the condensed water runs down hill and lands on the PAPer's face. NOT PLEASANT. (If the lowest point in the "system" is a bend in the hose, the water will accumulate there, and if enough water accumulates, you can waken to a rather nasty noise coming from *somewhere*. It usually is a "gurgling" sound, but it can have a whoosh noise as well or a whistle noise.)

(2) The air we exhale into the mask is both relatively warm and very, very moist. This warm, moist air hits the relatively cooler air the mask itself (and the mask's air may also already be nearly saturated from the heated humidifier). When the warm, wet exhaled air hits the cooler (and more turbulent) air in the mask, water starts to condense on the inside of the mask, even though there may be no water condensing farther down in the hose. With the limited space in a nasal pillows mask, some people have real problems with condensation in the pillows where the water is coming from their own exhalations. When this happens to me, it feels as though my nose is very, very wet.

The "fixes" in both (1) and (2) involve reducing the chance that the water vapor in the air will start to condense and in the case of (1) it's also important to figure out a way of making sure that any condensed water runs back into the machine instead of onto your nose.

Ways to insulate the hose and the nasal pillows help with rainout because keeping the air inside the hose and the pillows sufficiently warm allows it to hold more water. Hose cozies can help. Running the hose under the covers can help. A heated hose should eliminate rainout caused by the humidifier altogether. Padacheek sells pillow cozies that wrap the nasal pillow itself in a fabric insulating layer and that can make a big difference. The pillow cozies also keep the silicone in the nasal pillow from touching the upper lip.

Hanging the hose can also help with rainout since that forces any condensed water on the machine's side of the hump to run back to the machine.

rush of air pressure from the machine into the nose
You don't say whether you're using an APAP or CPAP. If you're using Auto mode, it's possible you're sensitive enough to feel the pressure increases. A change to straight CPAP might help.

Three other things that could be causing this sensation:

(1) You might be noticing a small leak. The machine will try to compensate for small leaks by pushing more air into the semi-closed system to maintain the desired pressure. But that small amount of additional air can feel like a small jet stream of air at the place where air is leaking out of the system. (Think about how you find a pinhole leak in a bike tire: You feel around until you feel the pressurized stream of air leaking out of the pinhole.) In this case, the fix is simple: Gently tug the mask away from the nostrils, let the pillow fully inflate and let go so the pillow can settle back against your nostrils and reseal.

(2) You could be sleeping with your mouth open (and hence there's a potentially LARGE leak in the system) and the machine is attempting to compensate by pushing more air into the semi-closed system to maintain the desired pressure. You eventually CLOSE your mouth, which fixes the leak, BUT momentarily the machine is still pushing more air than normal into the semi-closed system. And that extra air has to go somewhere and it's no longer going in your nose and out your mouth. So that extra air gets forced into the nose (and down the windpipe) and feels as though there is a (temporary) increase in pressure in the system caused by extra air being blown into the nose.

(3) You might be noticing the forced oscillation technique (FOT) that the S9 uses to distinguish between central apneas and obstructive apneas. When no airflow has been detected for about 6 seconds or so, the S9 starts to send oscillating bursts of pressure through the system; the signature of how these rapid pressure oscillations affect the system allow the S9 to determine whether the airway is blocked or clear. While most people cannot feel the FOT oscillations, a few people can. And a very small number of people are sensitive enough where the FOTs can be very irritating and bothersome. And under the "right" set of circumstances, the FOTs can wake up a some of these super sensitive people.

If I had to place a bet on what's causing the "rush of air into the nose" problem, I'd bet on "small leak." It's also worth pointing out that "small leaks" can (under the right circumstances) lead to "whoosing noises" if the stream of air from the leak is hitting something--like the covers or your pillow.

Aerophagia
My old nemesis. As in I used to wake up feeling like I'd swallowed a basketball. Aerophagia even affected my dreams.

If you search for aerophagia, you'll find all kinds of tips. Some probably won't work for you at all. Some will work really well. In my case, the aerophagia was initially caused by the fact that the lab had slightly over titrated me AND I was super sensitive to the pressure. After a pressure reduction (following an APAP trial), the aerophagia was reduced by not eliminated. Since I continued to be plagued by pretty severe aerophagia in spite of using rather low pressures, my sleep doc's PA eventually suggested a BiPAP trial. After two more titration studies and additional Auto trials, my current pressure range was prescribed and it's pretty much eliminated the aerophagia as an ongoing, constant painful problem.

If aerophagia is intermittent, pay attention to things that folks with GERD need to pay attention to: Don't eat supper too late. Track what you eat for supper on the nights when aerophagia is a serious problem; it could be you'll need to limit or eliminate certain foods or drinks from your "after 6 pm" diet. I find tucking my chin in near my chest while sleeping on my left side helps. Some people find elevating the head of the bed helps.

But if the aerophagia starts happening more nights than not and you find yourself waking up in PAIN, it's time to call the sleep doc's office.

And if I can't sleep well, I cannot take a nap during the day either because somehow I cannot fall asleep.
With such poor sleep, I can't perform well in the lab. I would be able to stay awake 2 hours in the morning (starting at 11 am), and even with constant stream of caffeine, I would feel very sleepy by 6 PM. And even while I am awake, my brain is so fogged that I can barely critically think about papers I read or experiments I perform.

First: I understand you're a PhD student in Chem. I do remember the years when I was working on my PhD in mathematics. And so I do know the crazy "schedules" grad students wind up living with.

But: The steady stream of caffeine may be part of the problem---even though you're feeling sleepy by 6 pm and you feel brain-fogged all the time.

As hard as it sounds, you may need less caffeine and a more structured sleep schedule. No matter how hard it seems on any given day, you should try to get up at about the same time---regardless of how much or how little sleep you get. And you should try to stick to something that resembles a half-way decent bedtime as well. Muddle through that sleepy period in the evening as best you can for a couple of weeks and try to stay awake until "bedtime". And if you've limited the caffeine after noon, it may be that by the time bedtime comes, your mind may just be sleepy enough to not fight the monster on your face.

And what would a reasonable sleep schedule look like? Well that would depend on your current schedule (as in your classes and lab obligations) and your self-identification as "night owl" or "morning person" or "somewhere in between". But once you know what time you need to be getting up by, then count backwards by about 7-8 hours to establish your target "bedtime."

Robysue that was a wonderful post. It's obvious you put alot of thought into that. I always learn from your posts. Regards, Oak

Thanks to Robysue for the excellent post regarding "Rainout" quite a while back. Very logical when read. My first day on this website I learned a lot. More than all the folks who have provided the equipment to me over the years.

You've reaped some good advice from the previous replies. For me, when starting CPAP, the noise issue with my ResMed machine was initially a huge deal (tho admittedly it is a very quiet machine) - however I eventually just got accustomed to it over a month or so. That may not be the absolute case with everyone but I think for the vast majority of CPAPtalk members that the adaptation curve is a few weeks to a few months. Nowadays, machine noise or even mask noise is the least of my complaints. Hope it works out for you and please stick with the therapy plan. Edit: If you do determine that the machine is defective then you can send it to Accurate BioMed, CPAPtalk user name 'accurate'... you can PM them in advance to get details.

Also try white noise. Fans, ocean sounds, whatever you like.

I found that would also help my brain filter out the drunkies being drunkies while living on campus. But it also will cover the more subtle cpap sounds because at first those threw me a loop. Now I just count 3 slow beats for my breaths in and out until I fall asleep and that rhythmic sound helped become more relaxing versus weirding myself out.

Robysue's advice is bang on though.