First night and a little frustrated

Well I finished my first night on my CPAP. I was only able to keep it on for 2 hours--of course it was set at 14 cm with EPR. I think though that I have figured out my problems.

1. Starting ramp pressure was set at 7 and was set to go to 14 in 15 minutes. I have already changed the starting pressure to 5 and will try to let it go to 14 in 15 minutes again. At my titration I handles 14 with no problem but we started ramping at 4.

2. The mask fits good until I start to move/roll over on my side then it starts leaking. When I move to my back it starts leaking different locations.

3. I am a mouth breather during my sleep so I think part of my problem is also trying to keep my mouth closed when starting. I know that during my titration I was able to sleep with my mouth open without any problems. It seems like when I opened my mouth last night that I was standing in the exhaust of a jet engine and looked like a chipmunk with a mouth full of nuts.

My RT said it would take some time getting used to CPAP and that I would probably only be able to do a few hours a night to start with but I was expecting to possibly go the entire night since I was able to during my titration study.

Suggestions???

With the full face mask an open mouth during sleep won't make any difference.

Start first with getting your leaks under control.

With the Quattro mask adjust the upper mask so it just wraps around your head... not tight. Use the forehead adjuster to make adjustments for the upper part. The lower straps you will need to play with. It may take some fiddling around to get the leaks under control.

Below is a chart from Resmed with leak ratings:

Leak (L/s) Rating
0.00-0.18 Excellent
0.19-0.26 Very Good
0.27-0.34 Good
>0.35 Poor

All I can say is keep going. I just finished my first week of cpap; I had a few great nights and a few not-so-great nights. The one thing that I noticed is your ramp time. I wonder if you need a longer ramp time? Maybe getting "up to speed" in only 15 minutes is hurting you? Have you tried a 30 minute ramp? Or even a 45 minute?

Mike

Hi Tv! Can I call you that? I will never remember your whole screen name. Something with gum? Anyhooo you came here looking for help not ridicule. Sorry I am having ONE of THOSE days.
So may I make some suggestions?

tvmangum wrote:1. Starting ramp pressure was set at 7 and was set to go to 14 in 15 minutes. I have already changed the starting pressure to 5 and will try to let it go to 14 in 15 minutes again. At my titration I handles 14 with no problem but we started ramping at 4.

Try a longer ramp time, eg 30 or 45 minutes. Also some people find 4 very suffocating, so your initial setting of 7 may still be on mark. The idea is to make the transition to 14 slowly.

tvmangum wrote:2. The mask fits good until I start to move/roll over on my side then it starts leaking. When I move to my back it starts leaking different locations.

Make sure that the angle of the forehead piece is adjusted. Also did the DME make sure it was a good fit? If you didn't get the right size, all the adjusting and tweaking in the world won't get it to seal right.
Also, some people do better with the Ultra Mirage FFM, and others the Quattro. You may want to try the UMFF if the Quattro just isn't working for you. Or test drive a Hybrid or a Liberty

HYBRID – by pjwalman
viewtopic/t33434/Hybrid-TestDrive-Continues.html

SMALL LIBERTY – by fortomorrow
viewtopic/t35474/ResMed-Mirage-Liberty-Test-Drive.html

LARGE LIBERTY – by echo
viewtopic/t35486/Large-Liberty-test-drive.html

Mask Roulette – thread for swapping masks
viewtopic.php?f=1&t=19546

Also quote popular, the NAII, but you would need to mouth tape for mouth breathing since this is a nasal only mask:
NASAL AIRE II – by Babette
viewtopic/t30639/The-Return-of-the-Grea ... Drive.html

tvmangum wrote:3. I am a mouth breather during my sleep so I think part of my problem is also trying to keep my mouth closed when starting. I know that during my titration I was able to sleep with my mouth open without any problems. It seems like when I opened my mouth last night that I was standing in the exhaust of a jet engine and looked like a chipmunk with a mouth full of nuts.

Welcome to the club
You can try a chinstrap to keep your mouth shut, or a pap-cap (http://www.pur-sleep.com/content/?id=44 .. created by one of our forum members SleepGuy. Though the site seems to be having problems at the moment!)

tvmangum wrote:My RT said it would take some time getting used to CPAP and that I would probably only be able to do a few hours a night to start with but I was expecting to possibly go the entire night since I was able to during my titration study.

Yes it does take some getting used to. Some people can use it the whole night from the first night, others need time. Leaks certainly don't help!
You can try to wear the mask during the day, or experiment with it in bed while you're still awake and not tired, and try to see where the leaks are coming from.
Be patient with yourself and the therapy, but don't be complacent and think that "this is as good as it gets" !! The mask is the most crucial part of the whole setup, so try different masks until you can find the right one!

Welcome to the forum - you have come to the right place for help and support! And wishing you many good nights of good sleep!!!

I second the motion of increasing your ramp time. 14 is not the highest pressure, but its a lot and the ramp can be very helpful, especially at first. I have no experiance with the Quattro, but have read lots of posts by people who have lots of the same leak issues you report. Here is a link to a fix that some have found useful:

viewtopic.php?p=284273

I had problems with getting a good seal with my nasal mask, and use a rope of Mack's Silicone putty to form a soft seal around the cushion where it touches my face. It worked wonders for me once I figured it out.

2 hours the first night isn't great, but it isn't bad. Keep at it, try to keep it on a little longer every night, you will get the hang of it. It's not always easy, but its not rocket science either!

One thing I might suggest, if you are having leaks. Is to start the machine at FULL pressure (without the ramp). Then adjust your mask for comfort and to reduce leaks. Once settled in, go ahead and hit that ramp button to drop the pressure so you can fall asleep.

It's fairly easy to get a mask to not leak at 7 cm H2O, but 14 cm H20 of air pressure can get pretty determined to get out. And it usually will find a way to start a leak. So adjusting your mask at the high pressure might help there.

I also second what other say about lengthening the ramp time. 7 to 14 in only 15 min is fairly steep. You will likely find that after a few weeks, 7 will likely become very easy to breath against. Over time, you may try to raise the beginning ramp pressure as you become used to it.

Good Luck, and keep at it. It takes time to get used to all of this, but with perseverance, you will begin to feel a difference. Welcome to the forum.

-craig