Help! New to cpap and having problems

I started cpap 3 weeks ago for osa. I have worn it every night. I have the Swift nasal pillows. They work fine and do not leak but I feel like I am not getting enough air to breathe. I almost feel like I am struggling to get enough air. I do have a deviated septum so could that be a problem. Also, I am feeling worse now than I did when I started. I am more tired and lethargic on waking up and am more tired and sleepy through the day. I feel like I could go to bed at 7:00 at night. I am extremely irritable and don't mean to be. I feel like my personality has changed due to this and not for the good. I also have been having migraine headaches frequently and otherwise having some headaches daily. I have been waking up biting my tongue and inside of my lips. I have never done this before and now have 2 bad sores on my lips and tongue. I know I am waking up a lot through the night but I do go back to sleep within a few minutes. I am so discouraged about this. I think before starting cpap I breathed through my mouth but I don't seem to be doing that now. I don't know where to start trying to fix this. Can anyone help me with any of this? I want to get better and am determined not to give up but I cannot go on like this. Thanks so much for any advice.

Dear Ka-Ann,

Please make sure that your CPAP machine is set to the pressure that your doctor recommended. My pressure is 8. What is yours?

My DME also brought me a Swift LT for her with nasal pillows. I too felt like either I could not get enough air, or I was having trouble on the exhale. So, I tried every day for a month to get used to it, and after wearing for a short while, would go back to the mask that I wore for my sleep study - a Comfort Gel Nasal mask - that was easier for me to get used to - as the air just swirls around over the nose.

Here's what I was doing that caused me not to breathe correctly through the Swift LT with nasal pillows:

1. I tightened the straps too much, causing the pillows to be too tight in my nose, restricting air flow.
The straps should be very loose, just tight enough to make a seal under the nose. The nasal pillows barely touch.
2. I felt like I couldn't breathe and so I was hyperventilating, making the situation worse.
3. I did not have the cushion angled nicely - sometimes it helps to jiggle it a little. Another friend on this site told me that once she does this, she opens her mouth, gets a rush of air, and then the nasal pillow makes a nice seal. My friend also suggested using a little lanolin around the nares - it won't break down the nasal pillow material but will help make the seal stick between your nares (bottom of your nostrils) and the nasal pillows.

Also, make sure that when you sleep you do not cover the vent with covers, or smush the hose with your arm. You don't want to cut off air flow.

You may need to see if another mask works better for you - I found that it felt more natural to breathe with a nasal mask rather than nasal pillows, but of course, everyone is different.

Please keep in touch and let me know how you are doing.

Warmly,

Jersey Girl

I had trouble with nasal pillows ( diviated septum) Try another mask. I use a full face and feel like I get more air flow. It will work out once you get it under control

As has been mentioned not everyone can use a nasal mask or nasal pillows as some need a full face mask.

It would help if we knew what machine, what pressure and if you use ramp (and if it is swift LT - look at the headgear for the name).

As an aside, Jersey Girl, it's nice to see you accumulate what's helped you and offer that to someone else so quickly!

Ka-Ann, do fill in your profile. If you have a machine that stores data to a smart card I highly recommend that you try to get a reader and software as you have some unusual challenges during the night and being able to see specifics might help.

I don't know how helpful your DME will be (mine was very helpful), but I would recommend that you call them and describe how you're feeling. If nothing else, you have the opportunity to try another mask, as already suggested. Finally, on occasion the pressure recommendation coming from the sleep study does not translate exactly to what happens in your home. That was the case with me and my pressure setting had to be changed. Until then I wasn't feeling too great on CPAP, although there was a slight improvement over my pre-treatment condition.

I think you need to better understand what's happening at night before you consider trying to make setting changes, but I wanted to mention that possibility. Good luck!

I think you may have been told to use the ramp feature so as to get used to Cpap air being blown in, and that the ramp would gradually rise over however many minutes the feature is set for, up to your prescribed pressure. The problem arises because the starting presssure of the ramp is usually so low no one can breathe at it and only once it gets up to a higher setting can you breathe, but by then you don't care, and are probably panicked. Here's a tip - forget the ramp altogether, most of us don't use it unless the prescribed pressure is very high and we (at least initially) need a bit of a lead-in, but if your scripted pressure is e.g. 8, that's relatively low (the majority of us seem to be at least 10) and just going straight for it, instead of using the ramp to inch up to it, will allow you to breathe right from the start.

The second thing is that you may well be opening your mouth once asleep - it happens a lot once Cpap starts and a lot of us have to switch to full face masks so we don't lose air that way. For some inexplicable reason, many, many DME's fit you with the Swift when starting out, but they'd do much better to at least try you on a properly sized and fitted full face mask instead, so if you even think there's a remote chance this could be part of your problem (and a dry mouth is a dead giveaway) consider trying some on.

Thank you all so much for all the information. I found this site yesterday. I have felt so alone with this problem.
I tried loosening the mask and it seemed to help the breathing. Tonight I will try not using the ramp feature. I think that may also be part of the problem because when I start off the breathing struggle is much worse. My machine is set to 7 so it is low anyway and should not be a problem.

I checked the numbers this morning on the clinicians menu (thanks to this site!!) and my AHI was 2.5, the AI was .2, and the HI was 2.3. The Leak was .04. I think these are good numbers from what I have read here.

Also, my daughter had bought a boil and bite mouth guard she had never used so I did that and wore it last night. It helped me not to bite my tongue or lips.

I still woke up constantly all night long. I think I am a very light sleeper and I have some sensory issues with how things feel. Eg. I don't like necklaces, rings, anything tight, rough textures, etc. so that is not helping. I hope I can adjust over time.

This morning I still have a headache and feel like going back to bed but at least I feel like I am taking action! Thanks again! Any other advice is greatly appreciated!