Struggling new Cpap user

[Trying to sleep]

Hello everyone. I'm Lisa and a new Cpap user. I started therapy on 10/2/15. My machine is an Airsense 10 Autoset set at first on Cpap with a pressure of 9. I started with a nasal mask, but traded it for nasal pillows after the first week due to a feeling of suffocation. I'm really trying to get accustomed to this therapy, but I'm struggling. I use my machine every night for 4-6 hours, but I'm still not sleeping well. I often feel as if I cant get enough air and deal with bedtime stuffiness. I've been experimenting with humidity and I've also changed the setting to APAP with a range of 9-11. I've seen an ENT about the nighttime stuffiness and he prescribed Nasacort daily at bedtime which I use regularly. My nasal stuffiness isn't much of an issue during the day, but at night when I lay down, it often becomes a major issue. My AHI and leak percentage is good most nights, but I feel like I'm fighting a losing battle since I'm still having trouble and not sleeping well. I've tried aromatherapy without much change in relaxation. I've even resorted to Tylenol PM, Melatonin and Ibuprofen at bedtime to help me relax and fall asleep. If anyone wants to ask any questions or provide suggestions, I'm willing to talk. I'm looking forward to becoming a member of this community. Thanks.

[andy88488]

Hi Lisa,

Sorry you're struggling. One thing you could try would be a full-face mask. I hated Nasal Pillows, personally, and although I didn't mind a nasal mask, I couldn't keep my mouth closed so it was ineffective. I switched to a full-face mask, and that has worked well for me.

One thing that a full-face mask would do for you is eliminate the problem with Nasal congestion. I mean, the congestion might or might not go away, but you could breath through your mouth without screwing up your CPAP therapy. I can certainly imagine how you would feel as if you were not getting enough air through the nasal-only interface.

Hope this helps,

Andy

[Trying to sleep]

I thought about contacting the RT at my medical equipment provider, and asking about a full face mask. I just kind of hate the thought of having to wear the full mask since I often read and watch TV before sleep. I really like how the pillows are so minimal and don't interfere with vision. I also am not a back sleeper at all and my preferred sleep positions are side and stomach. I'd think a full mask would make these positions even more difficult. Thanks for the recommendation. I think I will see if I can try a full face mask for a while to see if it helps.

[Pugsy]

Which nasal pillow mask are you currently using and what size nasal pillow?

[Trying to sleep]

I'm using the Airfit P10 for her in a size small. Just for information purposes, I tried the medium sized pillows in my box. It seemed to help a tiny bit with the airflow, but stretched out my nostrils and made them hurt.

[rohdej]

For the suffocation, many of us where sent home with machines that where set in auto mode to range from 4-20. @4 there is not enough air flow to vent all your exhaled air. Do you know what your settings are? Before i realised they could be changed I limped it through by turning of the ramp and disconnecting and reconnecting the hose to get the machine to give me more air.

[Pugsy]

I use the AirFit P10. I have used nothing but nasal pillows for over 6 years now. If the nasal pillows are stretching your nostrils ...they are too tight. They should fit gently against the nostrils but not go inside (other than the tiny inner core tips which touch nothing).

For years I was using either the XSmall or Small in any of the nasal pillow masks I have used over the years so when the P10 came out and I tried it I thought for sure the XSmall would work. What I found was that I was experiencing periods of time during the night where I would wake up sort of suffocating...pull the nasal pillow away from my face for split second and air started to move again. After some experimenting what I found was that the XSmall sealed a little bit too well and would sort of try to come into my nostril with inhale and when it did that the nasal pillow would collapse somewhat and then air movement would be minimal and I would then wake up. Took me several nights to figure this out. Once I realized what was happening I moved up to the size small...never happened again.

Since you say you are waking up in the middle of the night with the suffocation thing...it could be that you are experiencing what I experienced and it's worth a try to step up to the next size.

If you look in the mirror and you think those nasal pillows are stretching your nostrils or you think "piggy nose" then the tension is simply too much from the straps.
Take a nasal pillow and put it gently against the nostrils...no straps or anything...just a plain nasal pillow. That's the way these nasal pillows are suppose to sit against the nostrils. They don't have to be tight to seal and in fact too tight often sort of collapses the pillow so it can't inflate and it needs to inflate to seal.

Play with the positioning of the P10 headgear straps so that there isn't so much tension pulling on the nasal pillow....these things won't stretch out the nostrils if they are properly fitted.

[Tdub210]

I have a similar issue with stuffiness once I lay down. I can breath just fine through my nose when I'm upright, but once I'm horizontal it's hit or miss. Therefore, I'm a mouth breather and use the full face mask. My preferred sleeping position is on my side and stomach. This makes it a bit of a challenge with the FFM but I've made it work with help and suggestions from here. First, lay down in your sleeping position to make the adjustments for it to fit. Everything changes going from upright to laying down, and from back to side. I experimented and found a way for it to work with a normal pillow, again with suggestions from here. It's hard to describe but if you're a side sleeper you might get it. I take the bottom corner of the pillow and fold it under itself for a little firmer support. Then I lay my head so that the mask is somewhat hanging off the pillow. With the corner tucked in the pillow is supportive and keeps my head up enough to keep the mask free and sitting nicely, while also keeping my head aligned with the rest of my back and hips (back problems as well). It works the same when I sleep on my stomach. Initially, I kept waking up when I'd switch sides, I think because I was conscious of the mask and wanted to make sure I didnt bump it off. Now, I shift sides, move from side to stomach and back, without waking up. This took probably 2 months or so to get to. Also, the mask I use doesnt really get in my vision. When I first started, I sat with it and read or watched tv to get used to it without any issues. Now, I dont put it on until I'm ready for lights out. I think it might trigger something psychologically that it's time to sleep. I'm usually out in 5 min or less.

The suffocation feeling, I felt that very badly for the first week, then it subsided but was still there for another few weeks or so. Pugsy and some of the others are pretty good at suggestions for pressure. I'd just recommend wearing it during the day or evening when you're not trying to sleep to get yourself more accustomed to breathing with air blowing in your face. That helped me a lot. I'd sit with it and watch tv or read or something.

Good luck to you and keep coming here for advice. This place saved me from quitting.

[andy88488]

I thought about contacting the RT at my medical equipment provider, and asking about a full face mask. I just kind of hate the thought of having to wear the full mask since I often read and watch TV before sleep. I really like how the pillows are so minimal and don't interfere with vision. I also am not a back sleeper at all and my preferred sleep positions are side and stomach. I'd think a full mask would make these positions even more difficult. Thanks for the recommendation. I think I will see if I can try a full face mask for a while to see if it helps.

I always read before bed, but what I do is that I don't put on the mask until I am ready to turn off the lights. At first, you can't imagine that you could stay sleepy when you stop reading and put on the mask, but eventually, you become accustomed to it, and putting on the mask is a sleep signal. Not that it MAKES you sleepy, but it certainly doesn't interfere with it. I sleep mostly on my side, and the full-face mask is not a problem for me.

[Trying to sleep]

I think the small size is the correct size for me. A RT fitted me for them and they feel ok. The medium size that I tried one night were the ones that stretched my nostrils. I'm not using them any more. I think I discovered what you're talking about in the first few nights of therapy using them. At first they were working, then later it seemed like they were blocked. I have changed the strap position to make the fit much looser and that helped the fit. However the problem with nasal stuffiness remained, which I'm almost positive is in my nose and sinuses. I have a call into the RT at my supplier. Maybe I'll give the full face mask a try, although I really don't like the thought of it. Maybe it's not as bad as I imagine. After all, I have to breathe. My supplier uses ResMed. Any recommendations on a mask to try? I was thinking the Airfit F10 for her would be a good place to start.

[chunkyfrog]

Another tip: if a nasal pillow suddenly seems stuffed up, take a close look at it.
Most Resmed pillows are double wall, and if the inside cone flips around backward,
(Sneeze, etc) it acts as a one-way valve; and not the way you need!
When I had that problem, a small crochet hook was useful for turning it right side out without disassembly.

[Trying to sleep]

[quote="Tdub210"]I have a similar issue with stuffiness once I lay down. I can breath just fine through my nose when I'm upright, but once I'm horizontal it's hit or miss. Therefore, I'm a mouth breather and use the full face mask. My preferred sleeping position is on my side and stomach. This makes it a bit of a challenge with the FFM but I've made it work with help and suggestions from here. First, lay down in your sleeping position to make the adjustments for it to fit. Everything changes going from upright to laying down, and from back to side. I experimented and found a way for it to work with a normal pillow, again with suggestions from here. It's hard to describe but if you're a side sleeper you might get it. I take the bottom corner of the pillow and fold it under itself for a little firmer support. Then I lay my head so that the mask is somewhat hanging off the pillow. With the corner tucked in the pillow is supportive and keeps my head up enough to keep the mask free and sitting nicely, while also keeping my head aligned with the rest of my back and hips (back problems as well). It works the same when I sleep on my stomach. Initially, I kept waking up when I'd switch sides, I think because I was conscious of the mask and wanted to make sure I didnt bump it off. Now, I shift sides, move from side to stomach and back, without waking up. This took probably 2 months or so to get to. Also, the mask I use doesnt really get in my vision. When I first started, I sat with it and read or watched tv to get used to it without any issues. Now, I dont put it on until I'm ready for lights out. I think it might trigger something psychologically that it's time to sleep. I'm usually out in 5 min or less.

I'm glad to hear that side and stomach sleeping can be accomplished with a full face mask. I think I know what you're talking about with your pillow. I do something similar now with my nasal pillows and have even done it before Cpap therapy to give myself an adequate space to breathe. My only difference is that I use a solid memory foam pillow that provides extra support. Thanks for the input Tdub. Every little bit helps.

[Pugsy]

I am sorry but I don't use a full face mask so I really can't recommend anything.
The only full face mask that I have tried really was the Innomed/Respcare Hybrid. I have issues with anything that causes pressure on the bridge of my nose and/or the lower straps that come around the base of the skull and cause neck pain.

The AirFit F10 would/should be a good place to start if that's where you are wanting to go. Because of the bridge of the nose pressure (anything that touches my nasal bridge area causes me to have immediate congestion) it is something that I just have no interest in trying.

If you wish to try a different nasal pillow mask that might not be doing the collapsing thing (if that is what is going on with you) you might look at the ResMed Swift FX nasal pillows. They don't seem to do that and the headgear is more adjustable.

Nasal congestion that only happens when we put the nasal pillow mask on....usually related to humidity but you are already playing with humidity to see if more or less will help or hurt.

[Janknitz]

Even though your nasal pillows are not Swift fx, take a look at the swift fx fitting tips in my blog below. They will work for all nasal pillow masks.

That said, a FF mask is helpful for those congested nights. But they are difficult to adjust properly because there's a lot more surface area to seal. Good idea to have one, though. Some nights I wake up congested and switch to the FF mask.

Btw, have you experimented with your humidifier settings (usually down, not up) to see if it reduces congestion?

[andy88488]

I think the small size is the correct size for me. A RT fitted me for them and they feel ok. The medium size that I tried one night were the ones that stretched my nostrils. I'm not using them any more. I think I discovered what you're talking about in the first few nights of therapy using them. At first they were working, then later it seemed like they were blocked. I have changed the strap position to make the fit much looser and that helped the fit. However the problem with nasal stuffiness remained, which I'm almost positive is in my nose and sinuses. I have a call into the RT at my supplier. Maybe I'll give the full face mask a try, although I really don't like the thought of it. Maybe it's not as bad as I imagine. After all, I have to breathe. My supplier uses ResMed. Any recommendations on a mask to try? I was thinking the Airfit F10 for her would be a good place to start.

I have had a lot of luck with the Mirage Quattro. I've been using it for years. I do use it with the Pad-a-cheek nose bridge protector, because I had some issues with it hurting my nose, but your face may be (CERTAINLY IS!) different than mine. That's the Quattro, not the Quattro FX. I tried the FX, didn't like it as well. However, you might like it because it does away with the forehead support, so it is marginally less bulky.