Another Newbie a few questions?

[DrEd123]

Hi my name is Ed and I’m a new BiPAP user just a couple of question.
My orginal AHI at the lab was 91 with a lot of hyposomnias. My pressures are high as well, 24/20. Got my dream station pro and been using for about 3 night/ days (I work nights). Wearing a full mask.
1. I seem to only get ~2 hours in and tear the mask off. Sometime with good rest, AHI~5, others not. Suggestions?
2. My mouth although I feel I’m keeping it closed is dry as a dessert, I do have a humidifier.
3. How can I stay asleep? This more of a chronic problem, but I was hoping that this may have been due to the apnea itself and that I would able to sleep 6-8 straight.
4. Should I try nasal pillows? At my fitting I tried them and the were fine, just needed a chinstrap. I figured with the higher pressures the nasal pillows would not be as effective.

[MrsRinPDX]

Hello Ed and welcome to the forum,

I have been using a BiPAP machine and full face mask approximately 2 months. My pressures are high also, which by the way, adds challenges of getting a proper mask fit, so I understand where you are coming from.

Q1 and Q3. Getting used to the mask is normal and the 2 hour mark is just about right for a normal sleep cycle. We usually wake, go back to sleep and don't remember it multiple times throughout the night. Now you have an "alien" plastered to your face and it wakes you even more. Keep trying. Others have suggested wearing the mask throughout the day to get used to the feel. I personally was damn determined to keep that mask on and stay alive, as my sleep study AHI was 71. So I kept on trying. You're worth it. Whatever you do, don't give up.

Q2. You may be a breathing through your mouth and not even realize it. (I only mouth breathe during REM.) Mouth breathing is usually the reason behind using a full face mask. If the dry mouth is really a bother, then using a chin strap or taping are possible solutions.

Q4. I can't really address this as I've never tried them.

Best of luck on your journey.

MrsRinPDX

[ShiftWorker]

Hello DrEd123,
I have had a tough time during my journey, finding the "Right" mask, actually getting the correct machine for my therapy dry mouth congestion ect. and so on.
After six weeks or so of constant use I could sleep for about 4 hours, I would wake up feeling well rested and on point but would get tired early because 4 hours was not enough with out a nap. I work nights also.

I guess what I am trying to say is, this took a while for me to adjust to having that Plastic Alien Octopus strapped to my face, Time to adjust to the therapy, time to be comfortable with the pressures (this was easy to do, after about 3 nights of just wearing the damn thing it seemed natural).

It has been almost six months of compliance with therapy and I will get six or seven hours of good rest full sleep. I have a great Dr. who was willing to listen and adjust my therapy including authorizing an ASV machine and getting my charts looking fantastic, AHI .8 average.

Just give yourself time to get adjusted to this new therapy, the kind people on this forum will be happy to help with your settings if you don't happen to stumble on one of the Gem's like I have for a DR.

Robert.

[Pugsy]

Welcome to the forum.

Sounds like some sleep maintenance insomnia issues and while we often pray that cpap will fix the insomnia (and sometimes it does) if the insomnia is from something other than sleep apnea the cpap can't fix much.

You might read this. While RobySue calls this relating to cpap and part of hers was...she also has had lifelong insomnia issues not related to cpap or sleep apnea.
http://adventures-in-hosehead-land.blog ... er_19.html
She has some really good ideas on how to deal with insomnia in general.

The waking after 2 hours...that might be about the end of the first REM cycle where it is normal for us to wake up. Most people don't remember the wake up though and they go right back to sleep...which is what we want to do.
Some wake up enough that they have trouble getting back to sleep and they do like you do..take the mask off so they can get "some real sleep" and that's a bad, bad habit to make. You know about bad habits...easy to make and hard to break.
Just how good is that sleep without cpap really if you are having with that AHI of 91 you had at the sleep lab? Don't kid yourself.

For the dry mouth thing...the humidifier even at max wasn't ever really designed to re-hydrate the oral cavity. It was designed more to hydrate the nasal cavity. The oral cavity is too big to do a good job re-hydrating in some people. What is your humidity setting and do you use a heated hose?
You can try more moisture/humidity and see if it will help or not if you aren't already using higher but there's no guarantee that it will do what you want. Heated hose allows for greater customization of the humidity....you can get more moisture with it than without.

Actually if you can keep the mouth shut with a chin strap the nasal pillow mask might actually be more effective....often full face mask users who switch to nasal pillows have found that they can get by with less pressure using nasal pillows than what they were using with a full face mask. Not sure why unless it has to do with the positioning of that lower jaw with what we have to do to wear a full face mask.
If you want to try them....try them. What's the worse thing that could happen? You find out that you don't like them or the chin strap doesn't work...then you can go back to a full face mask.
But in terms of pressure needs...nasal pillows are just as effective, if not maybe more effective, as a full face mask.

Dry mouth...usually from mouth breathing. We all know that but it's not the only reason. Some people just get dry mouth easier than others for any number of reasons and might not be mouth breathing.
And it doesn't necessarily mean mouth breathing all night either. It can happen with as little as 5 minutes of mouth breathing.

If you normally breathe through your nose just fine during the day and night...try the nasal pillows if they interest you. I also thought I was a mouth breather when I started therapy but my nose was just fine. I was doing some mouth breathing but more from gasping for air because of the apnea events. Once the apnea events were dealt with I found that the mouth breathing I thought I was doing mostly went away. It was more out of habit than a real physical need to mouth breathe. I opted for nasal pillow mask right from the beginning. I had my own reasons for wanting to make nasal pillow mask work over a full face mask. I did do some things for about 3 months to limit that habit of mouth breathing (which I eventually broke that habit for the most part) and I have been using nasal pillows for over 8 years now.

So if you want to try nasal pillows...try them. You can always end up going back to full face mask if you find out that you end up having less issues with the FFM. Just wanting to try something...that's a good enough reason in my book. Now sometimes it doesn't always work out so good what we might try but we never know until we try what's going to happen. I have tried dozens of masks over the years just because I like to try stuff.
I always learn something...now sometimes all I learn is what a stupid idea that was but I learned something.

We need to get you to a point where you are sleeping longer AND not removing that mask so you can get "some real sleep"
It's tough for some people...and quite common.
If you had insomnia issues prior to cpap (and it sounds like you did) then you are most likely going to have to back up and start looking at doing whatever we would do for the insomnia no matter whether you were using cpap or not. I know that's not what you wanted to hear but it's the plain cold hard facts of life. Sometimes cpap can't fix all our problems no matter how much we want it to.

Finally...are you using available software to see the detailed results as to what is happening when you do wear the mask?
If not..get it.
https://sleep.tnet.com/equipment
There are some events that will get flagged by the machine that might indicate less than optimal therapy that aren't included in the AHI that you can see on the machine LCD display. Let's make sure that your therapy is optimal.
With your pressure settings...not much room for adjustment but let's look and see if there's something going on maybe during REM that is a factor in the insomnia. Gotta make sure the therapy is optimal first to have any hope in fixing things.