Newbie hello from England

[Timewarrior2001]

Hi guys,

I have recently been diagnosed with severe OSA with an oxygen desaturation index of 60, Epworth score of 11 and a mallampati score of 4
Neck circumference of 49cm
I also have stage 3 nasal polyps scheduled for removal in May.

I am due to be given my CPAP machine on Thursday 27th Feb and I am apprehensive about being able to sleep with it on. All i know right now is that it will be a full face mask due to the nasal polyps.
I also suffer from Anxiety/depression and take Citalprom 40mg and Propanolol 2x 20mg per day. And an Anti statin for hypocholesterolemia (atrovastatin 20mg per day)

Reading through the success stories gives me hope that things will improve, i was facing disciplinary action at work for falling asleep.

I have recently lost 2-3 stones in weight but that has not improved things enough.
I'm 43 years old and live in the North of England.

So....hello fellow CPAPers

[Pugsy]

Welcome to the forum.

[JeffHarnett]

Welcome Timewarrior2001 (Sontaran ref???).

I also had issues falling asleep at work (boss initially thought I was dead ) but luckily they have been very good about it.

I was also on Citalopram (for Depression/Anxiety) but had major issues with side effects.
When starting CPAP treatment my sleep Dr recommended switching to Sertraline which I find a lot better. So, depending on how you are finding Citalopram and CPAP, it may be worth discussing with your GP or Sleep Dr.

CPAP is a pain in the face but stick with it, try not to give up, it does work.

Best of Luck!

[Miss Emerita]

Welcome! It's great that you'll soon be starting therapy for your apnea. Something that you may find helpful: set the machine up outside your bedroom somewhere and use it during the day while you read or watch TV. The idea is to get your brain used to the weird sensations without the pressure of trying to go to sleep at the same time.

You can also lie down with it to adjust your mask straps just so, since it may fit a little differently when you're prone. Try watching a video for your mask to see if there are any little tricks to learn. Most people find that they benefit from having a fairly low, firm pillow, so if you have a pile of fluffy ones, try investing in something different.

Finally, try to find out what your minimum pressure is set at. Often people are started on a minimum of 4, which is way too low for most adults. If that's what you have, we can help you change it to, say, 7.

You can tell your sleep tech that it could be a week or so before you start night-time use. Easing into things can pay off with better adaptation and long-term use. -- That said, if your eager to jump right in, go for it!

[Julie]

And do keep an eye out for Rick Blaine who's in the UK and very helpful when members from there need help, especially 'translating' e.g. insurance or NHS issues, as well as regular OSA problems.

[ChicagoGranny]

I also suffer from Anxiety/depression

Untreated sleep apnea, especially with a desaturation index of 60, can cause severe anxiety/depression.

Quite often, doctors prescribe pharmaceuticals when they should be prescribing CPAP.

[zonker]

Hi guys,
<snip>
I have recently lost 2-3 stones in weight but that has not improved things enough.
I'm 43 years old and live in the North of England.

So....hello fellow CPAPers

welcome to the zoo! congrats on the weight loss. and for taking charge of your health.

yes, it's not enough to lose weight in order to get control of sleep apnea. but it CAN help.

you are certainly moving in the right direction.

once you get your machine, please come back to this thread with any questions you may have.

good luck!

[Timewarrior2001]

Thanks for the warm welcome guys.

I'll be spending time browsing these forums and will update when I have the machine etc.

[Timewarrior2001]

OK i got my equipment....been playing with it just now. Must admit its nice and quiet and the mask is fairly comfortable....i think i should be able to go to sleep wearing this.
I have made a few little adjustments to the fit and tested using the machine it reports all good so i guess no leaks.
The min pressure seems to change between 4.0 and about 5.4 i noticed while i was playing around....but i guess being an autoset it will provide whatever it thinks i need?

[ChicagoGranny]

The min pressure seems to change between 4.0 and about 5.4 i noticed while i was playing around

Maybe that is the ramp pressure? Go to youtube and search for "how to change pressure" on your model. This will get you into the so-called clinical menu, and you will be able to see what pressures your machine is set at.

[rick blaine]

Hi Timewarrior2001,

OK, now you need some technical info. I know how busy NHS sleep-medicine departments are these days. And I'm pretty certain they didn't tell you what I'm about to say.

First, you are fortunate in that the sleep-medicine department you go to has standardised on an auto-adjusting machine, as opposed to a fixed-pressure machine. A fixed-pressure machine is still what the NICE guidelines say is sufficient, but many SMDs in the UK go beyond that minimum, mainly because of better patient outcomes and compliance.

2. On the technical front, there are four main ideas to get into your head:

a. regular operation, with the machine set to two pressures – the minimum for you and the maximum for you. So these need to be changed to suit you (see below). Otherwise, the machine is as it came from the factory – with the settings 'wide open'. Ie, the minimum at 4 cm, and the maximum at 20 cm.

b. The so-called 'ramp' start – this is an option. You can turn it off and you can turn it on.

And you can adjust it – both the pressure which it starts at (which can be different from the factory minimum of 4 cm) – and how long it takes (in five-minute graduations) to get from 'press start' to your regular minimum pressure.

The idea behind this ramp start is that you get off to sleep before the machine reaches your regular minimum. But many people find, after a few months, that they get used to that minimum, so they don't bother with the ramp any more.

c. Expiratory pressure relief. This is a micro-variation in pressure that kicks in on each outbreath. It helps you breathe out against the pressure – useful if your regular minimum pressure is, say, 10 and above.

At its fullest – which is 3 – EPR will take 10 down to 7, and 8 down to 5. But it won't take 6 down to 3 or 5 down to 2 – because the absolute minimum for the machine is still that factory 4.

And because EPR is also an optional feature – sometimes called a 'comfort feature' – you can choose to have it on or off.

d. Auto-adjusting machines don't adjust continuously. Rather, the algorithms look at a moving four-minute 'window'. And then, on the basis of what they 'see', they either do nothing ... or they up the pressure by a small amount, usually 1.5 cm.

Then the algorithms wait to see what effect that has. Which means they wait for another short period. And then they go through those steps again.

Which in turn means that – if the machine minimum is still set at 4 cm, and what you need a great deal of the time is, say, 10 cm – you won't get there right away. And with a severe rating, that's not good.

So ... after a few nights use – and after you find out what your average or median pressure is – the machine needs to be adjusted to a regular minimum of 1 or 2 cm below that average.

4. The staff at the SMD are the people to set this regular minimum for you. If they didn't, then perhaps they want you to use the machine for a couple of weeks so that they can get some data about you. Do you have a follow-up appointment within the next few weeks?

Alternatively, the machine they gave you may have a cellular-phone chip fitted in it – so that your machine can 'phone home' with your data, and how you're doing. And the staff at the SMD can 'phone' your machine and change your pressures remotely.

Did the staff at the SMD mention this? Alternatively, you can look at the screen – is the word 'Air' lit up?

Obvs, there's more I can tell you, but I'll post this for now. And what you need to do now is start using the machine so that the adjustment process – both technical and psychological – can begin.

[Timewarrior2001]

Wow thanks for the detailed post Rick......very informative.

I slept last night fairly well for a first night with the mask....I woke up once coughing and felt immense pressure....it had hit 16.9cm and seemd a little too high for me...might be what woke me.
It soon calmed down when i panicked and pulled the mask off.

They did mention that they can monitor things and I log in online and get a basic report (9.7 events last night if I am reading it correctly.)
I dont have a follow up appointment until July so I am guessing that either things will be changed remotely or the machine will be left to adapt.

managed to use it for the full night last night and i feel great today.....didnt take me the usual 30 minutes to wake myself up this morning.

I'll work my way through your tips and tricks later when at home, thanks again for all the info

[ChicagoGranny]

I woke up once coughing and felt immense pressure....it had hit 16.9cm and seemd a little too high for me

When that happens, you can reach over, turn the machine off for a second, and then turn it back on. The machine will reset to the minimum pressure prescribed or the ramp pressure.