Welcome to the forum diceaaa!
diceaaa wrote: ↑Sun Feb 12, 2023 11:03 pm
I was diagnosed with an AHI of 50, and was set up with a Resmed Airsense 10 Autoset and have been using it for about a month.
This puts you well into the range of severe sleep apnea. And on average your body was dealing with a significant respiratory problem about once a minute, all night long before you started using your AutoSet.
Tried multiple masks — the N20, P30i and settled on the N30i as the most comfortable one for me.
The N20 was unbearably itchy as sweat would build up under the mask even with the temp/humidifier off, and the P30i of all sizes was just too hard on the nostrils. I don't open my mouth when I sleep according to the sleep study so have never tried a full face mask.
The battle to find a comfortable mask is a real issue for many new xPAPers. Is the N30i genuinely comfortable? Or are you still dealing with mask issues?
Unfortunately since starting CPAP I've been getting worse quality of sleep and am a lot more tired/sleep deprived than usual.
I believe this is because at night I'm usually up for anywhere from 30-60min fiddling with the mask, scratching because it itches or adjusting it because I turned over and it leaked.
It's not uncommon to have some real problems in terms of worse quality sleep and feeling more tired and more sleep deprived after starting xPAP, particularly when you are fighting problems like leaks. In my case, I had severe aerophagia problems that triggered a terrible case of insomnia that took took months to rein in. And it was only after I'd conquered the insomnia monster that I was able to finally learn how to sleep well with my machine and mask and start to feel better.
With time and experience, the amount of time you are waking up and fiddling with the mask should eventually start to decrease. But it will help us help you if you can tell us more about the leaks that are waking you up. As for the itchy nose, you're not the first person who has had this complaint. I use a nasal pillows mask (the Swift FX), and that means I have no trouble scratching the top of my nose when it's itchy. The N30i that you are using is a nasal cradle mask, and while it covers more of the nose than a pillows does, it's still pretty minimal. So some of the techniques that work with nasal pillows masks in terms of nose scratching and mask sealing should work with the N30i as well.
I never really had any daytime sleepiness or visible symptoms to begin with, and I did the sleep study mostly because the missus complained I was snoring a lot. The high AHI of 56 was surprising to me.
I too never had any daytime sleepiness or visible symptoms and underwent a sleep test only because my husband said I snored a lot and that he had witnessed times where he was worried I'd stopped breathing for a noticeable amount of time.
I have a pet theory that people who don't have significant daytime symptoms have more trouble adjusting. But that's just based on anecdotal evidence from participating here and in talking with numerous PAPers who are not on the forum.
On a normal night pre-CPAP I was sleeping for 8 hours, tossing/turning for maybe less than 10 minutes and got in about 30-60 minutes of deep sleep.
On almost every CPAP night for the last month I've been sleeping 8 hours, tossing/turning/adjusting the mask for 30-60 minutes and get in about the same amount of deep sleep.
You need to realize that before CPAP, the device that you are using to measure the time you spend awake and/or tossing/turning was most likely not picking up on the very real distress your body was suffering during the night. Your breathing was seriously affected about once a minute with either an apnea or a hypopnea. After many of those events, your body more than likely aroused for a few
seconds before you got back to sleep. You never remembered all of those micro arousals and breathing problems, but they were still damaging to your body. In my case, I remember that pre-CPAP I seldom had middle of the night wakes, but I would sometimes wake up in the morning telling my husband that it felt like I'd slept with my hands and feet in "fists" all night long; apparently my body was secreting a significant amount of cortisol during the arousals to get my breathing back to normal, and the stress from the cortisol was, in fact, causing my hands to curl into fists and my toes to curl to the point where I would sometimes wake up with significant foot pain that would get better as the day wore on.
So balancing it out, I'm breathing better according to the machine, but getting worse sleep and have a lot more daytime sleepiness overall. Snoring has also stopped. But energy-wise it's getting to the point where I'm doing coffee and naps daily and it's starting to have a negative effect on my job.
I am sorry to hear this. And as someone who had a really bad crash and burn at the start of my xPAP therapy, I understand what you are going through. I wish I had some suggestions on how to get through the difficulties you are currently facing.
I've attached both my OSCAR and sleep tracker (Apple Watch) data for a few sample nights to the post.
As I said before, I'd take the pre-CPAP Apple Watch sleep tracker data with a grain of salt: It really is incapable of registering the kinds of arousals that untreated OSA causes. But it is useful for helping measure longer periods of restlessness that you may not remember that last at least 30-60 seconds.
Would appreciate anyone who has any advice for:
1. If there's anything I need to tweak on my Airsense in terms of pressure, settings etc. From what I can tell in OSCAR and from what the doctor says, it seems to be working and doing its job.
Your machine's therapeutic settings are doing a good job of controlling your OSA. I would not be tweaking the settings in the hopes of somehow magically fixing your problems. But having said that, I will also add that ozij's suggestion of trying to get the minimum pressure setting to be close to the median pressure level in order to minimize the pressure spikes is a reasonable tweak.
Your leaks would not be a concern except for the fact that you say you are waking up a lot fighting with the mask. So I think it would be worthwhile for you to do some work trying to figure out how to better control the leaks. More on that in a bit.
2. If there's anything I can do to minimise the amount of itchiness/fiddling that goes on with the mask.
Some of this is experience. Some of this is finding the right mask. And while you've tried several masks, it's not completely clear to me if you've settled on a mask that you genuinely find
comfortable.
As for the itching: Unless you are waking up to an itchy nose, the best "fix" for this problem is most likely training yourself to fall asleep quick enough that the problem doesn't get started in the first place. And for some of us, giving our nose a good hard scratch before putting the mask on helps. With my nasal pillows mask, if my nostrils start to itch, I just gently pull the mask away and scratch to my heart's content, and then let go of the mask to allow it to resettle. It did take me a long time to learn how to do that without becoming a lot more alert.
Sometimes using Lansinoh nipple cream (i.e. lanolin) just before you mask up can help keep the skin on the nose and nostrils from getting too dried out and itchy. So you might try putting some Lansinoh on the part of your nose that is where the mask touches it and which is covered by the mask. Lansinoh also tends to help some people get a better seal with nasal pillows, so it might also help with getting a better seal with a nasal cradle mask like you are using.
And if you are waking up with an itchy nose, then you need to figure out a technique for scratching your nose that does not involve fully waking up. More on that in a bit.
I believe if I could get the mask adjustment awake time at night down to 10 minutes or so I'd feel amazing, but so far the only medical advice I've received is "keep trying until your body adjusts" and unfortunately my body is telling me that with CPAP I'm just not getting enough rest!
I think you may have identified a critical part of the puzzle that you need to find a solution to. And here are some starting suggestions for trying to deal with that problem.
1) Make sure you know how your mask is supposed to be fit. Many DME folks routinely tell new PAPers to keep tightening the straps in an effort to minimize leaks. But that results in the mask's headgear being over-tightened, and because most modern CPAP masks use air cushions for the seal, over-tightening can prevent the cushion from fully inflating, and that in turn can lead to the mask springing leaks in the night.
2) Fit your mask while lying down in your favorite sleep position and using your full pressure. You may find that you need to adjust the straps in an asymmetric way. In other words, you may find that you need to tighten or loosen straps on one side of your head more than on the other side. I typically sleep on my left side and I find that I need the left strap of my Swift FX pulled tighter than the right side. Oddly enough if I turn onto my right side (for short periods), I don't wake up needing to fiddle with the straps.
3) Practice adjusting your mask during the daytime or early evening far away from bedtime. Get the mask sealed well in your favorite sleep position and then start intentionally "tossing and turning" and moving around in bed. The idea is to first figure out what movements tend to cause the worst problems in terms of making you feel like you have to fiddle with the mask. Remember you are
trying to create leaks in this exercise, and when you do create a leak, try to figure out ways to fix the leak that require a minimum amount of effort. If the headgear is properly adjusted, you may find that all you need to do to fix a small, but pesky leak, is to gently pull the mask cushion away from your nose just a tiny bit and then let go. The mask may resettle with the leak fixed good enough to no longer bother you. Be prepared for the sound of rushing air when the mask is off your nose. That noise goes away as soon as the mask resettles on your face. In time you can train yourself to do this procedure without waking fully up.
4) Practice a nose scratching technique during the daytime or early evening far away from bedtime. While you're doing the practice for item #3, don't just take the mask off if/when your nose starts to itch. When your nose is itchy, try to figure out a way to scratch it with a minimum amount of effort on your part. When the bottom part of my nose or my nostrils are itchy, I first just pull my mask away from my nose a bit with one hand and start to scratch with my other hand, and then I let the mask go and it resettles and I can go right back to sleep---if my nose is not too itchy. The air blowing into my mask occasionally bothers me if my nose is really super itchy, and then I wind up turning my AirCurve 10 Vauto completely off (i.e. press and hold the power button for several seconds until it goes into power mode), and then I can scratch my nose as long as I want to before I let go of the mask so it can resettle when I turn the machine back on (which requires hitting the power button twice.)
5) Consider hose management. The hose attachment for the N30i mask you are using is at the top of the head. You may find that draping the hose across your headboard or using a hose hanger may help when you are moving around in bed. But you also need to make sure the hose is slack enough that when you move around the hose doesn't pull the mask around.
6) This one is counter-intuitive: If you feel like you've been fighting with the mask for more than about 10-15 minutes in the middle of the night, get out of bed and allow yourself some time to settle down and regroup. Go to the bathroom and get a drink of water. If you're still not calmed down, go sit in a quiet room for a few minutes. After you are feeling calm and, more importantly, feeling
sleepy, go back and mask up. Sometimes just giving yourself a small 5-10 minute break from the mask does wonders for getting over the hump of fighting the mask. But it's critical that you don't give yourself that break while lying in bed: You'll inevitably fall asleep without the mask and that's a very bad habit to get into.
Let me know if you think any of these suggestions might help you get over your current hump.
Joined as robysue on 9/18/10. Forgot my password & the email I used was on a machine that has long since died & gone to computer heaven.
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