First night on CPAP...not a success......

Needsdecaf · Post by **Needsdecaf** » Wed Apr 16, 2008 6:35 am

Well, last night was my first night on CPAP at home. I can't honestly say that it was a great success, but it wasn't an abstract failure.

I have spent a lot of time here reading old posts and the collective wisdom to avoid the most common pitfalls. So I rigged up a pretty good hose management system: I used one of my wife's hair elastics to attach the hose to the handle of the top drawer on my nightstand. Not as good as a hanging from above system, but it worked. I made sure to saline my nose and put some Ayr saline gel on my nostrils and upper lip to protect them.

I also spent time playing around with my Swift to select the right pad sizes, and tried out the nasal mask as well. I got the Swift to be quiet, but the nasal mask wasn't. The vent rockets down the hose and is LOUD. So I started out with the swift.

So at about 5 of 10 I laid down and started her up. Of course, I haven't used a CPAP but once, so I was getting used to the sensation again, and the noises of inhalation and exhalation. I was awake for about 30 minutes, almost falling asleep a couple of times. The pillows were kind of bothering me a bit, and I noticed most disconcertingly that as the pressure ramped up from it's baseline of 4, the whistling got louder. But I think I fell asleep before it got to full strength (I have the ramp set to 45 minutes).

Well, unfortunately, I was woken up at 2:30 am by my son. My wife is away from work, so I had to get up to get him. Normally he wakes up because he kicked off his blankets and got cold, but this time he had poops! So instead of giving him his pacifier and throwing a blanket on him, which takes less time than walking to and from his room, I had to turn on the light and change him. This is not normal from him, and frankly, he couldn't have picked a worse time.

So now there I am at 2:40 trying to go back to sleep. I didn't know what to do.....I had turned off the machine, but when I re-start it, do I do it at full strength or ramp again? I tried playing with both, but ramp seemed to be too low, felt like I wasn't getting enough air, but full strength was too much for how fast I was breathing...I hadn't relaxed enough yet. What to do? I made the mistake of choosing full power. I say mistake because I felt sort of out of sync with the machine, plus now air was humming as soon as I stopped exhaling and the CFlex went back to full strength. I sat and fiddled with the damn nasal pillows for at least 5 minutes, but to no avail.

Not to mention the fact that I'm not that comfortable with turning on my stomach to sleep....I don't normally, but it helps me get back to sleep if I've woken up. But I didn't feel comfortable doing that with the mask on.

So I tried to hit the ramp, but by then, I was somewhat used to the higher pressure, so it felt like I was getting too little air.

So a couple minutes after 3 I ripped it off, turned it off and went to sleep.

So I got 4 hours of therapy. I know it's working because I can really feel my throat being kept open by the air.

I feel like normal this morning, no better no worse. Good news....no funny lines on my face (although my wife will be making me strap covers when she comes home), nose is not stuffy or dry, and my nostrils and lip aren't irritated. Granted, I only had the machine on for 4 hours, but hey, that's the minimum recommended treatment time per night.

Here's what I worry about the most.

1) Getting used to the pressure. I'm thinking of maybe dropping the final pressure by 1 or 2 cm (it's at 8 now, I know it's low) for maybe a week so I can get used to it.

2) The noise. I don't mind the whistling TOO much, but it's going to drive my wife crazy. This is not good.

Any suggestions? Encouragement?

Thanks!

NightHawkeye · Post by **NightHawkeye** » Wed Apr 16, 2008 6:49 am

Sounds like a reasonably successful first night to me. A lot better than many report.

I suppose your ramp is starting out at too low a pressure. Lots of folks complain about feeling starved for air at 4 cm or 5 cm pressure. You might start the ramp higher. Either that or see if you can adjust the A/C-flex so that 8 cm is comfortable for you.

Sounds like you'll want a different mask if low noise is needed. (Welcome to the club ... ) Since nasal pillows seem to work for you, you might search through prior posts to see which ones are quietest. I've got the original Mirage Swift and can attest to its noise, for which there is no solution (except to use a different mask, of course).

Regards,
Bill

pjwalman · Post by **pjwalman** » Wed Apr 16, 2008 7:38 am

Congratulations on getting through your first night!!!

I'm new to this, too, but it's my understanding that you can hit the ramp button any time you feel you need to. Personally, I couldn't start right out at my end pressure, which is 11. I did change my ramp, though, from the 5 set by the tech because I felt like I wasn't getting enough air, and the lower levels bother me more on the exhale for some reason. That is a setting you can change yourself if you find it is bothering you.

I'm sorry I can't help you with a mask recommendation since I am still struggling myself to find one that's ideal.

Just wanted to do a little cheerleading. It's a whole new world, isn't it? Thank goodness we have the kind and helpful people of this forum to educate and help us along the way!!

Peggy

bap40 · Post by **bap40** » Wed Apr 16, 2008 8:18 am

Yes, it WAS a Success!!! Every night is like a new adventure!!! Will I get it right tonight? Can it get better?? The one thing good is that you get a new chance every night for better and better results.

Keep at it and good luck!

Pineapple · Post by **Pineapple** » Wed Apr 16, 2008 9:02 am

I argee with the others, last night was successful. There are some people that only make it 2 hours their first night.

I will admit the first 3 nights of my therapy, the noise of my machine bothered me (it was that breathing thing it does) and it just might be an adjusting thing, but it seems to me there was a thread earlier this month about someone's partner hating his machine. The resolution turned out to be the mask. I'm pretty sure he was using a Swift also. Once he changed the mask the problem went away. I agree with NightHawkeye, more research.

I can relate to the baby. Last night I woke up to my 9 year-old standing in the middle of my bed climbing a ladder (thats what it looked like) I asked her what she was doing, she looked around, laid down, and was sound asleep. See what you have to look forward to?

rested gal · Post by **rested gal** » Wed Apr 16, 2008 9:22 am

I think you did extremely well for your first night trying to sleep in this crazy new strange way!

I agree with the others that whatever you have your ramp set for now, change that to another cm or two higher, since later in the night you feel like it's "not enough air" if you have to hit ramp again.

Every nasal pillows mask I've tried makes its own certain amount of noise, imho. Mainly an increased whoooosh sound each time a person inhales.

If a very quiet mask is a must, there's a nasal mask that is the most silent I've used -- the Soyala by Somnotech.
https://www.cpap.com/productpage/Soyala ... dgear.html

LINKS to SomnoPlus and Soyala nasal and Soyala FF mask topics
viewtopic.php?t=16333

Needsdecaf wrote:Not to mention the fact that I'm not that comfortable with turning on my stomach to sleep....I don't normally, but it helps me get back to sleep if I've woken up. But I didn't feel comfortable doing that with the mask on.

There's a nasal pillows mask that is by far the best (imho) for sleeping in ANY position, including on one's stomach -- Aeiomed's Headrest mask. Also has an absolutely unique placement of the exhaust vent, which is the best I've ever used for not hitting anything -- the exhaust is at or above eyebrow level and vents straight up.

As with any nasal pillows mask, there will be that inhaling shuuuush sound.

LINKS to Headrest nasal pillows mask topics (same mask has had other names: Aeiomed Aura, then Headrest, then Invacare Twilight NP, then back to Headrest again.)
viewtopic.php?t=3098

sharon1965 · Post by **sharon1965** » Wed Apr 16, 2008 10:00 am

that sounds like a pretty typical first night

the ramping sounds brutal to me...i never used the ramp after the first couple of nights cause i was starving for air, which made me feel too anxious to fall asleep, but also because i couldn't stand the feeling of unconsiously waiting for the pressure to increase...8 is a relatively low pressure, you may find that you can start out there just fine without the ramp...the opinions about ramping vary, but my humble opinion is that it sucks

you could try wearing the mask for short periods during the day to get used to to the feeling ...read a little or watch tv...before you know it you'll be among the majority of people who find themselves wondering if their machine is even on, since they can no longer feel any sensation of air blowing; any time other than bedtime is also good for figuring out mask fitting and leak issues, when you're not feeling stressed about getting to bed at a reasonable time

as far as your wife is concerned...maybe the machine/mask noise will still be preferable to whatever you were doing pre-cpap...in my case, my snoring, gasping, snorting, talking, tossing, turning (my husband claims that flipping and flopping would be a more accurate description) jerking and twitching were all the issue (don't even get me started on the sleepwalking!); the noise of my machine and/or mask seems mild and almost pleasant to him now, though he does still wear ear plugs on occasion

i think you did really well...4 hours on the first night should definitely be considered a success....i also think you've gone into this with the right attitude, finding out as much as you can to make your treatment manageable and successful

as far as the baby is concerned, can't help you there...to the best of my knowledge no one has ever come up with a solution to the poorly-timed pooping issue

take care...wishing you continued success!
sharon1965

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CPAPopedia Keywords Contained In This Post (Click For Definition): Ramp

Claire · Post by **Claire** » Wed Apr 16, 2008 10:11 am

I have to agree with everyone else. Your first night sounds pretty good to me. Re wake ups. When it happens to me, I get up and read. When I start getting tired, I go back to bed and start at the low pressure of the ramp.

I once made the mistake of starting at my upper pressure--13--and practically blew backwards.

BigJim · Post by **BigJim** » Wed Apr 16, 2008 10:26 am

Not a bad start at all. I tend to agree with Sharon on the ramping issue. My pressures on a bilevel are 20 and 17, at first I tried to ramp and when it came up to pressure it always woke me up, so I just got use to it starting at full pressure. At first I admit it felt like a supercharged leaf blower strapped to my face but now believe it or not there are times I have to check to see if my machine is running. Just hang in there and there will come a time that you really feel as if you can't sleep without your new friend.

SleeplessInIL · Post by **SleeplessInIL** » Wed Apr 16, 2008 11:12 am

I also agree that it sounds like a good start.

I've had good luck with the Opus 360. You might consider giving it a try. It allows you to unhook the hose from the overhead strap so that you can choose to position the hose from up top, down your side, whatever. And it swivels to accomodate whichever side you sleep on. Unlike the swift which I believe is fixed on one side or the other.

Also, you might try adjusting your cflex. 2 was much more comfortable for me than the 3 setting. And since I seemed to be in a bit of a relapse phase the last week or so, last night I changed it to 1 just to see what would happen and I got a great nights sleep.

There's lots of adjustments that need to be made from your normal sleeping habits. Don't be afraid to try different things, you'll eventually hit the magic combination.

Good luck and let us know how it's working out!

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CPAPopedia Keywords Contained In This Post (Click For Definition): hose, cflex, swift

alnhwrd · Post by **alnhwrd** » Wed Apr 16, 2008 11:24 am

Congratulatons on your first night! At the very least, you have satisfied the gods of insurance by using your machine for four hours!

Everyone's experiance is different. My first night at home with CPAP I only slept for just over four hours, but felt better than I did after 8 hours of pre cpap sleep. Your target for tonight should be at least 5 hours.

Any issues with excess leaks? Are you able to get your leak rate from your machine? Any chance you are mouth breathing? If so, that will eliminate any benefit from the cpap and keep you from feeling better. If you sleep more and don't see improvement, you could try taping or glueing your mouth to see if that helps. Might be worth a try anyway.

The first couple of nights I was on CPAP I was sleeping so much more quietly, no more snoring, snorting and thrashing around, that my wife was worried I had croaked in my sleep. So maybe the total noise level will be less and it won't be a problem for your wife. We also have a fan going in the room, partly for air and partly for white noise. My wife has always slept with a fan, and it took a couple of nights for me to get used to, but it works great for drowning out other noises.

If it is possible for you to access your machines data, I would do so and either download it to your computer and review it daily or begin a "sleep diary" for yourself and record the data there. I did the latter for the first couple of months, and would highly recommend it. Each morning I would record AHI, HI, AI, leak rate and pressure. I also recorded how much time I actually slept, how I felt when I woke up, and any problems I was having, such as sore spots. It was helpful to be able to track improvement and to know that even if I did not do very well one night as far as, say, total hours slept, at least I brought my leak rate down or had low AHI. As long as I improved in even one area I felt like I could call the night a success.

The others are right about bringing your starting ramp pressure up a bit, but I would not change your ending pressure, since that is what you need to keep your airway open. You will probably get used to the pressure soon, like others have said I quit using the ramp and started wondering if the machine was even on after the first week.

Keep up the good work!

Needsdecaf · Post by **Needsdecaf** » Wed Apr 16, 2008 12:47 pm

Thanks all! Glad to hear some positive notes. I guess that I shouldn't be too dissapointed, I slept better than I did when I had my sleep study. Problem was that when I woke up from the sleep study, I felt better than I do now! So I guess my expectations were higher. The difference there is that I went into REM about 1.5 hours before I woke up.

A couple of things to note and to respond to:

I tried a couple of settings for the CFlex. The funny part was that what worked on the low ramp didnt work on the high. On that note....

I think I will try turning the ramp lower portion up from 4 to 5. I remember when I was done with my SS, I woke up with 8cm running and it felt like nothing so I can relate to what you are saying about getting used to it.. 4 still feels pretty easy so I think I'll try 5. I mean, there are going to be times when I have to get up in the middle of the night so I might as well make the ramp function work for me.

Regarding nasal pillows and mouth breathing...I took well to the pillows, I think. My nose fees fine this morning (granted only 4 hours on the machine) and my mouth is fine. The RT noted that I didn't mouth breathe at all during my study.

Regarding the mask....I only have one insurance mask left for now, so I'll have to grab a good one. Here's the question.... do I get a full face, a nasal mask or try to find a nasal pillow that doesn't make noise? Are there quiet nasal pillows? As I said above, the nasal mask I have is quieter than the pillows, but the vent seems to be much louder, so it's a wash.

Regarding data: It's an MStar Pro, so I can get data, but I have no software or card reader as of yet...working on that. And it only shows 7 and 30 day averages of AHI and leak rate on the screen. So no info available as of yet, unless it's available in the clincian's menu. I looked at the clinician's quick start guide, which was handliy left behind in the machine, and didn't see anything for it.

White noise...we may have to go back to that route. I used to be a big white noise guy. Couldn't sleep without a fan on. Been that way for probably 20 years. Then when I got married, my wife put a stop to that. Alhough now we run a humidifier in the winter and it's noisy, so she might not object any longer. I think it's going to be as hard on her as it is on me.

And I feel very fortunate to know that I have 3 nights on the hose before she comes home. That will help quite a bit!

So keep those suggestions coming on quieting the mask down! I'll keep researching.

ksp · Post by **ksp** » Wed Apr 16, 2008 1:26 pm

As you get used to the cpap you may find that you won't even use the ramp feature. I used mine for a week or so at the beginning and maybe occasionally now. My ramp is set to 6.5. Anything lower is like not enough air. When on straight cpap I am at 9.0 and when I go to apap (still testing) I'm at 8-15. Hoping to get those numbers tightened up a bit. Hang in theer. It's a learning process. Rome wasn't built overnight.

sleeplessinaz · Post by **sleeplessinaz** » Wed Apr 16, 2008 8:01 pm

Hey---congrats on your first night of CPAP!! That is great!! It is a very wierd and wackey thing to get used to ---so you HAVE done very well!!

As you get used to the cpap you may find that you won't even use the ramp feature at all. I do not use my ramp now - not ever. It seems too low and i just hit the straight CPAP feature and go to sleep. Now my pressure is not as high as yours. I am only at a 7 right now so I don't really need a ramp up to that anymore.

Just hang in there--it will be worth it ---just keep on masking up---there are still nights when I cannot get comfortable and I get upset that I have to wear all this gear to get some sleep but I try not to let it get the best of me.

Good Luck with the Nose pillows. I really wanted them to work for me and I drag them out every now and again but they are just so much louder than my nasal masks that I usually give up on the pillows.

SIAZ

motogary · Post by **motogary** » Wed Apr 16, 2008 8:38 pm

Be patient! I've only been on CPAP for about 3 months now. It was rough at the beginning, used it maybe 2 hours the first night, had the pressure too low, too high, too wet (rainout), too dry. Kept adjusting, tweaking, fiddling, fastened the hose to the headboard (makes the coolest grating noise when I'd move during the night. Woke me & the missus). It's not a perfect fix. What works for one person may not work for someone else, but with all the help you've got here, someone can help you over the bumps. I quit using the ramp after a couple of nights. I feel I reached a milestone a week or so ago when I not only make it through the entire night, but when I wake up, it takes me a few seconds to realize I've still got the CPAP on.

Machine	Mask

Additional Comments: new Airsense auto set 12/08/14. Cpap pressure is