Newbie Struggling

[hux]

I've tried to read through some of the existing posts for advice. My doctor/insurance company hooked me up with a Resmed Escape II with the Humidaire H4i humidifier. So far I have no actual complaints about the machine. The backpressure when exhaling is taking a little getting used to, but I find that as long as I don't actively think about that, it doesn't actually bother me. I've been trying to use the machine for 9 nights now.

I'm really struggling to adapt to the mask though. The mask is a Mirage Swift LT. I find the part of it that presses against my cheek to be uncomfortable, and it feels like my nose is running when I wear the mask. I also seem to itch a lot around where the pillow comes into contact with my skin/nose. Is this normal?

I have always been a side sleeper when going to bed and transition to a supine position during the night. I find it very difficult to turn onto my side with a mask on because of the way my pillow pushes against it, so I end up having to try and fall asleep on my back. It seems to be taking 2-3 hours for me to fall asleep, and then I'll wake up about every 90 minutes or so all night. I've been taking melatonin (at the doctor's recommendation) before bed time, but that doesn't seem to do the trick. Sleep aids tend to have a really intense effect on me making me unable to be alert or even safe to drive the following day, so something like Seroquel/Ambien isn't really an option. Benadryl doesn't seem to be strong enough, so I'm stuck in the middle with nothing working.

I feel more exhausted now than I did before using the mask, and it's affecting my ability to perform my job properly. (I'm a software engineer, my brain is my most important asset!) Any advice here?

I've felt like I've become a lot "dumber" over the last 10 years or so, so I'm really hoping that I can feel sharp again. I realize some of this comes with age, but I feel like it's happened faster than natural.

Thanks in advance for any advice. I know most of you have probably gone through this, but perhaps just hearing that this isn't abnormal will be comfort enough to keep pushing through.

-Brett

[Nord]

Hi Hux

1. The ResMed Escape does not provide any data other than readout on the LCD which can be difficult to know how you're doing.
Is this a test/ tryout machine ?? You may want to consider asking for better after reading here.

2. Have you looked at your AHI ?? Do you know what your Sleep Study report said ??

3. Are your leaks under control... they can negate all the therapy you think you're getting...

4. Masks are a very personal thing... what works for some will not work for others.

5. Do you have dry mouth during the night or in the morning ??

6. Is your Humidifier working ?? How do you know ??

7. Do you have EPR set up on your machine ?? It helps with exhalation by lowering pressure.

Thats a start to understand your difficulties... I do have some suggestions when I understand better.

Nord

[Hux]

1. The ResMed Escape does not provide any data other than readout on the LCD which can be difficult to know how you're doing.
Is this a test/ tryout machine ?? You may want to consider asking for better after reading here.

Unfortunately, this is the one the insurance company insisted on, and they didn't want to do a rental period, so I think this is what I'm stuck with.

2. Have you looked at your AHI ?? Do you know what your Sleep Study report said ??

Overall: 38.4, Supine AHI: 54.4, REM Sleep AHI: 48.3, Non-Supine AHI: 25.8
During the second study for PAP titration, at 11cm, they got it to 0.

3. Are your leaks under control... they can negate all the therapy you think you're getting...

I'm pretty sure they are when I lie on my back. I'm not so sure about when I lie on my side. I can keep it from leaking if I lie on my side while awake, but I don't know if it's leaking when I'm asleep.

4. Masks are a very personal thing... what works for some will not work for others.

Is there some way to tell the difference between normal adjusting and a level of discomfort that is unreasonable?

5. Do you have dry mouth during the night or in the morning ??

This hasn't been a problem (yet).

6. Is your Humidifier working ?? How do you know ??

I'm pretty sure it's working. I turned the setting up the other night and I was getting condensation in the line and woke up with "drool" everywhere. I turned it down a notch and it seems to be providing enough moisture, but not so much that I'm waking up with water everywhere. When I get up in the morning, there's notably less water in the humidifier.

7. Do you have EPR set up on your machine ?? It helps with exhalation by lowering pressure.

Yes. It's set to 3. Like I said, the exhalation pressure doesn't really bother me much unless I start actively thinking about it.

Thank you for any advice or input you can provide!!

-Brett

[Hux]

Attempting to add a reply that includes my equipment info in the "standard block" format.

[Janknitz]

I'm really struggling to adapt to the mask though. The mask is a Mirage Swift LT. I find the part of it that presses against my cheek to be uncomfortable, and it feels like my nose is running when I wear the mask. I also seem to itch a lot around where the pillow comes into contact with my skin/nose. Is this normal?

Do you have the little microfleece covers for the headgear? They come with a purchased mask, but not with the samples that sleep clinics get. If you didn't get them, you can order them at cpap.com. If you are using those and still having a problem, try wrapping the arms with more padding like a piece of microfleece (use a safety pin on the OUTside of the mask arm to secure it).

My nose feels like it's running too. Part of it is that if the room is cold and your nose is warm, there's an instant condensation between when the pillows are against your nose. If you can turn up the heat on your humidifier or preheat the air, that might help.

I feel a bit itchy around my nose too, but at least you can scratch! In nasal or FF masks, I would itch like heck and couldn't scratch. I keep a Q-tip by the bed to scratch under the headgear or nasal pillows where my fingers are too big to fit.

[Janknitz]

Whoops! Part II

I find it very difficult to turn onto my side with a mask on because of the way my pillow pushes against it, so I end up having to try and fall asleep on my back.

A couple of things might help.

1. Look on my blog. There is a tweak to keep the headgear from slipping--sew velcro hook tape to the inside of the back strap so it doesn't slip so easily when you move. I haven't tried it, but I think a satin pillowcase might help, too.

2. I hang my hose over my head from a wall-mounted swivel lamp, but people use things like a plant hanger or just a hook on the wall to hang their hoses. There are also hose management systems you can buy. That helps, but I still have the "bump the hose on the wall behind me" problem when I turn over, too.

If you are taking a long time to fall asleep on your back, you are better off to start on your side and just wake lightly to move the hose when you turn. You really will get more sleep that way, and after a while you will hardly wake up at all.

I know it's a lot to get used to, but for side sleeping a nasal pillow mask like the LT is a thousand times more comfortable than a nasal mask or FF mask. You are doing geat to make it 9 days, keep it going!

[Nord]

Hi Brett

There's nothing wrong with the construction and pressure delivery of your S8 Escape but...
It has some very severe limitations for you in assessing your therapy.
Unless there have been some updates to that model...
It will provide you with Compliance Info and very basic AHI results for the day or Average.
There is no breakdown of AHI into types of Apnea (they are not all the same)
There is no Leak data to tell you how well things are working while you sleep.

But it seems as though its fairly comfortable for you and you're got the Humidifier working well.
You don't mention your AHI results while on the Escape... ??
Basically... how you feel... which be your major consideration to success ??

You do mention that your Apneas are Supine related and somewhat REM related.
Many people are subjected to more Supine Apneas and you can use pillows and other aids to keep yourself off your back while sleeping.

I always suspect Leaks are the problem when therapy not working very well
Most people have more leaks in their mask when they move off their back...
The Swift LT can have an issue with pillows collapsing (inner pillow at the nose) so they should be just snug, not tight and not loose.
Head pillows can help with sleeping on your side which is generally more of a problem for all masks.
I have found that a very firm pillow works best with the LT and keep your face towards the edge as opposed to centre.
Your face (nose skin) also has to be cleaned before use and facial and nose hairs removed regularly.

Your mask and sleeping positions are going to be your major concerns...
BTW I use Melatonin as a sleep aid and it works for me in .75mg sublingual format.
I have tried 3mg and it has longer term effects.

Good luck
Nord