My adventure begins...

[Papa_Bear]

Well, it looks like I am one of you guys now. I picked up my CPAP machine yesterday and had a rough first night. But first, let me go back a bit.

I was diagnosed with OSA roughly 8 weeks ago during my first overnight sleep study. They were not able to do a split study and use a CPAP machine for the second half of the night since it took me so long to get to sleep with several dozen sensors glued to my head and face and wires attaching me to the bed. I don't have the official results in front of me, but by AHI was 50.1 events per hour. This prompted a return for a second night a few weeks later for a titration study. They fitted me with some nasal pillows which I thought I would like best, but they went ahead and fitted a nasal mask as well. After getting all hooked up again, it was off to sleepy land. Well, not quite.

I could not get used to the sensation of having air blown directly up my nose. I could tell I was fighting the machine. On my inhalation the machine would shut off flow right before I was done taking my breath. This gave me a sense of being suffocated. Then it was hard for me to force the air back out on exhalation. After switching from CPAP to BiPAP modes, up and down the pressure ranges and about 3 hours of fitful sleeping the sleep tech came in and switched me to a nasal mask. This helped with the sensation of being pumped full of air like a deflated tire, but the sleep was anything but good. I ended up with the following results:

Stage N1 time: 9.0 or 3.2% of TST
Stage N2 time: 147.0 or 52.0% of TST
Stage N3 time: 77.5 or 27.4% of TST
Stage R time: 49.0 or 17.3% of TST

I had 57 mirco arousals, which was about 12.1 per hour. It looks like they finally settled on a pressure of 14cm of water which gave me 16.75 minutes of REM sleep and an AHI of 3.6 events per hour.

So while I waited for my CPAP orders, I started doing research. That landed me here, and I dug through a lot of reviews and comments on the different machines. I found a wealth of information on what machines to stay away from, which ones are better, and which ones are popular. I also found some great information on what questions to ask my DME supplier. I went in for my DME fitting with knowledge in hand and ended up yesterday walking out with a ResMed S9 Autoset with the H5i humidifier, the ClimateCare hose, and a Comfort Gel Nasal mask. I had a great experience with my DME and they had no issues ordering the exact equipment I asked for. They even told me they usually provide the Respironics products because they have an agreement with them and they get a little more of a kickback. You can't ask for better honesty than that. I picked the S9 Autoset because of its size, the logging features, and fact that in the future if I want to I can try the APAP settings. I like tinkering with gadgets. I figured with all the data logging and options, this would be something I would want to wear and tweak on to get it right for me.

So I took my gear home last night, apprehensive to say the least about this thing being attached to my face while I sleep. I set it up in our living room and watched TV for an hour or so to get used to wearing it. I had no problems with it during that time, other than messing with the mask to get a better seal. I then took it up to bed with me and sat looking at it for about 20 minutes. I hate it. I hate what it means. I hate what it means for my future. I feel like I failed and I caused this, which to a point is true. I am a bit overweight. If I had been more careful in the past, I would not be in this situation. I hate that now I can't talk to my wife before I fall asleep with this thing on. I am afraid of all the questions my 3 (and soon to be 4) kids will ask. I am afraid of the added headaches it will cause me when I travel for work.

On the other hand, I know that this will help me sleep better. I know that my wife worries about me when I sleep because she has heard me stop breathing a few times at night. I know that my snoring keeps her up at night some times. I know that now I won't have to smell any more bedtime farts (hers or mine). I know that this is going to take time to get used to it.

I was able to keep the mask on for about an hour and a half last night. After that I noticed it was extremely hard for me to exhale. I also noticed that the pressure was almost forcing my mouth open. I finally took the mask off and noticed that my nose was completely stuffed up and could hardly breath out of it normally. I thought I might have to adjust the humidity setting, but I was not sure which way so I took it off and put it away for the night.

Tonight, I will try again.

God, grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.

[2flamingos]

Welcome!

1st, you are not to blame - and there is no blame, it is what it is. So, get over that feeling - now! Your understanding of how your apnea negatively impacts other people is a great start - but you also need to understand how it negatively impacts you and your overall wellbeing. Once you do that, it becomes easier to accept and not fight the therapy. Once you do that you begin to realize how much a difference (positive) it can make in your life.

You have a great machine, and I am sure you will enjoy checking data and seeing what and how things impact your sllep and sleep patterns.

Best of luck!

[Beckah54]

I wish this forum had a "like" button because I liked your post....your honesty and willingness to try the Pap.

I can also sympathize with the problems you experienced on your first night. I have been where you are now, wondering if I would ever adjust to air blowing up my nose every night and if I would ever feel rested again. I did adjust and now can't sleep without it.

I also blamed myself at first, even felt guilty because my snoring disrupted my spouse at night. I remember my mother snoring so loudly, it embarrassed me when friends slept over. I was a kid and knew nothing about sleep apnea. I wish I had, maybe mom wouldn't have died at 67 from a heart attack. I'm sure her untreated sleep apnea contributed greatly to her heart problems and death. This has given me the determination to use my APAP every night in the hope that I haven't already done too much damage to my body and what life I have left will be of a better quality than pre-APAP.

Good luck Papa_Bear and I encourage you to try to keep the mask on as long as you can in the beginning, wear it all night long as soon as you are able, and keep looking for answers to the questions that will come up.

Best wishes!!

[Pugsy]

Welcome to the forum.

Regarding the stuffy nose. It might be the humidity setting. Some people need more added moisture and some people need less. It is strictly an individual preference. There is no right or wrong setting...only the setting that works for your nose. If your setting is on the low side then increase the setting...if it is on the high side then try decreasing...if it is already in the middle...toss a coin. The nasal mucosa are really weird little things...if they get too dried out they respond by swelling up and if they get too much moisture they swell up. It is the swelling that causes the congestion.
Also, you are using a nasal mask which means it puts some pressure on the sides of the nose (up by the nasal bridge) and the turbinates are in there. For some people the least little pressure on the turbinate area will cause congestion. You can test to see if you are one of those by placing your finger on each side of the nose up by where the turbinates are and applying gentle pressure. If you start getting congested then you have drawn that short straw. I am this way...can't even where heavy sunglasses without my nose stopping up.
If you are "lucky" enough to have this sort of reaction to pressure then the mask pressure may be making things worse. Since people tend to tighten masks too tight in an effort to prevent leaks it is pretty common. So if you think this may be happening to you..try just a little less tension on the mask so it doesn't apply so much pressure to the sides of the nose. Makes it hard...too little tension and leaks will be a problem...so a fine line to walk on.

The hardest part to this therapy is the mask and leaks and comfort. It just isn't natural for us to have to stick all this stuff on our faces. It is an adjustment but the body will eventually adjust if you keep plugging along with it.

Quit beating yourself up over "if I didn't weigh this" or "if I hadn't done that" then I wouldn't be in this situation.
There are skinny people have OSA and morbidly obese people who don't. It's a product of the airway tissues. Often it is just what we are born with and happens to be in our gene pool.

Regarding the talking....at first it is hard to do with the mask on and air blowing but believe it or not you can actually talk with the mask on. I do it all the time now. Sounds a bit weird but it can be done and surprisingly it can be done without air gushing out your mouth. It took me several months to get the hang of it though. Tongue placement and an involuntary closure of the airway is involved.

Do what you need to do to resolve the nasal congestion issues. You won't be able to sleep comfortably until you do.
So play with the humidifier settings to see which way works best for you.

Baby steps. While there are a few lucky people who slap the mask on and turn out the lights the first night and wake up 8 hours later feeling like a million bucks..those people are really lucky and probably in a minority. Most of us it took some time to get used to all this "stuff" on our face.

You have a great machine. There is software available to help you monitor your leaks and overall therapy effectiveness.
ResScan is the ResMed software.
You can find it here in UncleBob's signature line.
memberlist.php?mode=viewprofile&u=38643
and a tutorial on how to use it here http://montfordhouse.com/cpap/resscan_tutorial/

There is also SleepyHead software. It was written by one of the forum members. I have links for all its information in my signature line. There is a Mac version available. It is Beta software and not without its little bugs but you may like it. It has some pros and cons just like any software would.

Good luck and remember that any problem you may encounter, someone here and often many here, will have faced the same problem and found a workable solution.

[Papa_Bear]

Thanks for the kind words everyone. I have a feeling they will be important in making this transition.

Pugsy, I think I actually found a similar post from you about nasal congestion and humidity settings while searching this morning. It seems you know a lot about the nose and all it's boogery mysticism.

I know that this will help me as well. Everyone tells me how much better I will feel after a "real" good night's sleep. I guess I have been functioning so long with OSA that I don't really even notice how tired I am.

Beckah54, you mentioned being embarrassed about your mom's snoring. I have driven my younger brother to sleep out in his car on a couple of occasions during family vacations and other things. That is not something I am really proud of.

I am thankful for finding this site already. I am sure it will be a fountain of good advice and moral support going forward.

[RandyJ]

Welcome! I'll try not to repeat what others have said, but it is important to get a handle on the congestion right away.

If it's not just a humidity issue, you'll have to be pro-active and get right on it if you want to continue to use a nasal mask. If you need to address it, I would start with nightly nasal irrigation with a NeilMed bottle or netipot, the pre-mixed saline packets and heated distilled water. DO NOT USE TAP WATER up your nose; I wouldn't even trust tap water once it has been boiled.

Some people find that nasal irrigation (daily at first, less frequently as you need it) solves the problem. If it doesn't, you may need to use a prescription nasal spray like Nasonex or Flonase at bedtime. These two are safe for daily use. Afrin will get you out of a spot for a day or two but you can't use it beyond that due to the rebound congestion it causes. Most people get results from nasal irrigation in a few days.

I also like Breathe-Right nasal strips which facilitate nasal breathing by opening up the nasal passages a bit.

If all else fails, don't despair. There are full face masks.

[Pugsy]

Pugsy, I think I actually found a similar post from you about nasal congestion and humidity settings while searching this morning. It seems you know a lot about the nose and all it's boogery mysticism.

I speak from experience. I am one of those people who need LOTS of added moisture to keep my nasal mucosa happy. Early on in my cpap therapy I tried turned the humidifier down from a setting of 3 to a setting of 1. This was before all the heated hoses and actual humidity sensors. We just either added more heat for more moisture or less heat for less. Well...that setting of 1 experiment was a total disaster. I woke up with the most horrible of nasal congestion symptoms...runny nose...itchy...sneezy, etc...pretty much just like a full blow allergy attack...my teeth even hurt from sinus pressure. Lasted 3 days.... So I thought..hmm..maybe a coincidence..maybe I would have had same problem if I hadn't changed the humidity setting but a couple of weeks after I recuperated from that episode I forgot to add water to my tank and it went dry early on in the night. I had a repeat of the very same symptoms...so spent another 3 days getting my nasal mucosa to forgive me.
Well it doesn't take me long to put 2 and 2 together and about a month later...yep forgot to add water to humidifier and it again went dry and yep same exact symptoms. That was the last time I forgot to add water.

I cringed when I read about someone in the high desert not even using a humidifier because I know what it would do to me but I know that there are lots of people whose nasal mucosa will rebel if they get too much moisture. So that's why I say toss a coin if you are already on rather medium setting.

If I don't breathe good I don't sleep good. Plain and simple. So dealing with any possible congestion issues would be my number one priority. Gotta get the sleep first before you can fix the sleep apnea.
During my titration sleep study the jackass of a tech tried me with a nasal mask (cover the nose) but had it cranked down so tight that my nose stopped up totally within 5 minutes. It was so totally blocked I might as well have had my fingers stuck in there. I made him take it off and forced him to let me use a nasal pillow mask for the titration. He wanted to give me a full face mask and crank it down again...what a dufus.

So yeah, I have had some personal experience with nasal congestion and I don't sleep well at all if I can't breathe well.
So for 3 1/2 years now I have been using nasal pillows. They work the best for me. Even when I have had a cold or upper respiratory infection I have been able to keep the nasal passages open and use my nasal pillows.

Mask preferences...highly individual. What I love the next person might hate and what he might love...I might hate.
Don't be afraid to try different masks if you feel the one you have is less than optimal. There is no way to know if another one would be better or worse without your trying it. If you can't get comfortable and can't breathe then you can't sleep and the cpap machine doesn't do much of a job if you aren't using it or aren't sleeping.

Did your DME tell you what their mask swapping policy is? Most of the mask manufacturers offer 30 days for each mask.
Seems like DMEs make their own in house rules and often that is strictly 30 days period.
Don't be afraid to experiment within any free swapping time you might have available...even if you end up going back to the first one.

[Papa_Bear]

One of the reasons I think it might be a humidity issue is that as soon as it got colder last week, I always woke up with a stuffy nose. It went away after a few hours of waking up. After I took the mask off last night, by morning it was much better. My Temp/Humidity is set for 70 deg right now. I am going to try and bump that up to the default (80 deg) tonight and see if that helps.

[Sheriff Buford]

Papa: know that your Autoset has the EPR feature. EPR technology is designed to make therapy more comfortable. EPR maintains optimal treatment for you during inhalation and reduces the delivered mask pressure during exhalation. You can select EPR in either CPAP or AutoSet mode. This should help you during exhaling. I know where you are coming from.. sitting at your bed and looking at that dang contraption (conclaption). I have done that too and I still do that. But... it makes you so much healthier and you will soon start to feel better. Don't give up! Finding a comfortable mask that doesn't leak is the key to your success. Work all your issues here.

Sheriff

[squid13]

After switching from CPAP to BiPAP modes

In your sleep study did they change you to a BiPap machine or just switch you over to Apap mode on the machine. If they did finish you on a BiPap machine why did they give you an Autoset instead of a S9 VPAP. The Sheriff has a good point about using EPR until you get use to it.

[Papa_Bear]

After switching from CPAP to BiPAP modes

In your sleep study did they change you to a BiPap machine or just switch you over to Apap mode on the machine. If they did finish you on a BiPap machine why did they give you an Autoset instead of a S9 VPAP. The Sheriff has a good point about using EPR until you get use to it.

The machine that the sleep center had was capable of both BiPAP and CPAP. At one point during the night they had set it to BiPAP. I could tell the difference in the exhalation pressure, and also the sleep tech told me that they tried BiPAP as well during the night when I was having trouble sleeping. I am not sure if the DME set the EPR up on my machine or not. I am going to install the software tonight and see what all the settings are.

[Pugsy]

You probably will want to get a copy of the provider/clinical manual.
You can find it here.
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf

In it you will find the instructions on how to get to the clinical setup menu area so you can see all the settings.
Default setting for Sleep Quality is "Usage" and that only give you hours of use...so you want to change it to "On" so that you can see all the data that the machine collects. Otherwise all the machine will tell you about your time on the machine is how much time you spent on the machine.

[johnthomasmacdonald]

I'd be interested in what others think of this but in my opinion it wouldn't be a bad idea to take some sleep meds or anti-anxiety meds- eg Valium/zanax - in the early days of adjusting to cpap/bipap

[squid13]

Here is a good video to watch for the S9.http://www.cpaplibrary.com/machines.html

[sleepnasta]

just wanted to say hi and welcome from another newbie! the people here are very knowledgeable and friendly. i hope you can work out the glitches and start feeling better soon