My First Few Nights - Please Help Me Stick With It

[jbt1125]

Hi, newly diagnosed with sleep apnea.

Spent my first few nights on the machine, a ResMed S9. I purchased both the Swift FX and full mask.

1) as much as I would like to use the nasal pillows (SO much more comfortable than mask), I am really puzzled how anyone can spend the entire night without ever opening their mouth. I mean, I can go to sleep that way, but at some point when you sleep, your body naturally opens the mouth. When that happens with the nasal pillows, its just very uncomfortable, wakes me up, etc. Is there some trick on this? I know that I could get a chin strap, but then isnt that pretty much just similar to wearing the face mask at that point?

2) With the face mask, I find it hard to strike a balance between tightening it enough to prevent air leaks vs. having it cause discomfort from being too tight. My best night, (according to the machine) I slept 6 hours with the full mask and had an AHI of 4.1. But otherwise, I wake up often from leaks and discomfort of the mask.

3) Although my machine has a humidifier/warmer, the air seems VERY cold coming out of the tube, is that normal? I am able to fall asleep, but its awfully cold, and I am wondering if I am doing something incorrect. Best I can tell the temp is set to 76 on my machine, so should be warmer?

I can see why people end up giving up on this process. I dont have any side effects or claustraphobia, etc. but it is indeed a very uncomfortable and unnatural process. From reading on here, I know that the right thing is to try to get past this hump, so I appreciate any help. thanks

[SleepWellCPAP]

I would suggest turning up the temp on your humidifier yes.

Also, when using the nasal pillows, do watch out for little leaks as they can evacuate your circuit of moisture. If that happens, drier air may cause your sinuses to react and your mouth to open due to flow restriction.

Sounds like you've got the right equipment. Give it at least a week. You might also practise using the machine during the day, making sure to keep your tongue on the roof of your mouth.

Good luck!

[ellen1159]

I got my BiPap machine on May 6, and I only started using it for a full 8 hours of sleep within the past couple of weeks. I had every kind of issue with my machine, from claustrophobia to irritation and dryness in my nasal passages and throat, discomfort from headgear that pinched or was too tight, massive leaks, and getting used to very high pressures (15 to 24) that felt like hurricane force winds. I thought I'd never get used to this machine, but my apnea was so severe, I kinda didn't have a choice.

The full face mask bothered me, but I was afraid I couldn't use a nasal mask because of my high pressures and because my mouth naturally drops open when i fall asleep. Tried a nasal mask with a chin strap and liked the nasal mask better (and turns out I could use it) but the chin strap wouldn't stay in place, it slipped around onmy hair and I really didn't like the feel of something under my chin (I don't even like to wear turtlenecks or choker necklaces). People here suggested I try a piece of first aid tape, placed vertically over my lips with my mouth just slightly open (so I could draw in a breath from the side of my mouth if I had to). That seems to work for me.

I'm on my fourth mask and still looking for one that is comfortable and doesn't leak. I've gotten my leaks down a lot but the headgear tension bothers the back of my head and neck. It's a process. It will get better, and there are a lot of people here who have been in your shoes and will be glad to offer sympathy and advice. Just stick with it.

[Jeannh]

I'm on my fourth mask

I'm on my 4th mask, too. I'm 3 weeks in, and decided before I started to give it 3 months before I decide it's too hard. For me, it's a path, not a destination.

No matter what problem you run in to, someone here will have experienced it too. Stick with it!

[robysue]

1) as much as I would like to use the nasal pillows (SO much more comfortable than mask), I am really puzzled how anyone can spend the entire night without ever opening their mouth. I mean, I can go to sleep that way, but at some point when you sleep, your body naturally opens the mouth. When that happens with the nasal pillows, its just very uncomfortable, wakes me up, etc. Is there some trick on this? I know that I could get a chin strap, but then isnt that pretty much just similar to wearing the face mask at that point?

A lot of it is just giving yourself enough time to learn how to get to sleep and stay asleep in this very unnatural way of sleeping.

And for the opening the mouth problem: Some of it is a question of degree: If it happens once a night and you wake up and close your mouth, it may not be too much of an issue. If it happens repeatedly throughout the night, then it's an issue.

One useful trick: You can try to train your tongue to stay in a position where the tip of the tongue is touching the roof of the mouth right behind your upper incisors. In this position, the tongue pretty much blocks the oral cavity off from the upper airway. And if the tongue is in the right position, it can be remarkably effective at preventing much of the airflow into the mouth, even if your mouth opens up a bit. (Try it when you are fully awake to see how this works.)

2) With the face mask, I find it hard to strike a balance between tightening it enough to prevent air leaks vs. having it cause discomfort from being too tight. My best night, (according to the machine) I slept 6 hours with the full mask and had an AHI of 4.1. But otherwise, I wake up often from leaks and discomfort of the mask.

What does the leak data look like? Or are you stuck with an S9 Auto Escape that provides you with the summary AHI data, but no leak data?

Since you are fighting leaks that are bothersome to you---in the sense that they wake you up---it's rather important to try to get your hands on the leak data. But if your DME sold you an Auto Escape, the machine records no leak data. In that case, I'd try calling the DME back and saying you know leaks are a problem because they're waking you up and you want (NEED) a machine that records leak data. The S9 AutoSet or the S9 Elite will work with your heated humidifier and heated hose and they both record leak data.

With the Swift FX, the headgear can actually be extremely loose and you can still get a very good seal. Many nasal pillows, nasal masks and full face masks (the ones that cover your mouth as well as your nose) use an air cushion to form the seal. For such masks overtightening the head gear can actually make the leaks worse because an overtight mask can prevent the air cushion from fully inflating. So what mask(s) are you using in addition to the Swift FX?

3) Although my machine has a humidifier/warmer, the air seems VERY cold coming out of the tube, is that normal? I am able to fall asleep, but its awfully cold, and I am wondering if I am doing something incorrect. Best I can tell the temp is set to 76 on my machine, so should be warmer?

There's a lot of air being blown through that hose---particularly if your pressure setting is high. And the moving air can feel colder than it really is. You can turn your heated hose up some and see if that helps. You can also see if redirecting the hose helps keep that (cold) exhaust flow from directly hitting your arms or chest. This is my biggest complaint about the Swift FX: Even after three years of PAPing, that exhaust flow can seem awfully cold; and my machine doesn't have a heated hose option. I've resorted to sleeping with long sleeves on even in the summer. I don't like the fact that this means we must run the AC a lot more in the summer time, but I have a real tough time getting and staying asleep when the exhaust flow is really irritating my arms and chest.

[jbt1125]

All very helpful...a few comments

I will try the nasal pillows again, not sure that I am willing to put first aid tape over my mouth yet, I am just not quite "there" yet

My full mask is the Quattro FX. My Machine is the H5i. I dont think that my machine has leak data, but I will check again. Supposedly the wireless unit sends my information to the sleep center. Also has an SD card. I was told it is the "Cadillac" machine, but who knows. All I saw was that if I push the knob down for 3 seconds, it gives me a green or red face that the seal is good, but that doesnt really help later throughout the night.

Thanks again for all the info, keep it coming.

[robysue]

My full mask is the Quattro FX.

See JanKnitz's Taming the Mirage Quattro essay for tips on how to fit that FFM of yours. The Quattro FX is not the same mask as the Mirage Quattro, but both use air filled cushions for providing the seal and her tips on fitting the Mirage Quattro are appropriate for the Quattro FX as well.

My Machine is the H5i. I dont think that my machine has leak data, but I will check again. Supposedly the wireless unit sends my information to the sleep center.

Te H5i is the name of the humidifier. The same humidifier is used for all the machines in the S9 series. Look at your machine. If it is an S9 AutoSet the word AutoSet should be on the blower unit right above the Start/Stop button to the left of the LCD.

[jbt1125]

Thanks, sorry, learning, new guy

It does indeed say Autoset. So that means there is leak data in there somewhere, correct?

I will read more about the mask. Thanks again.

[robysue]

Thanks, sorry, learning, new guy

It does indeed say Autoset. So that means there is leak data in there somewhere, correct?

Yep. On the LCD you'll be able to get at the 95% leak rate by getting into the long version of the Sleep Quality Report. If your 95% leak rate is reported as 7.5 L/min that means that for 95% of the night your leaks were AT or BELOW 7.4 L/min. And your leak rate was ABOVE 7.4 L/min for no more than 5% of the night. As a quicky way to think about the 95% leak number, you really want it to be (well) below 24 L/min since that's where Resmed says that the leaks are large enough to potentially adversely affect the efficacy of your therapy (and the accuracy of the data.)

But note that your AutoSet records full data. You have a record of each and every breath you take and the leak rate all night long. You have data about what's going on with the leaks all night long. You have data on when the machine is raising the pressure and why. To see this data, however, you will need to download it into either ResScan or SleepyHead.

[jbt1125]

Well OK! It's 5am and I just slept through the night with my nasal pillows! YEAH!

After reading the advice on here, decided to try that again. I dont want to get too excited yet, but at least for last night, it worked. No leaking, no pain from the tight full face mask. It hardly felt like the nasal pillows were even there. Woke up at 5am and couldnt go back to sleep. Display says 6.5 hours of sleep with AHI of 1.9.
A few other questions

1) Only downside is that I have MUCH more bloat/stomach discomfort than I did with the full mask. Is this normal? Any tips /tricks?
2) sleep center said to change the distilled water out every day...i.e. dump it out and add new... is that what everyone does?
3) sleep center said that when I travel I dont really have to take the humidifier, how big a difference does it make for a few nights away?

[kteague]

Congrats on a good night!

1) Will let someone who knows answer if they see a difference in belly air between masks. I've found position matters with me. Took a while to realize if I start my night on my left side I get more air. I have a hiatal hernia so my experience may not be the norm.
2) Some dump their water daily - many do not. I dump mine every few days - if I see it's not as clear, it smells "off" when I mask up, or see floaties. Years ago I had a humidifier chamber that almost never really needed changing. The last couple I have not been so lucky.
3) Use of the humidifier varies from person to person, climate to climate, season to season. Some don't use one at all. I prefer to take my travel machine which has no humidifier just due to ease. Have found I can only get by with that for maybe a weekend. Took a longer trip like that and mid trip couldn't use my CPAP because I got so dried out every breath felt like hot razors were slicing inside my nose - even without the machine. You might want to try it at home before planning to do that on a trip, keeping in mind the humidty level wherever you are traveling. Winter with hot dry heat requires more humidity for me.

[Shore Snorer]

Well OK! It's 5am and I just slept through the night with my nasal pillows! YEAH!

Congrats! Keep it up!

After reading the advice on here, decided to try that again. I dont want to get too excited yet, but at least for last night, it worked. No leaking, no pain from the tight full face mask. It hardly felt like the nasal pillows were even there. Woke up at 5am and couldnt go back to sleep. Display says 6.5 hours of sleep with AHI of 1.9.

SleepyHead will give you more data, and more ability to manage it.

A few other questions

1) Only downside is that I have MUCH more bloat/stomach discomfort than I did with the full mask. Is this normal? Any tips /tricks?
2) sleep center said to change the distilled water out every day...i.e. dump it out and add new... is that what everyone does?

I usually do, but not always.

3) sleep center said that when I travel I dont really have to take the humidifier, how big a difference does it make for a few nights away?

I got a very nice travel case with my equipment. It has one compartment for the S9 AutoSet, another for the H5i humidifier, and room for the hose, mask, and power adapter.

In the absence of a travel case, try running without the humidifier at home, before you travel.

ESSENTIAL TRAVEL TIP: If you bring your humidifier, be ABSOLUTELY CERTAIN to empty it before packing!!!

[jzap]

I hope you are getting used to your therapy.

I was very skeptical when the sleep lab tech started me off with a nasal mask during my second sleep study. She taught me that it really doesn't matter whether or not your mouth stays shut. The trick is separating your nasal passage from your mouth.

She showed me that if you put your tongue against the roof of your mouth behind your teeth, and pull it back slightly into the hollow of the roof of your mouth, it will kinda "suction cup" in place, and you can relax and it will stay there. With your tongue in this position, you can't breathe through your mouth, even if its wide open. While I trained myself to use this technique, I would loose the seal a couple times a night at first. The blast of air out the mouth would wake me up, and, I'd just reset. After a while, it got to the point that I only had to reset once or twice a week, and now, after a year, I haven't lost the separation in a couple months.

Try it, it may work for you.

[IrishSpike67]

I'm on my fourth mask

I'm on my 4th mask, too. I'm 3 weeks in, and decided before I started to give it 3 months before I decide it's too hard. For me, it's a path, not a destination.

No matter what problem you run in to, someone here will have experienced it too. Stick with it!

I'm on my second mask and it's the wrong size! I'm on my second Medicare Advantage Plan and they don't have a clue about Sleep apnea! I'm on my FIFTH hose and am looking to get a CARDBOARD cat!
Seriously, though, sometimes the problems with finding a mask that fits properly, hoses that don't get chewed within the first five minutes of unpacking them from the box they came in and other problems will make you want to go screaming into the street but the nights when you get complete rest and wake up feeling like a million dollars are so very, very worth it! We all have trials and aggravations with sleep apnea. I have sleep apnea, Type 2 diabetes, AND irritable bowel disease... think about how much fun that triple play is!! That's why I love posting advice and commiseration on boards like these. You're not alone, my friend. Hopefully, it WILL get easier.