New User – First Night!

[Lauperfan]

First night ... and it was horrible.

I have the Respironix APAP machine with the Airfit P10 nasal pillow mask. Five years ago, I tried this darn CPAP and it utterly failed (or I failed). I simply could NOT sleep after a solid month. My sanity couldn't take it.

Five years later, I'm still choking in my sleep and driving my husband mad, so I got the "newest and best" machine, according to the technician. While it was much better than the previous mask in terms of fit, I found that it was difficult to ONLY breathe in and out through my nose. Breathing out was harder (the resistance), and every time I opened my mouth, it was so jarring that I could NOT sleep at all.

How do I address this? What am I doing wrong? My technician said her husband has the exact same machine and Airfit that I do, and it took him 4 months to get used to. I can't imagine spending the next 4 months like last night.

Extremely discouraged

[R1200ST]

Welcome to the forum. Lots of information but the long time members here are going to ask you to post your mask, machine and specifications of your settings so they can help out.

I just recently moved from a Full Face Mask (FFM) to a nasal pillow and it has been great. I have a severely deviated septum and multiple sinus issues, so if I can do it I am sure you can too. Work with this group to find the right mask, the right settings on your machine and you will see great results.

You found the right place. You will be fine.

good luck.

R

[n2it]

I agree with R1200ST's post. This forum has some very good "experts" who I am certain can assist you. I am only familiar with my own machine but it has a setting, EPR, that can be manipulated to address the issue that you have described (I had the same problem but when they adjusted this setting, I was able to exhale with no further issues). I am certain that someone on here will know how to address your issue. Don't give up! I suffered untreated for years with severe SA and the CPAP therapy has been a Godsend. The mask is also critical. Personally, I went through 5 different masks before settling on the Dreamwear Under Nasal Mask (and I love it). That being said, I am not a "mouth breather" so it works perfectly for me. I did not like the P10 but numerous users on this board use that mask and prefer it. Somebody will come to your aid. Good luck!

[Pugsy]

What are your pressure settings?
Are you using the ramp feature?
Are you using the Flex exhale relief? If so which one and at what setting?
What size nasal pillow are you using?

[PEF]

I can really relate to the "mouth" issues. Through my limited PAP experience so far, I am realizing what a notorious mouth breather I am. For over 20 years, I had severe MISDIAGNOSED (by doctors) allergy problems. It turned out in the end there were 2 problems causing these issues, that were not related to allergies. One was a parathyroid adenoma that I had simple surgery to fix 3 years ago. For over 15 years, my doctors missed it even though I was seeing an Endocrinologist. After the surgery, my so-called allergies cleared up about 70%. But I knew there was something else going on. The other issue is my UARS that is causing allergy symptoms that are NOT allergies. I am on track with PAP to solve that also, but having a hard time. I think it is because my brain got so used to breathing through my mouth for so long. Now, my nose is about 80% clear, enough to only breathe through it, but my brain is just so used to breathing through my mouth after I fall asleep. At least that is my theory. Even taping my mouth shut doesn't work because the air gets into my mouth and my cheeks billow out, waking me up. So at least for now, I have to have a FFM. My plan is to use the FFM until I can train my brain to go back to pillows. The problem for me is my small face and recessed jaw. I have a Airfit F10 on order and I hope it works.

[sventory]

PEF How long were you sleeping horribly for? I am on about 3 months of 0-3 hours per night, it's really really difficult on me. Do you sleep better than that before PAP? And how long have you been using PAP and has it helped any? or just not possible yet because you aren't used to it?

[PEF]

I have only had my PAP for about 6 weeks, but because I have not yet found a mask that does the job, I can't really say if it is helping or not. The first FFM did not fit at all and the 2 nasal masks are very comfortable, but my mouth opens when I fall asleep. So I have not really had any therapy yet.

I have had really bad insomnia most of my life and dealt with it with mild antidepressants and on/off sleeping pills. Now, I can't take these much anymore because they seem to make the sleep apnea worse. I seem to go through cycles where for awhile it is not quite so bad, but then it gets bad again. My husband has often seen me choking in my sleep and then apparently going back to sleep. I don't remember these episodes. So I feel that I need to make the PAP work because I do not want to have some type of surgery.

I know this probably does not help much because I am so new. If you PM me, I can let you know what happens when I get my new mask and how things go. Your issues sound a lot like mine.

[lauperfan911]

Wow! I'm overwhelmed and grateful by the replies. Thank you! Apparently, I have a lot of self-educating to do. I don't understand half of the acronyms people are using, so sometimes the messages are a little confusing.

I did research on my settings, so here it goes:

Philips Respironix System One with Heated Humidifier
REMStar Auto A-flex
Nasal Airfit P10 (nasal pillows, size small)

When I press "Therapy," here is what I see:
4.0 cmH20, Humidity 2
A-flex: 3 (I set this to 3 because I thought it would let me breathe out through my nose with less resistance. True?)
AHI: 2.7 (I don't know what this stands for.)
90% (Again, I don't know what this refers to.)
Pressure: 8.0 (Pressure of what?)
Humidifier: 60w, 22, 2 (No clue what these values mean.)
Tubing type: 22 (No clue.)

Any thoughts on these predetermined values for my machine? Thank you!

[LSAT]

Wow! I'm overwhelmed and grateful by the replies. Thank you! Apparently, I have a lot of self-educating to do. I don't understand half of the acronyms people are using, so sometimes the messages are a little confusing.

A good place to start... http://www.sleepnet.com/definition.html

[Pugsy]

4.0 cmH20, Humidity 2
A-flex: 3 (I set this to 3 because I thought it would let me breathe out through my nose with less resistance. True?)

Your pressure is starting out at 4 cm and probably is set to 20 max. It won't go up from 4 cm until you are sleep and apnea events drive it up.
AFlex at 3 is the least amount of resistance but only up to 2 cm and that depends on how forceful you breathe but here's the problem...it doesn't even get enabled until the starting pressure is 6 cm so you aren't really getting any reduction at 4 cm.
I would like for you to try something while awake and not under any stress...change that 4 cm to 6 cm.
If you don't know how
http://www.apneaboard.com/pr-system-one ... structions

Humidifier: 60w, 22, 2 (No clue what these values mean.)

You are using a non heated 22 mm diameter hose with humidity set to 2 (which without the heated hose is actually a low setting).
If you want a heated hose you have to get an upgrade kit because it needs an 80 watt power brick, heated hose and a special lid on the humidifier. Available in a kit that is easy to hook up.

90% (Again, I don't know what this refers to.)
Pressure: 8.0 (Pressure of what?)

90 % pressure means for the pressure was at this pressure (8.0) OR BELOW for 90 % of the night.

AHI: 2.7 (I don't know what this stands for.)

Per hour average of all your apnea events added together. You need to use the software to see what kind of events they are.
https://sleep.tnet.com/equipment

What I didn't see listed was % of time in large leak...did you see any sort of leak number %?

Set the pressure to minimum of 6 cm with AFlex set to 3 and let's see if it's easier for you to inhale and exhale at those settings.
If that doesn't help...then try adding the medium size nasal pillow.

If you are going to hang around the forum why not register and add your equipment to your profile like I have min. Helps us help you faster when we have an idea what you are using without having to ask each time.
wiki/index.php/Registering_Equipment_in_User_Profile

[Lauperfan]

Thanks, Pugsy (and everyone) for the additional information. I'm not sure I want to mess with the predetermined settings established by the doctor. My main concern is that my choking/snoring is reduced or eliminated. Aside from my husband telling me the next morning, should I just check the AHI indicator every day?

Last night was just a little better than the night before. I think I slept maybe 4 total hours, but was kept awake or awakened by the nuisance of the foreign stuff on my face and the tubing when I tried to move around. On the bright side, my cat still slept by me the entire time.

[Pugsy]

Use the software to see if the snoring is reduced...snoring shows up on the events graph and doesn't show up on the machine's LCD screen because it isn't part of the AHI.

If you still have trouble with inhale/exhale...at least try what I suggested because you aren't getting any benefit from AFlex right now.
Do it while awake...if it helps and you are leery of sleeping with the change call up your doctor or DME and explain things.
They likely have set it wide open..4 minimum to 20 maximum and it's a rare doc that gets upset if you increase that minimum just a little...they are already okay with the machine going to 20.

A lot of people feel like they are suffocating at such low pressure.
Even my titration sleep study started out at 5 cm.
Give it a try while awake just to see if it helps or not. Won't hurt to just try it to see. Then if it does help just call up the DME or doc and tell them you want to change things if you are uncomfortable doing it on your own without their official approval.

Or...try the medium size nasal pillow...the openings are a little larger and it will move the air a little better.

[Lauperfan]

Thanks, Pugsy. I actually didn't have any trouble breathing in and out through my nose last night, so I believe changing the flex to 3 was a big help. Wouldn't that be the benefit of the Flex? The ability to breathe in and out easier?

[Pugsy]

If your pressure last night was 4 cm...you weren't using AFlex at all while it was at 4 cm...now once the pressure maybe got up to 6 cm (or more) then AFlex kicks in but AFlex is disabled until the pressure is 6 cm or more.

So when you started the night and if the pressure was 4 cm ...you couldn't have been feeling the effects of AFlex...There is no reduction available when the pressure is 4 cm because 4 cm is as low as it will go.

[Lauperfan]

So I shouldn't be using the prescribed settings??