First Few Nights

WellPlayed · Post by **WellPlayed** » Fri Mar 03, 2017 8:18 am

Hello fellow people who want to sleep good and learn how to do other things good too.

Recently diagnosed with sleep apnea. 29 year old male, 5'11, 175lbs.

On my initial sleep study I did not sleep alot, but in the few hours I did get AHI was 15, which I was told is borderline "moderate" sleep apnea.

Returned for another sleep study with CPAP. Was given nasal mask only, and was told I wasn't opening my mouth during the night so no need to try another mask. Got an RX from the doc for CPAP with data - I ask for an APAP, but the doc says 5cm of pressure completely clears my apnea which is very low, so there is no need for an APAP. I'm in Ontario where we get 75% through government run ADP. My benefits through work are really good, so I would have been happy to pay any extra, but was told this can't be done. Classic example of the government trying to help and making things worse. I begrudgingly accept the CPAP.

I pickup a Resmed Airsense 10 Elite with heated hose. I opt for the P10 nasal pillows as the nasal mask during the sleep study left a nasty mark on my nose that actually got infected.

First night: I sleep for about an hour and a half with the mask on. Feels like I can't get enough air. Try to get back to sleep for an hour then bail on the mask. AHI 0.68, although I realize that probably doesn't mean much over an hour and a half. Humidifier was set to 4, ramp was on but again my pressure is only 5cm, so not much to ramp to.

Night two: I switch to the "Large" pillows after reading it can help the feeling that you aren't getting enough air. Much better. I fall asleep easily and am almost immediately awakened by my mouth dropping open and air streaming out. This happens about 10 times over 3-4 hours until I wake up with mouth/throat so dry I go into a coughing fit - finally rip the mask off and sleep without. So much for being able to sleep with my mouth closed. Humidifier was set to auto.

Night three: I use an elastic bandage as a chin strap to try and keep my mouth closed, up the pressure to 6cm and turn the ramp off. Kept the mask on for a full 8 hours. Slept decently, but can remember waking up a few times almost gasping for air and feeling like I couldn't get enough through the mask. I'm wondering if these were apneas? Calmed myself down and went back to sleep each time. Woke up feeling pretty decent - bit of a hoarse voice. My girlfriend told me I was actually snoring a bit once when she woke up, which surprised me.

Stats from night three:

AHI: 3.26

Clear Airway 0.38
Obstructive 1.38
Hypopnoea 1.50
RERA 0.88

Total time in Apnea: 5:42

Questions:

If I wake up feeling like I'm suffocating and out of breath, and can't get enough air, is this likely OA?

I was surprised to hear I was snoring, and that my AHI was 3.26 at 6cm when during the study 5cm cleared everything. I tried to make the chin strap so that it was pulling up, not back on my jaw, but is it possible that chin strap changed my jaw position and made my apnea worse?

Ideally I would like to get that AHI number lower, but I realize it's only one night. Should I play with the pressure? I have a follow up with the doc in a month. Not supposed to be playing with the pressure etc. But I don't really care.

Pugsy · Post by **Pugsy** » Fri Mar 03, 2017 8:37 am

WellPlayed wrote:I tried to make the chin strap so that it was pulling up, not back on my jaw, but is it possible that chin strap changed my jaw position and made my apnea worse

Very possible.

WellPlayed wrote:If I wake up feeling like I'm suffocating and out of breath, and can't get enough air, is this likely OA?

Maybe..maybe not. Next time it happens reach over and turn the machine off and back on again so that there will be a break in the therapy line that you can look at using the available software
https://sleep.tnet.com/equipment
You can find the break in therapy and look to the flow immediately preceding it to see if anything was going on in terms of apnea events or flow reductions.
It's possible to have the same feeling if the nasal pillow gets a bit wonky...I have done that myself.

WellPlayed wrote: Ideally I would like to get that AHI number lower, but I realize it's only one night. Should I play with the pressure? I have a follow up with the doc in a month. Not supposed to be playing with the pressure etc. But I don't really care.

I don't know if you should play with the pressure or not. 5 or 6 cm sure isn't much and increasing it slightly is unlikely to cause any problems other than getting your hands slapped.
Most people find that there isn't enough air movement for comfort at those lower settings. Very similar to what you experienced with the smaller nasal pillow. We won't suffocate at those pressures but it can sure feel like we are.

Someone reporting snoring usually means that the airway is at least collapsing somewhat. Now it may not be collapsing totally or enough to earn an apnea flag...and that means the pressure is not quite holding the airway open well enough.
Especially if using the chin strap seems to cause the jaw to go backwards a bit and narrow the airway even more.

Do you have the software yet? If not, get it and start using it.

WellPlayed · Post by **WellPlayed** » Fri Mar 03, 2017 9:10 am

Thanks for the reply!

I am using Sleepyhead yes. Sounds like 6 wasn't quite enough for my airway with the chinstrap, I think I'll try 7 tonight.

OkyDoky · Post by **OkyDoky** » Fri Mar 03, 2017 9:15 am

You might also try a cervical collar instead of the chin strap and see if it controls the mouth breathing with more comfort. Sometimes just a little reminder helps keep the mouth shut.

ChicagoGranny · Post by **ChicagoGranny** » Fri Mar 03, 2017 9:21 am

WellPlayed wrote:Classic example of the government trying to help and making things worse.

Classic for sure. CPAP-wise, I have left my government program (Medicare) and will pay for all of my own stuff. There are excellent deals on APAPs and accessories. Screw Uncle Sam and the horse he rode in on.

Pugsy · Post by **Pugsy** » Fri Mar 03, 2017 9:30 am

WellPlayed wrote: I ask for an APAP, but the doc says 5cm of pressure completely clears my apnea which is very low, so there is no need for an APAP. I'm in Ontario where we get 75% through government run ADP. My benefits through work are really good, so I would have been happy to pay any extra, but was told this can't be done. Classic example of the government trying to help and making things worse. I begrudgingly accept the CPAP.

Yeah...that's the mindset of a lot of doctors here in the US and in Canada where you are. Ontario ADP seems especially tough to get an APAP from. This isn't the first time someone has come here with those frustrations.
Not much you can do except remember that if you ever decide to buy your own machine you can get that APAP.
If you ever want a back up machine (good thing to have anyway) you can either buy from someone privately (we have some forum members who might have APAP for you) or you can go to secondwindcpap.com and check out what they have.
They won't require a RX for an APAP to sell you an APAP.
APAPs are cpaps...it's just they have that extra mode available for the auto adjusting pressures and while you may not "need" those auto adjusting pressures at the moment...you might later.

Julie · Post by **Julie** » Fri Mar 03, 2017 9:33 am

I think the suffocation was most likely just a matter of your low pressure being set too low, nothing nefarious.

Okie bipap · Post by **Okie bipap** » Fri Mar 03, 2017 10:49 am

ChicagoGranny wrote:
WellPlayed wrote:Classic example of the government trying to help and making things worse.
Classic for sure. CPAP-wise, I have left my government program (Medicare) and will pay for all of my own stuff. There are excellent deals on APAPs and accessories. Screw Uncle Sam and the horse he rode in on.

Some times I think about pulling the plug Medicare, but right now it looks like my wife may need to get an ASV machine. These things are not cheap, so I will continue to use my Medicare for now. When I first started treatment, it was no problem using Medicare. I had a very good local DME that took Medicare. They lost their Medicare contract last July. I have since switched to an online DME that accepts Medicare, and so far have not had any problems with them. I will find out more in about a month when we actually order a machine for my wife.

ChicagoGranny · Post by **ChicagoGranny** » Fri Mar 03, 2017 11:44 am

Okie bipap wrote:Some times I think about pulling the plug Medicare, but right now it looks like my wife may need to get an ASV machine.

Good luck with that. Most deals I have seen on lightly used ASVs still are a good chunk of money. Your wife is owed some help from Medicare.

WellPlayed · Post by **WellPlayed** » Sat Mar 04, 2017 9:37 am

Thanks to everyone for the replies!

Upped the pressure to 7 last night. No waking up feeling like I was suffocating. AHI down to 1.44, with 0.26 obstructive.

I think I spent quite a bit more time on my side last night as well, which may have helped. My apnea is pretty much on my back only. I also loosened the chin strap significantly. Did have 2 large leaks - wondering if it could have been mouth dropping open. Waking up alot, still getting used to it I think. But overall a much more comfortable sleep.

Pugsy · Post by **Pugsy** » Sat Mar 04, 2017 9:46 am

It took me several weeks to not have several wake ups just because there was something new on my face.
It takes a while for the brain to come to grips with the alien on the face.
Glad you did better last night with the slight increase in pressure.

WellPlayed wrote:Waking up alot, still getting used to it I think.

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