Initial problems w/CPAP

sleepybigguy_30 · Post by **sleepybigguy_30** » Sun Nov 25, 2007 7:07 am

I am a heavyset person, BMI of 50 or 51. I snored loudly, enough to wake up rooms. I also woke up 3-8 times a night from either gasping or choking on bile or regurgitation or the need to urinate frequently. I remembered having a dream maybe once a month. Upon advice of friends, I went to an ENT. He explained these events are symptoms of sleep apnea and scheduled me for a sleep apnea evaluation.

The sleep apnea evaluation nurse was very friendly and helped me pre-fit a nasal mask and chinstrap before applying cold gooey gel and sticking 10,000+ electrodes on me. Then I went to sleep. The first part of the night (4 hrs) she studied my sleep patterns and the second part of the night (4 hrs), after I woke up for the 3rd time in 4 hrs to go to the bathroom, she helped me put the cpap mask on and turned the machine on "10" setting. It took me forever to get to sleep w/the mask on, it was so weird to have something on my face when sleeping. And I woke up 1 more time to urinate. The nurse turned the level up to "14" while I was sleeping. The study ended when my alarm clock rang and I left the sleep evaluation facility.

The ENT later told me I had 119 total apnea events per hour and mostly stayed in Stages 1 & 2 sleep w/out the Cpap machine, according to the evaluation. With the Cpap machine I stayed in REM about 50% so the ENT prescribed an apnea machine .

I have a Remstar Plus M Series machine @ "14" setting & humifier and am having several problems:

1. When I go to sleep, I usually fall asleep very quickly without Cpap. Now using Cpap, the mask doesnt bother me anymore. But, the pressure of the air and inability to breathe through my mouth is keeping me up "forever". It's ironic that I'm using this machine to fight apnea and I still can't get to sleep. Any solutions?

2. Thankfully, I am not having any gasping/choking incidents since using the machine. But when I finally do get to sleep despite the air pressure, I am still waking up several times a night to urinate. I am taking Diovan once a day for high blood pressure but I usually take the pill when I wake up so the side effect of urination shouldn't last throughout the day. Is my frequent waking up to urinate due to continued apnea incidents or just to a weak bladder?

3. I can deal w/the nasal congestion and dry mouth. But my ears always feel like they need to pop. My sinuses ache. And it's now an hr after last using the machine and my chest still feels "gassy" and tight. What's going on and is there any solution?

EdAPAP · Post by **EdAPAP** » Sun Nov 25, 2007 7:37 am

1. Going to sleep when you are getting used to CPAP can take some getting used to. One strategy is to lie down and get relaxed before putting on your mask. Get into a rhythm of feeling your abdomen rise and fall as you inhale and exhale. When you feel relaxed and getting sleepy naturally, then start your therapy. If you feel a strong urge to breathe through your mouth, ask your respiratory therapist to let you try a full face mask.

2. Nocturia is one of the side effects of OSA. One school of thought is that we feel the need to urinate because we are awakened by the apneas and then notice a full bladder feeling. However, if you were experiencing frequent nocturia before you started therapy, it could be related to your meds. Wait and see if the problem goes away when you start sleeping better.

3. You will adapt to the pressure after a few weeks. My sinuses felt tired but now I notice that I’m better when I wake up and my sense of smell is returning. If you wake up and are at your highest pressure setting, simply push the ramp button to go back to the lower start up pressue setting. I have very severe OSA and pressure setting of 18 cm. The first few weeks I woke up when the pressure maxed, but now I sleep through it. After a month I am feeling less bloated/gassy. My chest still feels tight, but less than a week ago.

Ed

DreamStalker · Post by **DreamStalker** » Sun Nov 25, 2007 8:21 am

Consider joining the forum big guy ... it costs nothing and you get to set up a profile listing your equipment. This is the best place for folks who want to get the best out of their apnea treatment.

The issues you are dealing with have been dealt with by several members here. At your relatively high pressure Rx, you may be a good candidate for an APAP with exhalation relief. We all go thru the tight/achy chest feeling ... your body needs to adjust to the treatment and it may take some time.

Depending on the mask they gave you, you may be leaking the pressure out of you mouth. For most, once treatment becomes effective with proper mask and pressure, the frequent trips to bathroom and your blood pressure will significantly decline. Hopefully you were provided with a heated humidifier and that too you will need to be adjusted for some of the other symptoms you have mentioned.

Again, do consider joining and you will have a really good chance to get your life back.

Best of luck!

allergyridden · Post by **allergyridden** » Sun Nov 25, 2007 8:33 am

Go to Walmart or local pharmacy & buy the Neilmed Sinus Rinse kit. It costs less than $20. If you use that every night it should help your sinus issues.
Many of us have had the tight feeling in the chest when we first start cpap. It should go away in a few weeks, if it doesn't talk to your Dr. It is common though.
I have the ear problem occasionally. The sinus rinse may help that too.
It has always taken me a long time to get to sleep, but it was even worse when starting cpap. Now after 3 months I fall asleep quickly. It really will get better.
You should have 3 settings for breathing relief on your machine. I have a Bipap M series, so it's probably different. Get out your manual & look up cflex, you may need to move it to the highest setting.
Good Luck!

Slinky · Post by **Slinky** » Sun Nov 25, 2007 8:37 am

SleepyBigGuy, how long have you had your Respironics M Series Plus? IF a month and a half or less, I would go back to your DME supplier and request that they upgrade you to a Respironics M Series Pro w/C-Flex. Your humidifier will not need to be exchanged as both the Plus and the Pro use the same humidifier. Explain the difficulties you are having.

The Plus provides compliance data only. That does NOTHING to help w/the problems you are having. The Pro will provide the data needed to help determine why these problems are occurring and IF your pressure needs to be adjusted up or down or if the C-Flex needs to be utilized and if so at what setting. Your ENT needs this information if he is going to monitor your therapy and have any idea at all of what adjustments need to be made.

Or you might want to start w/your ENT. Explain to him the problems you are having and that your DME provided you w/a compliance data only CPAP and you are SURE that he is going to want the full data the Pro is capable of providing to assist him in monitoring your therapy so that he can make any adjustments necessary instead of having to make any adjustments by guess and by gosh. Ask him to rewrite your equipment order for the Pro.

Also, have you seen a gastroenterologist or been scripted medication for reflux by your family doctor? If not, you certainly should!

I am guessing that you most likely do not need quite so high a pressure as 14 cms given your symptoms. Basing your pressure needs on a one night titration is difficult enough when it is based on only one full night of sleep in strange surroundings w/all kinds of attachments, it requires even more skill - and luck - when the titration is based on a split night study and only 1/2 a night of sleep.

The other option is to request that your ENT order a 2 week loaner autoPAP. In this case, since you already have a Respironics M Series humidifier it should be a Respironics M Series Auto Pap w/C-Flex (or A-Flex). Two weeks of data from the Auto combined w/the data from your titration session should better indicate what pressure you need for adequate CPAP therapy.

Either way, you do not want the Plus since it can't provide any data useful for your therapy. You want AT LEAST a Pro with its full data capability.

I would also request a copy of not just the dictated results (about 1-2 pages) of your split night study but also the full summary data report (about 5-6 pages w/a few graphs) of that split night study and of your equipment order (and amended order if your ENT will order the Pro for you).

What mask are you using? Are you using a chin strap as you did during the titration portion of your split night sleep study? If not, and it worked for you, you definitely want one. BUT, meanwhile you can cut the leg off of one of your wife's panty hose, preferably the opaque "tights", but either will do in a pinch and tie that around your chin and head to keep your mouth closed so you are not mouth breathing and losing most of your therapeutic pressure out of your mouth. You might want to adjust the setting on your humidifier to produce a little more humidity to help clear the stuffiness in your sinuses. You can also try some nasal irrigation or saline nasal spray to help clear and keep your sinuses clear.

Your chest feeling "gassy" and tight indicates you are swallowing some of that air pressure (its called aerophagia). The "full" ears needing to pop might be relieved the same way you do when it occurs while in an airplane or in the mountains. But MAY be an indication that your pressure is set to high. Often this will stop over time and you consciously and unconsciously adjust to the air pressure. But if it continues long term it can indicate a problem and possibly cause some damage.

30 days is more than a fair trial w/these problems and you should see your ENT regarding them no later than 30 days but at least 2 weeks after starting CPAP therapy.

This is just my opinion. I am not a medical professional, just a patient like yourself for the past year. But this is the way I would handle the situation.

sleepybigguy_30 · Post by **sleepybigguy_30** » Sun Nov 25, 2007 9:12 am

I've only had the machine for a few days. I'll contact my ENT tomorrow re upgrading the machine to fully track my sleeping/non-sleeping events. Thanks for the advice!!

ozij · Post by **ozij** » Sun Nov 25, 2007 9:44 am

It your breathing non/breathing events, sleepybigguy. No cpap machine we use at home can really track our sleeping non/sleeping, so make a point of wanting to track your breathing non-breathing, and the treatments impact on that.

Welcome to the forum - and good luck

O.

DreamStalker · Post by **DreamStalker** » Sun Nov 25, 2007 9:48 am

ozij wrote:It your breathing non/breathing events, sleepybigguy. No cpap machine we use at home can really track our sleeping non/sleeping, so make a point of wanting to track your breathing non-breathing, and the treatments impact on that.

Welcome to the forum - and good luck

O.

... and tell them you are having a difficut time breathing against the pressure and that an AFLEX machine will most likely be the best machine for you even if it is only set for 1 or 2 cm range about your titrated pressure.

Good luck!