New to CPAP (long post)

[Jason S.]

Hello. This is my first post. Sorry it's so long. I was recently
diagnosed with moderate sleep apnea, severe while sleeping on my back.
I've probably had it for many years, as my wife has complained about my
loud snoring. Thankfully she is a heavy sleeper. I was only alerted to
the problem in the last 6 months when I woke up suddenly gasping for
air, which was scary. This always happened while back sleeping, in a bed
or in a recliner. Most of the time I slept on my side, so I wasn't aware
of it happening very frequently. But occasionally I rolled onto my back.


So after two all-night sleep studies, one for testing and one for
titration, I bought a CPAP machine which is set to a pressure of 8 and
the Respironics Series M Confort-Gel full-face mask with heated
humidifier. I have a deviated septum and inflamed turbinates which have
resulted in longtime sinus problems, mainly bad headaches and
congestion. I only mention this because I have found relief from morning
headaches since using the machine. This may be due to the humidifier
aspects of the machine, and not the sleep deprivation part, or maybe
from not sucking in dry air through my mouth. In winter dry months, if I
didn't sleep with room humidifier I noticed my sinus problems were much
worse.

I've used the machine for about 210 hours, or about 35 six-hour nights.
Not all of these nights have been continuous however, because I stopped
using the machine on three occasions because I developed a painful nose
bridge ulcer. I started using a small fabric bandages and also loosened
the strap on the upper part of the mask. Thats seems to have helped, or
else my nose has just toughened up. I have a dented bridge (result of
deviated septum) and have always had a problem wearing eyeglasses. They
hurt my nose bridge after awhile. In the first few mornings after use I
had A LOT of gas and bloating, but that seems to have abated recently.
Has it abated because my body has become acclimated, or has the machine
stopped working for me? Anybody else experience this? If anyone has had
a colonoscopy where they pump you full of air, I would equate the
feeling to that.

I have definately noticed a reduction in afternoon sleepiness since
using the CPAP. I used to get very tired about one hour after lunch and
had to fight off dozing at my desk, a battle I sometimes lost. I also
would often fall asleep watching TV in a recliner as early as 8-9pm at
night. That semi-reclined position would soon lead to total closure of
my airway, causing me to wake up very suddenly with a start. Not a good
feeling. I would describe my sleep in general as "hard". I can't say I
woke up rested but I wasn't extremely tired either. I was, and still am,
sleeping only about 6 hours per night, but I'd like to think I'm getting
more REM sleep now. I feel like I had a little energy boost after about
the third day, including more refreshed on awakening, but unfortuneately
I had to stop then because of the nose ulcer. I guess its been
diminishing returns since then, with regard to the energy boost-morning
freshness, but as I've said I am less sleepy after lunch and even better
have had a huge reduction in morning sinus headaches, which I often took
sinus medicine for relief.

I feel like I have a problem with memory recall. I haven't seen any
improvement in that area. Do I need to wait longer for possible benefits
of energy boost, memory recall, alertness etc..? I have noticed that I
remember my dreams more and I also have had a reduction in acid reflux,
though I might attribute this to switching from diet soda back to
regular soda. I tried diet soda to lose weight. I didn't lose any weight
but my acid reflux got worse. I read that diet soda is worse than
regular soda. I am 53 years old. At 6'2" and 200lbs most people wouldn't
consider me overweight, but I've gained about 20 lbs in the last year
which has all gone to my gut. I don't consider myself as "fit". I've
gone up one waist size already and now that is too tight. I need to
start exercising more and get back on that treadmill.

One question I have is my setting for air pressure is 8, with a ramp up
from 4. I never notice the ramp up, but can hear the air pressure
difference when I start the machine and stop it, so I know its working.
However, I find myself sleeping on my back more now, because when I roll
onto my side the mask hits the pillow and is up against it, so it gets
moved out of position and results in leaks. So I gravitate towards back
sleeping which for me results in severe, not moderate sleep apnea.
Should I be concerned my machine is not set high enough?

Because of my sinus/septum issues I think I am a mouth breather while
sleeping. I used to soak my pillow with saliva. But after putting on the
mask I always breathe through my nose and keep my mouth closed. I
suspect that after I fall asleep my mouth opens and I become a mouth
breather. I always awaken with a dry mouth and still am, even with the
humidifier and the mask covering my mouth.

Another question is with the leaks. I wake up many times during the
night to adjust the mask. But I wonder that I might have a small leak
and not wake up, in which case the machine isn't working and I am
wearing the mask for nothing. I guess some leakage is expected (since it
always comes out the emergency nose hole anyway). So too tight causes a
nose ulcer and too loose causes leaks. I guess the Comfort-Gel mask is
designed to create a seal around the face. Perhaps the fabric bandaid
and beard stubble interfere with that? Someone else described their
nightly issues as "mask karma" and I guess that about sums it up for me
as well.

I use distilled water and set the humidifier at 3, because that is the
middle setting and the therapist didn't provide any guidance for me. I'm
not really good at cleaning, but I wash the plastic liner (the part that
touches the face) every few nights with dish soap and warm water.
Anybody know about those Citrix mask wipes? I wash the blue gel part
less often because when its gets wet it absorbs water and doesn't dry
easily. I rinse the hose with warm water every two weeks or so. It
doesn't get dry so I run the machine air through it for 60 seconds or
so. I'm sort of flying by the seat of my pants here. My health care
provider does provide replacement parts, but only after I've met my
deductible and then I think its only 75%.

Again, I apologize for the length of this post. It won't happen again.
Please feel free to offer suggestions or respond to any part of my post
that you have an opinion on. Thanks.

[RipVW]

Hello & Welcome, Jason S.! Glad you found this forum--SO much useful info and everyone here is so willing to help!

Sounds like you discovered your sleep apnea exactly as I did--my wife observed me not breathing a couple of times, and I awoke gasping for air two or three times--that prompted a trip to doc followed by a sleep study.

Re pressure, I used my titrated pressure of 8 for 18 months before finding this forum. Got not good results from that low pressure. Learned about data, saw a consistently high AHI (average 12), got an APAP, found my sweet spot for pressure (around 12), and things have been great ever since.

I use a CPAP pillow (from cpap.com) to help with side sleeping without disturbing the mask. Works for me.

Here's info from one of our trusted old timers, good advice for all:

Knowledge is power, so get busy

Watching this will help -
http://www.resmed.com/en-au/clinicians/ ... 40x380.swf

Start at the Yellow Lite bulb - Our Collective Wisdom found at the top of the page at http://www.cpaptalk.com
our-collective-cpap-wisdom.php
new-cpap-user.php

If you've been reading - do you have your PSG? Use the software?

Watching this will help -
http://www.resmed.com/en-au/clinicians/ ... 40x380.swf
http://www.resmed.com/en-us/patients/un ... 40x380.swf
http://www.nbc.com/Saturday_Night_Live/ ... -2/742141/

take a breath, put on your reading glasses and get comfy
there is NO wisdom pill
and one size does NOT fit ALL
Faces are like fingerprints

Reading this will help -
For Acronyms & Definitions
http://www.sleepnet.com/definition.html

Where A CPAP Newbie Should Start
viewtopic/t35702/Where-A-CPAP-Newbie-Should-Start.html

READ cpaptalk.com FAQ
faq.php


Learn to search
use Google & the syntax "search words" site:http://www.cpaptalk.com
or the Advanced Search at the top of each page.
or here - viewtopic/t35702/search.php

This is the Yellow Lite bulb you'll hear people mention aka "Our Collective Wisdom" -
our-collective-cpap-wisdom.php


Read some more.
Good Luck,
GumbyCT

"You are getting sleepy . . ."

[swcompassionate]

Welcome to the forum Jason. I am glad that you have had such good early success. Still working on mine. I am also glad that the CPAP has provided relief from your sinus headaches. In terms of the humidifier, my DME informed me to start out at 2, the standard humidification level and play with it form there until you feel comfortable. If three is helping you and you are not getting rain out, water dripping on your nose then stay at 3. If you have a pillow mask, which I am not sure yours is, then maybe it is time to get another set of pillows. I think I can get my pillows changed once a month or once every three months, I do not remember. I was also going to suggest the CPAP pillow. I do not have one but I sleep fine on a pillow with a lot of loft for side and back sleepers. I have a been a side and stomach sleeper all my life, back is awkward for me. In terms of getting away from sleeping on your back search for back sleeping for some posts/threads. I know different people have posted about this issue. Keep up the good work and you will find lots of helpful information and support here.

Maria

[CorgiGirl]

Hey, Jason...glad you're here.

I have just a couple of comments. I had similar problems with the bridge of my nose and solved it by going to a different size of the mask I like best. Unless you're already using the largest size of your mask, you might try a larger size. If you are using the largest size, you might try a different mask. I went through about 10 before settling on the Flexifit 432. I think the 432 works well for people who have bridge of the nose issues, so you might give it a try.

I assume that you have a Respironics machine since you're using the term "ramp." (Resmed uses a different term, but right now I don't remember what it is....) If you do have a Respironics, I believe you have to hit the ramp button in order for the ramp to start -- it doesn't automatically start at 4cm. At least my M series machine doesn't. Anyhow, 4 is awfully low. My machine as originally set at 5 and I found it suffocating. My current pressure range is 10-20 with the ramp at 8. I've gotten so used to 10 that I never use the ramp anymore. But the ramp was very helpful in the first few months when I was getting acclimated.

Cleaning habits vary widely among the board folks. I use the Citrus wipes every day and they work pretty well for me. I rinse out the humidifier chamber occasionally and almost never clean the hose. I do change the fine filters once a month and wash out the gray filter then, too. My husband also has a CPAP and he never cleaned his stuff, ever, in 5 years. Of course, he didn't have a humidifier then.

Please fill out your profile with your equipment info so we can help you better.

Hang in there! You're doing well.

[Georgio]

I second the ramp setting of 4 is very low. I am titrated at 8 also and the following are my numbers:

Titr.Press.=8,Settings: Low=7,High=12,Ramp=7. It's different for everyone, however you will probably find a higher ramp will be better.

Georgio

[Jason S.]

Hi, Thanks for the response. I posted my equipment. I start at 4 because that is what the therapist told me to do. I am not aware of any adjustments I can make to my machine. The only buttons she told me to push were ramp (4) and on/off (8). I believe the ramp takes 20 minutes to reach 8. I don't even notice it, or else I am asleep by then. If I remove the mask to go to the bathroom and return, its still running at 8 and I have no problem getting back to sleep. I could probably start at 8 without any issues if that is important.

Others have mentioned machine readouts and feedback on their sleeping habits, air leaks, etc. I don't have that, do I? And I left the software field blank. Last night I made an effort to sleep on my side. I had a long dream and felt a little more rested this morning. Last night before bed I shaved and didn't wear the bandaid over my nose. I thought this would help reduce air leaks. So bottom line I feel like last night's sleep was good, but I'm guessing.

Hey, Jason...glad you're here.

I have just a couple of comments. I had similar problems with the bridge of my nose and solved it by going to a different size of the mask I like best. Unless you're already using the largest size of your mask, you might try a larger size. If you are using the largest size, you might try a different mask. I went through about 10 before settling on the Flexifit 432. I think the 432 works well for people who have bridge of the nose issues, so you might give it a try.

I assume that you have a Respironics machine since you're using the term "ramp." (Resmed uses a different term, but right now I don't remember what it is....) If you do have a Respironics, I believe you have to hit the ramp button in order for the ramp to start -- it doesn't automatically start at 4cm. At least my M series machine doesn't. Anyhow, 4 is awfully low. My machine as originally set at 5 and I found it suffocating. My current pressure range is 10-20 with the ramp at 8. I've gotten so used to 10 that I never use the ramp anymore. But the ramp was very helpful in the first few months when I was getting acclimated.

Cleaning habits vary widely among the board folks. I use the Citrus wipes every day and they work pretty well for me. I rinse out the humidifier chamber occasionally and almost never clean the hose. I do change the fine filters once a month and wash out the gray filter then, too. My husband also has a CPAP and he never cleaned his stuff, ever, in 5 years. Of course, he didn't have a humidifier then.

Please fill out your profile with your equipment info so we can help you better.

Hang in there! You're doing well.

[CorgiGirl]

Mornin'

Monitoring your therapy with data is a good thing, but I believe the machine you have is not data capable. (Someone here will correct me if I'm wrong...) Without the software and the data capable machine, I'd have never been able to figure out what my optimal pressures are. If I were you, I'd go back to my DME and make them give me a Pro or better.

It is possible to change the settings on your machine. I'm not sure how the Plus works, but someone here probably has access to the clinician's manual and can help you with that.

I'm glad you are feeling better this morning.

[Jason S.]

I don't have the PLUS. I just selected that one because my machine is not on the list. It just says REMstart M Series. Nothing else. The referenced software is Encore Plus. The ramp feature is only adjustable by the provider. They didn't allow me to adjust it, although I think the machine is capable.

My readings are:

222 hours of therapy
233 hours of use (had machine on 11 hours, didnt turn off after I removed mask)
34 sessions
10365 compliance check value view system??

Does that help?

Mornin'

Monitoring your therapy with data is a good thing, but I believe the machine you have is not data capable. (Someone here will correct me if I'm wrong...) Without the software and the data capable machine, I'd have never been able to figure out what my optimal pressures are. If I were you, I'd go back to my DME and make them give me a Pro or better.

It is possible to change the settings on your machine. I'm not sure how the Plus works, but someone here probably has access to the clinician's manual and can help you with that.

I'm glad you are feeling better this morning.

[TheDreamer]

Welcome,

I used ramp a few times the first couple of nights, but after that I've never used it again.

The RT has set mine to start 4 and take 45 minutes....I found that I would lay there waiting for the 45 minutes to go by. It didn't take that long to adjust to the 7, and then sleep. And, then there were nights where I had trouble feeling the pressure and questioned whether it was working. Which I would test by opening my mouth to see if air comes out. I was thinking of turning C-Flex down....however that will have to wait.

I got the sore on the bridge of my nose thing, except it turned into a staph infection and now I'm on doctor's orders to not use my CPAP for while (and a two week course of doxycycline). I have a different mask lined up to try once I'm allowed to again (I'll update my profile after I'm actually using it).

I now use Citrus wipes for daily mask cleaning....find it easier than taking the mask apart every day to wash in a bowl of hot water and baby shampoo. (especially on the days where I forget to do it before I go to work and then the long wait for it to air dry....I seem to remember to wipe the mask each morning.) I'm not sure if I'm over doing it, but I cut a wipe into quarters.... I fill my humidifier with distilled water, which I top up each day (usually because I forget about it until just before I nod off) On the weekend, when I wash the headgear and such...I pay a bit more attention to the tank and its been just a quick rinse and let it dry out.

I only cleaned my hose once (so far)....it didn't dry out afterwards, so I had to use it that way. Now it is tied up to go up and over to my pillow, has a hose cover on it and a reptil heater along it....so it would be a bit more work to clean it. Plus the DME says I get a new hose every 3 months.

I wash the gray filter as part of my weekend CPAP cleaning routine....it hasn't been 30 days yet, so I'm still on the first white filter....though I'm starting to wonder if the DME will call me or what? Of course, I haven't used the machine since Friday (though I still cleaned it on the weekend).

So far when I've had a bad mask leak at night, I've woken up. (usually because my sleep is affected, or my mouth is dry) The RT told me that machine can compensate for small leaks, its the large leaks that they worry about and they can see among the smartcard data. Of which, they didn't see any when they looked at mine....and saw times that I got up during the night as the leak rate was ramping up.

When I got the humidifier, I was told to start at 2 and adjust it up and down as desired.

Actually, I haven't gotten anything new since the start of the year...so I'm not sure where I stand on deductible and coinsurance. I don't recall my deductible off hand, but I know my coinsurance changed from 90/10 to 80/20. Though I did start FSA this year, though I'm sure I'll have it all spent before I get to why I decided to try it this year....planning to get new glasses in the spring.

The Dreamer.

[Georgio]

If you decide to bump your ramp setting higher, you will find the directions here:

http://global.respironics.com/UserGuide ... Series.pdf

I don't know how your machine is being paid for, but it sounds like you have an M-Series Basic bottom of the line machine. While it will provide therapy, you will never know if it is or how well. You need to get a fully data capable machine. I would insist on it. You may as well get an auto while you're at it for it's added features and comfort.

I developed sores on the bridge of my nose that I couldn't resolve and went to a nasal pillow mask that works very well. This is a common occurence.

It sounds like you are making excellent progress since you already notice a difference in how you feel. You're on your way!

Georgio

[Jason S.]

Thanks! I changed the ramp from 4 to 6. Not sure if I'll use the ramp, since 8 is my full pressure. Unfortuneately I bought the machine, so getting another is not really financially viable for me. Insurance paid 90% and I paid 10% (my cost came to $170 for machine, humidifer and mask etc). I wonder if I bring my machine in if they can get statistics from it?

If you decide to bump your ramp setting higher, you will find the directions here:

http://global.respironics.com/UserGuide ... Series.pdf

I don't know how your machine is being paid for, but it sounds like you have an M-Series Basic bottom of the line machine. While it will provide therapy, you will never know if it is or how well. You need to get a fully data capable machine. I would insist on it. You may as well get an auto while you're at it for it's added features and comfort.

I developed sores on the bridge of my nose that I couldn't resolve and went to a nasal pillow mask that works very well. This is a common occurence.

It sounds like you are making excellent progress since you already notice a difference in how you feel. You're on your way!

Georgio

[Georgio]

No, a basic M-Series does not produce therapy data. Data is highly recommended. Don't feel bad, what happened to you (the DME taking the cheap way out) happened to many of us, including myself. I gave them my machine back and purchased the one I needed, even though I'm not working. You may be able to sell your machine for what you paid or close to it at cpapaution.com. Then you could shop for a data capable machine there as well. Also check Craigslist. In the meanwhile, you are getting some therapy if you are feeling better, it is just beneficial to monitor your therapy to maximize it's effectiveness.

Georgio

[CorgiGirl]

I don't have the PLUS. I just selected that one because my machine is not on the list. It just says REMstart M Series. Nothing else. The referenced software is Encore Plus. The ramp feature is only adjustable by the provider. They didn't allow me to adjust it, although I think the machine is capable.

M series has several different models. Look on the top of your machine just below the flip up panel...what does it say there?

[Georgio]

Jason S.,

"Aerophagia" is the term used for air pumped in by cpap. It happens to me too. I think it can be worth further examination, if associated with acid reflux, but I will have to defer to someone more experienced with that. Memory issues are very common and I have also experienced them. My memory and "recall" has definately improved, and I hope my brain cells, starved of oxygen for years, will continue to recover.

Dry mouth is a sure sign you are a "mouth breather". Not a good thing. You will need to find a remedy, either full face mask (yuck), tape your mouth closed, chin strap, panty hose tied around your head, or my may be able to train yourself to keep your mouth shut. I have been able to, intermittently using tape to help......I have found that my cronic sinusitis has significantly improved with cpap, and it's much easier to breath thru my nose than ever before...plus fluctinose spray and Zrytec D. One of the benefits of obtaining therapy data, is that it will show mask leaks, which diminish effectiveness of therapy.

Wash your face and lose the stubble to help avoid leaks. The comfort gel mask can be heated and moulded to you face, check the instructions. It didn't help in my case. It doesn't sound like that mask if going to work for you.
I only wash my equipment now and then, and don't have any problems.

Georgio

[CorgiGirl]

I disagree with Georgio -- full face masks are not yuck! I like them much better than pillows, cannulas, or over-the-nose types. But dry mouth often means mouth breathing, so you'll need to compensate for it somehow.

Also, if you are taking medications that cause mouth dryness, try using Biotene mouthwash. It is formulated to replenish some of the enzymes you've lost and keep your mouth more hydrated.