A little overwhelmed but desparate for sleep!

[mismah]

I've had my CPAP for about 2 weeks. I was diagnosed with mild sleep apnea and I was reluctant to start treatment because my sleeping problems are so severe that "mild" didn't seem to fit. However, at this point, I don't know what else to do. My main problem is that I don't sleep more than about 90 minutes at a time. I never get into a deep sleep and just feel tired and exhausted all the time.

The first few days were not bad. A few issues to figure out where to set the humidifier and hose but I worked through those. For the most part the first week I was able to fall asleep and I didn't really mind the mask. BUT, I still woke up every 90 minutes.

On day 8, I called the respiratory therapist that set up my machine. She had me change two things on it but I can only recall one of them. She also said she would probably swap my machine for an APAP on next visit but that's a few weeks away. We changed the CPAP from 6.0 to 7.0. After 6 nights, I have yet to be able to fall asleep with it anymore. My breathing seems more "labored" while the machine ramps and I just can't stay sleepy and fall sleep. it seems that every couple breaths I need to do a deep inhale and a deep exhale.

I'm not sure what things I should be tracking or what some of these settings on the machine do. I'd like to become more knowledgable so I can really commit to helping myself. The manual is useless as it only covers some basics as to how to change the settings. I'm not looking to change up every setting but to better understand this whole thing. A few key things to focus on would be helpful.

My machine is ResMed S8 Escape II. My mask is ResMed Mirage Micro. I'm very petite but the mask seems OK for my face. The settings on my machine are:
EPR - Off
EPR Level - Off
EPR Access - Off
EPR Inhale - Med (I'm wondering if this was the other thing we changed but I don't recall)
Start CPAP - 5.2
CPAP - 7.0
Calibrate - 1.09

It ramps for 45 minutes.

Any key pointers for a newbie would be greatly appreciated!

[msradar65]

My machine is ResMed S8 Escape II. My mask is ResMed Mirage Micro. I'm very petite but the mask seems OK for my face. The settings on my machine are:
EPR - Off--change to on
EPR Level - Off--change to 3
EPR Access - Off--turn to on
EPR Inhale - Med (I'm wondering if this was the other thing we changed but I don't recall)
Start CPAP - 5.2
CPAP - 7.0
Calibrate - 1.09

It ramps for 45 minutes.---I would shorten the ramp time. Most of use turn the ramp off after a few days.

Any key pointers for a newbie would be greatly appreciated!

[Jersey Girl]

Dear Mismah,

I don't know too much about your machine, but if it is not data capable, please insist that they give you a data capable APAP. Whether you purchase a machine or the insurance company purchases one for you, you will NEED a data capable machine to be able to tweak your therapy and see how you are doing over time.

I found that the ramp did not give me enough air, and so I simply set the ramp to off. That way I was getting to my pressure of 8 very quickly. A pressure of 7 is not very high and so perhaps you could turn your ramp feature to off and see if that feels better.

Remember, this takes time. We are not born with masks strapped to our faces and so it takes some time to find the right, most comfortable mask for you. I went through 4 of them to find my personal favorite.

Also, I found that I was getting condensation in my hose in the winter when the bedroom heat is set to 63 degrees and in the summer when my husband has the a/c going. I purchased a fleece hose cover from http://www.padacheek.com and I use that in the spring and fall and then purchased an Aussie heated hose for the winter/summer months. That stopped my mask/hose condensation problem.

I also purchased a Regenesis buckwheat hull cpap pillow from http://www.pur-sleep.com. This special pillow allows me to make a spot for my mask/hose anywhere I need to and doesn't have that "push back" that I was getting from my regular pillow.

I am not suggesting that you need to go out and buy all these things, but if you find something uncomfortable, there are products out there to help make your ccpap therapy more comfortable.

I'm sure all the fine folks here can give you some advice as well.

Wishing you peaceful, restorative sleep,

Jersey Girl

[Julie]

Hi, I would suggest that you try not using the ramp, or else using it starting at a higher number to begin with for a shorter time, because your pressures (including the ramp) are so low to begin with, most people couldn't breathe well at them and we find that just letting the machine go to the prescribed setting (as long as it isn't very high, i.e. 15) is easier in the end than bothering with the ramp. 7 seems to be about as low a prescribed setting as you'd want (most of us are around 10 by the time we fiddle with settings on our own), so forcing yourself to endure the ramp work-up to 7 is just making you work harder.

[Pugsy]

The ResMed Escape II is NOT data capable. It will provide compliance only (hours of use).
It will never be able to give you any idea what might be going on with your therapy.

If they swap it for an auto unit, don't let go of the Auto. You don't want the Escape..

[robysue]

I'd like to become more knowledgable so I can really commit to helping myself. The manual is useless as it only covers some basics as to how to change the settings. I'm not looking to change up every setting but to better understand this whole thing. A few key things to focus on would be helpful.

and

My machine is ResMed S8 Escape II.

You machine only records compliance data---i.e. how long you use the machine each night. You really need a machine that records efficacy data---how well therapy is working in terms of preventing events from happening. It's the only way you'll be able to really understand what's going on concerning your OSA.

Your machine is also an older model. The Resmed S8's were replaced some time ago by the Resmed S9's. So that is also a concern.

You also write:

On day 8, I called the respiratory therapist that set up my machine. She had me change two things on it but I can only recall one of them. She also said she would probably swap my machine for an APAP on next visit but that's a few weeks away.

Call the RT and insist that your appointment be moved up. (Is that RT at the DME? or at the sleep doctor's office? or at the lab that did your test?) Call multiple times if necessary. Be polite but persistant: Each time repeat that you need to swap the machine for an APAP as soon as possible because you are NOT sleeping more than 90 minutes at a time and that your "breathing seems more 'labored.'" And when the switch to APAP is made, insist that the APAP be a Resmed S9 AutoSet and NOT a Resmed S9 Auto Escape if the company insists on giving you a Resmed machine. I believe the Auto Escape is the only APAP that does NOT record full efficacy data. So a PR System One Auto, for example, would give you the data you want and need.

We changed the CPAP from 6.0 to 7.0. After 6 nights, I have yet to be able to fall asleep with it anymore. My breathing seems more "labored" while the machine ramps and I just can't stay sleepy and fall sleep. it seems that every couple breaths I need to do a deep inhale and a deep exhale.

If you can tolerate starting at your full CPAP pressure of 7.0, then just turn the ramp off and see if that helps.

I've been frustrated right from the start in that I simply cannot do deep inhales and deep exhales with my mask on. I have to take it off if I want to. And since that has long been one of the things I've used for getting to sleep, it's been a real problem for me.

I'll write more later tonight with some suggestions on what to do about your inability to fall asleep with the mask on. I really don't want to have to welcome you into the CPAP & Insomnia club if I don't have to.

[Janknitz]

Good advice above, I'd add just one other thing:

EPR is "exhalation pressure relief". It is a comfort measure. If you feel you are struggling to breathe out, you can enable this and it will reduce the pressure when you exhale to make it more comfortable. I would start out with a setting of 1 first (it goes 1-3) because your pressure of 7 is fairly low to begin with, but you can experiment and see what makes you the most comfortable.

Make sure you don't get stuck with that older model Escape. See "What you need to know before you meet your DME" in my signature below to understand that you can and should get a better machine. Sounds like you have someone working with you who has suggested the autoset, so that's a good start.

[lbw]

I would either turn off or decrease the time the RAMP is on. 45 min is too long, I started at 9cm which you can quickly get used to . A setting of 7 cm you should be fine with no ramp. It can take a while to regulate your sleep patterns

[DreamOn]

Mismah, you've received some excellent suggestions from the others already, and I don't have anything additional to add in that regard. I just wanted to welcome you to the forum!

[robysue]

I've had my CPAP for about 2 weeks. I was diagnosed with mild sleep apnea and I was reluctant to start treatment because my sleeping problems are so severe that "mild" didn't seem to fit. However, at this point, I don't know what else to do. My main problem is that I don't sleep more than about 90 minutes at a time. I never get into a deep sleep and just feel tired and exhausted all the time.

Did your "never sleep more than 90 minutes at a time" problem start before or after you started CPAP therapy? One complete sleep cycle is supposed to take about 90 minutes, so it sounds like you may be waking after every sleep cycle. How hard is it to fall back asleep with the CPAP mask on after you have one of these wake ups?

And if this sleep pattern predates starting CPAP, have you ever done any work on trying to address the insomnia, either on your own or with the aid of a doctor?

The first few days were not bad. A few issues to figure out where to set the humidifier and hose but I worked through those. For the most part the first week I was able to fall asleep and I didn't really mind the mask. BUT, I still woke up every 90 minutes.

Since you are still having problems with maintaining" sleep, which is a form of insomnia, I'll be honest: In my humble opinion as a fellow insomniac, I don't believe you will be able to reap the full benefits of CPAP therapy until both your therapy is optimitzed (and you need a full data machine to help with that) AND the insomnia is under control and you can sleep more than 90 minutes at a time.

Since I've been working hard on solving my own insomnia problems, I'll offer you these tips. They just might help you.

• 1) Work on improving your overall sleep hygiene. Two standard variations on the good sleep hygiene rules can be found at http://www.umm.edu/sleep/sleep_hyg.htm and http://www.sleepeducation.com/Hygiene.aspx .
  
  2) Report your current sleeping pattern of 90 minutes at a time and the fact that you feel you never get any deep sleep to the sleep doctor's office. Ask to speak with a nurse or a PA or the doctor and see if you can find someone who will help you learn how to deal effectively with the fact that you can't seem to stay asleep for more than 90 minutes at a time. Be clear about when the problem started---was it before starting CPAP or after starting CPAP.
  
  3) Consider using sleep meds if you think they might help. This is a personal choice in my opinion, and not everybody is willing to use sleeping pills (I am not). But they do make a real difference for some folks. If you decide to use sleeping pills, make sure you talk to a nurse, PA, or the sleep doctor about which ones are most appropriate: Some sleeping pills have a tendency to aggravate OSA. And many of them are better at helping an insomniac initiate sleep rather than maintain sleep. And you need help with maintaining sleepy. Be careful of just using OTC sleeping pills. Be cautious about triggering rebound insonmnia. If you do opt for asking for a prescription sleeping pill, be sure to talk to the person who prescribes it about how long you should plan on taking the medicine and how to wean yourself off the medicine in such a way as to not trigger rebound insomnia.
  
  4) If you don't want to use sleeping pills, then getting some help with the insomnia may involve cognitive behavior therapy---helping you to relearn how to sleep well at night. This will probably involve being rigorous about applying the rules of good sleep hygiene. It may also involve keeping a log of when you go to bed, how many times you wake up during the night, when you get up for the morning, and how much time you think you slept. The log may reveal patterns in your wakefulness that can be addressed. And, cruel as it sounds, a cognitive behavior approach to dealing with insomnia may involve some sleep restriction---i.e. limiting the number of hours you are allowed to be in bed temporarily in an effort to get your sleep cycles consolidated and to help your mind and body learn to fall asleep quicker when you are in bed with the mask on. It's not particularly easy work, but if you stick with it, it can work well as I'm finding out now---I'm currently using a CBT approach to dealing with a nasty bit of insomnia that started right after I started therapy. At the start of this process, I posted about what it involved in a thread called The insomnia monster raises its head again and again. Two recent threads about my experiences are at 1000th post: Update on my insomnia and xPAP therapy and Met with PA about insomnia and got 4th sleep test results.

Good luck. And I hope your time in the CPAP & insomnia club is short.

[HoseCrusher]

I just want to offer a different opinion on the ramp feature.

I use ramp all the time, and feel that it makes the therapy more comfortable. I have my ramp set for 10 minutes. I turn my machine on a few minutes before I jump into bed so my actual ramp time is more like 6 - 7 minutes. I am usually asleep before the machine fully ramps up.

I will agree that 45 minutes is too long a ramp time.

[mismah]

I can't tell you how impressed I am with this forum and alll the help and suggestions from all of you - "Thank you!!"

I made the changes to my machine as msradar suggested except that I turned the ramp off because so many had agreed that might be better. It definitely made a difference. I was at least back to where I started which means I can fall asleep using the machine. I'm still waking up every 90 minutes but typically fall back to sleep fairly easily. Last night I increased the pressure to 8.0 and I liked it more but same problem waking up.

The waking up every 90 minutes is exactly why I was referred to do a sleep study and the whole reason I started this journey. Apparently, at the end of a sleep cycle is when my breathing stops and I wake up.

I will definitely pursue a different machine and continue to learn about all of this.

[snnnark]

It could be that when you get to REM sleep you need more pressure. A lot of people need more pressure during REM which was one of the reasons for the auto machines.