CPAP Virgin - Rough First Night

[Grouch]

Hi everyone!

HIstory & Introduction
I'm new here and new to the whole world of treating sleep apnea. I've been clinically disabled for 15 years due to severe fatigue and other problems. My Health Issues page online at my medical group is a full page list of things. I wasn't trying to set any records. Really! Oh, I'm also an endometrial cancer survivor. So, I'm not a wimp when it comes to medical stuff.

I was sent for a sleep test by my primary doc last month. She didn't really think I had sleep apnea, but wanted to rule it out. She figured maybe a 20% chance, since I didn't have many symptoms. I had my first sleep test and the diagnosis was severe obsturctivv sleep apnea. The titration test after that didn't go as high as my doc thought, but apparently it was a "difficult titration." Yesterday I got my equipment.

I'm a really motivated patient, as I could have been mis-diagnosed for all these years. Treating my OSA *may* allow me to capture at least a bit of my life back.

I've listed my equipment in my sig, but another item is that my sleep doc set the pressure for 13-17 cm, but she thinks it probably needs to go higher. While the whole CPAP thing feels very weird right now, I wasn't having any trouble getting used to the breathing with it on. I used ramping at first, but later just went without it and was fine.

First Night and Questions
My titration test went pretty easily, though I did take my first sleeping pill ever to get through it. Ambien. I figured there would be some minor problems gettting things adjusted at home. Boy, was I ever wrong! The tech at the DME place was very thorough in explaining everything, plus I'm a great believer in RTM.

I ran into a lot of problems I wasn't expecting. Got 4 hours of sleep, but did have the mask on for 7.4 hours per the machine readout. I'm hoping you guys can help me out with these. I'm also passing these along to the DME, but may not hear back in time to prevent another bad night.

Water Dripping into my Nasal Pillow Yeah, I know the humidfier is adding humidity, but this is really annoying! My humidifier was set to 2 - the lowest setting I think. Couldn't turn it down any more, so tried setting it to 3. As counter-intuitive as that seems, that seemed to help. Also, it was a cold night, so I brought as much of the tubing under the covers as I could to help prevent condensation. I saw the tube wraps on the website, so ordered one. Is there anything else I should do/try?

Air Blowing out of Mask Vent Is this normal? There was a pretty strong, constant stream of cold air blowing all night long. Is this due to the pressure of 13-17cm? Is that a "feature" of this mask? Or is something wrong? I did do the leak test twice and the mask passed both times. No air is leaking around the outside of the pillows, but it's coming out of the vent on the front of the pillow. I had a difficult time getting the air to not hit the blankets and blow in my face.

Puffing Air Out of Lips This isn't new to CPAP. I did this occasionally, when sleeping on my back. I normally sleep on my side. But this was happening every time I started to doze off. And would repeat on each breathe until I was fully awake. I'd get a puff of air coming through my lips for about a second. Sometimes it would make my lips vibrate. That is a new and not very welcome variation. Probably due to the pressurized air. I tried changing positions, but was doing it on my left side (usual sleeping position), my back, and my right side.

This Morning I felt like I'd been run over by a Mac truck. Not exactly the feeling I was going for. This was worse than a fitful night without CPAP. It's an hour later now and I'm doing a bit better. I checked out the Info:
AHI = 11 While this number is far less than on my 1st sleep study, I was hoping for a lot lower number here. Was I overly optimistic?
Periodic Breathing = 0 At least this looks good. Right?
90% Mask Pressure = 15 Not sure what this one means.

So, please bring on the comments and suggestions. I'd sure like tonight to go a lot better than last night!

[apneawho]

Cute Avatar! Welcome. Sorry for the rough night. We can all chime in and give some suggestions.

Water Dripping into my Nasal Pillow Yeah,
Both a hose cozy and barrel cozy will help with condensation. Temperature of room makes a difference too so you may want to adjust that. Padacheek.com

Air Blowing out of Mask Vent Is this normal?
Yes, it is normal and it is cold. It is vented air and your mask needs to operate like that so don't block it. You will learn to sleep so that it doesn't disturb you or your partner.

Puffing Air Out of Lips This isn't new to CPAP.
Get a chin strap or read discussion threads here regarding taping mouth. If mouth or lips come open while using nasal masks or nasal pillows this will happen. I tried chin strap in beginning and now I tape my mouth.

This Morning I felt like I'd been run over by a Mac truck. Not exactly the feeling I was going for. This was worse than a fitful night without CPAP. It's an hour later now and I'm doing a bit better. I checked out the Info:
AHI = 11 While this number is far less than on my 1st sleep study, I was hoping for a lot lower number here. Was I overly optimistic?
Did you look at your leak? Ultimately you will want to get AHI lower. AHI <5 is considered optimal on cpap. You will want to look at your detailed data over the next week to determine next steps. There are many members who can look at your data with you and help with this. I don't use same cpap machine but there are members here who do and can help with specifics of Respironics.

You will do fine. Just takes some time. Stay with it and stay connected here.

[Bobby269]

This can reduce moisture in the tube and mask. http://www.google.com/products/catalog? ... ps-sellers. Having the hose
go over a bedpost can serve the same purpose.

[nanwilson]

Hi everyone!

HIstory & Introduction
I'm new here and new to the whole world of treating sleep apnea. I've been clinically disabled for 15 years due to severe fatigue and other problems. My Health Issues page online at my medical group is a full page list of things. I wasn't trying to set any records. Really! Oh, I'm also an endometrial cancer survivor. So, I'm not a wimp when it comes to medical stuff.
Boy, do you ever sound like me...even the endometrial cancer
I was sent for a sleep test by my primary doc last month. She didn't really think I had sleep apnea, but wanted to rule it out. She figured maybe a 20% chance, since I didn't have many symptoms. I had my first sleep test and the diagnosis was severe obsturctivv sleep apnea. The titration test after that didn't go as high as my doc thought, but apparently it was a "difficult titration." Yesterday I got my equipment.

I'm a really motivated patient, as I could have been mis-diagnosed for all these years. Treating my OSA *may* allow me to capture at least a bit of my life back.
You bet you will be able to get it back as long as you stick with the therapy, every night, all night.
I've listed my equipment in my sig, but another item is that my sleep doc set the pressure for 13-17 cm, but she thinks it probably needs to go higher. While the whole CPAP thing feels very weird right now, I wasn't having any trouble getting used to the breathing with it on. I used ramping at first, but later just went without it and was fine.

First Night and Questions
My titration test went pretty easily, though I did take my first sleeping pill ever to get through it. Ambien. I figured there would be some minor problems gettting things adjusted at home. Boy, was I ever wrong! The tech at the DME place was very thorough in explaining everything, plus I'm a great believer in RTM.
Read, read and read some more on this site, especially the cpap wiki and new users guy.I ran into a lot of problems I wasn't expecting. Got 4 hours of sleep, but did have the mask on for 7.4 hours per the machine readout. I'm hoping you guys can help me out with these. I'm also passing these along to the DME, but may not hear back in time to prevent another bad night.

Water Dripping into my Nasal Pillow Yeah, I know the humidfier is adding humidity, but this is really annoying! My humidifier was set to 2 - the lowest setting I think. Couldn't turn it down any more, so tried setting it to 3. As counter-intuitive as that seems, that seemed to help. Also, it was a cold night, so I brought as much of the tubing under the covers as I could to help prevent condensation. I saw the tube wraps on the website, so ordered one. Is there anything else I should do/try?
Make sure your machine is below your head...water runs downhill. I route my hose over my headboard, never get rainout.
Air Blowing out of Mask Vent Is this normal? There was a pretty strong, constant stream of cold air blowing all night long. Is this due to the pressure of 13-17cm? Is that a "feature" of this mask? Or is something wrong? I did do the leak test twice and the mask passed both times. No air is leaking around the outside of the pillows, but it's coming out of the vent on the front of the pillow. I had a difficult time getting the air to not hit the blankets and blow in my face.
Supposed to do that...your exhausted air goes out this way. I sleep on the edge of my pillow and let the mask hang over, and keep the covers at my shoulders so no blowback.Puffing Air Out of Lips This isn't new to CPAP. I did this occasionally, when sleeping on my back. I normally sleep on my side. But this was happening every time I started to doze off. And would repeat on each breathe until I was fully awake. I'd get a puff of air coming through my lips for about a second. Sometimes it would make my lips vibrate. That is a new and not very welcome variation. Probably due to the pressurized air. I tried changing positions, but was doing it on my left side (usual sleeping position), my back, and my right side.
If this is not the mask you, then change. The DME is supposed to allow you to change masks in the first 30 days...this is a manufacturers deal..not the DME. The DME onbly has to supply you with masks (free) ..fill in some paperwork and the manufacturers pick up the tab.This Morning I felt like I'd been run over by a Mac truck. Not exactly the feeling I was going for. This was worse than a fitful night without CPAP. It's an hour later now and I'm doing a bit better. I checked out the Info:
Not uncommon for the first night to be hell, things will get better as you adjust to this therapy.AHI = 11 While this number is far less than on my 1st sleep study, I was hoping for a lot lower number here. Was I overly optimistic?
Periodic Breathing = 0 At least this looks good. Right?
90% Mask Pressure = 15 Not sure what this one means.

So, please bring on the comments and suggestions. I'd sure like tonight to go a lot better than last night!

Welcome to the forum you have come to the RIGHT place for help. Do your homework and read all the info you can get your hands on.....this site is the best. If it wasn't for the good folks here, I would have never made it. I have gone through 8 masks in a year and a half of therapy and am doing great. You will too, once you get caught up on your lost sleep and begin to get lower ahi numbers...keep at it..and again welcome.
Nan

[Perrybucsdad]

I've been clinically disabled for 15 years due to severe fatigue and other problems. ...
I was sent for a sleep test by my primary doc last month. She didn't really think I had sleep apnea, but wanted to rule it out. She figured maybe a 20% chance, since I didn't have many symptoms. I had my first sleep test and the diagnosis was severe obsturctivv sleep apnea.

I don't think I can add anything more than what has been said pertaining to your questions, but I wanted to make a comment about the above statement. Please don't take this the wrong way, but I think your doctor is an idiot.

You state that you have been clinically disabled for 15 years due to severe fatigue, and your doctor didn't think to rule out sleep apnea? Then she goes on to state that you maybe had a 20% chance of apnea, and you end up with SEVERE OSA. Wow... please, do yourself a favor and find a new doctor before this one wastes any more of your time. You deserve much better than that.

Anyhow, welcome to the list and I look forward to seeing more posts from you. You sound like you are well on your way and are an educated patient. That is great. We patients have to be our own advocates at times and sites like these help us do that.

- John

[Mary Z]

I think most of your issues have been addressed. Hang in there. Some people have overnight improvement, but for most of us it takes time. As you see, each problem has to be dealt with separately and the chances of fixing everything the second night are slim. Give it time. One of the most important things is to wear the mask all the time you are in bed. Using the machine all night, every night, and naps is the best way to ensure success with therapy (as you work out your other issues).
Good luck, keep us posted.

[tomjax]

The first night is rough for many virgins.
CPAP should be no different.

I think you will find that as time goes by all the initial difficulties will become less of an issue and you will benefit and it will be natural and fulfilling..

This is not always the case as many never appreciate all the benefits and this can cause long range problems.

Some never adapt and will have to discontinue and do away with the problem altogether.
I hope this is not your case.

[Grouch]

Cute Avatar! Welcome.
Thanks! That's my English Cocker.

And thanks in advance for all your tips. Really appreciated!
Both a hose cozy and barrel cozy will help with condensation. Temperature of room makes a difference too so you may want to adjust that.
I've ordered the hose cosy. My room is warm - we keep the temp at the same as the daytime temp = 60 degrees. But it's still probably lower than the tube temp.
Air Blowing out of Mask Vent Is this normal?
Yes, it is normal and it is cold. It is vented air and your mask needs to operate like that so don't block it. You will learn to sleep so that it doesn't disturb you or your partner.
This was my biggest worry - that my mask was somehow defective. Nothing about this in the manual. Or I missed it. I've ordered a special CPAP pillow with cutouts on the side. That should allow me to keep the the vent somewhat stationary. as long as I stay in the same position - which I pretty much do. Plus, it may keep the air from hitting me or my boyfriend.

Puffing Air Out of Lips This isn't new to CPAP.
Get a chin strap or read discussion threads here regarding taping mouth. If mouth or lips come open while using nasal masks or nasal pillows this will happen. I tried chin strap in beginning and now I tape my mouth.
I don't think the chin strap will do much good, as my mouth never opens. It stays shut. But taping my mouth - that's something I never thought about. I do react to some of the tape, so will have to find some that won't leave big red marks on my face like it did during the sleep studies.

What seems to happen is that pressurized air enters my mouth occasionally and puffs out my cheecks. The air escapes through the path of least resistance - my lips. My mouth never really opens and my lips immediately shut after the air escapes.
This Morning I felt like I'd been run over by a Mac truck. Not exactly the feeling I was going for. This was worse than a fitful night without CPAP. It's an hour later now and I'm doing a bit better. I checked out the Info:
AHI = 11 While this number is far less than on my 1st sleep study, I was hoping for a lot lower number here. Was I overly optimistic?
Did you look at your leak? Ultimately you will want to get AHI lower. AHI <5 is considered optimal on cpap. You will want to look at your detailed data over the next week to determine next steps. There are many members who can look at your data with you and help with this. I don't use same cpap machine but there are members here who do and can help with specifics of Respironics.
I did do a mask leak check twice and everything was OK. Plus, there didn't seem to be any leakage (that I could feel) around the edges of the nasal pillow.

You will do fine. Just takes some time. Stay with it and stay connected here.

Thanks for taking the time to allay my fears. I'm already pretty confident that tonight will go better!

[Grouch]

This can reduce moisture in the tube and mask. http://www.google.com/products/catalog? ... ps-sellers. Having the hose
go over a bedpost can serve the same purpose.

Thanks for this tip! I'll give it a try.

[apneawho]

Grouch,
I have a ResMed unit and climate line and have not experienced water condensation or rain out yet. What others have said about positioning your tubing and cpap machine is good. You should look at that to see if those things will help keep the condensation from rolling into your mask.
You may want to put a pillow between you and your boyfriend if you need to block that vented air from your mask.
The tape I use is Nexcare paper tape. Available at Walgreens, WalMart and Amazon.com. Others use blue painters tape. I read someone uses thin coat of Milk of Mag around outside of mouth before taping up. Maybe that would help you as well.
When I mentioned the leak, I don't mean so much the mask fit indicator on your machine, but the leak data recorded on your smart card. Do you have that?

[Grouch]

[quote="nanwilson
Boy, do you ever sound like me...even the endometrial cancer
Sorry to hear that we share this.


You bet you will be able to get it back as long as you stick with the therapy, every night, all night.
As miserable as last night was, I'm all set to stick it out again tonight. I did wear the CPAP 7 3/4 hours - not bad for a first try at it.

Read, read and read some more on this site, especially the cpap wiki and new users guy.
I think I got my diagnosis 2 weeks ago and have been reading up on this as much as possible. Believe it or not - if I hadn't don't that, I would have had a lot more questions.

Make sure your machine is below your head...water runs downhill.

My only placement area is the night stand next to the bed. It's roughly the same level.

I route my hose over my headboard, never get rainout.
My headboard is a bookcase headboard, so it would crush the tubing, but I've ordered a gizmo that someone else advised that will hold the tube up.

Supposed to do that...your exhausted air goes out this way. I sleep on the edge of my pillow and let the mask hang over, and keep the covers at my shoulders so no blowback.
I normally sleep at the edge of the pillow, so as to not add to my congestion. So this was already in place. I was using my covers for protection, but sometimes the air hit them and came back into my face.

If this is not the mask you, then change. .
The mask was fine - no leakage around the nasal pillow. It was me!

Not uncommon for the first night to be hell, things will get better as you adjust to this therapy.
I figured it will probably be better tonight. I discovered some coping strategies last night and have picked up more from you folks here.

Welcome to the forum you have come to the RIGHT place for help. Do your homework and read all the info you can get your hands on.....this site is the best. If it wasn't for the good folks here, I would have never made it. I have gone through 8 masks in a year and a half of therapy and am doing great. You will too, once you get caught up on your lost sleep and begin to get lower ahi numbers...keep at it..and again welcome.
Nan[/quote]

Thanks for the welcome. I've already discovered what a terrific resouce this place is. I'll be coming back again and again.

And thanks for your info.

[Grouch]

I've been clinically disabled for 15 years due to severe fatigue and other problems. ...
I was sent for a sleep test by my primary doc last month. She didn't really think I had sleep apnea, but wanted to rule it out. She figured maybe a 20% chance, since I didn't have many symptoms. I had my first sleep test and the diagnosis was severe obsturctivv sleep apnea.

I don't think I can add anything more than what has been said pertaining to your questions, but I wanted to make a comment about the above statement. Please don't take this the wrong way, but I think your doctor is an idiot.

You state that you have been clinically disabled for 15 years due to severe fatigue, and your doctor didn't think to rule out sleep apnea? Then she goes on to state that you maybe had a 20% chance of apnea, and you end up with SEVERE OSA. Wow... please, do yourself a favor and find a new doctor before this one wastes any more of your time. You deserve much better than that.

Anyhow, welcome to the list and I look forward to seeing more posts from you. You sound like you are well on your way and are an educated patient. That is great. We patients have to be our own advocates at times and sites like these help us do that.

- John

John,

On reading this over, I can see how you came to this conclusion. As it turns out, my *previous* docs were idiots, but this one is a gem! I only recently started seeing her and she is very, very thorough. She is determined to "fix" me. She's done a lot of testing and sending me to specialists. She hit the jackpot with the sleep clinic referral.

The 20% chance of OSA was actually fairly realistic. This started 15 years ago and many of the symptoms I had back then are no longer present and I'd forgotten about them. LIke bad headaches, when I'd rarely had headaches, falling asleep during conversations - that sort of thing. Over the years I've developed coping mechanisms. The sleep clinic gave me a written questionaire about my sleep and my score was very low - below normal values - so sleep apnea really didn't look like a very likely diagnosis - even to the sleep test tech.

[Grouch]

I think most of your issues have been addressed. Hang in there. Some people have overnight improvement, but for most of us it takes time. As you see, each problem has to be dealt with separately and the chances of fixing everything the second night are slim. Give it time. One of the most important things is to wear the mask all the time you are in bed. Using the machine all night, every night, and naps is the best way to ensure success with therapy (as you work out your other issues).
Good luck, keep us posted.

I think I got a false sense of security at the second sleep test, when they did the titration. I had absolutly no problems and fell asleep in 3 minutes, after they turned the lights out. And slept until they woke me to turn onto my back. Then right back to sleep.

However, I do think tonight will be better than last night. Plus, I'll be more tired, so should be able to go to sleep easier. I don't do naps, but I did wear the mask for about an hour before I planned on going to sleep. This allowed me to familarize myself with the settings of the machines. I'll probably mask up early tonight, too, as I'm afraid I could fall asleep reading, since I only got 4 hours sleep last night.

I'm anxious for my software to arrive, so I can see the actual data.

Thanks for your good wishes!

[Grouch]

The first night is rough for many virgins.
CPAP should be no different.

I think you will find that as time goes by all the initial difficulties will become less of an issue and you will benefit and it will be natural and fulfilling..

This is not always the case as many never appreciate all the benefits and this can cause long range problems.

As I mentioned in my first post, I'm motivated to make this work. My life has become pretty limited by my health.

Some never adapt and will have to discontinue and do away with the problem altogether.
I hope this is not your case.

I don't think it will be. I know that I will reap health benefits from CPAP, even if it's difficult to adjust to. And it may not be that difficult, if I can get the bugs worked out. I have no problem whatsoever with breathing at the fairly high pressure (13-17cm.) I *want* to use the machine. It's just that right now, I also *want* to get a bit of sleep, too.

[Pugsy]

Welcome to the forum.

You have some software options so you can see more than the on screen 7/30 day AHI averages. The data available on screen pretty much sucks.
Options for software are explained here. viewtopic.php?f=1&t=64906&st=0&sk=t&sd= ... re+options

A word about condensation. The usual applies like using a hose cozy and having the machine lower than the mattress.
There is one place that condensation occurs that the hose cozy or machine placement won't help. That being in the nasal pillows themselves. Moisture from our own exhaled breath will form in the pillows and go right back into the nose. If you use a hose management system and route stuff over your head then the moisture in the pillows will only flow downhill....right back into your nose. It isn't enough to hurt you but it is annoying. Already I have had some of that moisture fly out the vent holes and come back down on my face in a little cold spray.

If you want to continue using the Swift FX (I use it too) then you may want to think about a barrel cozy or even 2 of them at once if you still get much condensation in your nasal pillows that goes into your nose.
http://www.padacheek.com/PACSwiftII_Barrel_cozy.html
Might also want to wrap a little fleece around that short hose from the long hose to the mask.
I use them. My body needs the added moisture from the humidifier and lowering the setting is not an option I want to do. The dryness in my nasal mucosa is much more of a problem than snorting a little water. Moisture needs are highly individual and you have to figure out what works best for you.

Even if you did not use a humidifier at all it is possible to still have rain out in the nasal pillows simply from the condensation of moisture in your own exhaled breath.

And yes, you will feel like you have been run over till you get things settled in and your get your AHI down. I had the same thing happen to me when I first started. AHI of 8 to 10 and I know that is hugely less than pre cpap 53/hr but it is still enough to make me feel like total crap. It took me a couple of weeks to get leaks under control and pressures optimized so that the AHI got down below 5.

So let's get you some software and see your reports and go from there. I suspect your minimum is not quite where it needs to be to be able to handle the events. Probably only need just a little more minimum. I had the same thing happen to me.
For more information about Pro (hint, hint ) just send me a private message. SleepyHead is actually very stable for being still young in its design. Decide which way you want to go on the software and let me know. I am pretty good with software stuff and I use all those offerings so I can help with pretty much any of them.

Edit....you have ordered the software...Encore Viewer? Okay...you might want to give SleepyHead a try then.
BTW your computer...what operating system is it and is it 32 or 64 bit computer?