1st week on the mask and can't get comfortable

[Kayrrie]

I just got my machine on Friday and what I was excited for was to get a good nights sleep. I have yet to achieve that because I have not gotten used to the mask yet. There are times I feel like there's no air coming through at all but when I lift it off my nose its on. Last night I had it on and ended up waking up from a deep sleep to slap it off my face because it felt like there was no air coming through. I've also noticed moisture in my nasal mask. Is that normal? Is any of this normal. I also feel a lil claustrophobic even though i'm not.

[LSAT]

Without knowing what mask and machine you have it's difficult to help. Please register and fill in your profile listing your equipment. Also...what pressure is your machine set at?

[jweeks]

I just got my machine on Friday and what I was excited for was to get a good nights sleep. I have yet to achieve that because I have not gotten used to the mask yet. There are times I feel like there's no air coming through at all but when I lift it off my nose its on. Last night I had it on and ended up waking up from a deep sleep to slap it off my face because it felt like there was no air coming through. I've also noticed moisture in my nasal mask. Is that normal? Is any of this normal. I also feel a lil claustrophobic even though i'm not.

Kayrrie,

Welcome to the forum. It would be great if you could go to your profile and fill in the type of machine and mask that you have.

I think that these are issues that have solutions.

The feeling of air not coming through is often due to the pressure being set too low on an auto-adjusting (APAP) machine. Some clinics are really lazy and they simply set it wide open to a range of 4 centimeters to 20 centimenters. 4 is too low for most people to breathe. 6, 7, or 8 is usually the lowest number where someone can get enough air. What we would need from you is the pressure settings from your machine. This can be done from your prescription, or from the data on your machine. Getting the data is a bit of a challenge when you are first starting out, but it is pretty important to learn how to do that.

Moisture in the mask is called "rainout". That happens because the air from the machine is warm, but the room air is cool. There are a few different things you can do to help that. First, put your machine at a level that is below the level of your head. Having it at least a foot below the top of your mattress is best. Next, make sure that the hose follows a path that has a bit of vertical rise to it. You want this water, if it condenses, to run back down into the machine and into the water reservoir. Next, you can try turning down the humidity control a bit. The last option might be the best option, but can also cost a little money--getting a heated hose. One name for this is a Climate Line (if you have a ResMed machine).

Give this a try, and let us know what you find for pressure levels, and if any of the rainout tips helps you out.

-john-

[Mundy]

I'm new too, about 10 days or so ahead of you. I've had the same experience with waking feeling like there was no air coming through the mask. Mine is a nasal only mask and if I open my mouth, air rushes out. I've learned that if I think the machine isn't working to open my mouth and see if air rushes out. If it does, the machine is working fine and I need to consciously take a few deeper breaths. I'm guessing that my dr will prescribe a higher pressure when I go back to see him on Monday.
In the meantime I've done as much as I can to be more comfortable with sleeping with the machine. I've given up caffeine after lunch so I'll be sleepier, no naps anymore, etc. I spend some time before 'lights out' with my mask on just relaxing. Its a slow process, but I'm getting much more comfortable and have slept all night the last few nights.

[Kayrrie]

I don't know how to edit my own post 'cause it was before I registered my username.

I have the ResMed S9 Auto Set Machine, even though my doctor has it at standard 13. I'm pretty sure I have the hose that warms up the water. I do keep my room very cold with the AC and the Humidifier was probably at 70.

I have the nasal mask, FlexiFit HC407 Nasal CPAP Mask with Headgear.

I'm thinking that the autoset may be best for me because I don't think 13 is high enough for me. Sometimes I have to take deep breaths too cause I feel anxious. The problem with that is that when I'm sleeping I have Hypoxia so I take tiny breaths at a time and My nasal passages get super dry too and swell shut. I have to use nasonex too according to my MD, just to keep them open and Afrin to keep it moist.

Thanks everyone. This is hard and frustrating.

[Julie]

Oh my... don't take my word for it (or that of the others who will follow me here) but do ask your pharmacist... Afrin is your problem, or 90% of it... it's known to be one of the worst meds for backlashing - e.g. first you use a little and it works well, then you need more and more and feel worse and worse and it's so hard to get off because you think you must have it to breathe!

There are other ways to keep your nose clear (ask also about Neti-pots and similar things) because you are trying to breathe through the Afrin 'straw' (narrow narrow nasal passages due to Afrin's swelling effect inside).

Until you get free of that, everything else will be a problem... you might find eventually that you don't need a pressure of 13 (it's high for a newbie) to breathe after that!

[Buckhorn dan]

Wow, my pressure is set at 6 and I think that is high . My Dr. started me at 8 and I couldn't adjust so he put me down to 6.. I guess I should be happy .. of course that is only if the unit is doing what it is suppose to do.

[Pugsy]

Julie is right. Talk to your pharmacist about prolonged Afrin use or frequent Afrin use. Not a good thing to do.
You might want to Google Afrin Rebound. It should never be used as a moisturizing agent. Your nasal mucosa become dependent on the chemicals to reduce the swelling and you end up using more and more and making a bad situation worse.
I have been there, done that, more than once and withdrawal is ugly.
Something like simple saline solution can be used as a moisturizing agent though.

[sol]

Beside saline spray you can read about Nazoil (sesame seed oil spray)
http://www.enttech.com.au/products/nozoil

[jweeks]

Wow, my pressure is set at 6 and I think that is high . My Dr. started me at 8 and I couldn't adjust so he put me down to 6.. I guess I should be happy .. of course that is only if the unit is doing what it is suppose to do.

Hi,

Yes, 6 is about the lowest possible pressure. Anything below that is basically less than what you can breathe on your own. If 6 works for you, then you are golden. The way to tell is to look at your AHI number on your machine. Your goal is an AHI of under 5, preferably as close to zero as you can get.

The issue here is that CPAP doesn't work on a sliding scale. For example if 6 is 75% of 8, that doesn't mean that you get 75% of the treatment. Rather, CPAP "stents" your airway open. Each of us has a magic pressure level where the airway will stay open. Think of that pressure being like a light switch. Get even 1 centimeter of pressure under that level, and it does almost no good. So moving the pressure back to 6 might make it easier to tolerate, it might not being doing much for your treatment.

Check your AHI...that will tell the story.

-john-

[robysue]

Yes, 6 is about the lowest possible pressure. Anything below that is basically less than what you can breathe on your own.

This makes no sense at all to me. But I'm an outlier who needs very little pressure: My BiPAP starts at 6/4 and that's where I am most comfortable breathing during the periods when I am awake at night.

The issue here is that CPAP doesn't work on a sliding scale. For example if 6 is 75% of 8, that doesn't mean that you get 75% of the treatment. Rather, CPAP "stents" your airway open. Each of us has a magic pressure level where the airway will stay open. Think of that pressure being like a light switch. Get even 1 centimeter of pressure under that level, and it does almost no good. So moving the pressure back to 6 might make it easier to tolerate, it might not being doing much for your treatment.

While there is some truth to this idea that there's a "magic" pressure, it's not so clear that the "magic" pressure is easy to identify in a one night PSG, and labs can over titrate as well as under titrate. And if you are dealing with serious aerophagia or with air getting into the eyes via the tear ducts, a modest 1-2 cm drop in pressure can take the edge off the aerophagia and spare the eyes and hence allow you to sleep with the machine. And such a reduction may or may not cause the AHI to increase enough to seriously affect the efficacy of your therapy. So in some circumstances it's certainly better to try a small reduction in pressure to see if it works rather than run the risk of giving up on CPAP altogether and not treating the OSA at all.

My original prescription of 9cm was based on 33 minutes of sleep at the end of the night in the lab: I had been sleeping at 7cm for about 2 hours when I finally had a small cluster of events that met the criteria for increasing pressure about a half an hour before the test ended and the tech chose to increase the pressure by 2cm instead of the usual 1cm. And the lack of a trial at 8cm was unfortunate because I simply could not tolerate my original straight CPAP pressure of 9cm at all due to both serious aerophagia and air getting into my eyes via the tear ducts. The three weeks I spent desperately trying to sleep with my original CPAP set to 9cm was one of the worst periods of my entire life, but my AHI was superb: During those three weeks, my AHI averaged 0.74. A switch to APAP showed that my pressures seldom went above 8 cm, and two subsequent bilevel titration studies identified pressure settings of (IPAP = 8, EPAP = 6) and (IPAP = 7, EPAP = 4). Over the last year, my long term average AHI is around 1.5, which is about twice as high as it was during those first three intolerable weeks. But a long term AHI = 1.5 is plenty low enough to say my OSA is well controlled with my current Auto BiPAP settings (min EPAP = 4, max IPAP = 8). And I can actually sleep well with my BiPAP as opposed to lying in bed fighting for sleep all night long.

[robysue]

There are times I feel like there's no air coming through at all but when I lift it off my nose its on.

and

I've had the same experience with waking feeling like there was no air coming through the mask. Mine is a nasal only mask and if I open my mouth, air rushes out. I've learned that if I think the machine isn't working to open my mouth and see if air rushes out. If it does, the machine is working fine and I need to consciously take a few deeper breaths.

While a really low stating pressure can cause these feelings, it's also important to remember that we get used to the pressure (no matter how high it is) during the night and many of us are not consciously aware of it when we wake in the night or for the morning.

There's a basic physical reason to explain this: At the beginning of the night, the machine has to pressurize the "semi-closed system" consisting of your upper airway, the mask, and the hose. And it does this by blowing additional air into your airway and it is pretty easy for many of us---particularly for newbies---to feel the sensation of the system being pressurized. But once the desired pressure has been reached, the machine only needs to blow enough air into the system as is leaking out of the system. And if you've got a good seal, that means the machine is only replacing the air lost through the exhaust vents of the mask. And this leads to the sensation that not much air is moving around in the system.

If you put your hand in from of the vents, you'll feel the stream of air. If you open your mouth, you cause a (massive) leak and you'll feel the air flow out. If you lift the mask slightly off your face, you cause a leak and you'll feel the air. Any one of these things is often all it takes to get over the psychological feeling that there's not enough air coming through the mask an allow you to quickly settle back down and return to sleep.