A Tale of Four Nights (Initial CPAP Usage...)

[Rosenkavalier]

OK, I got my CPAP setup all...setup, and last Friday night jumped in with both feet. (Thankfully, after a few minutes, I realized that the mask went on my face. I'm a slow learner.) Here's a quick rundown, along with a few comments/questions.

Night #1:
-- Figuring out where to put the machine, how to run the hose across the bed, all of those interesting decisions for a first night. I started off without a humidifier (see my previous posts for that story), so it's just CPAP --> hose --> mask.

I think it was mostly due to getting to bed late and being very tired, but I put on the mask, made only a couple of adjustments, connected everything, started the machine (without the ramp-up), lay down -- and proceeded to sleep for five solid hours. The respiratory therapist at the DME provider had warned me not to get too down if I didn't get more than 30-60 minutes in the first night, and that most folks usually need the ramp-up while learning to breathe against their pressure (I'm a 14).

I don't know why it is, but for some reason, I don't have any problem starting up with the full pressure. It most likely has to do with the CFlex setting on my unit (the therapist defaults all of the machines to level 3 as a starting point) making it easier. However it happened, it was really nice. I woke up after those five hours, turned off the unit, removed the mask, and stayed in bed for a couple more hours.

The only negative from the first night was a sore spot on the inside of the bridge of my nose, from the full-face mask (ComfortFull). I didn't do any bed/pillow preparation, so I ended up with the mask right on the pillow, creating a pressure point in that spot. With my skin being so sensitive (just look at it funny and it breaks out), I had expected some problems.

Night #2:
-- A sense of false confidence fills the air as the new CPAP user struts toward his bed, unaware of the struggle to follow...

After that (overly easy) first night, I went into night #2 with the impression that this would continue to be just as easy every night. Cue the 'Rude Awakening Music'. Not only was I not very sleepy when I tried to go to bed, but it was the night of the time change (Daylight Savings Time). And, in messing with the mask, I ended up changing virtually every adjustment possible.

As soon as I got into bed, the mask started fighting me. Every thing I did just made it worse -- no adjustment could stop the leaks. As soon as I thought I has the problem fixed, I'd move in a new direction, and a new leak would appear. I also got my first 'whistle' leak, which was a fun experience. After a fruitless hour of fighting, I gave up for the night.

Night #3:
-- A refocused and determined novice regains the upper hand, but does not return to that first night 'bliss'.

This time, I was determined to address both the mask and pillow issues. After reading a number of messages here, I figured out some things to try in adjusting my pillow to give me some face support while on my side or stomach, while not applying much (or any) pressure directly on the mask. I also spent some time in front of the mirror, working on addressing the mask placement.

I've struggled somewhat with exactly where the bottom of the ComfortFull should 'ride' when the mask is snugged down. I have the straps pulled down pretty tight in order to get a good seal (there are visible marks on my upper neck when I wake up from them), which is causing the bottom of the mask to rest just above the base of my chin.

I got the mask set on my face so it did not leak, I got my pillow adjusted so I could lie sideways without mask leaks or more facial sores -- and I got six hours on the CPAP that night. This time, I didn't get the completely uninterrupted sleep like Night #1; I got about four solid hours of sleep, and the rest came in two one-hour blocks. I didn't have any problems tolerating the mask or the pressure throughout the night.

Night #4:
-- A return to pre-CPAP sleep patterns?...

Before I started this, my standard sleep pattern for a given night was incredibly fragmented. Most nights, I would fully awaken at least five or six times during a six-hour period. Since I live alone, I can't say for sure why I was awakening beyond the hypopneas. (My sleep study noted extensive snoring, as well as some leg movement.)

This night, I left the mask in the same settings as Night #3, and they continued to work (no leaks, tolerated the mask throughout the night). I got in just shy of seven hours on the machine this night. However, I think the longest stretch of solid sleep I got in that period was about three hours. The rest was choppy, 60 and 90-minute stretches that I fully awoke from -- and, I found myself moving in bed from one position to another (something I hadn't done on Nights #1 or #3). I was disappointed, since the two previous nights where I was 'compliant' I had managed to avoid a lot of movement during the night.

General Impressions:
-- I seem to be one of the lucky ones who tolerate the mask and pressure without too many problems, right from the start.
-- I am not one of the users who experiences the "Eureka!" moment the next morning. So far, while I am feeling a little better, I could not say that I'm significantly improved overall. I may be one of the users who needs an extended period of usage before seeing improvement...or not?
-- I am wondering how differently the humidifier will make this work. Again, I'm tolerating CPAP reasonably well without it.
-- I was kind of grumbling about the cleaning regimen, until I followed the advice from the therapist and the folks here, and took the hose into shower: the little kid in me, and the physics geek in me, were fighting for control to see who would have the most fun (and make the biggest mess). Getting to play with a water level every three days -- maybe CPAP isn't that bad after all.

[Claerwen]

I enjoyed your tale. I'm going with auto-titrating in lieu of a second night's study, so my first night with a machine of any kind will be next Wednesday. I'm looking forward to it.

While I'm hoping for the Eureka! response, it's nice to get a light-hearted look at what I might be going through.