New to CPAP - can't sleep with nasal pillow!

[Robin.lewis]

Hey All,

I'm a 29 year old who for years has suffered with feelings of fatigue and drowsiness that - it now appears - has been caused by OSA. The cause of the OSA is either my large tonsils, obstructive throat anatomy or

deviated septum - my doctor isn't sure exactly which but says the treatment is the same regardless.

Recently I had a sleep study whih came back positive, albeit only for mild sleep apnea, so my journey into CPAP began. I'm now one week in and in sad to say - it's not going well.

I'm currently using an APAP machine with nasal pillows, however I can't seem to shake this feeling that I'm not getting enough air when I breathe. It's not that the airway isn't open, more that it feels as if there's not enough oxygen in the air I'm breathing and, as a consequence, I'm taking the odd breath through my mouth to compensate and, as you can inagine, am finding it near impossible to relax and drop off. The one time I did drop off it appears I ripped the mask off my face in my sleep.

My APAP machine appears to be set to '4' (I'm not sure what unit that is).

Does anyone have any advice for things I can do to help get used to this mask? Perhaps changing the settings or trying different mask types? I'd be greatly appreciative of any advice.

Thanks,

Robin

[Slartybartfast]

"My APAP machine appears to be set to '4' ..."

Ah, there's yer problem, Lady! That's the minimum for most machines. And most of us can't breathe with the pressure set that low. So what you're experiencing is to be expected. The minimum pressure I can tolerate is about 6. Your machine should be set with a minimum level. For instance, my lab titration study recommended a pressure of 11. The doc is a traditionalist and doesn't believe in automatic machines. So I set my minimum to 8.5 and the maximum to 13. With the lower and upper pressures defining the therapy window, I do just fine. Data shows my pressure usually lies around 9 cm, and spikes to as high as 12, averaging around 11, which pleased the sleep Doc when I showed him the data.

So set your machine to at least 6 cm and see how you feel.

And log in to the User Control Panel just below the search box in the upper left corner of the page, and add your equipment so we can speak intelligently, or at least more intelligently, about your situation.

[Pugsy]

My APAP machine appears to be set to '4' (I'm not sure what unit that is).

Does anyone have any advice for things I can do to help get used to this mask? Perhaps changing the settings or trying different mask types?

That starting pressure of 4 cm (that's the unit) is probably the reason you are having trouble feeling like you aren't getting enough air/oxygen. While we won't suffocate with that low of a pressure it sure can feel like we are.

Do you know you pressure settings...is it start out at 4 cm and go up to where it needs to go? If so if you start at 5 or 6 cm you likely will be much more comfortable. Also sometimes going up a size in the nasal pillow will help also.

I would look at changing that minimum pressure before changing masks...you likely will feel suffocated with any mask at that pressure of 4 cm.

You didn't say which machine you are using but if you go here you can find your machine and request the clinical manual and figure out what your settings are and how to maybe increase that minimum just a little and I bet you will be more comfortable.http://www.apneaboard.com/adjust-cpap-p ... tup-manual
When you have time please post your equipment to your profile so we can see at a glance what you are using.
Please use text option (see mine as example) because the icony images don't easily show model names.
If unsure about exact model...if a ResMed machine it clearly states the model name on the top of the machine up by the on/off knob. If it is a Respironics machine the model number is on the bottom of the blower unit. It's a 3 digit number with maybe DS or REF in front of it. Tell us the model number and we can tell you exactly which model it is.

[Robin.lewis]

Thanks SlartyBartFast and Bugsy for the responses. I've now updated my profile with some details about my setup. I'm afraid I'm not exactly sure of the model of my Nasal Pillow and Humidifier, but can confirm that they're both also manufactured by ResMed.

I've just got home and am pleased to say that, having upped the minimum pressure to '6', it already feels significantly better!.I'm actually quite excited about potentially getting a got night of sleep! It's a shame they set the initial pressure so low - especially as I was advised not to alter any of the settings.

I'll let you know how I get on!

[SleepyToo2]

If you still have problems with "suffocating" at 6, you can probably move slowly up until you feel comfortable. I started at 4, and lasted about 10 minutes before I increased it to 6, and then took off the ramp completely so that the starting pressure was the same as my (fixed) pressure for the rest of the night - 8 cm. I have since gone up to 10 (Dr recommended), and have no problems at that level. Good luck - it will make a difference in your life, now and in the future.

[Tatooed Lady]

FWIW, I use the Swift FX nasal pillows and had been started on a too small size AND low setting of 4. I got scolded when I asked the DME about bumping up the air pressure, as I had a hard time breathing... SO...I went to a larger size pillow which helped quite a bit, but still wasn't happy...so I fiddled with the pressure, bumping it to 5. Nirvana.
I also bought a full face mask (ResMed F10) last week, and found that I felt more comfortable bumping the pressure up yet again, to 6. Could be because I was home and we don't have a/c, and the weather was rather humid. But at 6, the nasal pillow isn't comfortable. Right now, that is just too much pressure.
In any case, a little bump up from 4 can be just what YOU need, not necessarily what the doctor ordered. After all, who has to wear this thing?
Good luck!

[robysue]

My APAP machine appears to be set to '4' (I'm not sure what unit that is).

If this is the number that you are seeing right after turning the machine on, there's a good chance that it is the HUMIDITY setting and NOT the pressure setting since you are using an S9. As I recall, the humidity setting is HUGE on the S9's LCD when the machine is in use.

Please confirm what your pressure setting(s) are by looking at them in the clinical menu. The pressure settings do NOT appear anywhere in the Patient menus.

I'm currently using an APAP machine with nasal pillows, however I can't seem to shake this feeling that I'm not getting enough air when I breathe. It's not that the airway isn't open, more that it feels as if there's not enough oxygen in the air I'm breathing and, as a consequence, I'm taking the odd breath through my mouth to compensate and, as you can inagine, am finding it near impossible to relax and drop off. The one time I did drop off it appears I ripped the mask off my face in my sleep.

If you are using the RAMP, turn it off or turn the beginning ramp pressure up.

If you are NOT using the RAMP, call the sleep doc and report the problem. Ask if bumping the pressure up 1 or 2 cm is ok.

Also consider the mask type you are using. There is some psychology at work here as well. And sometimes the mask style simply makes people feel a bit claustrophobic, and once that starts, it's difficult to not get worried about whether or not enough air is coming in through the mask.

[gdgiles]

I'm not sure what settings I should use. I also have an auto setting and using the ramp feature to get to sleep the pressure drops to a 3. The highest I've ever seen it off ramp is like 5.2. I know I don't snore any more, and I know I'm sleeping better, but I'm surprised to read all these high numbers here. I discovered getting past the 'not enough air' phase for me was a mental issue; I just had to get myself in a calmer more relaxed state.

[The Latinist]

I'm not sure what settings I should use. I also have an auto setting and using the ramp feature to get to sleep the pressure drops to a 3. The highest I've ever seen it off ramp is like 5.2. I know I don't snore any more, and I know I'm sleeping better, but I'm surprised to read all these high numbers here.

Everyone is different. Some people even with severe OSA can be helped by quite low pressures; others even with mild OSA need much higher pressures for effective treatment. There seems to be no rhyme or reason; it's just something that you and your doctor have to figure out.

[gdgiles]

In my case I'm doing it on my own. So far I think it's working. I still wake up every 2 hours but my sleep is much better.