Hi All - My First Night Experience

[JayDee]

HI All,

I've recently been diagnosed with Sleep Apnea and received my equipment yesterday (ResMed Airsense-10 AutoSet & full mask). Got home and started googling to see what info was out there and what I should expect and found this forum.

Greetings! Pleased to meet you all!

I did a home study about three weeks ago and was told my results were and average of 38 events an hour with oxygen levels around 85%. The home study device was like a giant wristwatch with a fingertip sensor and a stick-on sensor for my chest about the size of a large bottle-cap. The adhesive on that chest sensor was some serious, hair-ripping stuff! Note to others: shave a spot!

Last night was my first night with the machine and it was a pretty bad experience. I managed about 5-1/2 hours of fitful, unsatisfying, very light sleep - more like dozing than actual sleep - before I took the mask off.

Now, I do understand it takes time to get used to CPAP and iteratively tweaking settings to find the "just right" configuration is to be expected. So I am looking forward to it getting better. I'm presuming my first night experience is not terribly unusual.

My main issue was feeling like I couldn't get a satisfying inhalation of air:
- I had the sensation of breathing into a sealed-bag and only getting "used", second-hand air.
- I kept wanting to pull the mask away from my face so I could get a breath of fresh air. I didn't, but the desire was there.

I'm thinking it was the warmed, humid air that felt so stifling. Imagine some giant was breathing heavily right into your face from an inch away. So for tonight, my first instinct is to figure out how to cut the warmth & humidity by at least half -or- just turn them off completely.

Other than that, no other complaints. I was able to sleep on either side and I sure did some tossing and turning without getting tangled in the hose or breaking the seal. As for noise, the machine itself was absolutely silent. My breathing seemed noticeably amplified though.

Overall, it was a pretty disappointing first night. I'd have to say I hardly slept and I feel pretty dull this morn after my mug of coffee, more so than how I usually felt in the mornings before CPAP. There will undoubtedly be a nap later today and I don't know if I should try the machine when I nap or not. I think I'm really going to need that nap...

But, I'm optimistic it will get better! It has to!

Thanks,
-JayDee

[Pugsy]

Welcome to the forum.

My first thought with your main issue is the pressure setting is probably too low for comfort. Not enough air is moving.
It's a common complaint when people are given the kind of machine you were given and the needed settings are unknown.
The give you the machine at the factory default minimum and maximum settings and let the machine sort it out.
The problem is the factory default minimum is really fairly low and for a lot of people it simply isn't comfortable.

Let's figure out exactly what your machine is set at then decide what might be a little more comfortable for you.
It's hard to sleep when we aren't comfortable and the name of the game here is getting good quality sleep and keeping the airway open.

Go here and get the clinical manual for your machine. It explains how to get to the special area where you can see all the settings and make changes if you want to.
https://sleep.tnet.com/home/files/resme ... -guide.pdf
Make note of all the settings for pressure and any exhale relief (EPR) as well as the humidity settings.
Come back and tell us what you find and we can then offer some ideas.

[Pugsy]

Oh...one other question.
Can you normally breathe through your nose just fine or do you have chronic nasal congestion issues where you just have to mouth breathe because you can't get enough air through your nose?
I am wondering why they started you out with a full face mask.
Was it I sometimes have to mouth breathe thing or I always have to mouth breathe because my nose is so stopped up thing?

[bombayone]

Congratulations on taking the first step to better sleep. Adapting to CPAP takes time. This forum is a good place to get some great advice on making a smooth transition. Down load the clinical manual as suggested. Continue to ask questions. You will succeed.

[Okie bipap]

Welcome to the group. You did better than I did my first night. I only lasted 4 hours before I had to take the mask off. Now, it doesn't feel normal if I don't have it on when I lay down.

[JayDee]

Thanks for the link to the clinical user manual! Awesome!

No issues nose breathing. Wife says I'm a snoring nose-breather when I sleep.

Here are my current settings:

Initial Settings:
Therapy
- Mode: Autoset
- Max Pressure: 20.0
- Min Pressure: 5.0
- Mask: Full Face

Comfort
- Response: Standard
- Ramp Time: Auto
- Start Pressure: 5.0
- EPR: On
- EPR Type: Full Time
- EPR Level: 2
- Climate Ctrl: Auto
- Tube Temp: 80 deg F

Accessories:
- AB Filter: No

Options
- Essentials: On
- Smart Start: On
- Reminders: (all off)

Thanks,
-JayDee

[JayDee]

Also, I told them I had a concern about "wiping" the mask off in my sleep and they suggested the full face mask. They said I could exchange it within 30 days, if the test-drive wasn't satisfactory. I'm game for giving it a few days since it's all new to me.

Thanks,
-JayDee

[Pugsy]

Okay...
Go in and change Essentials from "On" to "Plus"...this will give you access to the limited data available on the machine's LCD screen.

You apparently have a heated hose and it is set to 80 degrees....that's part of the warm muggy feeling you are experiencing. Feels great in the winter but not so great in the summer.

Humidity setting is for "Auto" which I think is 85% and equal to about a setting of 4 or 5 if you were doing manual (goes from 0 to 8 when manual humidity control is used). The reason it is the default setting is because most people do well at that setting. I use the setting of 6 myself...I like a little more moisture than most people. We joke about it...that I would snort water if I could.

I don't like to change too many things at one time because we never know which change caused what results if we make a lot of changes at one time. I like to keep any changes made to the settings as few as possible to better gauge the results.

First thing I suggest...go in and change that hose air temp from 80 degrees to something around 68 degrees. See what that feels like at the current Auto setting for humidity. You may or may not have condensation happen at the lower hose air temps (depends a lot on the ambient room temp) and if you do you will know it and there are options available to better prevent it. Condensation in the mask or hose...we call rain out. It won't hurt you but it is highly annoying.

The stale air feeling...starting pressure is 5 cm and that's barely above the lowest the machine will go which is 4 cm. Common complaint with some people. When I tried my apap on my sister I had to use a starting minimum of 6 just to get her comfortable with the air movement. So try 6 or even 7 as the starting minimum.
Use available software later to see if it needs to be higher or not.
https://sleep.tnet.com/equipment

Hopefully with a little higher starting minimum pressure and a cooler hose air temp...you will be more comfortable and sleep better.
That's all the changes I would make for now...2 changes.
See how you do and go from there.
If your DME squawks about the pressure change...tell them you were suffocating at the 5 cm pressure and needed more air movement and they can get the doctor to okay the change if they have a problem with it. They can't legally change the doctor's RX but there's nothing in the laws about the patient changing things.

The humidity and hose air temp settings along with EPR are considered comfort features and fair game...usually no one cares if the patient plays with those settings.

Do make use of the 30 days mask swapping available time for your own educational experience if nothing else. The various nasal masks have much less of a footprint on the face and are usually easier to fit and seal than the full face masks. So do plan on giving another mask a try at some time. You might really like it...and you might not but you won't know unless you try.
You can always go back to the first mask if you find you end up liking it the best.

You actually did quite well last night...better than I did my first night that's for sure.
It will get better and easier with time and experience.
You will be surprised how much difference relatively small changes can make in your comfort and we have to be comfortable to sleep decently.

[JayDee]

I was sorely tempted to call it quits a few times last night, but stuck it out. I don't know which is more applicable to me -- that I'm more tolerant of the discomfort, or that I'm determined to make this work. Either way, I'm willing to do whatever it takes.

I do appreciate the advice. I'll make those changes and see how it goes.

Thanks again!
-JayDee

[cpapmoma1]

Glad to see you here and welcome.
You are already on the way to good results. Listen to learn gets you there every time.
Bon voyage

[JayDee]

My 2nd night was much better. I still woke up more than I'd like during the night aware of the contraption on my face, but that's just acclimation. I'm confident I'm on the right path and it will continue getting better!

Adjusting the minimum air pressure was key. I experimented yesterday with min pressure at 6, 7, 8, 9 & 10 for several minutes each to get a feel for it. I felt that 8 was the sweet spot for me.

Adjustments made:
Minimum/starting pressure of 8psi for now. I may play with that as days go by +/- 1psi-ish.
Ramp is off. If I need air, I want it *now*. Plus, I fall asleep fast.
Humidity is off. I'm in Georgia - high humidity permeates *everything*. I may turn it back on when it gets drier in winter.
Tube Temp is down to 69 - matches the house thermostat at night.

I'll use these settings for a bit and see how it goes, but from this point, it's just a matter of making minor mid-course corrections to dial the machine in to suit me. Thanks to the links Pugsy provided, I've now got access to the settings, plus good machine documentation.

I'll install SleepyHead and start tracking things for a bit. That's a fairly comprehensive wiki and I see how that app can be a useful tool to help get me where I need to be.

I'll keep trying the full face mask for a few more nights just to give it a decent test-drive, but I'm leaning towards keeping it as a backup. I'm thinking it will come in handy if I catch a cold/flu and get stuffed up. I'm browsing through the threads looking for side-sleeper mask preferences, looking for anecdotal experiences. I'll probably just outright buy either a nasal mask or pillows so I can keep the FFM instead of swapping it.

Thank you Pugsy for the info & advice!! You're awesome!! Reading over some of the "newbie" messages, you've clearly got a knack for making it all easily understandable.

Thanks again!
-JayDee

[Pugsy]

Before you go spending money on another mask confirm that your DME requires you to physically return the full face mask if you do a swap. Some DMEs call it a swap and just tell you to keep the other mask because they won't be doing anything with it but toss it in the trash can. Some DMEs require physically returning the first mask...some don't.
They don't lose money. The mask manufacturers just require a little paperwork to get credit for any additional masks they dispense beyond the one that insurance reimburses them for.

[JayDee]

Good point -- I had thought they would likely just have to dispose it if I returned it, so I'll check with them Monday. But I'm prepared to go on my own if they do want the FFM returned.

[Pugsy]

I might have a donated mask you could have for cost of postage only.
Depends on what you want to try.
Slightly used but still with enough life in it to try it and see if you even like it or not. If used freaks you out though...I would go with cpap.com and make use of the return insurance available (sometimes at no cost and sometimes at minimal cost) so that I wouldn't be spending a lot of money on masks that I might end up hating.
Cpap.com will require a copy of the RX though but that's easily obtained. They will even fax your doctor for you to get the RX.

If you want a freebie and used doesn't freak you out...send me a PM with what interests you and I will let you know if I have that model available.

[raisedfist]

Sounds like you're off to a pretty good start. I underwent an acclimation period as well. When I did a split-night study, and subsequent titration on bi-level, in the lab I was terrified and it felt like I was never going to be able to get to sleep. The pressures used felt like I had a leaf blower on my face. Now, if I fall asleep without it, how I feel the next day reminds of just how much the machine can do for you.