CPAP – Struggling and needing suggestions

[floki_cpap]

Hello,

I have been using CPAP since December 2019 with no noticeable difference.

I have periods when I will use it consistently week after week and there are times when I won’t use it and I can not say that I feel “more rested/restored” when I am on CPAP.

I have only slept well once in the last few years but I was on medication (muscle relaxant) treating an issue I had. The next day I felt alert, I could focus for long periods of time and had the impression that I could get things done.

The general pattern when I sleep with or without CPAP is that I sleep for 2 to 3 hours with no problems. Then I have my first awakening. After which I use the restroom and then spend the rest of the night in and out of sleep.

When I am on CPAP, after the first awakening, I usually take off the mask and don’t use the machine anymore for the rest of the night. This is because with the mask on I find it harder to fall asleep. I just end up laying in bed awake. When I take off the mask I find it easier to fall back to sleeping although it is choppy.

When I don’t use CPAP, I try to sleep as much as possible on my right side. Sleeping on my left side causes me shoulder pain. Sleeping on my back causes me to wake up with with back pain in the morning. Sleeping on my back also causes me to wake up during the night due to back pain.

When I use CPAP, I have to sleep on my back because when I try to sleep on my side the mask (DreamWear Nasal CPAP Mask with Headgear) starts to move, becomes uncomfortable and I become more aware of it.

Do you have any suggestions on how I can sleep on my back without back pain or how I can sleep on my right side without the mask moving and me hearing and feeling the moving air?

In the last 2 to 3 months, I have been getting bad sore throat/dry throat after using CPAP and once when I did not use the CPAP machine. A pharmacist suggested that it was probably due to a lack of humidity. I got a room humidifier and that seems to have helped. I don't get sore throat/dry throat when I sleep with out the CPAP anymore.

Due to the dry throat I was getting when using the CPAP, I did not use it for a few nights. However, the night I decided to go back on it I got very bad sore throat/dry throat so I went off it again. I spoke to my doctor last week and he believes that I am having a mouth leak. He suggested that I get a chin strap.

I decided to tape my mouth first to see if that makes a difference before investing in a chin strap. I taped Sunday night when I used the CPAP machine and I did not wake up during the night with sore throat. So that is an improvement.
I did wake up about 2 hours after I fell asleep but managed to go back to sleep with the CPAP machine.

However, I woke up Monday morning with very bad back pain probably because I slept on my back. Usually if I wake up with back pain it is usually gone within 2-3 hours after I wake up but on Monday the pain endured late into the afternoon.


Here are some OSCAR screenshots.
The first one is from a night I had bad sore/dry throat with CPAP
The last two are from the first two nights of tapping my mouth.
Looking at the images, is there anything that sticks out to you?

Thank you.

One


Two


Three

[Julie]

SShots aren't working - either do Oscar and post results here, or on Imgur.com with a link in this thread.

You don't have a humidifier that goes with the machine?

[floki_cpap]

Hello Julie,

I fixed the images. I forgot to add the .jpg to the imgur link.
Yes I have a and use the built in humidifier that comes with the machine.

[zonker]

Hello,

welcome to the zoo!

two questions-

1. do you know why you are on fixed pressure?

2. see the event graph marked "pressure"? it's stopped at 12 and won't go any higher. it plainly wants to but is restricted by the setting of 12. it CAN go higher if you set it higher. i think that this is probably the main reason why you aren't seeing better results.

i'll wait and see what the more seasoned veterans of the forum say.

good luck!

[robysue1]

floki_cpap,

You write:

I have been using CPAP since December 2019 with no noticeable difference.

The one thing that stands out and grabs my attention about your data and the written information you provide in your post is the usage: You're simply not sleeping long enough with the CPAP each night to feel its benefit.

I know that's not what you want to hear. But the fact is, for CPAP to work (and work well), you do need to use it all night long, every single night. And you're not doing that yet:

I have periods when I will use it consistently week after week and there are times when I won’t use it and I can not say that I feel “more rested/restored” when I am on CPAP.

and

The general pattern when I sleep with or without CPAP is that I sleep for 2 to 3 hours with no problems. Then I have my first awakening. After which I use the restroom and then spend the rest of the night in and out of sleep.

When I am on CPAP, after the first awakening, I usually take off the mask and don’t use the machine anymore for the rest of the night. This is because with the mask on I find it harder to fall asleep. I just end up laying in bed awake. When I take off the mask I find it easier to fall back to sleeping although it is choppy.

In other words, the problem that I think you need to work on (and solve) is learning how to get back to sleep with the mask on after you wake up about 2-3 hours into the night.

Because laying in bed awake or yanking the mask off to get some additional choppy sleep is the most likely reason that you are still feeling tired and/or sleepy during the daytime.

So let's talk about that first awakening: You wake up 2-3 hours after going to sleep and then you get up to go to the bathroom. Do you wake up feeling an urgent need to go, or do you simply decide to get up and go to the bathroom since you are already awake for some unknown reason? Do you turn the lights on when you go to the bathroom? If so, how bright are the lights?

And when you are awake, do you wind up doing things like deciding to check your phone for any reason? Do you look at the clock and immediately start thinking about such things as:

• how little time there is before you have to get up in the morning
• how much sleep you've already gotten, with a focus on how little sleep it is
• wondering why you are awake yet again in the middle of the night
• worrying about the fact that you know it's not going to be easy to get back to sleep

In other words, you need to be honest with yourself about whether there are behavior patterns you have fallen into that are aggravating the sleep maintenance insomnia and the problems you have with getting back to sleep after a middle of the night wake. And you need to work on replacing those potentially troublesome behaviors with ones that will encourage your body (and brain) to learn how to quickly get back to sleep (with the mask on!) after you wake up in the middle of the night.

And you also need to focus on resisting the desire to just rip the mask off so you can get back to sleep: The sleep you eventually get is, in your own words, "choppy". And it's choppy because its full of apneas and hypopneas interrupting your sleep with the frequency of your untreated OSA.

It's worth noting: When you use the CPAP at the beginning of the night, the machine clearly controls your apnea: You have almost no events in the data you've posted, and at the scale we're looking at, the breathing actually looks like pretty decent sleep breathing---in other words, when you are using your CPAP during the first 2-3 hours of the night, there's not much obvious evidence that screams out that you are dealing with a whole lot of arousals and sleep-wake-junk type breathing caused by tossing and turning and not being able to get into a sound sleep.

So it's a question of what can you do to teach your body to accept the CPAP mask and get back to sleep quickly and soundly after that first awakening.

The first thing is: Don't go to sleep without masking up. In other words, always mask up when you return to bed. Give yourself a reasonable amount of time to fall back asleep, but do not watch the clock. If you find yourself feeling like you are tossing and turning and you think you've been restless for more than about 20 minutes, get up and leave the bedroom. Do something quiet and relaxing---sitting in the dark listening to soft music is a good choice---until you start to feel sleepy. Then go back to bed, mask up, and try to go back to sleep. Rinse and repeat as many times as needed in order to finally fall back asleep with the mask on. Eventually you will get back to sleep and hopefully your body will allow itself to get into a quality sleep.

The second thing is: Try to get up at roughly the same time every morning---no matter how tired or exhausted you are. A regular wake-up time is one of the most powerful tools for fighting insomnia. Going ahead and getting up and struggling through the day helps convince the body that being asleep while in bed is a requirement for the privilege of being in bed.

The third thing is: Try to establish some kind of a bedtime routine, but only go to bed if you are feeling sleepy, which is different than feeling tired or exhausted. It's hard to fall asleep and stay asleep if you are not actually sleepy regardless of how exhausted you feel.

I have only slept well once in the last few years but I was on medication (muscle relaxant) treating an issue I had. The next day I felt alert, I could focus for long periods of time and had the impression that I could get things done.

It's worth considering whether taking a prescription sleeping aid might help you. Have you ever tried something like Ambien or Belsomra?

When I use CPAP, I have to sleep on my back because when I try to sleep on my side the mask (DreamWear Nasal CPAP Mask with Headgear) starts to move, becomes uncomfortable and I become more aware of it.

Do you have any suggestions on how I can sleep on my back without back pain or how I can sleep on my right side without the mask moving and me hearing and feeling the moving air?

The mask that you are currently using (DreamWear Nasal Mask) has the hose attachment at the top and the air runs down from the top to your nose through hollow tubes that make up the sides of the mask frame down to the nasal cradle. It could be that you become much more aware of the mask when you are on your sides because of the sound of your own breathing being conducted through the tubes to your skull. It could also be that the thickness of the side tubes are "fat" enough for you to notice when you roll onto your side. These things are caused by the design of the mask, and if they are why you find you have a tough time getting (or staying) asleep when you are on your side, then you may want to consider an alternate mask with the hose attachment at the front rather than the top of the mask. (You can use a hose hanger to get some of the benefits of having the hose attachment at the top of the mask.)

And it could be that the way you are fitting DreamWear mask is making it more difficult to move around. I would strongly suggest fitting the mask at the beginning of the night while you are lying on your right side. You may find that you need to adjust the straps in an asymmetric fashion when you are on your side so that the nasal cushion is not pushed out of place. Once you have the mask fit while lying on your side, turn onto your back and see if the mask stays put.

But a better solution would be to try a mask where the air is not rushing by the side of your head so that you have a better chance of being able to sleep in your side as well as your back. The Resmed AirFit N20, the Resmed AirFit N30 (but not the N30i), and the Resmed Swift FX Nano are all nasal cradle masks that do not have air tubes on the sides of the head.

In the last 2 to 3 months, I have been getting bad sore throat/dry throat after using CPAP and once when I did not use the CPAP machine. A pharmacist suggested that it was probably due to a lack of humidity. I got a room humidifier and that seems to have helped. I don't get sore throat/dry throat when I sleep with out the CPAP anymore.

Do you have a humidifier attached to your CPAP machine? If not, get one. If so, what setting do you use?

Due to the dry throat I was getting when using the CPAP, I did not use it for a few nights. However, the night I decided to go back on it I got very bad sore throat/dry throat so I went off it again. I spoke to my doctor last week and he believes that I am having a mouth leak. He suggested that I get a chin strap.

The leak lines you posted show some evidence of intermittent mouth breathing that is not significant enough to adversely affect the efficacy of your therapy (in my opinion). But it could be aggravating your sore, dry throat. I would suggest using the heated humidifier for your machine in addition to the room humidifier you've already added.

Also keep yourself well hydrated in the daytime.

I decided to tape my mouth first to see if that makes a difference before investing in a chin strap. I taped Sunday night when I used the CPAP machine and I did not wake up during the night with sore throat. So that is an improvement.
I did wake up about 2 hours after I fell asleep but managed to go back to sleep with the CPAP machine.

This confirms that you may be doing some intermittent mouth breathing. If you are comfortable with taping, that's as good or a better solution than using a chin strap would be.

However, I woke up Monday morning with very bad back pain probably because I slept on my back. Usually if I wake up with back pain it is usually gone within 2-3 hours after I wake up but on Monday the pain endured late into the afternoon.

Or that backache could have been triggered by you sleeping extra soundly for a longer period of time.

Still, I think the better solution is to try a mask where the air is not rushing by the side of your head so that you have a better chance of being able to sleep in your side as well as your back. The Resmed AirFit N20, the Resmed AirFit N30 (but not the N30i), and the Resmed Swift FX Nano are all nasal cradle masks that do not have air tubes on the sides of the head.

Here are some OSCAR screenshots.
The first one is from a night I had bad sore/dry throat with CPAP

The leak from 0:50 to 1:40 is long enough to explain a dry, sore throat the next day. But it's not large enough to adversely affect your therapy.

The last two are from the first two nights of tapping my mouth.
Looking at the images, is there anything that sticks out to you?

The leaks are much improved on these nights. If you are comfortable with taping, then I'd suggest continuing to tape.

[floki_cpap]

welcome to the zoo!

two questions-

1. do you know why you are on fixed pressure?

2. see the event graph marked "pressure"? it's stopped at 12 and won't go any higher. it plainly wants to but is restricted by the setting of 12. it CAN go higher if you set it higher. i think that this is probably the main reason why you aren't seeing better results.

i'll wait and see what the more seasoned veterans of the forum say.

good luck!

Hello zonker,

1. That is my latest prescription from the doctor. I was on Auto range before (10 to 13).

[robysue1]

2. see the event graph marked "pressure"? it's stopped at 12 and won't go any higher. it plainly wants to but is restricted by the setting of 12. it CAN go higher if you set it higher. i think that this is probably the main reason why you aren't seeing better results.

The pressure is set at 12 in CPAP mode. The increase in pressure from the start of sessions up to 12cm is caused by the OP using a ramp. Since the machine is in CPAP mode, of course it's not going to go any higher once it reaches the set pressure.

And there is nothing in the flow rate data or the event data that indicates the machine needs to go any higher: The handful of events that are scored are well separated in time and given the PR auto algorithm, if the OP were using Auto mode with a min pressure of around 12, the pressure would not have gone much higher except for the PR "search" subroutine that periodically tests a 1-2cm increase in pressure to see if it "helps".

In other words, given what the OP is dealing with, there's no good reason to add "Auto" mode to the mix: He has successfully dealt with a mouth leak problem. Now he needs to figure out a way of fitting the mask so that he can sleep in his preferred position and so that he can move around in bed, both with a goal of learning how to sleep with the machine all night long, every night.

[robysue1]

Hello zonker,

1. That is my latest prescription from the doctor. I was on Auto range before (10 to 13).

Which mode was more comfortable for you in terms of getting to sleep and in terms of being willing to put the mask back on after your initial wake 2-3 hours into the night?

Because if you are more comfortable with straight CPAP, then stick with straight CPAP.

A majority of members here use Auto mode, but there are a couple of folks who strongly prefer straight CPAP. If you prefer straight CPAP, then stick with it.

[floki_cpap]

Hello robysue1,

Thank you for the detailed response.

In other words, the problem that I think you need to work on (and solve) is learning how to get back to sleep with the mask on after you wake up about 2-3 hours into the night.

I agree.

So let's talk about that first awakening: You wake up 2-3 hours after going to sleep and then you get up to go to the bathroom. Do you wake up feeling an urgent need to go, or do you simply decide to get up and go to the bathroom since you are already awake for some unknown reason? Do you turn the lights on when you go to the bathroom? If so, how bright are the lights?

I rarely ever feel an urgent need to go. I go because I am awake and because I want to cross that out as something that woke me up or could wake me up later in the night. Going also helps to prevent me from ruminating about whether I need to go or not.

And when you are awake, do you wind up doing things like deciding to check your phone for any reason? Do you look at the clock

No I dont check my phone except if I think it is close to the time my alarm is set to go off. Then I just check the time.
If it is, then I just usually get out of bed.
I dont have a clock in my room. I do see the clock in the living area though on my way from the restroom back to bed.

immediately start thinking about such things as:

how little time there is before you have to get up in the morning
how much sleep you've already gotten, with a focus on how little sleep it is
wondering why you are awake yet again in the middle of the night
worrying about the fact that you know it's not going to be easy to get back to sleep

Not immediately but if I dont get back to sleep right way (under 2 minutes I would say), I start having thoughts like that.
Sometimes I would have thoughts like that but I still manage to go back to sleep.

When I get the impression that I have been tossing and turning for a while:
* If I have the mask on: I take it off and try to go back to sleep.
* if I dont have the mask on: I usually get out of bed. Depending on the time and how awake I am, I just get started with my day.

The first thing is: Don't go to sleep without masking up. In other words, always mask up when you return to bed. Give yourself a reasonable amount of time to fall back asleep, but do not watch the clock. If you find yourself feeling like you are tossing and turning and you think you've been restless for more than about 20 minutes, get up and leave the bedroom. Do something quiet and relaxing---sitting in the dark listening to soft music is a good choice---until you start to feel sleepy. Then go back to bed, mask up, and try to go back to sleep. Rinse and repeat as many times as needed in order to finally fall back asleep with the mask on. Eventually you will get back to sleep and hopefully your body will allow itself to get into a quality sleep.

I think I can do this.

The second thing is: Try to get up at roughly the same time every morning---no matter how tired or exhausted you are. A regular wake-up time is one of the most powerful tools for fighting insomnia. Going ahead and getting up and struggling through the day helps convince the body that being asleep while in bed is a requirement for the privilege of being in bed.

Just a note about this one:
I go to the gym on Wednesday, Friday and Sunday mornings.
I get up at 5:30 AM on Wednesdays and Fridays so that I can go to the gym.
I started exercising in the mornings because I was up anyway and I thought I might as well do something with the time.

I tried switching things up so time ago and trying to go after work but going in the mornings seemed to work out better.
Between 5pm and 8pm: I found the gym packed with people and harder to work out.
After 8pm: I am "pumped" after exercising and falling asleep is harder.

The third thing is: Try to establish some kind of a bedtime routine, but only go to bed if you are feeling sleepy, which is different than feeling tired or exhausted. It's hard to fall asleep and stay asleep if you are not actually sleepy regardless of how exhausted you feel.

I am working on this right now.

It's worth considering whether taking a prescription sleeping aid might help you. Have you ever tried something like Ambien or Belsomra?

No I am not on a prescription sleeping aid.
I have not tired either of the two you mentioned.
If my memory serves me right, back in 2019, my doctor gave me something that she said what not habit forming.
I used it for a few days before I could get an appointment for my sleep study.
I dont recall what it was but I dont remember it helping.

The majority of the time I dont have trouble falling asleep.
It is the waking up after 2 to 3 hours that is the main problem right now.

Which mode was more comfortable for you in terms of getting to sleep and in terms of being willing to put the mask back on after your initial wake 2-3 hours into the night?

Because if you are more comfortable with straight CPAP, then stick with straight CPAP.

I cant say that one feels better than the other.

In regards to masks, I have tried a number of masks.
I dont remember the exact names for the earlier ones I tried but they look like the ones listed below.

Previous ones that I might be getting their name wrong:
1. https://mdaccpap.com/product/philips-re ... -headgear/
I found it hard to sleep on my side and the tube kept getting in the way.
Due to the problem of the tube getting in the way, I asked for something with the tube on top so that when I turned the tube was not in the way.

2. https://clinicalsleep.com/products/cpap ... -headgear/
When I told the person at the DME place where I got my machine that I was having problems speaking on my side with this mask she suggested at that I try the DreamWear Nasal CPAP mask.

3. https://clinicalsleep.com/products/cpap ... l-pillows/
I tried 1 or 2 pillows masks similiar to this but found them uncomfortable and could not sleep on my side.

Using right now:
DreamWear Nasal CPAP
https://www.cpap.com/productpage/pr-dre ... k-headgear


I might have missed one or two other masks that I tried.

But a better solution would be to try a mask where the air is not rushing by the side of your head so that you have a better chance of being able to sleep in your side as well as your back. The Resmed AirFit N20, the Resmed AirFit N30 (but not the N30i), and the Resmed Swift FX Nano are all nasal cradle masks that do not have air tubes on the sides of the head.

I will talk to my DME about this.
Do you think I should talk to them right away about this or wait a few weeks to see if the other suggestions have an effect first?

Do you have a humidifier attached to your CPAP machine? If not, get one. If so, what setting do you use?

Yes. I am using the one that comes built in the with DreamStation 2 Auto CPAP Advanced with Humidifier.
Right now humidity is set to 4 (I just increased it to 4 last week) and Tube temperature is set to 3.


I dont know if it is important but I also sleep with ear plugs.

[floki_cpap]

Hello,

This is from this current night.


I decided to do do what robysue1 suggested about only sleeping with a mask and avoiding the no mask choppy sleep.

I cant remember the exact time when I had my first awakening this night.
After using the restroom and going back to bed with the mask, I was struggling a lot to get comfortable with the mask. I had to tightened it harder than when I retired earlier for the night for me to not hear and/or feel the air leaking/moving.

However tightening the mask just made it more uncomfortable.


After struggling for what felt like a few minutes and feeling more alert/awake, I decided to get out of bed. I went to the living room area and just laid on the sofa for about 20 minutes. It seemed like I was getting in and out of a sleepy state.

After that I decided to try to sleep again with the CPAP but the experience repeated itself so I got out of bed and laid on the sofa again. However this time around I was even more alert/awake.

At this time I concluded that I was done for the night as I was fully on awake on.

It is about 4:19 AM right now and I think I will go to the gym as I don't want to wait around until 5:30 AM to do so.

Also I was having some left shoulder/left neck pain during the night. I wonder if that might have contributed.

[ozij]

It is the waking up after 2 to 3 hours that is the main problem right now.

That's not a problem, unless you think it is.
The problem is that you have so much trouble getting back to sleep afterwards with the mask on.

Try to start by accepting that some of us wake up at a certain point. And try to respond with "OK, so now I'm awake". And let it be.

Not immediately but if I dont get back to sleep right way (under 2 minutes I would say), I start having thoughts like that.

I'd certainly call that immediately!

And then do everything robysue has recommended you do in response to your waking.

[nightnight]

I find it odd that you were initially on 10-13 pressure, and then it was changed to a flat 12. What does that accomplish? OMG. If you did that, then OK. But, if a clinician or doctor did that, I would not think too highly of them...... I mean, really........that does nothing to help the situation.

Remember when you learned to drive.......... how fast did you go on your first drive? Probably 5 mph in a parking lot to get used to it, right? Why didn't your instructor tell you to floor it - get up to 100 real fast? Because.......you had to get USED to driving.......

Same with PAP therapy. They determined that you need a particular pressure by a single test.......in home, or at a clinic... however you were tested. I'll bet you woke a lot, and they kept adjusting it. If your mask was leaking...........they adjusted the mask, or the pressure........

So, to think you will just put on the mask and begin to get therapy, and boom, all is perfect, is not - IMHO - the right approach.

Think of the car again........... go slow.

Based on the evaul, you need therapy. OK. How about starting out SLOW? Then, begin to increase the pressure as needed!! Rather than starting from the highest pressure?

Higher pressure = louder noise. The loud noise of the machine used to wake me up! I have very sensitive hearing..........I hear everything!

Talk to your doctor. Begin at 4, or 5......whatever the machine's lowest pressure is. Get used to sleeping with that low pressure. HEY, you have been sleeping without any pressure for many many years.........you can wait a little longer for that higher pressure. Then, increase slowly...........see how you feel/sleep.........

Possibly you could need a BIPAP machine....... That way the exhale pressure is reduced to allow you to - just do it.

I also suggest you try out a full face mask. I found the ResMed mask not to feel right for me. I use the F&P mask, and it works well for me. I also sleep on my side. And, I find that the high pressure used to wake me up! I now put a pillow over my exposed ear (can't use earplugs).

Almost forgot............>>! Pillow height! Make sure that your spine is horizontal on the bed. Your neck should not be tilted up..or down....

I have been using PAP for 20 years - I think. It took me 2 years to adjust to a full night sleep. And, it took me 19 years (sigh) to take control of my settings.........

Don't give up. I can remember 4 or 5 days of my ENTIRE life where I have woken up and said........ "WOW I feel great". Yesterday, I said........ "Hey, I feel pretty good!".

Lower that pressure.

[Miss Emerita]

Nightnight, the OP has been using CPAP since 2019 and is describing sleep problems that show up with or without CPAP. I would also note that many people feel somewhat air-starved with pressures of 4 or 5.

Floki, I'd suggest leaving your settings alone and really focusing on the advice you're getting from robysue.

[floki_cpap]

Floki, I'd suggest leaving your settings alone and really focusing on the advice you're getting from robysue.

Hello Miss Emerita,

Understood.

If I remember correctly, I started with an APAP setting of 8 to 15.
There were a few modifications until we settled on 12.

[RogerSC]

Still, I think the better solution is to try a mask where the air is not rushing by the side of your head so that you have a better chance of being able to sleep in your side as well as your back. The Resmed AirFit N20, the Resmed AirFit N30 (but not the N30i), and the Resmed Swift FX Nano are all nasal cradle masks that do not have air tubes on the sides of the head.

The only one of these masks that's a nasal cradle mask is the N30. The N20 goes over your whole nose and the Swift FX is a nasal pillow mask. Yes, none of these masks has the side tubing that can conduct noise into your head. The tubing on them all is off the front.

So your point is well made, but wanted the OP to be clear about what they're getting into with any one of these masks *smile*. Personally, I'm a side sleeper and the side tubes of the Dreamwear nasal cradle mask don't bother me, just the weight of it and the stream of air out the front vent is annoying. but this whole mask thing is so personally subjective, and even changes over time with one person, I've found.