Problems with my BiPap. I'm completely new to this. Advice?

[FishOil]

Yeah I've always suspected I have TMJ problems, its never really been an issue though until now. I'll loosen the mask a bit tonight. I did put it on REALLY tight before so that it didn't come off no matter what position I slept in.

[robysue]

FishOil,

First, I agree with the others: You're probably adjusting that Mirage Quattro way to tight. Janknitz has an excellent post about Taming the Mirage Quatto on her blog.

I don't know what my IPAP and EPAP pressure settings are, or what that even means.

Archangle has told you how to find the IPAP and EPAP by looking at the screen on your machine when it's on and you are breathing.

The IPAP is the inspiratory pressure setting: It represents how much additional pressure (over the current atmospheric pressure) the machine is generating when you are inhaling.

The EPAP is the exspiratory pressure setting: It represents how much additional pressure (over the current atmospheric pressure) the machine is generating when you are exhaling.

Both the IPAP and EPAP are meaured in units called cmH20, which NOT the same as the "inches of mercury" that is used to measure air pressure to describe weather. Nor is a cmH20 the same thing as a PSI (pounds per square inch) that is used here in the states to measure the pressure in car and bike tires.

I assume you mean ONE AM and not SEVEN AM since you go on to say:

No, I meant 7am. The thing about me is, I have trouble falling asleep if its before 7am. As in, sure I can sometimes fall asleep at 12-1am, but usually it takes me a long time unless I'm dead tired. But if its AFTER 7am, I can fall asleep in minutes even if I already slept a bunch beforehand. So if I get woken up at 2-3am, its almost impossible for me to fall back asleep. But if I get waken up at 9am or something, I'll barely notice I'm up and fall back asleep instantly.

As we put it in my night owlish family: Sounds like you've got your days and nights turned around. Any history of working the night shift at some point in your past?

You say you can sometimes fall asleep at 12-1am and later on you say you'd like to be asleep between 12 and 2 am each night. But usually it takes you a long time unless you are dead tired. Do you ever feel sleepy before 1 AM? Note: Feeling sleepy is NOT the same as feeling dead tired and exhausted. You may need to work on learning to distinguish the difference. An excellence source for learning more about the difference between feeling sleepy and feeling exhausted is Dr. Barry Krakow's Sound Sleep, Sound Mind. Because if you don't actually feel sleepy until 7:00 AM on a regular basis, you might have a circadian rhythm problem to deal with as well as the OSA you are currently treating.

Yes, I've always had trouble falling asleep even without the mask. ... I mentioned to my doctor that I have trouble falling asleep, but he was more concerned with the sleep apnea than my inability to fall asleep.

Do you have a sleep doc who is managing the OSA/BiPAP? Or is your PCP doing the day-to-day managing of the OSA/BiPAP? Because it's beginning to sound like you might have a circadian rhythm problem (i.e. "days and nights mixed up") in addition to the OSA. And circadian rhythm problems are not quite the same as insomnia. Now that you are being treated for the OSA, you need to bring the other sleep problems back up with your doctor---and preferably your sleep doc if you have one that actually saw you. And do NOT be vague in describing the problem as "I just can't seem to fall asleep easily." You need to provide as many specifics as possible:

• You don't think you have any serious anxiety issues concerning the mask and you are wearing it all night long, every night when you sleep
• You CAN fall asleep soundly after 7:00 AM and if you wake up 9:00 AM, it's easy to get back to sleep. And how late would you normally sleep if you just waited until 7:00 AM to go to bed?
• You have serious trouble getting to sleep around 1:00 regardless of how tired you are. And do you actually ever feel sleepy this early in the night?
• You want and need to be able to fall asleep sometime between 12 and 2 am on a regular, nightly basis.
• You want and need to get up by (FILL IN APPROPRIATE TIME) during the week to start your day.

Because with this kind of info, the doc and you can come up with a strategy to get you where you want to be. If the problem is a circadian rhythm problem instead of just plain old insomnia, what to do?

Well the doc may want to put you on some kind of sleeping medication. So you need to think carefully about whether you want to be on sleeping pills. In addition to the prescription pills, you doc might also suggest using OTC melatonin pills. If he does, make sure to find out (and write down) exactly how much melatonin he thinks you should start with and how close to bedtime you should take it.

If you don't want to use sleeping pills, the doc is likely to suggest some kinds of behavioral therapy, which will take a long term commitment from you and a lot of hard work from you to make it work. Some things that might help:

• Waking up and GETTING OUT OF bed at the same time every single day regardless of how little sleep you've actually gotten the night before. And NO naps in the day. This will help you body get tired and your mind get sleepy at a more appropriate time each evening.
• Establishing a regular target bedtime that is NOT too early. Count back six or so hours from your WAKE UP TIME. And that's your "tentative" bedtime. You don't go to bed before the fixed bedtime regardless of how sleepy you are. And you only go to bed at the fixed bedtime if you are SLEEPY at that point. Otherwise, you stay up until you do start to feel sleepy. And remember that feeling sleepy is not the same as feeling tired.
• Get some really bright light right after you get up each morning. As in OUTSIDE SUNLIGHT. Or a light box designed for treating Seasonal Affective Disorder. Using a light box for 30 minutes in the early morning or getting outside for 30 minutes of SUNLIGHT each morning may help your body's melatonin cycle get back on a more normal schedule. And the waxing and waning of the melatonin cycle each day determines when we get sleepy and when we are more typically wide awake and alert.

Trouble sleeping when it's hot and humid. Common problem. And tough to fix unless you have A/C and can turn the thermostat way down at night.

Yes I have AC, and 2 fans in my room. But sometimes even that won't be enough to make my room cool, even if I open a window. The AC has to be at FULL BLAST, but then everybody else in the house gets cold and turns it off while I'm sleeping, so when awakened, my room will be hot and I'll have trouble falling back asleep

Time to break out the extra blankets for the rest of the family in my opinion. And tell them: Put on long sleeves, flannel PJs and sleep with a winter weight blanket if you have to , but DO NOT TURN THE A/C OFF AT NIGHT. Tape up a note above the A/C switch if you have to.

Have you tried talking to the other folks in the family about the fact that your sleep problems MUST be dealt with in order for you to ever regain your health? And how turning the A/C off creates serious and significant problems for you as far as sleep goes?

Can you describe how you go about cleaning the mask each day? You might try dissembling the mask and soaking all the drool-covered parts in a vinegar/water bath for 30 or 40 minutes.

I don't completely disassemble it because honestly I'm afraid of breaking it. The instructions aren't really clear on how to take it apart. However I do remove the lining part and soak that in water, but then the inside of the mask like where the holes are always get drool on them somehow. I'm a restless sleeper so I'm all over the place, so I'm not surprised the drool somehow went up

Contact the DME and set up a meeting with the RT who set you up with your machine. Have the RT show you how to dissemble the mask and reassemble it correctly. Then have the RT watch you do it several times until both the RT and you are comfortable that you know all the steps involved in taking it apart and putting it back together.

It's also possible that you will become a less restless sleeper as your body starts to really acclimate to the biPAP and begins to realize that it does not have to constantly arouse itself just to keep breathing. Certainly that's happened to me.

Ive never had pains when I wake up, no headache, don't need to urinate or anything, however one thing I did notice, is that I stopped sweating as much when I use the machine. I used to wake up with my shirt drenched, but it hasn't happened lately even now in the summer. Still tired though, but yeah I guessed that it takes some time before it really starts working.

My guess is you're not waking up sweating because the apneas that were triggering the night sweats are no longer occurring. Night sweats ARE a pretty common symptom of OSA; and they typically disappear once the body starts to acclimate to xPAP.

And this is the kind of observation that I meant when I said that a sleep log can help to identify subtle, but important changes due to xPAP.

And as for the fact that you're still tired: It's going to be hard to tease apart how much of the tiredness/exhaustion was from the OSA (now treated) and how much was from the other sleep problems which have not yet been addressed. Because as long as you are NOT sleeping during the time frame you want to allow for sleep, you won't feel particularly refreshed or energetic during the daytime.

[FishOil]

Few things, since those 2-3 days when my jaw kept hurting after I woke up, it hasn't happened anymore. I didn't really change the tightness on the mask, it just stopped happening. It had happened a few times before in my life, but not for that long, so hell it could have just been coincidence.

Another thing is, I think I might need a bigger mask. I have a medium Quattro, and honestly I think with my restless sleeping I get a ton of leaks. The reason being that right as I'm about to fall asleep, I'll try to get into a really comfortable position on my side, but I'll start feeling air in my eyes because of it, so I'll move my head into a less comfortable position. Therefore I know that when I'm not conscious and asleep, I'll get into that comfortable position with no regard to leaks. Another reason is that I snore loudly, so when I sleep my mouth opens really wide, and I've been noticing that the second I wake up in the morning, my mouth is open so wide, that the bottom of the mask is on my bottom lip, and I'm sure there have to be leaks there. I don't know if a bigger size will work though since the mask already practically reaches my eyes and the bottom part down to my chin, its just not long enough when I open my mouth though. I wish I could have one that just has a bigger "jaw" part.

[FishOil]

I just realized something else. I'm usually a light sleeper. Any little noise will wake me up. But lately, I think I've been getting really deep sleep. Alarms don't wake me up anymore and I've been oversleeping a lot because of it. Before, any little noise my phone make would instantly wake me up. But now I can miss the alarm for an hour and have 8 missed calls when I wake up. Could that be because the machine is working and letting my body rest deeply? I still feel tired all day after 8 hours and still have the absolute hardest time getting out of bed, but maybe its starting to work?

[cflame1]

try this template to see if you need a different size on your Quattro

http://www.resmed.com/us/assets/documen ... mplate.pdf