First night on CPAP did not go so well :Update- a breakthru!

[lazer]

I suspect it is going to be a learning curve for me since I'm basically going into this on my own with only my PCP's support but he's not a sleep specialist and I currently have no backing from a DME so am totally reliant at the moment on the advice of this forum. Pugsy on here has been an awesome help to me thus far and provided me not one, but two masks to start out with. I was given a 10+ year old Respironics Remstar Plus Domestic Model No: 1005960 from a co-worker to start out with and it was initially set at 12cm but I was able to learn how to change the internal settings with the help of Pugsy, so started out at 8cm. Also started out with the Swift LT mask with "small" nasal pillows as they seemed to fit fine, however, upon turning on the CPAP, I immediately started freaking out in not being able to exhale and seemingly was losing my breath unless I opened my mouth to exhale which of course defeats the purpose so some PMs back n forth with Pugsy and we decided I should go with a lower pressure which I set to 5cm and go up a size to the "medium" nasal pillows. This seemed to allow me to breath normal and without opening my mouth to catch my breath so I proceeded to get into bed aprox 9:30 EST. It didn't take long to fall asleep but I did take 2mg of xanax (prescribed.. well actually I'm prescribed to take 1mg at night but the last several nights I've found it takes me 2mg in order to fall asleep in a timely manner). Woke up at 1:30 AM with a sore as hell nose. The mask was still well in place but I promptly took it off for the rest of the night because I knew I wasn't going to fall back to sleep with my nose feeling like it did. I suspect lack of a humidifier OR just the process of getting used to this new contraption on my face at night? Anyhow, woke up this morning for work and my nose feels fine now but as usual, I don't feel like I rested well.

I'm going to stick with this and keep trying but any suggestions are welcome. I do have a script on file at cpap.com by my PCP for an APAP which I have picked out if/when the time comes to make that decision --> PR System One REMStar 60 Series Auto CPAP with Heated Humidifier and Heated Tube

So questions:

In your opinion, would the learning process be any easier with this APAP vs.s this 10yr old straight CPAP?

Would the waking with a sore nose be caused by the lack of a humidifier?

I like the (slightly used) Swift LT but would I fair better starting with a "new" or different nasal pillow mask and if so, any suggestions?

Any other specific tips or 'threads' I should review as a newb to this? (I have read several of the "stickies" already)

Thanks!

[Drowsy Dancer]

Having pressure relief ("C-Flex+") on the newer machine might make the exhale seem more tolerable. I'm assuming that feature is not available on the older machine.

I believe APAP would give you the ability to auto-titrate a bit more accurately, as I understand it.

Did you have the pillows shoved into your nose too hard to try to get a good seal? I used to do that.

[lazer]

Having pressure relief ("C-Flex+") on the newer machine might make the exhale seem more tolerable. I'm assuming that feature is not available on the older machine.

I believe APAP would give you the ability to auto-titrate a bit more accurately, as I understand it.

Did you have the pillows shoved into your nose too hard to try to get a good seal? I used to do that.

I don't think so but anything is possible I'm totally on my own with this regarding not having anyone with knowledge present with me to fit the mask, ect... I may have had the strap tighter than I should so will keep that in mind tonight when I try again and this time I don't have to worry about waking up for work so I might have a little more patience throughout the night if something goes bad.

[Drowsy Dancer]

What I did initially was put the pillows up to my nose, but not put on the head strap/ear loops, turn the machine on, then once I got a good seal tightened the straps just enough to hold the pillows on my face. Tighter is not always better.

Also, you might very well get a sore nose from lack of humidity.

[Pugsy]

Loosen the top strap...I suspect some of the nose soreness is from the top strap being a little too tight.
It is common problem. People tend to over tighten and it doesn't take much to over tighten.
The nostrils are virgin territory...never really had much of anything rub up against them... use of the Lansinoh ointment will help. For tenderness...it works better than Ayr gel I think.

Lack of humidifier...if that was an issue it doesn't usually make the end of the nose sore (if that is the only area sore)....it creates pain inside the nasal mucosa and sinus areas...runny nose, congestion...allergy like symptoms..that sort of thing.

The Medium nasal pillow...was never used...it looks used due to it being out in the air. I always used Small or XSmall. Being out in the air and the age of the nasal pillow can sure affect the seal though..even if unused. So yes a brand new nasal pillow might help seal better but at this point we can't really evaluate seal anyway...just your comfort..

Personally...If you are thinking a different new mask...The Aloha is the way to go. It offers a better seal without the tendency to want to over tighten the straps. Plus is is just more comfortable all around.

So...for next night...loosen that top strap a bit more.

[lazer]

Loosen the top strap...I suspect some of the nose soreness is from the top strap being a little too tight.
It is common problem. People tend to over tighten and it doesn't take much to over tighten.
The nostrils are virgin territory...never really had much of anything rub up against them... use of the Lansinoh ointment will help. For tenderness...it works better than Ayr gel I think.

Lack of humidifier...if that was an issue it doesn't usually make the end of the nose sore (if that is the only area sore)....it creates pain inside the nasal mucosa and sinus areas...runny nose, congestion...allergy like symptoms..that sort of thing.

The Medium nasal pillow...was never used...it looks used due to it being out in the air. I always used Small or XSmall. Being out in the air and the age of the nasal pillow can sure affect the seal though..even if unused. So yes a brand new nasal pillow might help seal better but at this point we can't really evaluate seal anyway...just your comfort..

Personally...If you are thinking a different new mask...The Aloha is the way to go. It offers a better seal without the tendency to want to over tighten the straps. Plus is is just more comfortable all around.

So...for next night...loosen that top strap a bit more.

Thanks Pugsy... I knew you would chime in That Lansinoh ointment, is that something you can buy retail at like Walmart or a pharmacy? I'll definitely try loosening that top strap tonight. I didn't end up with runny nose or congestion, ect... but then again I only ended up having it on half the night.

Do you have a link for that particular Aloha mask you mention at cpap.com?

Thanks!

[Pugsy]

Lansinoh is found in the Baby Section of most Walmarts. Over my the baby bottles and such. Breast feeding moms use it for nipple soreness. Pure Lanolin and works wonders..use it during the day too.

Aloha link
https://www.cpap.com/productpage/devilb ... -mask.html

It is a lot like the Swift LT but the nasal pillows are different...seal easier with less tension.
I am trying it now. Just had it a week now. The straps are extremely loose on me...yet my leak rate isn't bad at all.

[lazer]

Lansinoh is found in the Baby Section of most Walmarts. Over my the baby bottles and such. Breast feeding moms use it for nipple soreness. Pure Lanolin and works wonders..use it during the day too.

Aloha link
https://www.cpap.com/productpage/devilb ... -mask.html

It is a lot like the Swift LT but the nasal pillows are different...seal easier with less tension.
I am trying it now. Just had it a week now. The straps are extremely loose on me...yet my leak rate isn't bad at all.

Thanks for the link to the Aloha, I've added it to my preliminary "cart order" at cpap.com

And I'll be heading to walmart for the nipple cream tonight....

[Pugsy]

And I'll be heading to walmart for the nipple cream tonight....

Hey....at least it isn't in the feminine products aisle.

Some pharmacies have Lansinoh in their baby section. I actually found it $2 cheaper at my local mom and pop pharmacy than Walmart offered. Go figure that one.

[lazer]

Just a little more background on me, figured I would post it in this thread. After my sleep study in January, my doc also indicated to me that he wanted me to lose about 20lbs so he put me on a carbohydrate restricted diet (40-60) net carbs per day. This was quite a change for me as my former regime included a lot of pasta, potatoes, sodas, pop tarts, ect... Well with his advice and a neat weight loss/diet tracking program for my Android called "LoseIt", I have lost 24lbs since Feb 1st and my BMI index is now in the normal range. We were both hopeful this would help with my sleep quality, however it hasn't seemed to make a difference. I have a slight bit more energy during the day which I suppose is the complete avoidance of any unnatural sugars but still don't want to get out of bed in the morning and never feel rested.

As noted in my other thread, my AHI is below 5 but my sleep study did indicate "mild apnea" and that I snore a lot and loudly. My PCP is in my corner and my insurance has also approved a pre-auth for a month rental but the original DME won't touch it because of my AHI below 5 even with the pre-auth and I have yet to hear back from the 2nd DME so am about ready to proceed on my own.

Are there any other folks out there diagnosed with a low AHI with "mild apnea" that CPAP/APAP has helped them? I search google and find conflicting reports on whether this will prove helpful to me or not.

[lazer]

Just an update. I'm still struggling with this. I've been practicing with the mask before sleep. All seems well enough, however I did notice that now that I seem more comfortable breathing - exhaling with the unit running I have started to feel like I could use a little more air pressure so in the past few days I've bumped up from 5 in 1cm increments and am now back to the 8cm pressure setting. Here is my ongoing problem. I keep waking up sometimes 4 hours later, sometimes as quick as 1 hour later and things just don't seem right. I don't know if it is the mask feeling uncomfortable or the air pressure getting to me either too low or too high but I end up taking it off to get back to sleep for the rest of the night. I have yet to get a full night in. This morning I especially didn't want to get out of bed for work, it was a real struggle. I probably got a total of 8 hours sleep but took the mask off after the first hour.

On a bit of a positive, if you've followed my other initial thread on here several weeks back about the "DME refuses to submit to insurance for issuing me any equipment", I now have a new DME which I called yesterday to confirm they received my information from the Dr. They seem willing to pursue this and get me going with the process. I have a tentative appt set to go in next Monday at 11AM to get fitted and hopefully started with their equipment, ect... The man from the DME was nice with me and mentioned about doing something for a week to establish my pressure/compliance, or something? I'm not sure what exactly he meant but seemed to indicate this wouldn't be done with the actual APAP that I will eventually be put on as things progress.

[RandyJ]

lazer,

It's really important that you don't get used to sleeping without the mask. If you wake up and don't feel you can get back to sleep, you should get up and do something else relaxing until you feel ready to get back in bed and put on the mask.

See robysue's blog in her signature - Taming the CPAP induced Insomnia Monster...

[lazer]

Thanks Randy,

I appreciate what you are saying and it only makes sense. I have been reading through robysue's blog quite a bit lately. My problem is I always feel run down and like I want to sleep but when it comes time to sleep, I usually have a problem getting to sleep. I have a history of Insomnia already along with my other problems - Depression & Anxiety. So adjusting to this new environment with CPAP is proving especially rough. I'm hopeful that once/if this new DME works with me and gets me established on newer equipment with CFlex/AFlex, humidifier, ect... hopefully and a properly fitted mask that I will fair better. Right now I'm basically on my own along with the great help and suggestions Pugsy has provided which much of has helped me even tolerate to any degree. I just want that feeling for once in my life to wake up feeling rested and refreshed which I can never remember having.

lazer,

It's really important that you don't get used to sleeping without the mask. If you wake up and don't feel you can get back to sleep, you should get up and do something else relaxing until you feel ready to get back in bed and put on the mask.

See robysue's blog in her signature - Taming the CPAP induced Insomnia Monster...

[RandyJ]

lazer - I sympathize. Perhaps when you get your new equipment and mask you can set yourself the goal of not sleeping in bed without the mask. I know it can be hard - unfortunately many things that we do require a "getting used to" period that sometimes involves actually re-training our brains, and are not without their share of discomfort or pain... you probably won't feel the benefit until you start going all night with the mask, so of course the outcome is related to the input.

There is a lot of good stuff in robysue's blog, I'm glad you've been reading it. When there are many pieces to the puzzle - medications, diet, habits - sometimes you have to work on all three at the same time. It's not easy. Hopefully we in the forum can be of some help... the putting into practice is 100% on you. But we are here for encouragement...

[lazer]

Thanks Randy,

And you have all been a huge help and this even being possible for me. I know it is about learning a new habit and process to get used to and that can be tough for me. I'm going to try to make it a goal for tonight to tough it out and keep the mask on for the night. I just want to get used to this so IF I do get this shot next week with the DME providing me equipment, that I can be in a position to comply and let the data be collected to give me a legitimate shot at this working out with my insurance OR know that I can still benefit from ordering on my own via cpap.com and having this prove successful in giving me improved sleep.

lazer - I sympathize. Perhaps when you get your new equipment and mask you can set yourself the goal of not sleeping in bed without the mask. I know it can be hard - unfortunately many things that we do require a "getting used to" period that sometimes involves actually re-training our brains, and are not without their share of discomfort or pain... you probably won't feel the benefit until you start going all night with the mask, so of course the outcome is related to the input.

There is a lot of good stuff in robysue's blog, I'm glad you've been reading it. When there are many pieces to the puzzle - medications, diet, habits - sometimes you have to work on all three at the same time. It's not easy. Hopefully we in the forum can be of some help... the putting into practice is 100% on you. But we are here for encouragement...