CPAP: Day 0

A few points.

1. It is intuitive when starting out to think tighter means less leaks. It seems you are discovering the truth is the opposite. Overtightening a mask can make it leak more and then there is the discomfort factor.

2. You mention your lab AHI while sleeping supine. Have you been evaluated for Positionally-affected Sleep Apnea (PSA)? Which position(s) do you sleep in? PSA means apnea is more severe and pressure requirements may be higher when backsleeping. ResMed says 40% of patients have significant PSA.

3. What climate do you live in? Do you know your bedroom humidity level? A humidity setting of 4 is very high and can be counterproductive for therapy unless you live in a very dry climate. I do not use a humidifier except on the coldest winter days when the central heat has driven the room humidity down to 35% or so.

4. What does your leak data show? A "raw throat" is a symptom of mouthbreathing or leaking pressure from the mouth.

5. What comorbidity that causes fatigue are you referring to?

6. You are going to bed with fear that the process will fail in one way or the other during the night. This is normal when we first begin CPAP. It usually takes some period of successful nights before our confidence in the process is good. Additionally, you are coming from an untreated state where you are exhausted and under great stress from the apnea. As your strength builds and the anxiety subsides, your confidence will also bloom.

Bloom? Sorry, but it is spring and I worked in the yard yesterday.

The mask was WAY TOO TIGHT. You think 'air-tight seal' and the idea comes to mine to jam those pillows in and tighten those straps to keep it in there. Playing with the mask this morning... they maintain a seal even with very little pressure beyond being gently seated on the nostrils. My brief experiments this morning seemed to indicate that the mask could be much more loosely strapped on and irritate my nose much less.

Do I get to say "I told you so"??? This is kind of counterintuitive and why the nasal pillows are challenging for newbies.

Tonight, when you adjust the mask, start out with it too loose, and tighten it just enough to get a seal, no more. Try to tighten only during the inspiratory (breathing in) phase of the cycle, so that the pillows are fully inflated when when you adjust everything. It takes some practice, but you'll get it.

For your dry throat and nose, drink plenty of fluids during the day and consider using a saline nasal spray to keep things moist.

Outside Enemy, you learned a lot just from your first night with the machine and mask! Those are all common problems when we start out. You'll be able to work through the challenges.

It takes a while to get used to breathing with the machine/mask. I was also very aware of my breathing in my first weeks. Now I don't notice it at all. Machine settings, such as starting pressure, ramp, and the EPR setting, can sometimes make a big difference. The machines are often set to start at a low pressure, which can actually make it more difficult to breathe. And with the EPR setting higher, for me it felt like the machine was forcing breaths, which I didn't like. I turned EPR down to 1 after a few weeks, and I've had it off for months now. Everyone's different. Some of us like Ramp, while others don't, especially when the starting pressure is set too low.

Since you're using a nasal pillows mask, it's quite possible that your sore throat is due, at least in part, to leaking therapy air from your mouth. Was your mouth dry too? You may not even be aware that you're leaking air from your mouth. Many of us sleep through many of the leaks. What was your machine-reported leak rate? If it is too high it can adversely affect your therapy results.

As for nose soreness, you may want to try a tiny dab of Lansinoh Lanolin on the outside of your nares. It can usually be found in drugstores in the baby/nursing mother supplies aisle. It can help to keep the nasal pillows in place and protect the skin. I don't have to use it anymore, but when I first started using nasal pillows I also coated the inside of each nostril with Ayr Saline Nasal Gel. Other nights I would use Simply Saline Nasal Mist. That helped a lot to keep the tissues moisturized.

There are lots of other helpful tips you can find on this forum. If you can't find a solution to a problem, just ask and someone will be happy to help. We've all been there ourselves!

I hope that your sleep and daytime fatigue get better and better with each passing day!

P.S. - Ro(o)ster, that's an extraordinarily beautiful photograph!!!

3 months ago I was wondering how i could survive the work day. I woke up with dread knowing i was exhausted before i ever left the house. I am still having some problems getting my therapy perfect but i feel better than I used to. My wife says she noticed a difference. I would imagine i have more energy am a bit less grumpy etc. I am on the right path and the folks here are worth their weight in gold. the advice and knowledge shared here will get you where you need to be. The therapy works if you work at it to get it right.