cannot sleep at night with CPAP

Hi,
My history:
Age:39
Height: 5'2
Weight:120
CPAP machine: GoodNight 420G with heated humidifer
Mask: Mirage Quattro Full face, Breeze Sleep Gear
Pressure: 12cmH2O with ramp


I have been diagnosed with sleep apnea 4 years ago. I have tried to use a CPAP and have never been able to adjust to it. I have tried adjusting the heated humidifier, if its too high then water drips and I wake up. If it too low my mouth dries up and I wake up. With the full face mask, I end up breathing thought my mouth and eventually I wake up with a dry mouth. I then cannot sleep afterwards. I have also tried a dental appliance but has worked for a short period. I have recently seen an ENT doctor and had a surgery in my nasal passage to remove excessive muscle. This has helped me to breath better through my nose. I am still not able to successfully sleep at night. I sometime take a magnesium supplement to relax my jaw/tongue muscle i think and gets me a few hours of sleep. I know that there is an insulated hose that is available for purchase but this might not solve the issue. I need help. I am willing to try anything to sleep..

Questions:

1. Is it normal to breath thought mouth? Should I breath thought the mouth?
2. Are there other machine that work better BIPAP/Autopap that I should try


Thanks for the help

rahul wrote: I know that there is an insulated hose that is available for purchase but this might not solve the issue. I need help. I am willing to try anything to sleep..

Get the hose cover it will help a lot... you said you where willing to try anything... these only cost about $20.

rahul wrote:
1. Is it normal to breath thought mouth? Should I breath thought the mouth?

Its generally a bad idea to breath though your mouth, it will make your apnea worse. Use a chin strap to try and prevent it.

rahul wrote:
2. Are there other machine that work better BIPAP/Autopap that I should try

Yes you could try a BiPAP but I would suggest solving the other problems first.

To repeat:
1) Solve the rainout problem, the solutions are simple
2) Prevent mouth breathing unless you are congested

Thanks for your response jskinner, I will try your suggestion. Can you tell me the difference between BIPAP and AutoPAP? What is the rate of acceptance of these different machines. Which one should I try if your suggestions dont worrk. I currently don't get to sleep and keep adjusting the pressure between 10 to 12cmH2O. I know its not the right think to do change the pressure, but I have no choice to try.

Thanks

rahul wrote: 1. Is it normal to breath thought mouth? Should I breath thought the mouth?
2. Are there other machine that work better BIPAP/Autopap that I should try

Hi,

It is best to breathe through your nose. Some people have stuffed up noses due to sinus and allergy issues, and mouth breathing is their only real option. I used to be a mouth breather due to allergies. After starting CPAP and later switching to a nasal pillow mask, I find that I am rarely stuffed up any more. I suspect that it is a combination of not having my nose breathing near my bedding (rather, the air is filtered by the CPAP machine) and the pressure. After switching to the nasal pillow mask, I had to teach myself to keep my mouth closed. As the previous reply suggests, a chin strap can help. You can also find full-faced masks that have a chin support to help you keep your mouth closed.

Your pressure level isn't all that high, so I would be surprised to hear that BiPAP does much for you. Auto doesn't do much to reduce the pressure, rather, it allows the pressure to go up when you are having periods of difficult breathing. But since this is a life-threatening condition, you need to do anything you can to find a treatment that works. Set up an appointment with your DME, and see if you can borrow a different machine. Maybe it will help. Maybe they will have some adjustments that will help you, such as CFLEX or a larger/longer ramp time. You may also want to try different masks. I had to go through 7 different masks before I found one that worked. Since I am a self-pay, it was expensive, but it is still cheaper than dying.

Please post back on your progress and to let us know what you are trying.

-john-

Sorry to hear all you've been thru trying to get some sleep and breathe at the same time. Few thoughts about your cpap efforts...

Since the rainout can be resolved, are there other aspects of your treatment that hinder your sleep? There are very few equipment issues that can't be effectively addressed. Some people have no choice but mouth breathe due to nasal blockages, and the full face masks are intended to accomodate that. Hopefully being able to use more humidity will help with your dry mouth. If there's nothing wrong with your nasal passages, attempting to force the mouth to stay closed may be the way to go. The type of machine is not likely to make a difference for the issues you have mentioned thusfar.

However, I suggest you either get a loaner of an apap or buy a data capable machine to make sure the pressure you are using is therapeutic.

I don't know how much time you dedicated to attempting to adjust to cpap, but consistency and perseverence are needed. I was not one to adjust readily, even quit for a bit. I am glad I tried again, with data and different masks and support here I succeeded and wouldn't think of going to bed without it.

If resolving rainout doesn't result in more sleep, let us know exactly what's happening. Some have it rougher than others, but just FYI, JSkinner is encouraging you to hang in there, and he's speaking from experience. His journey has not been easy. Hope you figure things out.

Hi,
Last night I wanted to try to determine why I was not sleeping. I noticed that I was having a difficult time breathing out and was waking up at the pressure of 12cm. I then gradually lowered and determined that I was able breath in and out at 9cm. Then my snoring started and was waking me up. I then decided to use the dental appliance(mouth closed) to eliminate the snoring with the CPAP at 9. I was then able to breath in and out. I next preceded to lower the pressure gradually to 7.5 and was able to sleep for a lot longer. The dental appliance helped to lower the pressure and eliminate the snoring that was waking up at 9. When I has my sleep study last year, the doctor recommended to raise my pressure to 10-12cm to eliminate the snoring. I dont think he understood the opposite effects of raising the pressure. I did not use the humidifier at 7.5. So the question is how do I get the benefits of the dental appliance and the pressure from a CPAP? Should I see the ENT doctor to determine how to eliminate the snoring?

This is my first day that I have slept for 5-6 hours without getting up at night. I will try this for the rest of the week and hopefully it will improve.

So I need comments/suggestions..

I have read on here of others using a dental device with their cpap in order to use a lower pressure. Sounds like a good plan if it gives you some decent sleep. Ideally you would have data during this experiment. It could expedite "getting it right". Continued best wishes as you move forward.

When I has my sleep study last year, the doctor recommended to raise my pressure to 10-12cm to eliminate the snoring. I dont think he understood the opposite effects of raising the pressure. I did not use the humidifier at 7.5.

Well snoring is only one issue. Do you have an oxymeter to check your oxygen level? How do you know you are not having events at that lower level. I don't snore at 7 either but I have plenty of apnea events.

BlackSpinner, you have a point. I have a sleep study in october for adjustments. I need to know what to ask for in the study. Would a bipap or an auto pap help me to determine if there were any event at 7.5cm?

They will put you on a variable pressure machine and keep changing the pressure until they find the lowest pressure at which you don't have events. Make sure you get checked sleeping in your most comfortable position as well as the worst - on your back.

And try and get a machine which records real data when you get your next machine so you can actually see what you are really experiencing.

rahul wrote: Last night I wanted to try to determine why I was not sleeping. I noticed that I was having a difficult time breathing out and was waking up at the pressure of 12cm. I then gradually lowered and determined that I was able breath in and out at 9cm. Then my snoring started and was waking me up. I then decided to use the dental appliance(mouth closed) to eliminate the snoring with the CPAP at 9. I was then able to breath in and out. I next preceded to lower the pressure gradually to 7.5 and was able to sleep for a lot longer.

Hi,

This is good info. What would be nice is to see the data from your machine that goes along with it. If breathing out is the issue, then some kind of exhale relief may really help you. In fact, that is what a Bi-Level machine does. It kicks into high pressure as you breathe in, and drops the pressure significantly when you breathe out. My treatment is a pressure of 20 when breathing in, and 13 when exhaling. I hardly noticed the pressure after I got use to it after a few weeks.

Some folks say that any snoring is bad and will interrupt your sleep. As a result, it seems worth it to eliminate it. CPAP doesn't work on a sliding scale where 50% of the pressure gives you 50% treatment. Rather, it is more like digital TV where it is all or nothing. You need a certain level of pressure to keep your airway open. That pressure works like a light switch--once it gets high enough, you can suddenly breathe. As a result, you have to be careful about reducing it--you might back off 1 or 2 cm, and suddenly you are getting almost no treatment value. That is what a titration study is all about, finding those magic treatment levels.

I think you need to visit your DME, and share with them your struggles. I suspect that you want to walk out of that meeting with a data-capable machine that has some form of exhale relief, such as a C-flex, A-flex, or BiPAP. Your life may depend on it.

-john-

Day 2:

with dental appliance and CPAP at 7.5cm. I am able to sleep a lot better. I got up 2 times at night and what not pulling off my mask in my sleep. I got about 6 hours of sleep and could not sleep further and was hungry. A definate improvement in my sleep. Now I need to know if a bipap can work to replace my dental appliance. I think I have no option than to try a bipap...