Another "first night" post from a first timer.

First, I'd like to thank billmyinsurance for getting me set up with the 420E with HH and the Ultra Mirage FF mask - hurricane not withstanding. I'm a happy customer. Thanks again to rested gal, wulfman, etc. and cpaptalk.com for all the help in dealing with DMEs and the basics of cpap as well.

Secondly, I must say that my "first night" is probably atypical since I had spent the previous 36 hours awake - attending then driving back from a family funeral in Texas so I WAS READY to sleep in a big way.

I opened the box and set up the equipment myself. I followed the directions to the letter (including washing the brand new humidifier reservoir?). I adjusted the mask/headgear and figured out the controls. (The good people at billmyinsurance.com preset the machine for me at 4 to 13 cmH2O).

FIRST IMPRESSIONS:

1) The 420E is SMALL!

I was expecting a kleenex box sized piece of equipment but it is tiny and light weight.

2) It is also QUIET.

I've read all kinds of posts about noise and maybe I'm just not THAT sensitive but dang, my ceiling fan makes more noise! My wife even commented that at one point last night, she had to turn the light on to make sure I was still breathing. She couldn't believe how QUIET I WAS last night.

3) I slept all night with it on - only getting up twice.

I only got up once because I felt thirsty and needed to drink some water. I set the HH to 1 per instructions but decided to put it on 2 after this. I don't know if that was a good idea or not. I filled the HH almost to the max line but this morning it was almost empty! I don't know if this is heat related or simply because AZ is SO dry - anyone know?

4)The 2nd time I got up was because of a "pressure issue"

I woke up feeling like I was getting blown away. I woke my wife and asked her to check the machine and it said 13! I was about to just take the mask off but instead I shut the machine off then back on. It went back down to 4 and I went back to sleep. Anyone have a guess as to what that was all about? I suspected it was trying to compensate for a leak or something but the pressure was seriously high to me -at least it "felt" that way.

5) My back hurts.

One of the things I've been excited about was being able to sleep on my back. I love sleeping on my back but my wife always rolls me over when I snore/stop breathing so I've gotten used to NOT sleeping on my back. After last night, my back is sore. I guess I need another pillow under my knees.

6) I did not have any panic attacks/ claustrophobia with the FF mask like I did at the sleep lab. BIG PLUS!

7) I purchased the software but haven't had a chance to tinker. I'm very curious as to what the "numbers" look like for last night though.

I feel better today and got up a bit earlier than normal but I also went to bed very early because of the trip. I'm looking forward to stringing together a few nights with the CPAP.

I still have many questions regarding the humidifier, settings, software etc. but as I lay in bed last night trying to get to sleep I was feeling good about hopefully getting a handle on this and getting my life back...

Thanks again to all who've helped my on my journey and I hope to eventually help others who find themselves in need of assistance or even just encouragement.

NOzsnAZ

Sounds like you're off to a great start. Congratulations and keep up the great work. I never heard of anyone complaining about a machine being TOO quiet before (although I don't think it was a complaint, actually, but an observation).

I think your auto was picking up on something and that was why your pressure rose to 13. Probably down the road, you won't awaken when that happens, once you get used to the higher pressures, and you'll only know it happened from looking at your software reading from that night.

Good luck. Hope it stays as least as good as it was last night and just gets better and better.

NOzsnAZ,

Glad to hear that things went pretty well on your first night.....and hope they continue to.
I've never used an "auto", but from what I've read, snoring can increase the pressure settings on them.

Please keep us informed as to how things are going.

Best wishes,

Den

Hey NOzsnAZ,

Last night was my second night and my experiences were also very good. My machine is quiet too. I thought it was going to be noisy but it wasn't. I am looking forward to my third night. I know what you mean about getting your life back. I am already seeing a difference in my energy. It has been way too long since I had gotten a good night sleep. Like you, my first night I woke up twice. Last night I only woke up once and that was because my mouth had gotten extremely dry. I do have a humidifier on my CPAP but it isn't heated. Not sure why I got so dried out! Good luck fellow newbie!

Da

Da,

It looks like your humidifier is indeed heated. Do you know how to turn it on? In the photo, do you see the plug? If it wasn't heated, why would you need a plug? PM me and I can give you specifics if you need them on how to operate it. Looks like we have the same equipment.

Actually it isn't heated. It is the intragrated model. There wasn't a picture of that one to choose from. Mine doesn't have a cord........I am going to talk to my doctor when I go back. I would prefer the heated because I do like to sleep in a cold room and apparenlty from the dry mouth last night the plain humidifer doesn't work well.

It took some searching online for me to find the humidifer that I have, doesn't seem to be much call for that one! Wonder why......lol

Here is a link to the one I got....see....not tail!

http://shop.store.yahoo.com/sleepquest/reinpahu.html

Shucks!

Da

Well, now it makes sense. I thought the photo you showed was the one you had and I just thought maybe you didn't realize it was heated. There are so many things to learn when you start out that it wouldn't be surprising if that was the case, but hopefully you can get them to get you the one you want. Good luck.

Hi Da,

This caught my eye:

Last night I only woke up once and that was because my mouth had gotten extremely dry. I do have a humidifier on my CPAP but it isn't heated. Not sure why I got so dried out!

If you are not using a FF mask, it sounds like you are probably leaking treatment air out your mouth or are mouth breathing some of the night. Even if you had a heated humidifier instead of the passive humidifier, mouth breathing can happen. A heated humidifier might lessen the chance of that happening though, if it's because the nasal passages get congested for lack of good humidification and cause you to try to breathe through your mouth.

But most of the time, mouth breathing or mouth air leaks are caused by the tongue simply not maintaining an airtight seal during the complete relaxation of sleep. A very dry mouth is often an indication of that.

Good luck!

NOzsnAZ, congratulations on a successful first night! May it only be the first of many.

IMHO, you got the best combo going with the 420E, HH and UltraMirage FF mask (course, that's the setup I started with, so I may be a tad biased! LOL) Small. quiet, comfy AND it works. Hard to beat.

One thing you'll find when you fire up your Silverlining software and download your data is that there is no AHI reading as such. There are separate listings for apnea index (AI), hypopnea index (HI) and a couple of other listings, including one for acoustical vibrations (aka snores). To get my total AHI, I just add together the AI and HI. With my UltraMirage mask, the total usually runs 1.5 to 3, which ain't bad. I recently got a DreamFit mask which is working even better. I always thought I was a strict mouth breather, but since insurance paid for the DreamFit I figured why not try a nasal mask. Now my AHI is running between 0 and 1.5!! I definitely feel the difference, too. Something for you to think about.

Best of luck in the nights to come.

This therapy WORKS!!!

TXKajun wrote:I always thought I was a strict mouth breather, but since insurance paid for the DreamFit I figured why not try a nasal mask. Now my AHI is running between 0 and 1.5!! I definitely feel the difference, too.

Yahoo!!! Like you said, "This therapy works!!!"

Thanks for the tips everyone!

Night 2 observations:

I had a bit more trouble with the pressure runaways - twice. I realized that at 13 cm H2O, the mask gets very leaky/noisy relative to my titrated level of 7 or of the starting level of 4. I'm not sure if this is what woke me or if it was the added pressure. An interesting thing is that even after I wake up and realize the pressure is SO HIGH, if I simply remove the mask temporarily, the pressure drops but ramps right back up as soon as I put it back on. The only way to get it back down is to turn the machine off and then on again. ???

Hopefully tonight I'll get the software up and running and figure some things out.

I woke up once because I was thirsty. I'd really like to know if there is a way to adjust the humidifier to improve this issue. Is it more heat or less ? Or does that even make a difference? My room is at a constant 80 degrees and D-R-Y. There is no moisture whatsoever in the hose/mask etc. in the morning.

I really liked the nasal pillows mask at the sleep center but I could not keep my mouth shut and the idea of taping or strapping my mouth shut creeps me out. Maybe for my next mask I'll give a nasal mask a try.

I fell better today than yesterday...I hope this trend continues...

NOzsnAZ

NOsnz, I bet you still have your ILF1 turned on (or is it IFL1??). That will cause more pressure ramps and runaways than just about anything. To turn it off, you have to hook your 420E up to your computer, get your software installed and running and then go to the Settings part....then Advanced, if I remember right. Then uncheck the box next to ILF1. Be sure to save the settings or it won't kick in. While you've got the settings open, you may want to shorten your range of pressures. You say you're titrated at 7 cm, so maybe consider setting your range from 5 to 9 cm?? Again, standard disclaimer...I'm not a doctor or RT or in any way affiliated with a medical profession, so my ideas are not to be taken in any way, shape or form as qualified medical advice!

Also, if you wake and the pressure is too high for you, hit the Ramp button (the second button from the right on top of the 420E) and that should restart your ramp at the lower pressure.

Hang in there. Sounds like you're doing pretty good.

This therapy WORKS!!!

NOzsnAZ wrote:Thanks for the tips everyone!

Night 2 observations:
<...snip>
An interesting thing is that even after I wake up and realize the pressure is SO HIGH, if I simply remove the mask temporarily, the pressure drops but ramps right back up as soon as I put it back on. The only way to get it back down is to turn the machine off and then on again. ???

It doesn't "ramp down" - it just senses there is no person or mask out there, and stops blowing to the defined pressure level, it will go the defined pressure the minute you put on your mask.

If you want it back at the beginning of the range, you have to turn it off, or use the ramp button - if you have ramp defined.

I woke up once because I was thirsty. I'd really like to know if there is a way to adjust the humidifier to improve this issue. Is it more heat or less ? Or does that even make a difference?

You'll have more humidity with the humidifier higher.

I fell better today than yesterday...I hope this trend continues...

That's great !!!

O.

NOzsnAZ,

I can't answer your question about the machine and why as soon as you put the mask back on, the pressure goes right back up. I can, however, tell you that if you're waking up with a dry mouth, you need more humidification. HOWEVER, if you turn up your hh too high, it creates condensation or what we on this site call rainout. My DME told me to turn it up very little at a time each night. If you do end up with having to keep it so high that rainout occurs, you can always look into the Aussie heated hose which prevents it from happening. They sell it on http://www.sleepzone.com.au/. Must make sure you buy the one that goes to your machine.

Also, one other tip would be, to avoid rainout ending up in your mask, it's thought to best keep your machine lower than the level of your mattress as it helps to drain the condensation back into the humidifier tank instead of into your mask. Very unpleasant when that happens.

Also, about nasal pillow masks, and this is totally my experience, I've used two of them, the Swift, which I really liked, and the Aura, which I really love. Now, the Swift, for some strange reason, is the only mask I've ever had a problem mouth breathing with, except for my first mask, which was an oral mask, the Oracle. You're supposed to mouth breathe with that one, but I wouldn't recommend it. By the way, I've had five masks and only mouth breathed with the Swift. Since I've switched to the Aura, I haven't mouth breathed since. Someone mentioned the reason may have to do with how the air is delivered; ie, the construction of the delivery tubes and their angles. I don't know. But it could be that perhaps you would have the same luck as I did and wouldn't mouth breathe on it. I am only at 10 and I don't know what your titrated pressure is, or if being at 13, when yours goes up, would affect that or not. But maybe that might be something you would want to start a new thread on if you are going to consider purchasing one.

Look, you'll work out all the kinks. It takes time. Sounds like you're off to a decent start. Just keep asking questions and before you know it, you'll have learned a lot. Best of luck.

Night 3 was a setback. I turned the HH up to 3 and turned off the IFL1. I woke up at some point in the night with the pressure at 13 cmH2O AGAIN but this time I just took the mask off and fell asleep. I was no where near rainout but the air temp was too hot inside the mask (I think). I'm a little bummed about not keeping the mask on...

I got the software up and running last night and I looked at the reports but wasn't sure how to interpret them.

On the synthesis report:

Compliance (h/d): 8h21min

Events:............Number.....Index/h
Apneas:..............5.............0.3
Apneas/CA:.........4.............0.2
Hypopneas:........22............1.3
Hypopneas(FL):....5.............0.3
Acoustical Vib.:...638.........38.2
Runs(FL):..........276..........16.5

Average pressure: 9.2 cmH2O
Low pressure: 4.0 cmH2O
High pressure: 13.0 cmH2O
Pressure efficient more than 90% of the time: 13 cmH2O

HELP???

NOznsAZ