first night failure help!!!

I'm new here, thank you in advance...
Last night was my first night wearing a mask, outside of my second night at the sleep center. It didn't go well. Though I had the best night's sleep that second night of my testing, woke up feeling fantastic, it was far from last night's experience. I hadn't minded the pressure there, but I didn't care for the accoutrement of it, having all that "stuff" in my eyesight. The doctor suggested I get a nasal pillow, so that's what I was set up with yesterday. It's a ResMed Swift FX, brand new on the market and the machine is a REMstar Pro C-Flex+. I need my pressure set at 12. The tech set it up so that I start at 4 and in 20 minutes it rises to 12.
I was tired when I went to sleep, but I couldn't get comfortable with it. I know one has to get used to it, but I couldn't help wondering if it was the wrong mask for my needs. The noise really bothered me and I worried it was disturbing my husband. The noise increased with my inhales and exhales. Is that normal? I've heard that these days it's a constant white noise sound, which I was kind of looking forward to, as was he. (rather than my gasping for air all night and snoring). Unlike the blissful night at the center, I never felt sated by breathing into this thing. Could it be that I just need to get used to it? I was told nasal pillows are easier to use, but perhaps not for me? there's something finite about plugging up your nose like that, rather than sealing around it...I could not get comfortable. The noise, and something about the exhaling, I dunno... I'm a side sleeper (tho prefer stomach). I kept turning the machine off and starting it again so I could fall asleep B4 it reached 12 - til' 3:30 AM. then I took it off. Any advice, I'd love it. Thanks again.

welcome

you need to think positive and be patient, try to have some daytime naps using CPAP

try the other type of mask if you want to, you will get used to the noise, earplugs may or may not help

ooohh - that hurts. I remember those days. Stay with it, it does get better!

The nasal pillows didn't work well for me - I switched to a nasal mask and it works much better. The nasal pillow just felt too invasive, and it would get dislodged during the night and not easy to readjust just right.

Also, none of this should be noisy. The machine should be really quiet and the mask should be quiet unless leaking.

Lots of the adjustments need to take place inside the head as well - visualize the changes you want to see with better rest and work on accepting the mask and hassles as your friend to help you get there.

Best wishes!

Hi

Welcome!! Stick with it .. first night is always hell on wheels. Like you - I had an awesome experience at the sleep study and I felt WONDERFUL the next day. I begged the sleep tech to let me sleep another hour.. but they just threw me out .. personally emulating the feeling I had after my sleep study is what has kept me going. Its a few months down the line - and I have made steady progress towards that goal. I think the reason the we had such good success - is because our bodies have been starved for sleep in such a long time - that just about any situation where you can sleep and breath is WONDERFUL.

From my experience - I now have about 7 masks that I own .. including the one you currently have the FX. The FX is a really really nice mask when compared to some of the others I have tried. My pressure is much higher these days and the FX will not work for me. Alot of people have had success with the Activa or LT. Trial and error - you might even try a Full Face and see if that suites you better - alot of people can't tolerate them - but the are great if you can because it allows you to breath through your mouth if you get a cold.

Hose management is a simple and effective way to keep your leaks down and make you more comfortable. I found myself getting wrapped around the stupid hose and that was bothering me alot. There are many suggestions - some as simple putting a hook on the wall and using a bit of string to secure it.

All I can say is stick with it. I remember very vividly how I felt after my 2nd night - I will do just about anything to get that feeling back - I must stay - everyday it gets better and better - every minor adjustment has its rewards.

Ivan.

Thanks, all. This whole diagnosis has really thrown me. I am truly shocked by how much my mind and body have been affected by not getting enough oxygen and REM sleep over the many years I've gone undiagnosed. You're right, Ivan, I must remember how incredible it felt that night at the sleep center, I'd been committed to that til about 2AM this morning. I will try to look at the cpap as a friend, attempting to resurrect that single night's deep deep wonderful sleep. I cannot remember a sleep as incredible as that. This has been going on so long... unaware, untreated... The diagnosis is so recent and I know so little about it all. nap coming right up...

First of all, welcome! You are in the right place, I don't know what I would do without this forum. I had the same experience you did at the sleep lab, I woke up the morning of the titration study with a feeling I did not recognize and it kind of spooked me. When I finally realized that feeling was "alert" I actually cried to think that I no longer recognized that feeling. Unfortunately, it went away and I am still chasing it in my third month of treatment. But, we can't give up, it will come!

I do want to echo what you've been told..it should not be noisy. I have the same brand machine as you and it is very quiet. The only time I have noise is when my full-face mask decides to spring a large leak. Masks are challenging beasts and you may need to experiment a bit to see what works for you.

Once again, welcome and keep us updated on your progress and ask questions. The folks here are very helpful.

Jeanette

hey jersey girl,

i just put the mask on so my husband could listen. It sounds like my inhale and exhale are amplified, coming from the machine and from the mask area. Could be that because it's a nasal pillow the sound is more intense because it's that much close to the ears, thereby acting as a conductor of reverberation??? it is very loud and not okay. something just isn't right. and yes, the exhalations don't feel right. my machine is set for 3, having a 1-3 choice, 3 being the highest. I don't really understand what this is. all the manual says is that it "helps" with exhalation. I don't feel like I can breath normally with this, that I'm exerting more than I should be. I'm trying to be "normal" with it, but, jeezukes... Lisa (sleep lover)

Oh my, no wonder you couldn't go to sleep! Your story sounds like a near replay of mine. Let's discuss the ramp feature, as it was the main cause of my early problems, except for I dozed off immediately out of exhaustion, but quickly sprung back awake. A ramp of 4 was just too low, and I couldn't relax because of the sense of suffocating - not because of the mask or its style, but the inadequate pressure. And if you keep hitting the ramp all night long, it means you never get to experience a therapeutic pressure. That's a recipe for failure. I strongly recommend you increase your ramp to at least 6, maybe even a little more. You could turn it off, but it may be a bit much to start off at 12 while all this is so new. Getting used to the new sounds and feels is enough of an adjustment without adding pressure issues, whether too low or too high.

Even though I've been using cpap since late 2005, even now a mask change can make me hyperaware of subtle changes in sound. When I got a new mask of the same type, it was louder and it took me several nights, but fortunately the brain learned it as a new normal very quickly.

Let us know how the next few nights go for you. Best wishes.

Kathy

Kathy,

before you go, why do you say to put the pressure up higher than 4? that seems counterintuitive. I prefer it at the lesser amount, it's much easier to inhale, for me. Is this one of those situations where it's different for everyone, or is there a rule of thumb that only experience folks know about?

thanks,
Lisa

The starting ramp pressure is a different for everyone comfort thing. If you like a starting ramp pressure of 4 you can leave it alone. I and many others find that pressure so low that it feels like not enough air. I think you would know a 4 setting is uncomfortably low for you. If you do find breathing difficult when you first start on CPAP for the night consider increasing that starting ramp pressure. I don't use the ramp feature at all anymore.

With respect to noise, I can "hear" myself breathing in and out as the pressure raises and lowers via Cflex. To those not wearing the mask the machine will not sound anything as loud. This is something you should get used to over time. There will be less of an ebb and flow at a lower Cflex setting. My typical setting is 2 on both the M series Pro and the PR1. This is an optional comfort feature. You can go lower, or off if you like, but I think you need the clinical menu for "off". The "sound" at 3 frankly drove me crazy on the M series Pro. I don't find this to be related to using nasal pillows over a nasal mask. You'll still have the ebb and flow.

I assumed you had a REMStar M series Pro, but I though Cflex+ only came in with the System One, which I have now?? Either way my comments still apply. The PR1 is a quieter machine. My first machine was a REMStar M series Pro.

EDIT: Sorry I thought you had a S8 .. Same applies. Just different Terminology : C-Flex=EPR - there should be a mask fit function on your machine. Incidentally .. you will need to get used to the pressure. I would not turn it on and off to keep it ramping. If you are not asleep by the time it reaches 12 breathe against the pressure. See it as doing some breathing exercises. You will get used to it.

I agree with everyone above. couple of things.. EPR - I HATED EPR. It's to dumb in my opinion. Try turning it off or set it for 1. RAMP : I find anything under 8 as a starting point very uncomfortable - after sometime I am now able to comfortably ramp from 12. I like the extra pressure.

Mask fit : Spend sometime this afternoon fiddling with the mask and the MASK FIT feature on the S8. Put the mask on - and then hold the start button till it starts blowing like crazy. Make sure you get a good fit with NO LEAKS - and play with different strap positions on your head .. preferably lying down - so you get used to doing it while you are in bed. Take it off ... put it on .. make sure it still seals. Like learning to drive - first few hundred times you have to do everything consciously .. but it gets easier over time and as you develop a "feel" for things.

Some people will argue - but try putting your cpap on floor or half way up your bed ( use some phone books ) - just taking it out of the same level as your ears makes it ALOT quieter.

Also point the back of the machine away from the wall .. and away from you. It doesn't look neat and it ends up taking over the table but it does help with the noise.

Good luck.

Hi,
First I will say it will get better. Hang in there and try new things till you get it the way you like it.
I had the Swift LT nasal pillows and tried for a month to make them work. they were just not for me. I had a lot of leaks at first. Then after I got the leaks fixed I had terrible sinus problems! I now have FFM and it is so much better but that is a matter of personal preference. You may have to try some different masks to find what works for you. Insurance will usually let you try a new mask within a 30 day window. Check with the DME. The sound bothered me at first too. I put it down on a low stool and it was so much better. I fit my masks the way Katie suggested. That worked well for me when she told me to do that.

On ramp- I also started at a ramp of 4 and thought I was going to suffocate! I now don't use ramp at all. My pressure is 9.

I too had a wonderful night at my sleep test and felt great the next day and then it was such a disappointment to have so much trouble. I think that is common though. I have taken my mask off like you in frustration in the middle of the night and decided that any kind of sleep is better than that. It's not! Keep working at it till you get it right for you. You have some ups and downs ahead but it will be okay.
Best of luck to you.
Karen

Thanks folks..
I'm going to try everything you've all suggested. Will post results tomorrow to let you know what happens, and for the chance of helping someone down the road with similar problems. I really appreciate your thoughtfulness and support. jerseygirl... thanks for the helpful conversation, very kind of you to take the time, Lisa

sleep lover wrote:Kathy, before you go, why do you say to put the pressure up higher than 4? that seems counterintuitive. I prefer it at the lesser amount, it's much easier to inhale, for me. Is this one of those situations where it's different for everyone, or is there a rule of thumb that only experience folks know about?

Welcome Lisa. I know this was asked of Kathy, but I'm going to toss in an opinion too. My own experience is like that of Kathy and Jersey Girl, that ramping with too low a starting pressure can be uncomfortable. I will admit right off the bat that people have quite different reactions to this, but I've seen many posts where too low a starting pressure seemed to be part of the problem. Pretend you were just hooked up to the hose but no machine, so that every time you inhaled you had to suck the air through a six-foot hose. It would take work to inhale. It requires a certain amount of pushing from the CPAP end to make inhaling feel comfortable, and for me at least, it takes more than 4 cm-h2o. If you don't feel difficulty drawing air in at the start, then maybe this isn't a setting you need to worry about, but starting at 7.5 makes me feel much better. I also found I liked a shorter ramp period. I know the idea of "ramping" is that you fall asleep before it hits full speed, but that never worked for me. Call it performance anxiety if you like, but the thought that I had x minutes to go to sleep made it difficult to go to sleep. I do five minutes now to avoid that "sticking your head out a car window" feel of starting at full pressure (15 in my case), but don't expect to doze off until the ramp is complete. Some folks do without.

Exhalation relief (C-flex) eases the pressure while you exhale so you don't feel so much like you're blowing up a balloon. How much people like it is highly subjective. I reached a point in a few months where I didn't even notice the pressure any more if I woke up during the night. I had a funny thing happen to me last week. I woke up and I seemed to have trouble inhaling. I wasn't suffocating or anything, but it just seemed a little harder than normal to inhale. I could hear my CPAP machine going. My mind began running through imaginary medical conditions -- pulmonary embolism, congestive heart failure, etc. Finally, I discovered that I had pulled the hose off the CPAP machine at the machine end. With time, exhaling against pressure had become such second nature that I didn't even realize I wasn't. Some problems, like finding the right mask, take effort, but others will improve on their own.