My first night, not good

Elena88 called it the "ring of fire", it appears I won't be able to avoid it.
I didn't sleep well, the wheezing sound of my own breath in the mask
kept me awake, and I asked for the quietest mask they had.
It is quiet when my nose is relatively open, but when it closes
off (like it does every night), the breathing becomes really loud,
primarily on exhales, so we didn't notice this at the fitting.

I was also awakened by mask leak, the Zest mask made a loud noise like a balloon
deflating when it leaked, tightening solved it, it only happened once.
I also thought I heard some kind of alarm once, but it might have been a dream,
sounded like an old VW bug horn going off twice, like "Herbie".

I like that the Zest mask has the CO2 port recessed, so it can't be blocked
if you roll over and bury your nose in a pillow (I tend to do this).

I also like the S9's EPR algorithm, better than the Respironics I was titrated on.
No surprise actually, thanks to those here who described the two exhale algorithms.

I feel pretty bad, had a headache all night on the machine (that was wierd),
it got better after I got off the machine, but is still lingering.
I also had a slight feeling of suffocation most of the time.

Wondering if anyone knows what might be causing the headache.

My script is CPAP 9 with c-flex of 3. I set the S9 to APAP +/- 2 (7-11), EPR of 3.
Didn't seem that radical, I was curious what the machine would do,
but I am feeling kinda dumb about that now.

I have the SW, got all the graphs, don't understand all of it yet,
AHI of 0.5, 4 centrals, and one OSA, 9.8 hrs of trying to sleep.
Leaks were 1.2 avg with a 95 %ile of 1.2 also.

The machine stayed at 7cm all night except for a few brief periods it went up to 9,
95 %ile was 8.4.

Thinking of just setting it at 9 for now. Until I get past the mask noise
it will be pretty hard to know if diddling with settings makes much difference.

- Kurt

Just because the CO2 port is recessed does not mean exhaust airflow cannot be blocked.

Your headache symptoms suggest CO2 re-breathing as the cause.

Your headaches and 'wheezing' suggest lack of therapy, most likely due to mouth breathing when you sleep, often begun when Cpap starts pumping air into your system with nowhere to go but out, unless you make a point of keeping it in (and down your airway) with a full face mask. Try taping for a couple of nights and if things improve, try some FF masks on. You didn't mention what pressures you need, but if you're using the ramp to reach them, try turning it off or at least shortening the run-up time - you only need it if you "need' it, it's not therapeutic, and if started too low can make you feel as if you can't breathe at all.

Hi Dreamstalker, I was thinking the same thing, that lack of oxygen was involved.
The feeling of suffocation seemed to tie in with that too.

I'll try the tape Julie because I need to be sure, but I didn't have drymouth,
and am not a mouthbreather to my knowledge.
In my titration study there were no mouth-breathing events.

I am thinking (out loud here) how to fix a CO2 problem.
I was careful to avoid obstructing the mask as far as I know,
so I am thinking maybe the pressure is just too low.

The S9 seems to use the EPR level for most of the breathing cycle,
so most of the CO2 exhaust would have been at 4cm, which seems really low in retrospect.
I'll set it for 9 and EPR 2, which will exhaust at 7cm.

I'll let y'all know tomorrow how it goes.

If this turns out to be the cause I want a battery powered oximeter with an ear-piercing alarm on it. I will be nervous about power failures now.

9 + hours your first night? You were truly committed to giving this a good try. Pat yourself on the back for persistence!

Yes, it's hard, and it WILL get easier but you must give it time. There are a few people who take to CPAP like ducks to water, the rest of us struggle in the beginning as you are doing. Hang in there.

Headaches could be caused by many things--the aforementioned mouth leaking or CO2 blockage MIGHT be the cause or might not. It could be stress, tension from the straps, sinus congestion, or a host of other things. The pressure from the machine plugs my eustachion tubes and that sinus pressure gives me a feeling just shy of a headache some nights.

Try tackling the sinus congestion first (because you identified it as a problem and it's an easy thing to work on). Make sure you use a sinus rinse (i.e. neti pot) or at least a saline mist every day. If it's OK for you medically, an OTC allergy med like Claritin or Zyrtec helps too. I keep my humidifier LOW--my congestion increases with more humidity, but others find just the opposite.

I find I am acutely aware of my breathing sounds at night when I'm trying to fall asleep, but I can't hear them at all in the morning, even when I try--I don't know why it's so loud at night. You might try masking the sounds with white noise from a sound machine or an MP3 player with a relaxation recording (music or sounds). It will also help you sleep. I use an MP3 player (a little iPod Shuffle) some nights and since I sleep on my right side I have a bud in the left ear only.

Finally, your plan to set your pressure at 9 is a good one. 7 isn't bad, but it may still be hard to breathe at that level. I have my low pressure set at 9, any lower and I feel like I'm suffocating.

The others have given you some excellent suggestions. You're just starting out and your body needs time to acclimate to CPAP, so I think it would be wise to stick with your titrated pressure of 9 for at least a week or two and see how you do. There will be plenty of time to experiment later if needed. There should be no problem changing EPR to 2 or 1 to see if that's more comfortable.

Your machine data results last night were excellent. It's possible that you could have been hyperventilating a bit. I know that I was concentrating on my breathing quite intensely at first. And I had ramp on, starting at a much-too-low pressure, so it felt difficult to breathe. It does get much easier with time!

You mentioned feeling a bit nervous about power failures. There shouldn't be a problem breathing through the mask if that were to happen, but if it does bother you, you could buy a power alarm like this one: https://www.cpap.com/productpage/relian ... light.html. I purchased mine at a local hardware store.

I hope that your second night goes well, and you wake up headache-free tomorrow! Let us know how you do.

Thanks guys, great suggestions so far, will use the CPAP 9 EPR 2 setting tonight and see how it goes.
I got a HW store on the way home that should have that blue painters tape.

wrt congestion:
I have been dealing with congestion for years now (almost 20).
I will be downloading the congestion webcast from yesterday when I have
time to listen to it.

I am already on allergy shots, flonase (cortical steroids),
and sleep in a near clean room environment.

I sleep with 3 HEPA air filters, a digitally controlled humidifier,
and a white noise maker.

I have high hopes the little S9 auto can replace most if not all of my current pile
of bulky sleep aids.

A little trick I gleaned from this forum is to take a HEPA filter from the Respironics
M series (the hypoallergenic one) and cut it so it will fit in the S9.
Anybody know which side is the air intake?

My DME gave me the 'M' filters when I asked for them, and though it was a cool idea.
I did that last night and my nose liked it a lot. No household room is ever
perfectly clean so getting air straight from a filtration device seems superior to me.

A single portable device that provides filtered, humidified, and pressurized air is a godsend to me.

I just have to get it to not try to kill me with CO2 poisoning.

CPAP can actually HELP reduce the congestion - assuming humidifer isn't set too high. Of course CPAP could make congestion worse, so the neti pot and meds are a god-send for many of us here.
Fixing silent GERD/reflux can also help with the congestion - and is one of the main reasons why cpap therapy can be tweaked perfectly yet you still feel tired (of course, in addition to mouth-breathing!).

FWIW, most sleep labs either don't notice or don't note the mouth breathing. I leak like a seive through my mouth but never heard a word about it from my sleep lab during the titration. It could also be that we only start mouth-breathing once we're at our correct pressures for the whole night and/or have been using CPAP for a few days.

Yeah I need to try the tape. Never occurred to me they wouldn't tell me about
mouth leaks in a titration. My S9 thinks my leak stats are pretty good however
so unless it can't detect mouth leaks I am likely ok there.

I forgot to mention also use a nasal rinse every night before bed too,
I use the neil-med sinus rinse, and it helps a lot.

Supposedly some machines can detect mouth breathing, i haven't read enough about it here to know which ones. I wish someone would make a post on that and give some explanation!

I use the neti pot in the morning, if i do it too close to bedtime my congestion is even worse.

I agree, the fine filters help immensely!!

good luck

kurth83, they do make hypoallergenic filters for the S9 machines, sold in packs of two or six: https://www.cpap.com/productpage/resmed ... ilter.html. Just wanted to make sure you knew that is an option.

echo wrote:I leak like a seive through my mouth but never heard a word about it from my sleep lab during the titration. It could also be that we only start mouth-breathing once we're at our correct pressures for the whole night and/or have been using CPAP for a few days.

I didn't leak therapy air from my mouth during my titration study either. It didn't start happening until a few weeks after beginning CPAP. I think the mouth leaking was occurring because I was finally getting good REM sleep, my body was relaxing fully, and my jaw/tongue dropped down.

It took me a while to figure out what was going on. I could see that the machine-reported leak rate had gone up. I didn't think it was due to mask seal leaks because the Activa LT worked very well for me in that regard. I kept hearing these very strange sounds coming from somewhere but I couldn't identify the source in my groggy state of half-sleep. It wasn't until my mouth started getting very dry that I realized the increased leak rate was due to loss of therapy air from my mouth. In my case, the PAPCap chin strap took care of the problem. It doesn't work for everyone, but my leak rate is zero now.

DreamOn wrote:It took me a while to figure out what was going on.

I didn't have a data capable machine at the time, I didn't even know I was mouth leaking - never woke up. My boyfriend told me one day that my machine sounded REALLY loud in the early morning hours and it was waking HIM up. After some testing with him (is this what it sounds like? what about this?), some reading on this forum, and noticing the very dry mouth, I figured out it must have been the mouth leaking and tried taping... slept really well after that.

I had a chronic stuffy nose before CPAP and now it's clear as a bell. I'm also taking two oral allergy meds regularly that I wasn't before, but I hated the steroid nasal sprays (my HMO only pays for the one that smells kind of floral, and it makes me gag!).

The regular nasal rinses, the meds, and the CPAP have all contributed to clearing out the nose.

AND, I don't have reflux on CPAP--that helps too, I'm sure.

Like Janknitz, my stuffy nose (and throat) are much better since CPAP.

echo wrote:I didn't even know I was mouth leaking - never woke up. My boyfriend told me one day that my machine sounded REALLY loud in the early morning hours and it was waking HIM up. After some testing with him (is this what it sounds like? what about this?), some reading on this forum, and noticing the very dry mouth, I figured out it must have been the mouth leaking and tried taping... slept really well after that.

The mouth-leaking wasn't waking me up either. It's amazing what we can sleep through! I would occasionally get chipmunk cheeks with the little puffs of air escaping while awake, but not often. Then every once in a while I would hear a very odd sound as I was waking up to turn or whatever. I was in such a confused state that I didn't even realize the sound was coming from my mouth. My first clue was the higher machine-reported leak rate, but it was the dry mouth that really made the light bulb go off in my head and made me realize I was mouth-leaking while deep asleep.