FIRST night with CPAP machine

Are you using EPR? If not, let's add EPR of 3 to your settings.
How to get to the clinical menu to makes changes is explained in the provider manual.
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf downloadable PDF
It might be that patient access to EPR is turned off...you can turn it on. Everything can be done in the clinical menu.
Additional instructions and a video available here...
http://www.apneaboard.com/resmed-s9-cpap-setup

Up to you if you want to try APAP mode....I never want someone to do something that they aren't comfortable doing for whatever reason.

But...the goal of this therapy is to get good sleep and keep the OSA away...if you can't sleep because of the therapy...it doesn't make any difference what the pressure is...no sleep is unacceptable.
It's better to maybe use a lower pressure for a little while to get used to all this and maybe work up to the needed pressure (and sometimes the RX of hurricane force winds ends up being not quite to high anyway) and get some therapy and some sleep than perfect 19 cm pressure and no sleep.
In other words...some therapy is better than no sleep or no therapy.

If it were me...just starting out....ramp maximum time...
APAP mode...with minimum of 10 and maximum of 20. It's a big range and the 10 might not be quite ideal but it will get you close. It can be tweaked later. Let's get you sleeping first..then worry about optimal pressure...the machine can do a decent job with minimum of 10 cm.

With your already using EPR of 3...you likely would do better with a bilevel pressure machine but you may need to prove this one doesn't work before you can get a bilevel.

Check out the links in my signature line for Software information...where to get, how to use and what it means...just follow the links to links to other threads. Lots of reading...don't try to absorb it all at once though.

Tell your DME you want to try a nasal pillow mask....Try to get the new ResMed AirFit P10 nasal pillow mask...
Be firm...tell them you have a friend that successfully uses a nasal pillow mask on an ASV machine with pressures of 20 and up all the time.
IMHO...the Eson mask...there may be better options for leak management and comfort. Not every mask works for every one.
In terms of cushions...The Swift FX Nano cushion...and you can use the nasal pillows with the same headgear.
https://www.cpap.com/productpage/resmed ... dgear.html
If you can get your hands on one of these Swift FX Nano cushion masks...I can send you a nasal pillow if I have a size you can use.

Yes, getting used to a hurricane going up your nose can be a challenge but I have never used anything but a nasal pillow mask..it's far from impossible especially if you use the ramp and a lower minimum pressure (apap mode) and EPR and hopefully by the time you need higher pressures you will be asleep and it won't matter.

Your neurologist had a harsh reaction to your question? Man that really irritates me. Don't let him get in your face, push back. He's not the one who has to sleep with it.

WindyCityEsq wrote:I was so excited for this machine. Felt like it was going to solve so many problems. After last night’s experience I am feeling SO defeated and frustrated and more tired than ever.

What am I doing wrong?!

It does not happen over night.
You are not doing anything wrong, you are learning.
Cpap is about much more than blowing air up your nose.
Patience, perseverance and practice.

You are going to leave your trusted routines and comfort zones far behind.
Embrace this challenge, a new life awaits you.
It is my belief that cpap is the grandest of adventures.
It's a journey into ourselves,
to help us learn who we are and
what we are about.

Get educated. Become your own best therapist.
You got'a believe.

It's your life.
It's my life.

I'll see you on the road.

But how much persistence? How long were you completely unable to sleep with your machine?

I've heard it implied it can be months. That's not remotely do-able for me.

WindyCityEsq:

First of all, best of fortunes. I have a QFX and have learned how to succeed and thrive with it after a tragic first few weeks in early 2013.

I was a lousy sleeper my entire adult life and began CPAP. Right off the bat, I had many problems but have found nocturnal bliss as I adapted to the gear and the way it works.I've got a simple program that did wonders for my adaptation to assisted sleep. Here it is:

This is the four-step program I devised. I had a tremendous sleep study at the local krankenhaus but ran into a granite roadblock as I attempted to get accustomed to masks on my own. You might want to give this a try:

My main advice is to back away from immediately trying to do all-nighters with your full-face equipment. Use my four-step weekly plan WHICH WORKED WONDERFULLY for me:

1) During the first week sit, watch TV, or read with your equipment whirring away next to you. Get accustomed to the sounds, feelings of the moving air, and all the external trappings of the great chance at quality sleep you are nearing. Do NOT go to bed with the equipment.

2) Take the phone off the hook, draw the shades, evict everyone from the house, don't think about any nearby clock, and loosen your clothing as you lie on your bed in mid-afternoon. Turn on the CPAP gizmo, put the mask on your face, and close your eyes. Think peaceful thoughts, whatever they are to you. At some point in the week you WILL fall asleep. After you have this nap, you'll be amazed at what a refreshing experience it was.

3) During the third week have all your CPAP gear ready for action as you go to bed for the night. As you've done so many times throughout the years, you'll awaken far before morning. When you do, slap the mask on your face and turn on the CPAP gear before your groggy brain has any idea what's going on.

4) After successfully completing the first three steps at your pace, decide on a night (mine was March 3rd, 2013) when you have full confidence and will retire for the night WITH your mask on. You'll succeed!

My biggest mistake was expecting everything to go perfectly from the first night. It rarely occurs because the brain must be retrained after all those years of awakening in the middle of the night. One must be patient and keep anxiety as far away as possible. On March 3rd, I had a goofy sort of celebration to mark one year of refreshing sleep I never had - over four decades - before last year.

By the way, I went to bed at 11:00 a few nights ago and awakened non-stop at - ready for this? - 7:00 this morning. For decades that NEVER happened.

Be patient, best of luck and God bless

WindyCityEsq wrote:So if my dr is wrong about the apap... and if I decide to switch to apap on my own, how do I know what range to set it at? Do I just take a wild guess and arbitrarily decide my own range? I don't have my titration study (nor would I know how to read it), so all I know is that my cpap level is at 19.

Under the HIPPA laws you are entitled to have copies of your medical records. You need to get a copy of your sleep study from the Dr's office along with a copy of your prescription. As you read through the study and have questions, you will get answers from this forum.

The prescription is useful if you are traveling and need to get supplies or parts allowed only by the Rx.

BeadyEl wrote:But how much persistence? That's not remotely do-able for me.

What is the alternative?
What is your life worth?

Fight for your life.....

@ Pugsy- OK I'll try to switch to apap mode from 10-20 tonight. I don't know how to switch my machine from cpap to apap but I'll look up the instructional booklet and try to figure it out.


You mention to try the ResMed AirFit P10 nasal pillow mask and then you later say try the Swift FX Nano cushion mask. I think I can only swap out one mask at a time for my trial-- which one should I start with ? My DME is a good one--- he said he will deliver whatever I want to my home. I don't know what nasal cushions are so I'm looking that up now.

Some people mention try using the machine when I watch tv or read. I guess I'll try that on the weekend. But I currently work for 65 hrs + a week, and commute for another 18 hrs. So on most times, I come home and just head straight to bed. No time for anything else. But I guess I will try the waking therapy on the weekend to see if I can get used to it.

@ djhall: I think I'm gonna give this another week, and if I'm still not seeing any progress, then I'll have to call up my dr about bipap. Thank you so much for your helpful references- I'll be sure to use this as ammunition if I get any pushback.

@ msla: Thank you for your tip. Yes, I know I can get them (the medical records) if I want. I guess my concern is that it's just going to be pages and pages of numerical data and I'm not going to be able to understand it for it to be of any use to me. Am I wrong? Is the having the titration study data/medrecs useful? Good call on the script... I'll be sure to get a copy of that.

Does anyone want to address the constant runny nose thing? I've read so many contradicting things now from other websites: some say it means you're allergic to the hose/mask material (but I've never had any other allergies), some say it means the equipment is dirty (but mine is brand spanking new so i cant imagine that's it), some say that it means you have to INCREASE humidifier, some say it means you have to DECREASE humidifier, and some say it's just a symptom that happens while your body is getting used to constant air pressure being blown.

On the humidity. Very individual, you may need more, you may need less, no way to tell. Since you have it near max, I would try lower and see if that helps.

You don't need the raw data from your diagnostic and/or titration study, just the summary pages, usually only a few pages long. I insist on copies of all reports from all medical tests, no matter for what. I make sure that all doctors understand that I am in charge of my health care. If they don't like that I fire them and move on. Most doctors are fine with that (sometimes after they get over the shock). Sounds like your doc and I would not have a long relationship!

There usually is a summary cover sheet on the data that will be helpful for your journey down this road.

Your ESON qualifies as a nasal cushion mask...over and around the nose.
Cushions sometimes fit in a rather hard plastic shell and sometimes no shell like the Nano or the ESON.
Full face masks also have cushions...often we only have to replace the cushion and not the entire mask/headgear and plastic shell frame (if it has one).

If you can get the Resmed AirFit P10...start with that if they have it.

Worry about the Nano later if needed...I mentioned it in case they didn't have the P10...you could try the Nano which is smaller and might be easier than the ESON to keep sealed and I can get you a Swift FX nasal pillow that can be used with the Nano headgear. The Swift FX nasal pillow mask would be a close second behind the P10 in terms of recommendations for a new nasal pillow user. The P10 is new...just released a couple of months or so and not all DMEs stock up on the latest and greatest immediately.

I gotta go get some work done. Will be back later this evening if you have further questions.

Watch the video ...it will help a lot with your questions about your machine...then come back with questions if you need clarification.

Windy, I'm only a month and a half out from my first night of CPAP, and I had a first terrible week. Then I learned about mask liners on this forum, which I see no one has yet mentioned in this thread. My DME didn't even tell me there was such a thing, but they are a great help for many who have leak problems or find the mask a bit uncomfortable. My problem, with FF mask, was leaking so bad it sounded like a whoopee cushion all night long! The mask liners have greatly reduced the leaks, and have eliminated the noise. I only feel a few blips every now and then from leaks. It takes a long time to acclimate to the "alien being" on your face, learn the proper tightening, and get used to the machine, but slowly it happens, and you're able to benefit from the therapy.

I'm going in for my compliance check next week, and I'm hoping to get the answer to some questions I have about pressures, etc. at that time.

You might want to ask your DME about liners, they will probably have the ones called REMZzzzs. There are also some called Pad A Cheeks that you can order online.

Good Luck, and come back here whenever you have problems or questions... I've learned more from this forum than from RT and the DME...

Windycity if you look at that video in the link that I sent you it shows you how to do all that stuff you want to do like get into the clinical menu. http://www.cpaplibrary.com/machines.html

BeadyEl wrote:But how much persistence? How long were you completely unable to sleep with your machine?

I've heard it implied it can be months. That's not remotely do-able for me.

Yes, it can take months, yes you can do it, but no, not while completely unable to sleep. Disclaimer: YOU are responsible for your own treatment and your own results, not some random guy giving advice on the internet. That said, it is my opinion that the long term results are more critical than the short term results. That may mean settling for sub-optimal results now in order to get optimal results later. Any treatment is better than no treatment when the alternative is giving up.

I started by reducing my pressure in order to allow me to sleep with and get acclimated to my machine and mask. When I was able to comfortably sleep at the new pressure I would raise it a little and get acclimated to the higher pressure. It took roughly two months and six masks before I was routinely and easily falling asleep and staying asleep without leaks at pressures of 15 to 16. It took another 3-4 months from there to work the rest of the way up to 18 - 20 pressure without swallowing air and waking with gas cramps.

In short, I was sleeping through the night with the machine at lower pressure after the first week. I was in a somewhat effective 5 - 10 AHI range after the first month. <5 AHI after two months. Still working on getting below 2. But I don't think would ever have gotten here if I had 18 - 20cm pressure blowing full force every time I tried to sleep right from the start.

WindyCityEsq wrote:@ Pugsy- OK I'll try to switch to apap mode from 10-20 tonight. I don't know how to switch my machine from cpap to apap but I'll look up the instructional booklet and try to figure it out.

Pugsy knows way more than I do, but I will mention that when I started with Auto mode 10 - 20 would have given me the same experience you are having with ramp mode... fall asleep at 10 and wake shortly after to an 18 or 19cm hurricane in my mask! I need high pressure, so my machine climbs there fast in auto, but I wasn't acclimated to sleeping through such a high pressures yet. I had to start with a lower range like 10 - 14 at first, even though that prevented my treatment from being fully effective at first, and then raise the maximum a little at a time as I grew acclimated to it.