New CPAP user needs help: waking up often

[Bharat]

I have been using a CPAP machine (Respironics Dreamstation, Vitera Full Face mask) for about 3 weeks. I have been sleeping worse, waking up often -- I don't have a problem falling asleep. I am a frequent snorer, so that is reduced, but I'm not getting enough sleep--only about 4 hours /night, occasionally less.

Plus the mask doesn't feel great -- the medium size seems to touch the ends of my lips, and the large just doesn't feel good. It's got worse over time -- in terms of relative lack of comfort with the mask... At times I wake up feeling suffocated--like I can't breathe.

Sorry to sound so picky, but I've always been sleeping only 4-5 hours / night and in my mid-to-late 50s that became too tiring; so I got this CPAP (the sleep study had a score of 11, with a low O2 sat of 81%, with lots of snoring), if that helps.

I would be forever grateful for any tips. Should I get a new mask? The machine seems great...

Thanks for any tips! Would be so grateful,
Bharat

[khauser]

Hi Bharat, and welcome!

Please continue to use this thread so we have your history.

We need to know a bit more to even start. Two things that would help:
1) There are SO MANY different "DreamStation" models. Please remove the humidifier chamber (if present), flip it over (pretty sure its on the bottom) and find the model number. It'll begin with DSX
2) Do you have the results from your sleep study? Can you blot out any personal identifying info and post an image?

Regarding the mask, it is the rare person indeed that loves their first mask. It is a rather big trial process to get there, and there's no way around that. Insurance (if you're in the US, anyway) isn't all that helpful, and the DMEs often hide that you can request a different mask if the one they provide does fit, because that hits their bottom line.

Do you NEED a full face mask? That would only be the case if you were a mouth breather that can't find a way to change the habit. NOTE: many people think they are mouth breathers because before CPAP therapy they naturally do that, but it's more an attempt to breathe when you can't, so don't be too quick to assume...
-Kevin

[nicholasjh1]

It would also be helpful if you posted sleep results with your new machine ( I think there is a thread pinned at top on how to do it). Bad sleep can also be related to not fully treated apnea.
Other possible reasons for sleep issues:
1) Nasal masks - for some people (depending on mouth architecture, and pressure needed) air entering the nose starts filling the mouth cavity, causing either cheek ballooning, sputtering lips, or just dry mouth from air flowing out of the mouth. People solve this one in various ways (cervical collar, chin straps, taping the mouth shut, combination, switching to full face (which doesn't work for some due to face architecture etc))
2) Full face - face doesn't conform to any "standard face" template - face too broad, face too narrow, mouth slopes back too quickly (people with these issues often move to nasal). Badly fitting face mask can cause mask sputter, mask leak, pressure points. Solves are switching to nasal, pure lanolin in sensitive areas, finding the correct fit mask. Air pushed in can balloon cheeks ( not sure about the solution on that one other then get used to it or switch to nasal)
3) Recovering metabolism. - Imagine you got into a life or death situation AHI time hours you slept a night (a X h). Imagine the body is adaptive. Imagine you suddenly weren't expending all that energy at night (whether you remember it or not (remember low oxygen can lead to black outs)). Imagine how energized you would suddenly feel when after waking up after 3 hours of solid sleep, not having expended a lick of energy and you weren't able to get back to sleep for 2 hours because your body was so primed from all the night time cardio you had been doing for (Undiagnosed Apnea TIMES Years.(UA X Y) ) (This resolves over time, but the middle of the night hyper wakefulness can really confuse some people)
4) pressure too low - unexperienced Docs (most of them ) who prescribe an auto unit often prescribe minimum pressure 5 to max 12-20) thinking that the machine will take care of everything. 2 issues with this - 1 with a pressure of 5 breathing in often feels like you aren't getting enough air (to many people(there are about 1000 posts here on it)) 2. a too low pressure can cause more initial onsets of apneas that the machine has to ramp for. The machine may not ramp "fast" enough and you end up rousing from the apnea/lowering oxygen levels, this may not even be reflected in the machine stats as Apnea's under a certain threshold of seconds are not counted (could be different depending on machine).
5) Not used to breathing against pressure, Luckily for many this resolves over time, but especially initially breathing out against pressure can feel difficult. ways to help this "relief" settings for your machine. sometimes called APR. The machine attempts to sense when you've ended your breath in and lowers pressure so you can breath out more easily.
6) hypervigilant about breathing - caused by having breathing relief on - for some who breath in for a longer period where their inspiration goes past the detection from the machine and the machine does breath relief with APR or other it can feel like the machine is telling you to stop breathing in before you are actually "done" breathing in and it can start to feel like you're "hyperventilating" That's not actually the case, but for some the breath relief can actually impose concern.

Note this is not an inclusive list. Other issues can include Claustrophobia, Lack of patience (to get used to things), lack of willingness to experiment to find the right set up, over reliance on the doctor for instruction and denial etc.