First night on CPAP Nasal Pillows - failed -help please.

[Rodea22]

Good morning.
I was recently diagnosed with obstructive sleep apnea with AHI of 16. I am not overweight but have lost 75bs from my heaviest a couple years ago. I have snored bad my entire life regardless of my weight. I was given a ResMed S9 Autoset with humidifier and my mask is the least intrusive wiht nasal pillows and a basically a rubber band. I used it for the first time last night and failed miserably. I had to remove it after about 30 minutes of staring at the ceiling. The pressure was uncomfortable which I expected would be for a few days to a few weeks but what really made me feel almost closterphobic was having to keep my mouth closed. I normally breathe through my mouth so it felt like I was breathing through straws. My therapist told me that I probably breathe through my mouth because of the apnea and 90% of apnea sufferers get used to the nasal pillows.

Is this true? How long should I give the nasal pillows a chance before going for a bigger full mask. I'm reall hoping is just my adjustment period but not sure if I'm spinning my wheels without just going for the mask (which may be equally as uncomfortble- I haven' tried one yet) . Would it be easier of an adjustment to start with full mask to get used to CPAP and then give the nasal pillows a shot or should I carry on as is and push through. Any feedback, advise, guidance and help would be greatly appreciated. Thanks

[Pugsy]

What pressure were you using when you started the machine?...were you using the ramp feature where it starts out at 4 cm? What size nasal pillow are you using?
Which nasal pillow mask? Sound like maybe the ResMed AirFit P10 since you say "basically a rubber band".

What you describe as "breathing through a straw" sounds like a combination of pressure being too low (often seen when ramp is used) and a tiny nasal pillow. Easily fixed in most situations once we know what you are using.

So...are you using the ramp feature?
Are you using apap mode with a range of pressures and if so, what are they?
What size nasal pillow?

Mouth breathing can be habit from gasping for air during the night...I had this myself.
If you normally can breathe through your nose just fine...then you are a good candidate to at least try the nasal pillow mask. If you can't breathe through your nose comfortable because of nasal congestion that can't be cleared up the you need a full face mask. So it depends on if you are mouth breathing out of habit at night or out of physical need.

Let's start with what pressure is being used. Often just a little more starting pressure along with maybe moving a size up in the nasal pillows will make a big change in comfort. It's also a good idea to play with it while awake like while watching TV so you can get used to it without the stress of having to fall asleep.

[Rodea22]

Thanks Pugsy.
I do not have the machine with me a the moment however my mask is an Airfit P10. The RT told me this is the least intrusive. He also set the machine for 10 minutes to auto adjust or something like that after asking me how long it took me to fall asleep. Not sure if being awake while the machine was adjusting itself was part of the problem? I am not sure what you mean by " ramp"? I am using the medium nasal pillows. The RT measured me and told me I am medium but I took his word and didn't try the others yet. Not sure the pressure ranges. He told me it will take care of itself. I am currently not congested so I'm hoping to learn to breathe through my nose. Are there settings for pressure range I need to adjust? Thanks for your feedback

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[WinterLily]

Hi Rodea,

Have you tried a nasal mask? I just switched from Airfit P10 to the Wisp (which fits over the nose and rests softly against the face). It's made a good difference- less breathing-through-straws feeling, less claustrophobic. Maybe that's something to try out?

It might also help to turn off the ramp feature on the machine. The pressure might be too low while the ramp is on, which contributes to the stuffy sensation.

[Pugsy]

I bet the ramp is on (that's something that is turned on or off in the clinical setup menu).
Go here and get the manual for your machine.
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf
And here's a video that will also help
http://www.cpaplibrary.com/machines.html

The P10 is a nice little mask and the medium pillow should have enough volume so that won't experience discomfort if the pressure isn't too low.

Ramp is where the machine starts out at a much lower pressure and gradually goes up to whatever pressure the machine is setup to go to over whatever time frame is chosen.
It normally starts at 4 cm and that's low and often people complain of feeling stifled or suffocated at that pressure because not much air is moving. Some people describe inability to exhale when it is actually more they just can't comfortably breathe in terms of air movement in general.

EPR is ResMed's Exhale Pressure Relief designed to help with exhale by a reduction in pressure during exhale.
Nice feature (it's an option in that clinical setup menu) but when someone is using a low pressure (either by using ramp or just a low starting pressure) it can't do much because 4 cm is as low as the machine can go.

So get the clinical setup manual so you can understand what your machine does...watch the video...then go into the clinical setup menu and find out exactly what those various settings are and I bet we can fix it so that you will have a more comfortable time with the machine.
So...ramp is probably on and most likely the starting pressure is 4 cm (that can be changed)..check to see how long the ramp is set to function.
Need to know which mode the machine is set to....choices will be cpap or auto
Need to know if EPR is turned on or off and if on ....at what setting
Need to know the pressure the machine is set at...if cpap mode there will be one pressure for therapy and if auto (apap) mode there will be a minimum and maximum setting.
Tell us the above and I bet we can come up with an idea to help you be more comfortable.

Also...there is software you can use to show how well you are doing. Links in my signature line for that.
But for right now if you can't sleep with it...it's not going to show us anything so let's get you to where you can sleep with the mask and machine first.

[rodea22]

Thanks all.
I know the machine is set to "auto" so it adjusts pressure as I need it.
Yes the ramp feature is set to "on" and I believe it' s set to 15 minutes. Not sure until I get home if it starts at 4 or not. Based on the feedback I bet it is as I felt favor labored breathing but I do generallly if I try to breathe 100% from my nose (maybe beause Im just not used to it, just what I've always done) I feel I get more air from my mouth but I do not have any blockages in my nose.

I will report back with the range its set to but is it the consensus I should turn off the ramp for now?
What is the point of the ramp?

and I will wear the machine at least 30 minutes before bed to try to get more used to ist.

[Pugsy]

Turning the ramp off may not fix the issue.
It just depends on what the machine is set to start the pressure minimum at. If it has an already low setting (and often the DME just leaves the default setting of 4 to 20) then ramp may not even be the problem. The problem might be the minimum setting itself.

If the settings for apap mode are 4 minimum and 20 maximum....ramp isn't even a factor because the ramp starting point is already the minimum setting.

[flyingcow]

I'll chime in in saying that the vast majority of people have had very good results with the P10, but there are a few of us that it doesn't work for. If you're still struggling after trying some of the above suggestions, a different mask might do the trick. I went from being able to last about 2 hours on the P10 to going through the night without waking up on my Swift FX (and now over a year of 100% compliance). At first I thought it was a moisture issue, but I'm starting to think it has more to do with the lack of adjustability (and my immense, thick noggin) preventing the pillows from inflating properly. Again, the P10 has worked for scores of people, but since it doesn't adjust, I think there are a few heads it simply doesn't fit.

[englandsf]

Try the bigger (large) pillows for the P10, they may help open your nose.

[Wulfman...]

Good morning.
I was recently diagnosed with obstructive sleep apnea with AHI of 16. I am not overweight but have lost 75bs from my heaviest a couple years ago. I have snored bad my entire life regardless of my weight. I was given a ResMed S9 Autoset with humidifier and my mask is the least intrusive wiht nasal pillows and a basically a rubber band. I used it for the first time last night and failed miserably. I had to remove it after about 30 minutes of staring at the ceiling. The pressure was uncomfortable which I expected would be for a few days to a few weeks but what really made me feel almost closterphobic was having to keep my mouth closed. I normally breathe through my mouth so it felt like I was breathing through straws. My therapist told me that I probably breathe through my mouth because of the apnea and 90% of apnea sufferers get used to the nasal pillows.

Is this true? How long should I give the nasal pillows a chance before going for a bigger full mask. I'm reall hoping is just my adjustment period but not sure if I'm spinning my wheels without just going for the mask (which may be equally as uncomfortble- I haven' tried one yet) . Would it be easier of an adjustment to start with full mask to get used to CPAP and then give the nasal pillows a shot or should I carry on as is and push through. Any feedback, advise, guidance and help would be greatly appreciated. Thanks

Sounds like you've been set up to fail. If you're machine is set to a range of pressures and you're having trouble breathing through your nose, it's going to register as Flow Limitations and/or Snores.......which will drive up the pressures on an APAP.
If you're using a higher humidifier setting, that can contribute to nasal congestion, too.
Nasal cleansing before bedtime may help open your nasal passages.

It sounds counter intuitive that you or your "therapist" would select or recommend a nasal mask if you're a dedicated mouth-breather. There's also more profit in the little nasal masks.


Den

.

[cpapmark]

Hello,

I had the same experience as you when I first started back in June. I always breathed through my mouth at night, and found it hard to adjust to breathing through my nose only. I had the option to switch masks within the first 30 days. I made an appt to switch masks, but had a 2 week vacation scheduled so had to wait until I got back to switch. Over that time period I got used to breathing through my nose only. The humidifier helps a great deal if you have any congestion.

When I got back from my vacation, I took the full face mask even though the nasal mask was working for me (I was able to keep my old mask as well). The full face mask was a disaster for me. It leaked all over the place if I moved slightly. I found the pressure when I opened my mouth really annoying (my setting is 12, slightly lower than yours). I switched back to the nasal mask and never looked back. I am interested in trying a nasal pillow. My nasal mask leaves a nice red mark on my nose every morning.

Just give it some time, at least a few days to a week. You can always try the full face mask to see if that works for you.

Good Luck!
Mark

[Wulfman...]

Hello,

I had the same experience as you when I first started back in June. I always breathed through my mouth at night, and found it hard to adjust to breathing through my nose only. I had the option to switch masks within the first 30 days. I made an appt to switch masks, but had a 2 week vacation scheduled so had to wait until I got back to switch. Over that time period I got used to breathing through my nose only. The humidifier helps a great deal if you have any congestion.

When I got back from my vacation, I took the full face mask even though the nasal mask was working for me (I was able to keep my old mask as well). The full face mask was a disaster for me. It leaked all over the place if I moved slightly. I found the pressure when I opened my mouth really annoying (my setting is 12, slightly lower than yours). I switched back to the nasal mask and never looked back. I am interested in trying a nasal pillow. My nasal mask leaves a nice red mark on my nose every morning.

Just give it some time, at least a few days to a week. You can always try the full face mask to see if that works for you.

Good Luck!
Mark

There are many "full face masks".......not just "the full face mask". Like other masks, some work better for some people than others. You didn't mention WHICH one you tried. I've tried a couple others, too. One of them definitely didn't work for me (could only tolerate it for three nights) and the other was OK, but not as good as the one in my profile.
Also, the bed pillow can make a HUGE difference in how well or not a mask will work. Some allow the head to sink too far into it and push the mask out of alignment.

So, I'd caution you to be specific when describing "the full face mask" and not lump all full face masks together.


Den

.

[cpapmark]

I tried the Resmed Airfit F10. My point was not to knock full face masks, but to give the current setup sometime since my experience was similar (was a mouth breather at night, had a hard time breathing through just my nose).

[mrbeck66]

Hi Everyone,

I too started with the nose pillows as mentioned this past week. The first night was tough as I couldn't get comfortable. My breathing is all I could hear as I stared looking at the ceiling. A few nights in I was able to get about 3 hours at the most. Last night I returned the nose pillow and replaced with a nasal mask Resmed Mirage. Boom almost got 6 hours on this mask with a good nights sleep. Here's hoping this continues.

Chris