New to CPAP, 2 questions:

Fscott · Post by **Fscott** » Tue Jul 01, 2008 3:05 am

Tonight makes exactly one week on CPAP.

I am using a Respironics Remstar Pro M-Series, with a Resmed Mirage Quattro mask, pressure at 10 cm/H2O.

1rst question is probably simple: Why are there vents at the nose bridge area on this mask? That would seem to lower the pressure the machine is delivering, no? (Also, my wife doesn't appreciate the blast of air in her face if I roll over facing her lol)

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The more important question:

2nd is a more about tolerating/acclimatizing to treatment. I think I am tolerating the treatment very, very well with regards to physical comfort while sleeping. After the first two nights I didn't even find it necessary to use the ramp feature. I have been sleeping 7+ hours from the first night. I haven't had any of the severe toleration problems I have heard about, and am thankful for that. 2nd nature almost.

HOWEVER, I am sleepier than ever. I did not have severe problems with hypersomnolence prior to treatment, it was not a problem of mine. However my events were frequent and we (doctor, family, I) suspect that my sleep apnea goes way back into childhood. So the sleep apnea may be deeply ingrained. Maybe this is the kink?

Now I *need* coffee to get going in the morning, and find myself crashing early evening where I was a night owl before. I have heard the term "sleep debt," and wonder how long it will take before my body and mind are able to adjust to *not* having to deal with oxygen deprivation on a nightly basis.

Any insight into this problem forum members can provide would be extremely well appreciated.

Guest · Post by **Guest** » Tue Jul 01, 2008 4:29 am

Hello,
Welcome to the board. You have come to a great forum for support.
The Quattro and all masks for that matter have exhaust ports for the air to go. It has to go out if it comes in. The masks are designed to deliver the air pressure dialed into the machine to splint open your airway.
They have to exhaust somewhere.
Yea the exhaust ports can be annoying to the spouse, mine too.

The sleepier is normal too. You will gradually pay back your sleep debt then you will notice more energy during the day and more awake times. It is gradual, be patient. That first month or so is the hardest in my opinion.

There is plenty of help here if you need it, we are happy to help.

Karen

sleepydoll · Post by **sleepydoll** » Tue Jul 01, 2008 5:18 am

Hello and welcome!
Just like padacheek said, the vents are in place so you can exhale your Co2 and breath in nice clean air( just like normal breathing). I konw it can be loud, but the again normal breathing doesn't have the pressure of 10cm/H2O either.
With time, every-one will get used to the noise...be patient....we've all been a bit frustrated too.
Like you, I'm still in "sleep debt," ...but I know that one day soon I'll wake up and finally feel refreshed!
Hang in there buddy!
We're one big family!
D.

RipVW · Post by **RipVW** » Tue Jul 01, 2008 5:49 am

Hello & Welcome, Fscott! Glad you found this forum--SO much useful info and SO many helpful people here!

Ditto to the responses to your questions posted by Padacheek and SleepyDoll. Indeed, this just takes time, more than a week, and that time varies among CPAP users. And, in order for CPAP therapy to really work, all aspects must be optimized (pressure, mask, mask leak . . .). Good luck!

"You are getting sleepy . . ."

kteague · Post by **kteague** » Tue Jul 01, 2008 6:06 am

Welcome. It's good to hear of experiences like yours, where the adjustment to using the mask has been minimal. The vent rate of each mask is factored into the pressure, so would not reduce your prescribed pressure. All masks have different vent placement. Some are diffused, others one hole.

About the sleepiness, for me I believe my brain and body was just so glad to sleep it wanted all it could get for a while. Our brains and bodies have an amazing ability to compensate, but once it doesn't have to, maybe it just relaxes and enjoys not having to struggle. (That's not medical, just my thoughts.)

I have the same machine as you. Did you get the card reader and software to watch your data to assure the pressure is therapeutic? If not, your DME should be able to download treatment data (not just compliance data) from your card from time to time.

Best wishes in working the quirks out.

Kathy

bethtara · Post by **bethtara** » Tue Jul 01, 2008 7:25 am

I work for an NHS Hospital and I diagnose and treat OSA. What I want to know is if this is only your first week on CPAP how did your provider know you need a CPAP pressure of 10cmH2O? Our patients spend their first 2 weeks on CPAP using an 'auto-titration' CPAP machine which helps establish their pressure requirement. It is only then that they are put on their fixed pressure machine. Otherwise, patients could be undertreated. Too high a CPAP pressure can cause problems too, such as arousals due to pulse rate rises, so it's very important to have the pressure requirement determined correctly.

Needsdecaf · Post by **Needsdecaf** » Tue Jul 01, 2008 7:37 am

[quote="bethtara"]I work for an NHS Hospital and I diagnose and treat OSA. What I want to know is if this is only your first week on CPAP how did your provider know you need a CPAP pressure of 10cmH2O? Our patients spend their first 2 weeks on CPAP using an 'auto-titration' CPAP machine which helps establish their pressure requirement. It is only then that they are put on their fixed pressure machine. Otherwise, patients could be undertreated. Too high a CPAP pressure can cause problems too, such as arousals due to pulse rate rises, so it's very important to have the pressure requirement determined correctly.

Slinky · Post by **Slinky** » Tue Jul 01, 2008 7:55 am

BethTara, here in the USA most all sleep apnea patients go thru both an in-lab sleep evulation study for an OSA Dx and then a second in-lab test to titrate what pressure is needed. On occasion both the sleep evaluation and the titration are both done the same night in-lab.

Our Medicare (similar to NHS in the UK) is only recently allowing some at-home Dx'ing and titrating w/an autoPAP.

Insomniyak · Post by **Insomniyak** » Tue Jul 01, 2008 11:32 am

Ditto to what was said about the exhaust ports,

I have been on CPAP for a week. I slept like a rock at my titration and felt SO refreshed the next day that I couldn't bare the wait. I borrowed a CPAP from a friend and just recently acquired my mask from the DME who is now hounding the sleep lab for my Rx. I managed to get my pressure from the Nurse practitioner. I am still getting used to the mask and fitting it, tweking it, etc. I do find that although tired, it is not that exhaustion and malaise I had been feeling. I naturally drink coffee to wake up anyhow, I doubt that will change in time.

I can say I was told by others here and the NP at the lab that it takes 1--3 months to catch up on the sleep you are deprived of and this is characterized by "REM rebound" early on. Once you are comfy with the CPAP and can sleep through the night, you'll hopefully have more than usual REM or delta sleep and this is the restorative sleep you body needs and makes you feel refreshed.

Good luck.

Lee2263 · Post by **Lee2263** » Tue Jul 01, 2008 12:25 pm

I can't help you with the techy stuff, but perhaps I can assist with the blowing air in your wife's face problem.

What I did was to slipp a small square pillow in between my spuse's pillow and mine. This effectively deflects air blowing across into the other person's face.

Lee

Fscott · Post by **Fscott** » Tue Jul 01, 2008 1:34 pm

Thanks everyone!

I really appreciate the outpour of help and advice from ppl who are going through and have been through all of this. I didn't realize it could take up to a few months until I was fully acclimated to the machine and sleep debt paid off. Good to know. As urged from the beginning, I will be sure to stay the course.

RE: bethtara and the pressure level, the respondents were correct. I first went through a traditional sleep study that found I had sleep apnea. Once that was determined I was scheduled for a CPAP titration sleep study. So I had two full night studies, vs. the split study some people have.

As a side note some may find interesting, the Dr. was all but positive going into the first study I would be found to have significant sleep apnea. This was given my history, but furthermore my throat structure. Apparently my air passage is around 1/4 the size "normal" for my neck girth. Well, needless to say, his predictions were vindicated.

CUatX · Post by **CUatX** » Wed Jul 02, 2008 7:11 am

My wife LIKES the eshaust blowing in her direction. She says that her throat is not as dry in the morning, even though we have an evaporative humidifier in the room.

danw61 · Post by **danw61** » Wed Jul 02, 2008 2:08 pm

Fscott,

I'm glad to see you have the Pro model M-Series. That model collects data. I would urge you to get the card reader & software (or at least have your DME read it for you periodically) as Kathy suggested. In the mean time, go into the clinician menu and turn on the option that lets you see the AHI on the LCD. It only gives you the 7 day & 30 day averages, but it's better than nothing. You can get a rough idea of how much the cpap therapy is helping. Of course the important thing is how you feel. Give it time...

Dan

Fscott · Post by **Fscott** » Wed Jul 02, 2008 11:02 pm

Thanks, just googled the clinical menu and had a look, the 7-day average AHI is 1.7, which I gather is not bad.

Said mask leak rate was 36 L/min (?), is that high? And does the machine account for the type of mask you're using when computing that, because a full face that vents as much as the Quattro would seem to spew more air than a smaller nasal unit.

So much I have yet to learn.

Fscott · Post by **Fscott** » Wed Jul 02, 2008 11:20 pm

Managed to get my questions answered in the chat room by he who knows diddly squat very well

Looks like I am doing ok.

*Very* glad to have found this place, great resource.

New to CPAP, 2 questions:

New to CPAP, 2 questions:

Welcome aboard

Mask vents