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Brand new cpap user! Some questions regarding my first night
#1
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Brand new cpap user! Some questions regarding my first night
Hi guys I'm Ryan, I was diagnosed with an AHI of 21 and just received my cpap yesterday. I have the ResMed Airsense 10 Autoset with a F&P Simplus Full Face and also a Resmed AirFit P10 Nasal Pillow. My machine is on a ramp setting with the lowest starting at 4.0. My max pressure is set from 12.0 to 14.0. EPR at 3. Climate control off and humidifier at 1.

Last night was my first night sleeping with the cpap after the in lab sleep study. I did the sleep study with the full face mask but I also wanted a nasal pillow to see which one I would prefer so they also gave me the Airfit 10. I tried both out for a test run before I went to bed however the pressure was so high with the nasal pillow my ears would pop every time I swallowed and I ended up with a slight headache after testing it for just 5 minutes so I decided to use the full face overnight.

During the sleep study I think the technician had started me off at 8 or so but had to go up to 12 to fully get rid of the apneas so I think by the time I was at 12 I was pretty deeply asleep. However last night as soon as the pressure would ramp up to 12 I would wake up from the discomfort, as well as not being able to exhale all the way due to the pressure. Not being able to exhale all the way was extremely uncomfortable and after a while I felt some pain in my chest and I was feeling a bit dizzy so I decided to stop the cpap so I could get some sleep for work.

I have also been checking the myair app periodically and it seems like the data from last night has not been uploaded yet. I think I only logged about 3.5 hours with the mask on anyway. I think I fell asleep a few times but always ended up waking up again.

I have been doing some research today and I have a few questions.

1. Do I need to lower the pressure while using a nasal pillow as opposed to using a full face? If my technician went with 12 for the full face what would be the equivalent for the pillow?

2. Is my problem exhaling something I just need to get used to? I felt like I could only exhale about 3/4 of the way before I had to actually exert myself to push the rest of the air out. My EPR is already at 3, would a bipap be something I should look at?

3. Is the dizzyness and chest pain typical of a new cpap user?

My doctor advised me to not change any settings for a week or so until they get enough data but I am thinking I will drop the max pressure to 10 tonight and hopefully I can actually fall asleep, if I just end up taking the mask off anyway they won't get any data right?

Also I have been looking on craigslist and such and I see a brand new aircurve 10 vauto with only 1 hour of machine usage time on it for 400 dollars. You guys think I should jump on that just in case I end up needing a bipap?

Thanks so much for everyone's help. Looking forward to becoming a part of this community! 
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#2
RE: Brand new cpap user! Some questions regarding my first night
Hi and welcome to Apnea Board.

First, let's get you to download OSCAR so you can show a chart with the symptom or question about therapy. No need to repost the questions on this one however. Second, being in the US, HIPAA permits you to get your full detailed sleep study report. 1 this is for your own records, 2 it is so you can redact personal data and post the report here. Data drives therapy settings and suggestions from members here.

Now I will answer as many questions as possible. Others will throw their 2 cents in as well.

The PAP machine has a mask setting that needs edited when you change from full face to nasal or pillows or vise versa. I can't suggest lowering pressures, especially when not seeing the data. Pressure adjustments may be needed, but which direction is what the data tells us.

EPR 3 would have been a setting to suggest for assistance in breathing out. FWIW typically Ramp is more bothersome as it induces pressure modifications that in itself can be disturbing your sleep sessions. Ramp at 4 is almost always too low and causes discomfort as PAP patients need to breathe in through the straw.

Perceived chest pain and/or discomfort are probably normal for PAP users, as the alien mask thing and PAP in general has upset the unhealthy breathing that has gradually became our normal. Now with the mask and PAP upsetting the cart, it doesn't feel normal and causes us to notice odd items for all the changes we've dumped on ourselves with the PAP. With a short time invested, it will pass. However, if it's major discomfort or pain, get it checked.

BPAP or VAuto is useful if you tend to require higher pressures, around 15 or so in my mind. If you decide to get the VAuto, it's not going to hurt unless you've got pre-existing CA. In that case the VAuto would make therapy worse, but I think that's about the only scenario the VAuto would be worse for you. Neither can blow up lungs or balloons for that matter.

I know I'm a broken record on data, but if we see data, we may say to adjust pressures now or sooner than a week. Doc and insurance really only care about compliance as in 4 hours per night for 21 of 30 days, with 3 months to get that. They may monitor pressures but most do not. If they try to tell you that you're not allowed to do so, that may be their opinion, but it's not illegal to adjust it. And again it cannot kill or make lungs explode. If you care to visualize the PAP pressure, I think it's like blowing bubbles in a tall glass with a soda straw.

PS if you'd like a headstart on getting used to the alien monster with a long tail, use it while awake and reading a book, or listening to some audiobook, etc. It'll help you get used to the interaction with the PAP and mask.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Brand new cpap user! Some questions regarding my first night
Welcome Ryan,

Do you have OSCAR and would you be able to upload a screenshot of your night? Myair can take about 1.5 hours to upload to the cloud I have noticed, and unfortunately doesn't seem to have any useful data in it.

Both masks should be fine at those pressures but you are probably not used to using either at the moment, I also started on the n30 and it felt like a jet engine was blasting up my nose but really more than likely it's just because you are not used to the initial feeling because it's so different than normal. Now I barely notice it. With ramp on your start pressure is only 4.0, it should be the most comfortable possible in order to fall asleep. The downside of ramp is you get no treatment during the ramp period, and I think most of us have it turned off now (but try to get used to wearing your mask for now, so if you need it to get to sleep at the moment I say use it and revisit this later as your start pressure is on the higher end).

My first few nights I struggled even with an EPR of 3, however now I can turn it off and it's not an issue to breathe so it could be something you need to see if your body will get used to or not. It only took me a few days to get used to how weird it was exhaling against air trying to come in.

Chest pain can come from muscles in your chest not being used to working in the way they are now with CPAP, the pain should go away over time. Not 100% sure about the dizziness someone else might be able to answer this question, likely related to extra airflow also.

Once we can look at some OSCAR data I am sure some of the smart people on here will be able to offer some further advice.
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#4
RE: Brand new cpap user! Some questions regarding my first night
I would start with an EPR setting of 2, as long as you are not prone to Central Sleep Apnea...  which we don't know until we can see some data.

The EPR will help you to exhale against the pressure, but can also increase clear airway events.  

Looks like you have OSCAR installed, so follow the link below for guidance.  Then use the attachment feature to post a chart from the daily page.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Brand new cpap user! Some questions regarding my first night
Your chest pain is presumably aching muscles, quite normal at the beginning of the therapy.
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#6
RE: Brand new cpap user! Some questions regarding my first night
Thanks for all the responses guys, sorry it took me so long to reply. I have gotten 4 more nights in, two with the nasal pillow and two with the full face. The first night and last night (24 and 27) were with the full face, it seems like I can actually stay asleep with it and not want to rip it off halfway through the night.  I think the difference between the full face and the nasal pillow is just that the nasal pillow has way too much pressure and I cannot breath out as easily.  It takes me forever to fall asleep and I don't really think I ever truly fall deeply asleep, it feels like the whole night is just me trying to breath out through that mask.  I eventually just give up, rip it off and go to sleep around like 3 AM.  

The full face I have is the FP Simplus mask but it feels so bulky.  Are there any other masks you guys think I should try?  Budget is not really an issue, I just want to find the best mask for me even if I have to get a dozen before I find the perfect one.  Ideally I would just be able to use a nasal pillow type but so far the Airfit P10 has not worked out too well.  
 
The chest pain has largely gone away however I seem to have problem with aerophagia in the form of burps and just generally feeling a lot of air in my stomach.  Also there was one day where one of my ears would suddenly start ringing and then suddenly I couldn't hear as well through it.  That was one of the nights where I was trying the nasal pillow.

My original diagnosis when I did the home sleep test was 21 AHI.  My in lab results have not yet been sent to me but I will post those as soon as I get them.  To reiterate my sleep technician went up to 12cm pressure during my in lab test to get rid of my apneas.  I came back with my machine set from 12-14 but the pressure was so high I lowered it to 10-12.  It seems like the machine never went past 10.8 or so during the night.  Of course I only really have two real nights of data so far but what do you guys think I should do for the next week or so?  I am thinking the following.

1.  I still really want to get used to the nasal pillow for the comfort would I be able to try and slightly lower minimum pressure with it?  Maybe set the minimum to 8 or so and see how it goes?

2.  I picked up the Aircurve 10 VAUTO as well, it was in perfect condition with only an hour of use.  Would I be able to switch to the biPAP and try the nasal pillow to see if it is more comfortable?  If so what should I set the settings at in the Aircurve?  

3. Do you guys have any other recommendations for more comfortable masks?  This full face just feels like I'm Bane from batman and if I don't have it really tight I can't move at all without it leaking once it ramps up to full pressure.

4.  What do you guys do about the hose?  I feel like it's always getting in the way, do you guys usually have the machine above your head?  Are there any full face masks with the hose at the back of the head?  

I think the two nights with the full face were relatively successful, especially last night.   I really appreciate everyone's help, it is comforting to know there are so many people out there who are also in the same situation and also to know that other people have done this before and have had success.  Please let me know if there are any other graphs you guys need to see in oscar and I can post them asap.
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#7
RE: Brand new cpap user! Some questions regarding my first night
One more post until I can post images..
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#8
RE: Brand new cpap user! Some questions regarding my first night
Use the F12 key to take a screenshot of the daily page in OSCAR, then read the link below to help guide you in organizing the chart and then post it here.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Brand new cpap user! Some questions regarding my first night
FWIW a positive on the F&P Simplus is that it's easy to get a leak free sleep session.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Brand new cpap user! Some questions regarding my first night
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