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My 5th night on CPAP, a new batch of observations w/ detailed play-by-play
#1
Hello, forum. Last night was rough (for ME, anyway). According to my ResMed.com/MyAir score (I plan to get on SleepyHead soon), it was my worst night by far, out of the last 5. I actually feel worse and more tired now than I did before I got my CPAP. However, I'm committed to CPAP therapy for the long-haul because I believe it's worth it. There are so many adjustments and suggestions out there, and I'm open to trying whatever. Unfortunately, however, it's apparently going to get worse before it gets better, and that's just my reality.

I decided to take notes throughout the night of my experiences. Here is a detailed play-by-play - my own personal version of a makeshift sleep study. It's long and boring, and if you have nothing better to do at the moment, please read on:

8:30p - Put my mask on and went to bed. Was pretty sleepy, so I fell asleep quickly (normal for me). The pressure starts at 4 and then ramps up to 9 after I fall asleep.

10:47p - Woke up to use the restroom (I've experienced nocturia practically my whole life, and while it's always annoyed me, I never knew it wasn't normal). Once I got back in bed and got back on the mask, I was too awake to fall back asleep. My legs and, curiously, my abdominal area felt "restless."

11:08p - After lying awake, I turned off the machine and went out to the living room couch. I'm not sure how or why, but this relaxes me when I'm lying in bed awake. I eventually dozed off, untreated.

12:15a - Woke up from the couch to use the restroom (2nd trip of the night) then shuffled back to bed and got back on the mask. I was experiencing some mouth leak (jaw mostly closed, but lips cracked open), and my body went back to being restless. Once again, I couldn't fall back asleep.

1:11a - Got up to use the restroom (3rd time). Laid back down, mask back on, still restless and awake.

1:34a - Tried taking off the mask in order to help me relax. It worked, and I fell back asleep in bed, untreated.

2:47a - Woke up to use the restroom (4th time), and then decided to try going back on the mask.

3:07a - Still lying there awake, and I'm noticing (and trying to interpret) some sensations. The "restless" feeling in my abdomen I described above is now a soreness, and I'm pretty sure it's my diaphragm. I'm awake, the pressure is at 4 (hasn't ramped up yet), and I'm keeping my mouth closed and having a hard time breathing through my nose - even with with the assistance of the 4 pressure. It starts to make sense why my diaphragm is sore - it seems it's being overworked. I was tempted to open my mouth to breathe, suggesting I may be a mouth-breather (which I didn't know before). I feels like 4 is not enough - even for being awake - and I find myself wishing the thing would go ahead a ramp up to 9 without waiting on me to fall asleep. Frustrated, I removed the mask again, and breathing actually got easier, which is confusing.

3:16a - Wide awake, I try going back on the mask again. Once again, the pressure is at 4, and breathing through my nose feels too labored.

3:31a - I ditch the mask yet again and head back out to the couch.

4:30a - Relaxed, but still slightly awake, I return to the bed for yet another attempt on the mask (by the way, I always get a good seal, and the mask isn't uncomfortable). Once again, trying to breathe while awake with the pressure at 4 still feels labored, and my diaphragm is still sore.

4:58a - Still awake and exhausted, I finally ditch the mask for good and sleep untreated until 6:45a when it's finally time to get up and get ready for work.

And that was my night. Anything you relate to? All responses are welcome. Thanks for reading.
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#2
Hi Nicholas,

I am facing my own difficulties with CPAP at the moment - they are different issues to yours but I do struggle to get a good nights sleep - so I can certainly relate to your feelings of frustration.

Regarding the labored breathing you mention, that is something I too have struggled with recently, that was caused by a blocked up nose... I found that by increasing the humidity on my machine, my nose is no longer blocked so I can breathe much more easily... perhaps that is something you will want to try...

Not much else I can add. I am sure others will chime in with suggestions for you. Good luck.
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#3
Get rid of the ramp or start it at 6-7 cm. Why would you do that to yourself?

Keeping a log as you sleep is a sure way to stay awake. A few notes in the morning should suffice as a daily log to record progress or problems.
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#4
First off, most people find 4 too low of a pressure to be comfortable.  I would feel panicky and air-starved.  I will suggest increasing this to at least 6 for now.  Or just don't use the ramp.  I am at a pressure of 15, I don't use the ramp.  It is just a matter of getting used to it so that it seems totally normal.  There is no medical reason to use the ramp.

Don't dither about, go get Sleepyhead and let us see how things are going.  Otherwise, we are just guessing and that rarely works out well. 

Next, you went to bed at 8:30 and expected to get up at 6:45.  That is way too long in bed.  There is no way you are going to get a restful night of unbroken sleep like that.    Don't go to bed when you start to feel sleepy.  Go to bed when you can no longer stay awake.  Force  yourself to stay up.  You need to start training your brain to go to bed, go to sleep, and stay asleep.  It took me months to fully achieve that.  I, too, thought that hourly bathroom trips were normal.

Getting out of bed when you can't sleep is a good thing.  Train your brain that bed is for sleep, not tossing and turning.  Sleeping out of bed is a bad thing.  Read, listen to music (don't watch TV with its blue light).  When you are about to fall asleep, go back to bed.  Can't sleep?  Get out of bed!

It is normal to experience some chest/diaphragm discomfort at first.  You are exhaling against pressure (not a lot, but more than none) so the muscles have to do more work.  This will pass in a couple of days once you stay on the mask all night.  It is just like body building, the muscles grow to do the work demanded of them.

It sounds like your nasal pillow size may be too small or is not sitting in your nose correctly.  I have the P10, but I have not used it recently.  I do recall that it was possible to have them slightly out of alignment in your nose and that this made breathing difficult.   You might find a nasal mask more comfortable for you (easier to breathe with).  The Fisher and Paykel version Eson works well for many people.

That is all that I have for now.
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#5
(04-26-2017, 09:59 AM)Nicholas Wrote: Hello, forum. Last night was rough (for ME, anyway). According to my ResMed.com/MyAir score (I plan to get on SleepyHead soon), it was my worst night by far, out of the last 5. I actually feel worse and more tired now than I did before I got my CPAP. However, I'm committed to CPAP therapy for the long-haul because I believe it's worth it. There are so many adjustments and suggestions out there, and I'm open to trying whatever. Unfortunately, however, it's apparently going to get worse before it gets better, and that's just my reality.

I decided to take notes throughout the night of my experiences. Here is a detailed play-by-play - my own personal version of a makeshift sleep study. It's long and boring, and if you have nothing better to do at the moment, please read on:

8:30p - Put my mask on and went to bed. Was pretty sleepy, so I fell asleep quickly (normal for me). The pressure starts at 4 and then ramps up to 9 after I fall asleep.

10:47p - Woke up to use the restroom (I've experienced nocturia practically my whole life, and while it's always annoyed me, I never knew it wasn't normal). Once I got back in bed and got back on the mask, I was too awake to fall back asleep. My legs and, curiously, my abdominal area felt "restless."

11:08p - After lying awake, I turned off the machine and went out to the living room couch. I'm not sure how or why, but this relaxes me when I'm lying in bed awake. I eventually dozed off, untreated.

12:15a - Woke up from the couch to use the restroom (2nd trip of the night) then shuffled back to bed and got back on the mask. I was experiencing some mouth leak (jaw mostly closed, but lips cracked open), and my body went back to being restless. Once again, I couldn't fall back asleep.

1:11a - Got up to use the restroom (3rd time). Laid back down, mask back on, still restless and awake.

1:34a - Tried taking off the mask in order to help me relax. It worked, and I fell back asleep in bed, untreated.

2:47a - Woke up to use the restroom (4th time), and then decided to try going back on the mask.

3:07a - Still lying there awake, and I'm noticing (and trying to interpret) some sensations. The "restless" feeling in my abdomen I described above is now a soreness, and I'm pretty sure it's my diaphragm. I'm awake, the pressure is at 4 (hasn't ramped up yet), and I'm keeping my mouth closed and having a hard time breathing through my nose - even with with the assistance of the 4 pressure. It starts to make sense why my diaphragm is sore - it seems it's being overworked. I was tempted to open my mouth to breathe, suggesting I may be a mouth-breather (which I didn't know before). I feels like 4 is not enough - even for being awake - and I find myself wishing the thing would go ahead a ramp up to 9 without waiting on me to fall asleep. Frustrated, I removed the mask again, and breathing actually got easier, which is confusing.

3:16a - Wide awake, I try going back on the mask again. Once again, the pressure is at 4, and breathing through my nose feels too labored.

3:31a - I ditch the mask yet again and head back out to the couch.

4:30a - Relaxed, but still slightly awake, I return to the bed for yet another attempt on the mask (by the way, I always get a good seal, and the mask isn't uncomfortable). Once again, trying to breathe while awake with the pressure at 4 still feels labored, and my diaphragm is still sore.

4:58a - Still awake and exhausted, I finally ditch the mask for good and sleep untreated until 6:45a when it's finally time to get up and get ready for work.

And that was my night. Anything you relate to? All responses are welcome. Thanks for reading.

I have had nights like that before the xpap devices. 

never a problem breathing in due to pressure only exhale if pressure were too high
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#6
Good advice above. I had to go up 2 pillow sizes and min pressure of 5+ before I could get comfortable. Took almost a year before I stopped getting up too pee but now I never get up and leaks are at a minimum. Now getting away from the chin strap. Can't stay in bed more than 7-8 hours.

It takes time and patience.
Dont-know  I am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
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#7
Quote:Keeping a log as you sleep is a sure way to stay awake. A few notes in the morning should suffice as a daily log to record progress or problems.

Yeah, point taken. Anyway, it's not something I intend to do regularly.
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#8
@chill Makes complete sense. All points taken. Grateful for the help.

Regarding the diaphragm, I attributed the soreness to labored breathing in - it didn't occur to me that it could be caused by breathing out against the pressure. Anyhow, I thought my machine was supposed to detect when I breath out and reduce the pressure for that reason. Maybe I have that wrong.

@Rcgop Awesome. That's encouraging.
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#9
(04-26-2017, 10:48 AM)Nicholas Wrote: @chill Makes complete sense. All points taken. Grateful for the help.

Regarding the diaphragm, I attributed the soreness to labored breathing in - it didn't occur to me that it could be caused by breathing out against the pressure. Anyhow, I thought my machine was supposed to detect when I breath out and reduce the pressure for that reason. Maybe I have that wrong.

@Rcgop Awesome. That's encouraging.


Nicholas,
Do you know how to change your pressure?  Order the Clinicians Manual for your machine.
http://www.apneaboard.com/adjust-cpap-pr...tup-manual

Be sure to follow the directions and state the name of your machine exactly.

And yes, it is a normal feeling to have that chest tightness when first starting out.  Once you get used to it, that feeling will diminish.

I agree with the advice above, turn off the ramp, and raise your minimum pressure to 7cm. You will actually breath better than at a lower setting.

There is also an EPR feature (expiratory pressure relief).  Set it to 2, and that should help you exhale better.
OpalRose
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www.ApneaBoard.com

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#10
I believe you will not get the pressure reduction on exhale until you are above 4.  my machine does not do any pressure reduction until inhale pressure is 6, and it starts doing 4 cm at exhale.
I think your machine (if set on EPR=3) does 4 in 4 out, then 5 in 4 out, 6 in 4 out, 7 in 4 out, and then always 3 less out than in.
So, yes you should start out at least 6 cm.
Data will show us if there is a better pressure choice, and we will see.
Good Luck.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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