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Started therapy 5 days ago and it is a nightmare
Started therapy 5 days ago and it is a nightmare

I just started APAP therapy 5 days ago, and it is a nightmare. I havent slept so bad before in my entire life. I already started to sleep without the machine again, and I have to force myself to use the mask.

I can just sleep 2-3 hours at max with the mask since I got it. It takes forever to fall alseep, if it happens. It leaks very easily, it blasts air in my eye sometimes, it itches on the skin after a few minutes, it is hard to breath out, I wake up several times with it with maxed up ramp and then cant sleep in anymore. It feels so uncomfortable, I kinda feel "scared" with it too when waking up after an hour or so and try to sleep in again. My skin hurts on the head and skin starting to "go to sleep" of it being too tight, if I loosen it a bit, it starts to leak. When I move the tiniest bit around with the head, changing position from back to side, it leaks.

I totally have no idea, how I will be able to sleep with this mask. It is a pure nightmare. The mask is a ResMed Mirage FX. I wasnt even told by the doctor, that this mask is not usable if you have a beard.

I tried adjusting settings, changing EPR from 2 to 3, which helps a bit with the breathing out. Pressure during sleep is about 8.9 as per OSCAR, which isnt soo high anyway I guess.

Any helpful tips, what I should do? I honestly never slept so bad before. I cant sleep longer than 2-3 hours with wearing the mask.

My doctor diagnosed an AHI of about 23, most of them obstructed, central apnea were around 5-8. I analyzed the data with OSCAR software and it says I have around 11-14 central apnea per hour. I read that the central apnew can go up when you start therapy, is this true? You cant do anything about it though?

Thank you very much
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RE: Started therapy 5 days ago and it is a nightmare

1. mask fit can be the hardest part of cpap-ing. there's nothing for it but to keep trying masks until you find one that works.

I have a full beard and none of the half dozen or so masks they tried on me the night of my titration sealed until they gave me a nasal pillow mask (in my case, the resmed airfit p10). fyi, I have to wear a soft cervical collar to limit lip leaks and reduce clusters of events.

2. post some oscar charts so folks can see what's going on. getting leaks under control is the first imperative. large leaks can reduce effectiveness of therapy and render the reported data inaccurate.

3. many new cpap-ers get pressure induced central apnea which dissipates after 30-90 days. your machine isn't designed to treat central apnea (ca) so the trick is to find the sweet spot between raising pressure for obstructive apnea (oa) and lowering pressure for ca. personally, I'd use fixed pressure (min and max set the same or cpap mode), adjusting until my oa and hypopnea (h) are as low as possible while watching what happens to ca. once you find the sweet spot, you can experiment with a range of pressures (different min and max) and epr. if you have sufficient 'native' ca rather than pressure induced ca, you might need a different machine, but that's to be determined down the road.

best thing is to put up some charts for informed responses.
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RE: Started therapy 5 days ago and it is a nightmare
G'day Solycap. Welcome to Apnea Board.

Getting the right mask is the hardest part of this therapy. It must be comfortable, no leaks and no skin irritation. If you haven't already done so, please read the mask primer: http://www.apneaboard.com/wiki/index.php...ask_Primer That will tell you all about the different types of mask available and how best to use each one. A few general observations:
  • Every face is different, and it can sometimes be quite a trial to find the mask which best suits your own face.
  • It's usually best to start with the least intrusive type, the nasal pillows. If that doesn't work, try a nasal mask, and if that doesn't work come back to a full face mask.
  • If the headgear is hurting you then it's too tight. It should be firm but not tight.
  • If the silicon is causing skin irritations ask for a different type. Or else use a mask liner, which puts a layer of fabric between the mask and your skin. This can also help with leaks.
Once you have the mask under control then we can start thinking about other problems. It is largely a matter of psychology, adapting to this new way of breathing with a plastic alien strapped to your face and blowing air up your nose. Shock In the meantime you might try a gentle sedative / sleeping drug like melatonin. If it's really bad see your doctor about getting Zolpidem.

Good luck with your CPAP journey. You're experiencing the very worst of it right now, but don't give up. It will get better and it will safeguard your health in the years ahead.
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RE: Started therapy 5 days ago and it is a nightmare
"...it's a nightmare."

I hear you, Brother.  My first night was so bad I thought I'd almost rather live with the apnea and my new heart problems.  


The others have responded comprehensively and well.  Treat this the same way you did learning to ride a bicycle and learning how to swim.  There were some terrifying moments, and some minor scrapes and filled lungs, but you now wonder what all that fuss was about.

Masks leak.  They simply do.  Some more than others, especially when they are in poor condition, poor adjustment, or just plain wrong for you.  You'll have to try different masks, but also different sizes of the same mask.  Some machines require you to tell them which mask type you are using.  It matters.

Itchy skin means you might need to use a skin barrier, but it sounds like pressure might be the problem if your head gear is as tight as I think you are saying it is.  If you get rashes and itching, and if you can't exchange masks for a different material, try using a barrier cream.  Haut(schutz)crème..?

Put on your mask and wear it at least one other time during the day...not just for a nap.  Read with it on and the machine running.  Learn how to adjust all straps so that you can wear the mask with some lateral forces and still have only minor leaks.  If you spend a day doing this, and another couple of days wearing the mask as you watch TV, for example, you may find that it isn't quite so intrusive while you are sleeping.

Keep working on this.  It's worth it, and in six months you'll wonder what took you so long.  Wink
Serial Tapist
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RE: Started therapy 5 days ago and it is a nightmare
There are companies that will let you keep exchanging masks (for an extra one time fee) until you find on that works for you.
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RE: Started therapy 5 days ago and it is a nightmare
Hang in there.  For sure, when I started, I thought how on earth am I going to sleep with all this stuff on my face and head?

At first, it is a strange thing to try to sleep with this gear on. The sensation is bothersome, but if you persist, your brain will adjust and accept it.  You are training your brain to make a change.

As the advice has already been given, it is true -- try different masks.  I found that it really helped to put the machine and mask on a while before bedtime and just sit up with it to read or watch TV a while.  Distracting the mind away from the sensations and letting things sort of settle.  The trick is to adjust lights, remote, etc. so you don't have to get up and take off the mask to turn everything off and then.... put the mask back on and start all over again.
This worked for me.  But, it took a few days.
Took a few weeks to find the right mask.
Persistence is key.
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RE: Started therapy 5 days ago and it is a nightmare
Hi solycap,

As others have mentioned, finding the right mask is a crucial part in cpap therapy and there is no other way but to try different masks.

I second the suggestion that you try a under the nose mask. I had a nasal mask that is similar to yours (although by a different brand) when I first started out and while that worked for me, I had the occasional leaks which woke me up whenever I turned from side to side and I didn't like that the mask was preventing me from watching tv or reading while wearing it. All of that was solved when I switched to a under the nose mask. 

There are two competing brands of under the nose mask and there are two kinds: pillows or nasal.  You just have to pick which one suits you best. Either one should work with a beard because they only cover the openings of your nose. One last thing, be sure to get the package which includes all three sizes. 

Goodluck in your therapy!
Hosehead padawan 
Repaying my sleep debt, 1 night at a time...
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RE: Started therapy 5 days ago and it is a nightmare
hearsay, I have almost no experience with masks. the p10 nasal pillow has been working ok so I haven't experimented. I've thought about it though and I 'assumed' the nasal masks seal against the upper lip. so I figured they'd be prone leaks sitting on a mustache. is this not the case? do some or all of the nasal masks seal against nostrils like the pillows? wait. I get lip leaks so a nasal mask wouldn't work any better than pillows for me, would it?. still, I'm curious. do nasal masks seal, at the bottom, on the upper lip or against the openings of the nose?
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RE: Started therapy 5 days ago and it is a nightmare
You see my beard and stash,

I use the P10 Pillows, ESON 2 nasal, F&P Nasal, Mirage Activa nasal, and Amara View on my VAuto, the P10, ESON2, F&P nasal, and the Mirage Activa (for Years) on my DV54D Intellapap.

The beard and stash give me no problem on either machine.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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RE: Started therapy 5 days ago and it is a nightmare
bonjour? I think you must be leak proof. and how do you decide what to wear each night? actually, I'm as curious as I am joking. how do you decide?
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