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[Treatment] Can't tolerate CPAP for more than 4h
#1
Can't tolerate CPAP for more than 4h
Hello everybody,

i got my Löwenstein Medical Prisma20a CPAP machine last november, after spending 3 days at a sleep lab. My initial treatment was set to 8 hPa at a continuous pressure with a nose only mask. Actually i felt that this pressure was way too low for me and i felt like not getting enough air like this (even when still awake) so i changed the settings, which now feel better for me to APAP 11 - 15.5 hPA and i got a full face mask, because at night i woke up because of air hissing out of my mouth with the nose only mask. For a few weeks I also experimented with a soft cervical collar, which i read here about and tried a backpack like device that was supposed to prevent me sleeping on my back. But whatever i tried i still hardly can get above 4.5 hours of CPAP treatment per night. I usually wake up after around 4 hours sleeping with the CPAP on and then feel like i have to take it off, because i can't breathe properly anymore through my nose. After taking it off i fall asleep quickly, but probably will have even more apnea events without the CPAP on.  I also tried taping my mouth, because initially i had problems with air getting pressed into my stomach as i started with the full face mask. Actually the time i tolerated the CPAP went down because of this even further. I recently figured out, that i seem to have an allergic reaction to the tape which leads to my nose swelling up and making it hard for me to breathe. Since i don't tape my mouth anymore the time i tolerate the CPAP treatment went up again to around 4 hours and i don't seem to get air pressed into my stomach anymore. Maybe my body adjusted to that somehow. I attach some of last nights data from the PrismaTS application as screenshots, since as far as i know Löwenstein Medical is not compatible with Oscar. I hope i can get here some hints what i can try or what i am doing wrong to improve my CPAP treatment, thanks in advance! Smile

   

   
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#2
RE: Can't tolerate CPAP for more than 4h
It looks like you've figured some things out for yourself concerning leaks, taping and wearing a full face mask.

The Obstructives are clumped together and suggests a positional sleep problem.  If you are sleeping on your back, you could be tucking your chin into your chest, which cuts off your air supply.  

Try sleeping on your side as much as possible.  Other than that, use one thinner sleep pillow, instead of thick puffy pillows.  This will keep your neck from falling forward.

Keep trying to adapt to the use of a soft cervical collar to support your chin/jaw from falling forward.

I can't really say why you might be waking up after 4 hours.
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



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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#3
RE: Can't tolerate CPAP for more than 4h
Hey, you are in a similar situation in which I was until a week and a half ago. I spent 3 months trying out different things and the most I could manage was a couple of hours of sleep before I wake up and then I simply couldnt fall back asleep with the mask anymore. When I took of the mask I fell asleep almost instantly.

It took me 3 months to find the right combination of stuff that works for me. I tried 6-7 masks before I found one that I actually found comfortable ( Dreamwear nasal cradle mask ) - but I still couldnt sleep that well on the side with it since it kept getting moved a bit and I had air going in my eyes.

Then I tried buying a CPAP pillow ( Contour CPAPmax 2.0 pillow ) because I was hoping that it would help with side sleeping and tossing and turning. It was a big improvement but I still wasnt fully comfortable and the mask would still move a bit or hurt my nose in the morning ( I had to make it fairly tight to avoid leaks and also had a nose surgery last September, so bad combo ).

Then I decided to try the Airfit n30i mask which is almost identical to the Dreamwear I had but I was lucky and this one fits my face better and I have no leaks with it and its more comfortable when sleeping on the sides.

Then I also had to get a chin strap because I tend to talk in my sleep from time to time.

After getting this combo, I started sleeping a lot more with the mask. I still wake up after a couple of hours but because I find my mask comfortable now, I manage to keep on sleeping.

My point is : you need to keep experimenting, try different masks, pillows, cervical collars, chin straps etc. I was honestly absolutely desperate to the point where I got badly depressed due to the lack of sleep/energy. But I kept trying things until I found the magic combo. For me it had nothing to do with just using it until I got used to it, I had to keep trying different things until I found the right combo.


ps. I also have a Prisma device and I cant seem to install their stupid software on my laptop, annoying.
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#4
RE: Can't tolerate CPAP for more than 4h
(06-02-2020, 04:54 PM)OpalRose Wrote: Keep trying to adapt to the use of a soft cervical collar to support your chin/jaw from falling forward.  

I can't really say why you might be waking up after 4 hours.

Thanks for your reply. You motivated me to give the soft cervical collar another try. Smile I dont actually think i have a pillow problem because i rarely ever lie with my head on the pillow, rather on the mattress or on a small and thin pillow.

My assumption why i can't tolerate the CPAP longer than 4 hours is, that because of the clustered apnea events my body gets into a lot of stress and this causes me to wake up and feeling like i have to get rid of the mask. I also usually feel then that i don't get enough air through the mask, which is only after wearing it a few hours, not at the beginning. Maybe also the CPAP pressure is too low to keep my airway open. I will try and raise the upper limit a bit.
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#5
RE: Can't tolerate CPAP for more than 4h
(06-03-2020, 08:08 AM)vrapche03 Wrote: My point is : you need to keep experimenting, try different masks, pillows, cervical collars, chin straps etc. I was honestly absolutely desperate to the point where I got badly depressed due to the lack of sleep/energy. But I kept trying things until I found the magic combo. For me it had nothing to do with just using it until I got used to it, I had to keep trying different things until I found the right combo.


ps. I also have a Prisma device and I cant seem to install their stupid software on my laptop, annoying.

Hi, thanks for your reply. Interesting to hear from someone with a similar problem! Actually i have the same nasal pillow mask from Resmed AirFit N30i. I find it very comfortable. The reason why i don't wear it anymore is that i have severe leakage through my mouth. Either i wake up from the hissing sound and / or i wake up with a very dry mouth. I got myself the Philips Dreamwear Full Face mask and now don't have problems with leakage anymore or waking up because of it. It takes of course some days to get used to the larger mask, but i think for a full face mask it's still comfortable to wear. Concerning the Prisma software, did you try the 4.1 version, which is linked here somewhere in the forum? I had no difficulty installing it on my Windows 10 desktop.
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#6
RE: Can't tolerate CPAP for more than 4h
Hi,

i wanted to give a small update on my CPAP journey. My above described problems are unfortunately still present. I can hardly endure the CPAP therapy longer than 3h a night and my apnea events are still ocurring clustered and don't seem to get much better from CPAP. Now after the first year of therapy i had 2 Weeks ago a diagnostic night at the sleep lab to check on my settings.

They were surprised that i needed that much pressure (at last i had my Prisma 20a set to APAP 10.5 - 14 hPa / softPAP 1). The initially from the sleep lab prescribed settings were CPAP 8 hPa and a nasal mask, which i quickly substituted myself for a Dreamwear Full Face mask, because with the nasal mask i had leakage from my mouth. The diagnostic night was done with APAP 10 - 15 hPA, so almost my settings i used before and the Doc was really surprised, that i actually needed that much pressure. It seemed he usually makes this dependant from the BMI of the patient. He even advised me to increase the pressure further to 18 hPA, because the apnea events weren't much impressed from the maximum of 15 hPa. From the data of this night it seems that i don't have apnea events when lying on my back. They are REM related, independent from the position i sleep in. The AHI during that diagnostic night was 6, which is not too bad, but i still don't feel that i have good sleep at night and really would like a lower AHI.

Because my apnea events are usually very clustered which i was told here usually relates to a form of positional apnea i asked my Doc from the sleep lab in advance of my diagnostic night for a Philips NightBalance Positional Trainer that i could test out for a few weeks, which is what i am doing right now. Though because my apnea events were (at least in that diagnostic night) not dependant of my position it probably won't help.

Also i have problems with the very high pressure that was prescribed to me now (APAP 10.5 - 18 hPA). Last night it went up to 17.5 hPA and when i woke up i felt my stomach hurting. It seems the air doesn't get into my lungs but rather into my stomach. Maybe any advice how to avoid this, except taping my mouth?
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#7
RE: Can't tolerate CPAP for more than 4h
Hi mptrs,
Thanks for updating us.  The condition you describe of swallowing air is called Aerophagia.  You can read more about it here:
http://www.apneaboard.com/wiki/index.php/Aerophagia

Since you didn't experience this prior, it may be due to the pressure increase that your Doctor made.  This will probably be a balancing act for you... finding the right pressure to tackle your apnea without causing the air swallowing.  

Talk to your doctor about this to see what he would advise.  Most folk that suffer Aerophagia will find relief by using a lower pressure even though you may experience more apnea's.  Try resetting the pressure back down and then each day if your not experiencing Aerophagia, raise it a little at a time.  Do this each day until you find that balancing act of no Aerophagia (swallowing of air) and lower Obstructives.  Give this a good weeks time and note how you feel while slowly adjusting the pressure back up.

One more thing... does your machine have a "exhale pressure relief" setting? This would be similar to ResMed brand called EPR. On a ResMed machine, you can set it between 1 and 3. This drops the pressure on exhalation which makes it more comfortable.

Also, let us know how the Philips NightBalance Positional Trainer works out for you.
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



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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#8
RE: Can't tolerate CPAP for more than 4h
Hello OpalRose, thank you for your reply! My Löwenstein Prisma 20a does have an exhale pressure relief, it is called softPAP and it can also be set from 0-3. I have set this to 1. I think i read on this forum, if you set this too high it can provoke central apneas? I have read your link on Aerophagia and think i will see if i maybe adjust in the next few days to the higher pressure settings. Also i will report on my experience with the Philips NightBalance! Smile
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#9
RE: Can't tolerate CPAP for more than 4h
It can take months of fine tuning to get settled with CPAP / APAP..

For about 6 months I changed things around before getting it sorted to the point where I could sleep for 4+ hours, and could easily get back to sleep with the mask on if I woke fully or need to get up for a bathroom visit in the middle of the night.

When you make changes only do one thing at a time, and give it a few days to a week to settle to the change before changing it (or something else) again.. sometimes your body needs time to adjust to the new settings / mask etc..
- They are not spelling/grammar errors.. I live in Australia, we do it differently Down Under  Big Grin -
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