theprincesbride's Therapy Thread

[theprincesbride]

Hello CPAP experts!

I am brand new to CPAP therapy.  I had a home sleep study done in September that I had recently received the results from and self-paid for a CPAP.  I received it on Wednesday.  The initial prescribed therapy was 4 - 20 with ramp on auto.

I was the one who suggested the sleep study and the CPAP to my doctor because all my life I had a problem with snoring and have been feeling tired lately despite getting a solid 8 hours of sleep.  However, I am having trouble adapting to CPAP, having sudden bouts of heightened anxiety and panic continuously that gets much worse at night.  Part of the reason is because, at the same time, I completed treatment for latent TB that I took while on an SSRI, so my doctor thinks this heightened anxiety is coming from the interaction from the meds (he said I was starting to get Serotonin Syndrome from the sounds of the symptoms I was having).  So I am not taking the SSRI for a week to see if the anxiety decreases, which it had a bit by Sunday.

I know I don't have much good information yet from OSCAR, but I posted the 2 nights that I have been able to keep it on the most.  Both of these nights, I wore the F30i mask (I know 15th says pillows, but I was only trying on the N30i, it did not stay on this setting.)  I did not get very much sleep both of these nights due to the nighttime anxiety I've had.  When I wear the CPAP, I have a feeling of air hunger that heightens my anxiety.  It was a bit better last night perhaps because I turned on EPR during ramp.  For most of the night last night, I had ramp initially set to 5 going up to 6.  I would wake up feeling very air hungry and SOB last night, the pressure was over 11.  And while before, I never woke up feeling air hungry without CPAP, I am now waking up with that sensation even without the mask, which started happening a couple of days before receiving the CPAP.  Again, this may be as a result of the anxiety and panic issues from the medication interactions.

I am looking for recommendations on what to set my machine to in order to help me feel more comfortable and help with my compliance.  I feel the anxiety is subsiding somewhat and that if I can just get rid of this air hungry feeling while wearing it and fall asleep for a good amount of time, I will be able to stick with it.  Should I increase my minimum pressure?  Should I turn off ramp?  Should I turn on EPR full time?  I greatly appreciate any recommendations you all can give me.  Thank you!

[UnicornRider]

Starting any PAP therapy is stressful. Your pre-existing conditions probably contribute to the stress of starting APAP

I suggest turning ramp off. Ramp provides no therapy.

As for the air hunger. 

 Try setting EPR to ON.
  EPR to 3 cmH2O
  Pressure Min to 9 cmH2O
  Pressure Max to 15 cmH2O 

  Continue practice using the mask at pressure while comfortably watching TV, reading, gaming or some other recreational activity daily.

  Give it a couple of days to get comfortable. then post follow up OSCAR reports as well as how the rest of the experience is going.

   It does take time to get used to both the mask and the pressure.

    With additional Oscar reports the therapy settings can be fine tuned to provide the relief you need.

[PeaceLoveAndPizza]

With a median close to 7, try the following…

• Set your range to 7-12 EPR 3 full-time
  
• Turn off Ramp
  

That should help the pressure ramps as it is being driven by flow limitations.

Regarding the mask, use whatever works. If you are a mouth breather, then a full-face or half-face mask would work well. If a nose breather, then pillows are good. You can also use a soft cervical collar or mouth tape with pillows to stop mouth breathing. Most of us go through a few masks before settling on one, which may/may not change over the years. I went from 5 years with P10’s to an Evora half-face.

[theprincesbride]

Thank you so much for the replies! I have always been a mouth breather when sleeping, but I do breathe pretty easily through the nose with F30i when I'm able to settle down with it. I was planning on sticking with F30i until I get a little more comfortable with CPAP due to my history of mouth breathing then try the N30i I got as well. I think based on both of your replies, I'll turn off ramp, try 7 - 15 for the median close to 7 and 15 to allow for more pressure if I need it since I didn't really go into a deep restful sleep those two nights and turning EPR to 3 full-time and see how I do. I'm really hoping this helps. I'll try this for a couple of nights and post more OSCAR data.

[theprincesbride]

Hello everybody!

I have spent the past several nights with a pressure range of 8 - 15 (noticed that on the first night at 7, my pressure kept going up to 8 and felt more comfortable there).  The CPAP feels much better to wear, however, my sleep is still very fragmented and I am still having episodes where I wake up anxious, air hungry and short of breath.  This happened around 2:56am this morning, which correlates with a hypopnea on the OSCAR data.  Counterintuitively, I usually end up taking the mask off for a period of time before putting it on again, mostly due to still having heightened anxiety at night.  I get the same symptoms when I don't wear the mask, where I wake up anxious, air hungry and short of breath.  Checking my pulse ox after an episode last night where I wasn't wearing the mask showed that I was at SpO2 88% and heart rate 130s.  Wearing the masks during the day goes quite well, but at night, I'm still struggling.  

I have mostly stuck to the F30i with difficulty since I am a mouth breather, it is hard to for me to keep a good seal with that mask without constantly adjusting it, but I know I just have to get used to it.  I wore the N30i on 11/23 but had a lot of leaks so did not post the data from that night.  I got the P30i small pillow cushion to go onto my N30i frame from a good Black Friday deal and tried wearing this morning from 7am until I woke up after 10am.  Surprisingly, I actually slept a few hours with the nasal pillow and my mouth taped shut to help keep me from mouth breathing.  That feels like a small breakthrough for me lol since I haven't been able to sleep more than an hour or two since starting this journey.  Since I actually slept for a few hours with the nasal pillow, I think I will try to wear it again tonight instead of the F30i.

Looking at my data from the past few nights, do you all have any suggestions on tweaking my settings?  Do you think my pressure should go up some more?  I'm just wondering what  I can do to stop those episodes where I wake up SOB.  Thank you for your help!

[PeaceLoveAndPizza]

From a therapy perspective, it looks good. I would not change anything at the moment. 

You need to find the proper mask fit for you. To help with the anxiousness, consider not using your smart watch/SPo2 gadgets for a bit. One less thing to stress over.

It does not matter what you end up with as pillows, nasal, full-face, will all deliver the therapy you need. Maybe it will need a bit of a tweak here and there, but finding something that works for you and you can wear all night is most important at the moment.

Pick one and stick with it for a week, unless things go totally bonkers. It takes a while to get used to CPAP, so give yourself time.

[UnicornRider]

  I got the P30i small pillow cushion to go onto my N30i frame from a good Black Friday deal and tried wearing this morning from 7am until I woke up after 10am.  Surprisingly, I actually slept a few hours with the nasal pillow and my mouth taped shut to help keep me from mouth breathing.  That feels like a small breakthrough for me lol since I haven't been able to sleep more than an hour or two since starting this journey.  Since I actually slept for a few hours with the nasal pillow, I think I will try to wear it again tonight instead of the F30i.

  That is a Big Breakthrough! Continue to practice during the daytime, it helps getting used to the fit/feel of the mask plus the pressure of the therapy.

   I also tape my mouth, since the first day I tried taping I felt such a great change in comfort, that I continue to tape under the current masks I use. 

    Every bit of confidence helps.

    As PL&P said continue on with the current pressures, after a few days when you overcome some of the anxiety and can get a good nights sleep under therapy, post additional OSCAR Reports.