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Sleep Hygiene questions from the newly diagnosed

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altlmiss +0 points · 5 months ago Original Poster

Hi - Discovery: Just Dx with moderate obstructed sleep apnea. Never would have thought about it except that I started seeing a new pulmonologist for asthma and he had a bunch of intake questions I hadn't been asked before that lead me to ask him what he thought. He thought it highly likely because of my small airway and snoring in my family (don't know if I snore as I live alone. ) He ordered a home sleep study (anyone else hate those nose prongs? I kept trying to blow my nose while wearing it). It came back positive (score of 13 I think - stop breathing for 3-5 sec every 13 minutes).

Symptoms: Over the past year I have been irritable and tired. I work from home so no one has noticed that I keep falling asleep during the work day (even in meetings once or twice). Then I'd take a nap again later. I would be in bed for 10 hours to get enough sleep. I just thought I was one of those people who needed more sleep. Plus it usually takes me an hour to fall asleep the first time.

What makes this exciting: Now, usually I don't want to have a disorder, but before I had the study, when the Dr went over the possible effects of sleep apnea, I was really hoping I had it. You see, I also have a mental health Dx and this could be a contributing factor as it causes some of the same symptoms. Getting a positive on the study was wonderful because the fix is simpler than figuring out the right medication for things like depression.

Questions for long term CPAP users: I am now waiting for the CPAP Rx to go through. I'm interested in knowing how using one of these machines has effected your sleep habits. Do you need to plan more time to get ready for bed? Do you find it harder to wear an eye mask? Any tips on how to determine the best CPAP system for me? Do you have a favorite manufacturer or brand? Any thoughts on what you would have liked someone to tell you before you started using the machine?

Thanks!

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Biguglygremlin +0 points · 5 months ago Sleep Commentator

Hi altlmiss

I certainly hope you get the results you want.

There are lots of threads here that might help if you have the time to browse.

I have never considered the time issue but yes it does take a minute or two to refill the humidifier and get the mask settled and the same to clean the gear from time to time.

The eye mask should be manageable if you put it on before the mask.

As to other things.

Keeping the airways clear is critical with or without CPAP so I always have antihistamines and nasal spray on hand although I only use them when absolutely necessary.

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Sierra +1 point · 5 months ago Sleep Innovater

Apnea is normally classified using the AHI index. It is a count of the total number of obstructive and central apnea event plus the total of the hypopnea (reduced flow) events in the night divided by the hours in bed. It ends up as an events per hour number. 0-5 is considered normal, 5-15 is mild, 15-30 moderate, >30 severe.

On your questions, once you get into the routine, it might add 5 minutes getting read to go to bed. I don't wear an eye mask. I like a totally dark room.

With mild to moderate apnea you could consider a dental appliance as an alternative to a CPAP. They need to be fitted by an experienced dentist and if not covered by insurance can be expensive. A recommendation for a CPAP depends to some degree on where you live and who is paying. On a pure technical basis, I think the best choice is an auto CPAP. The two leading brands are ResMed and Respironics (DreamStation). I will admit I am bias, but of the two I believe the ResMed AirSense 10 AutoSet For Her is the best choice. If you want to know why, ask and I will explain more. The DreamStation Auto is a credible machine too if you are forced to take it. If you are a guy, and your pressure requirements are lower, the For Her version (despite some styling appearance things) is the better choice. You can turn off the For Her mode if it doesn't work for you, and the cost of both models are the same.

On thought before starting, I would thoroughly question the Sleep Clinic on what the appropriate machine is if you have any indication of central sleep apnea. It could change the best type of machine to use. Do some research on central vs obstructive sleep apnea ahead of time so you understand the implications. The other aspect is the mask. Most of the comfort issues with using a machine start with the mask. If they offer different version to try as a trial I would encourage that. There are many different masks and not one mask suits everyone.

Hope that helps some. Ask if you have more questions. It is always best to be informed going into this thing!

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altlmiss -1 point · 5 months ago Original Poster

Very helpful! Thank you for your thoughts. I'll look up the things you mentioned. I'm just learning about this and you have helped me narrow the initial investigation. :)

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Sierra +0 points · 5 months ago Sleep Innovater

On the sleep mask thing, a nasal pillow type mask would probably be the best type to allow the use of the eye mask. They tend to fit under your nose and make minimal contact with your face.

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altlmiss +0 points · 5 months ago Original Poster

How are the nasal pillows for sensitive noses?

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Sierra +0 points · 5 months ago Sleep Innovater

I have tried the nasal pillow type (ResMed P10, F&P Brevida), the nasal (ResMed Mirage FX), and full face (ResMed Mirage Quattro, AirFit F20). I could not get the full face masks to seal against my face without the leaks making rude noises, or worse still blowing into my eyes. The nasal type had the same issues but to a lesser degree. The two nasal pillow masks did initially irritate my nose to some degree. I did get used to the P10 by getting the right size that was big enough that it did not go too far into my nostrils. I also used some hydrocortisone 1% cream on the exterior of my nose for the first week or two. The Brevida seemed to irritate my nose more, and if I had toughed it out longer I probably could have gotten used to it. It is larger and seemed to deflect off my face easier than the P10, so I gave up on it.

This said masks and what each individual likes and tolerates differ a lot. Many people use full face masks quite successfully. Same with nasal masks. My wife used the nasal Mirage FX for more than three years, and said she liked it except for the marks it left on her face in the morning. I finally convinced her to try the Brevida (that I rejected!), and she now achieves a much lower leak rate. She couldn't exhale with the small size, but the larger insert works fine.

The other thing to keep in mind is the big "mouth breathing" issue. You really can't mouth breathe with a CPAP. If you open your mouth, air blows out, but you can't breathe in. It just results in a large leak that drys out your mouth and throat. The issue is that sleep clinics can designate you as a mouth breather, and not suitable for a nasal or nasal pillow mask. You must use a full face mask! The problem is that with a full face mask you will still breathe through your mouth and get a dry mouth and irritated throat. Believe it or not, the better solution is to use a nasal or nasal pillow mask and tape your mouth shut. This forces you to breathe through your nose, which is the way we were intended to breathe.

When I decide to try it, my wife thought I was nuts. She claimed it was not necessary and if one sucked it up, you could learn to keep your mouth shut. But, for me it worked. Despite being male, I couldn't keep my mouth shut without tape, and I couldn't stand the full face option. Then she began having issues, and I told her she was making a lot of loud "air leak noises" during the night. I also showed them to her on SleepyHead. She put that together with waking up with a dry mouth, and started to accept she had not actually "learned to keep her mouth shut". The final straw was a YouTube video I found on the internet. She watched it, and reluctantly agreed to try mouth taping. She is now sold on the idea. The amazing part is that not only did her leak rate go down but her obstructive apnea frequency went way down too.

Sorry for the long story, but the point is that I think there are alternatives to using a full face mask, and they are probably a better solution, because it is much better to breathe through your nose, than your mouth. Don't reject a nasal pillow because of potential nose irritation or "mouth breathing". There are solutions.

Here is the video. It was done by a dentist - Mouth Taping for a Better Sleep

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MountainGoat +0 points · 5 months ago

I've suffered with seasonal hay fever, allergies and sinusitis all my life and have sensitive skin also, including nose and face. To complicate things further, the ENT said I have very small nasal passages, so much so that when he did the nasal endoscopy, he couldn't get the camera through the right nostril and had to use the left. We spoke about CPAP and using a nasal mask. His advice was to use steroid nasal spray every night. Apparently the dose is so low that it doesn't have any systemic effect and can be used permanently.

When the time came to buy a mask, I opted for the Resmed N30i. It doesn't have anything that go into your nose, it just seals against the underside of your nose and have openings corresponding to the nostrils. The starter pack is supplied with three different sized pillows, so finding one that fits your nose is important. The air pressure inflates the pillow and I find it seals quite well. I'm a side sleeper and find the mask reasonably comfortable overall and will probably be even more comfortable for a back sleeper. The air connection is at the top and swivels in both directions, so it isn't in the way of your arms when you turn around while sleeping. I tuck the hose between the pillow and the headboard and haven't found it to be restrictive or get in the way.

I found that at higher pressures, I ended up breathing through my mouth but tucking a pillow tightly under my chin helped for that and I so far don't find it to be a major issue.

Depending on the pressure you have to use, it may not work for you though.

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Sierra -1 point · 5 months ago Sleep Innovater

I think the ResMed N30i is ResMed's answer to the Respironics DreamWear masks. The DreamWear headgear looks very similar. With the DreamWear system you can use the nose and mouth (full face) but minimal contact inserts, the nasal with the oval opening, and the nasal pillow type. So you can change your mind on the type of mask without changing the headgear. Not sure if ResMed does that as well. I have a friend that uses the nasal version of the DreamWear and he likes it. The only possible downside is the tubes going up the side of your face and any potential noise from them.

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