Long time snorer, first time CPAP wearer (mask question)

August 2, 2022 7:52 AM

I got a dx of moderate sleep apnea a few years ago and didn't do anything about it. Decided I'd lose some weight. Instead put on some weight. I finally went in for the CPAP intro and machine-conferring ceremony. Last night's sleep, it was not good. I have questions.

I know that part of using CPAP is getting used to it. I'm fine with that. I think I'll need to try this all again next week when I'm not working because I can't do a bunch of workdays on not much sleep.

My more specific questions though are these:

1) If anyone here uses CPAP, have you tried the "nasal pillows" that don't have headgear? There aren't many of them, and they seem to rely on sort of adhesive pads that adhere to the side of your nose, which sounds non great. It's just that having something strapped around my head gives me a headache. And

2) Is it possible CPAP is going to make me grind my teeth really badly? I think because I often breathe through my mouth at night (because apnea!), having to keep my mouth tightly closed for the four hours I used the machine before turning it off and getting some sleep left me with the feeling of having REALLY gritted my teeth.

Thanks for any insights.

posted by less-of-course to Health & Fitness (25 answers total)

It can take a while to get used to it, but was a life-changer for me.

Haven't tried nasal pillows. I don't remember why they prescribed full face masks for me. Anything you wear is going to be hard to get used to strapped around your head and also depends on your sleeping style. I can only fall asleep on my side, so I had to find a low side-profile mask.

Grinding--if your mask covers your mouth, probably, unless you add in a night guard. I've been using a cpap for seven years and have some grinding. Given that I use a cpap and take sleep meds already, I didn't want to add in the complication of a night guard. Your dentist may know more options though.
posted by mermaidcafe at 8:04 AM on August 2, 2022 [1 favorite]

There are different kinds of headstraps, padded headstraps, etc. that you can try. I have to be really careful about where my hair goes to avoid putting extra pressure on certain parts of my head (via a bunch of hair getting under one part of a strap, for example) and causing a headache, and sometimes I don't succeed.

Nasal pillows work great for some people; they just gave me a cracked and bloody nose, but everyone's different.

I use a mask that covers my nose and mouth because I clench my jaw all day and it just isn't going to stay closed all night.

Good luck figuring out the right combo for you!
posted by wintersweet at 8:04 AM on August 2, 2022 [2 favorites]

Check the humidity.

You can get a tooth-grinding mouth guard from a dentist, but there might be some available at the local pharmacy too. I know that doesn't help directly with jaw pain from being tense, but it might help indirectly, and it will help protect your teeth.
posted by amtho at 8:19 AM on August 2, 2022 [2 favorites]

Finding a mask that worked for me was one of the biggest challenges I had when I started using CPAP 15 years ago now. I couldn't tolerate the chin strap for keeping my mouth closed that I needed with any nose-only mask, so have ended up with one that covers my nose and mouth, though at one point I actually tried a mask that was literally full-face, that covered everything including my eyes. I looked like a jet pilot wearing it.

The straps can definitely be a challenge. Right now, I have long hair for the first time since I started with CPAP and I can't figure out how not to have my headgear end up pulling my hair—-I wake up with a sore scalp on top of my head and suspect that the CPAP headgear may be contributing to some hair loss I'm having along my hairline, so I'm fixing to experiment with sleep caps to wear over my hair and under the CPAP straps.

I feel for you finding that the straps can give you a headache. I know that when I first started using mine, I had a very hard time getting my straps adjusted so I wasn't having leaks, though once I got the hang of it, I was kind of mystified about what I found so hard about it. During that early time, I was often over-tightening my straps as a way to try to stop leaks. Hopefully, you will eventually find a way to mitigate that problem, because it's not a big help in your life if you're getting headaches from it.

There is a secondary market for CPAP hacks people come up with. My mask style has a part that rests on my forehead, and I can end up with a very distinct depression on my forehead in the shape of that piece. When I'm doing botox as a treatment for my headaches, and the muscles are paralyzed, it's even worse. I found a person who was making little cloth covers for that piece, and that made a big different, though since then I've found that a folded piece of cloth, like a bandana, works just as well. But you might explore the world of consumer-made CPAP adaptations. Searching "replacement CPAP headgear" will bring up a mix of official banded merch and independent "compatible with" headgear, and you might find something that looks like it might reduce the headache triggers. There are also some masks on the market that do not require headgear but claim us use a differing method to keep the mask in place. Here's one I came across poking around just now.

It took me a long time to get the hang of my CPAP. I hope you're able to find equipment that makes your nights better instead of worse!
posted by Well I never at 8:27 AM on August 2, 2022 [3 favorites]

I've been using a CPAP for 4 years and watched my dad use one for at least a decade before that. A full face, believe it or not, is often much more comfortable, as others have stated above. I did have to get a night mouth guard for teeth grinding, which is a minor annoyance.

Some other tips:
1) Have your DME go over the breath relief adjustment settings. That made a *huge* difference for me.
2) I use a "chemo cap" or "silk hair cap" under my mask to help keep it from pulling on my hair and causing a headache. It's basically a cotton sleep cap lined with silk that protects my hair from breakage, keeps the mask from slipping (I guess I have slippery hair?), and keeps the mask from pulling on my hair, causing headaches.
3) The Pad-a-Cheek type of cushioning that goes over the straps can provide a lot of relief.
4) Seconding checking the humidity; it changes the way the mask fits AND helps keep you from waking up dry
5) Your DME should have a program where you can try multiple masks for free during the initial stages. Take full advantage of that! Try out a full face (my current favorite is the ResMed F30 but I also like the Philips Dreamwear), try out different styles of nasal pillows. Your first mask may not be the one that works for you long term....and that's ok. I recently had to change the mask I was using due to weight loss changing the contours of my face. You're not stuck with the same type of mask for life.
6) There are some REALLY good Facebook support groups for CPAP users. They talk about what works for them and that's been a lifeline for me. I highly recommend Fat-Positive Sleep Apnea.

Lastly, and nthing what's been said above -- this is a big deal physically and emotionally and it takes a lot of time to adjust. It's ok if it takes you a couple of weeks to a couple of months to fully ramp up (the DMEs and your insurance company will tell you it's ok to watch TV while using the CPAP to get used to it so you don't have to necessarily wear it for the whole night at first). Give yourself some grace and I really hope that the CPAP is ultimately as life-changing as far as fatigue goes for you as it was for me.

If it would help to chat, feel free to MeMail.
posted by eleanna at 8:33 AM on August 2, 2022 [4 favorites]

I need to breathe through my mouth at night because my nose-breathing is too obstructed, so I have a full-face mask. Might not be the ideal option for you if you can make the nasal pillows work but keep it in your pocket as a backup plan to try.

If I really needed to have the nasal pillows for some reason I think I'd try one of those chin straps that will hold your mouth closed for you, and see if that provides any relief from the gritted-teeth sensation if you don't have to do that muscle work yourself.

Good luck, I hope this works out and improves your sleep and your health!
posted by Stacey at 8:40 AM on August 2, 2022 [1 favorite]

This may sound weird, but you can get botox injections in your massater muscles in your jaw to stop teeth grinding. It works great and has no other affect on your face or jaw function.

I also found that I would get pain and tension headaches with a mouth guard because even though it protects my teeth, I was still grinding/clenching. The guard seemed to actually make the clenching worse. My dentist recommended the botox and I've been extremely happy with the results. No pain! No mouth guards! It's a couple hundred bucks twice a year. Well worth it, in my opinion.
posted by ananci at 8:57 AM on August 2, 2022 [1 favorite]

I use a nasal mask because I couldn't handle the full face mask which prevented me from opening my mouth even a little when falling asleep. I do have it strapped to my face rather than stuck on. It seems I am able to sleep without opening my mouth too much, because my apnea events score is low even with just the nasal mask. I had to have my pressure decreased though, because I was opening my mouth enough during the night to get some air down the wrong tube. Turns out that level of pressure still works to prevent apnea for me.
posted by catquas at 9:07 AM on August 2, 2022

it took me MONTHS to get fully used to mine but I love it now. proviso: I don't breathe with mouth open when I sleep so I just have the small nose mask (without the pillows) the strap does not give me a headache.

I already wear a nightguard for bruxism, perhaps you could look into getting one? you will feel so sexy when you go to bed with all this gear on/in your head LOL but I sleep so much better and my other sleep disorder is rarely triggered now.

there are a lot of options available with CPAP but I think patience is crucial. I really struggled at first but its great now that I have sorted out which mask works best for me.
posted by supermedusa at 9:16 AM on August 2, 2022

Full face mask user here. It took me a good ten days, mostly because the mask held my mouth shut and I had 45 years of experience to overcome. But now if I take a nap on the couch, my mouth stays shut on its own!

The damn thing still wakes me up at night, but when I am asleep it's so much better: I haven't dozed off in traffic in years!
posted by wenestvedt at 9:28 AM on August 2, 2022

I've used a CPAP since 2004. Nasal only. I tried switching to nasal pillows and it was terrible. I'd wake up because I couldn't breathe. Given how long I'd been using CPAP, it was really odd. Hated them

Anyways, I use the Fisher & Paykel Eson 2 Nasal System, size S with a M headstrap. I push the strap that goes over my head to the back of my head. Can't stand it.

I used a heated hose, and humidifier.

Also, make use of the RAMP button. I've a friend who's struggling, and I suggested that he hit the ramp button if he was struggling. The decreased pressure makes it easier to breathe against (RAMP in my world, it slowly builds the pressure up over a period of time). He went and had his system changed so his RAMP is over an hour which has helped a lot. I don't use mine anymore, but have suggested to a few people and its helped.

Another tip Blistex Medex has menthol. So a little under your nose helps to open up nasal passages. It helps with the stuffy feeling. I used to use a nasal spray when I first started using CPAP but don't need it anymore except with a cold.
posted by Ftsqg at 9:49 AM on August 2, 2022 [1 favorite]

It'd help to know what machine and mask you're using.

having to keep my mouth tightly closed for the four hours

That sounds awful! You shouldn't have to do that. I breathe through my mouth and use a full facemask (ResMed F30i, also an F20) and my mouth is slightly open most of the night. I know this because my mouth dries out, a different uncomfortable problem.

If you're using a full face mask but feel you can't open your mouth a little, something's wrong with the fit. If you're using a nasal mask and are somehow keeping your mouth closed, that can work (there are straps that help) but may not be best for you.
posted by Nelson at 10:19 AM on August 2, 2022 [1 favorite]

if you do wind up wanting a mouth guard to prevent grinding, I ordered a custom one off the internet, it's excellent. much smaller, softer and cheaper than the one I got from the dentist (which cost triple digits and was too big and rigid to use at all.) you can choose upper or lower jaw. you can memail me if you want the company name.
posted by fingersandtoes at 10:52 AM on August 2, 2022

I wear a nose mask, and I had to find the right sized one, which was medium. I accidentally ordered XL and turns out I don't need XL. I have the two-strap system headgear and it does require a bit of adjustment to get the right tension, so it provides a good seal yet not too restrictive.
posted by kschang at 12:11 PM on August 2, 2022

I kept unconsciously removing the full mask while asleep and was in danger of not meeting my insurance compliance numbers, so my sleep provider recommended the nasal pillow style. The pillow I use is still attached to head straps and doesn't use adhesive. I know a lot of people have trouble keeping their mouths closed when using this style, but that sensation is so uncomfortable for me--filling my ears up and making my throat feel weird--that I instantly closed my mouth if it drifted open while sleeping. Eventually I was just trained to keep my mouth shut. Those who have difficulty acclimating to keeping their mouths closed while using the nasal pillow stype sometimes use chin straps to assist. My scores are great--usually 1.2 or lower--and my compliance is almost 100%. I have a lot of hair and used to get some head tenderness from the straps, but I switched to a faux satin pillow from Amazon (usually marketed to people who require protective hairstyles and environments for sleep) and just removing a lot of the friction between the straps and my pillow cured my head tenderness.

A lot of people love their warm hoses and humidity from the water tanks but they felt absolutely awful to me, like I was sleeping in a jungle while having an asthma attack.

Side note: Don't put vaseline products, like Blistex menthol, around your nose if you try a nasal pillow style, because the petrolatum can degrade the mask materials.
posted by MagnificentVacuum at 12:54 PM on August 2, 2022

I use a nasal mask, and like others above I've found that I've had to try out different straps. Everyone's a bit different, so getting the right mask/strap setup (and dialling in the right settings) for something as all-important as comfortable sleep may take a bit (or a lot) of experimentation and adjustment time.

One of the early problems I encountered was pulling a "Princess and the Pea" every so often by rolling over on the hose, and waking myself up that way because it was poking into my back. I remedied that by using a gooseneck clamp-on GoPro mount that ends up working just like the various purpose-built hose holder/hanger arms you can get. So hacked solutions often help!

There was one strap that had a little bump around one of the velcro attachments that would create a pressure point (even when just pressed between the pillow and my skull) if I slept on it just so that would give me a headache. The one I use now doesn't cause that problem.

A lot of people love their warm hoses and humidity from the water tanks but they felt absolutely awful to me, like I was sleeping in a jungle while having an asthma attack.

Yeah, this seems to vary for people. I like the humidity in the winter. Prior to starting on the CPAP, I used to get a couple of nosebleeds every winter. That hasn't happened since I've gotten the CPAP.

I do find that I need to dial down the humidity level a bit in the summer months because I found that I was waking up a little too...swampy around the nose if I leave it at the setting I use in the winter!
posted by mandolin conspiracy at 1:32 PM on August 2, 2022

I've been using a nasal mask (not nasal pillows) for about 5 years now. It took me about 2-3 weeks to acclimate to falling asleep using my CPAP, but now I can't fall asleep without it!

If you're allowed to try several different mask styles, do it. It took me 2 or 3 different styles before I found the one that really worked. Good luck, using a CPAP changed my life drastically for the better!
posted by schyler523 at 1:34 PM on August 2, 2022 [1 favorite]

The only thing I will add is that I use a "ramp" setting which starts out with a lower pressure so I can fall asleep without fighting the full pressure. Once I'm asleep, I don't have much trouble with the CPAP but it did take me several tries to find a mask and headgear that I am comfortable with.
posted by Ochre,Hugh at 2:19 PM on August 2, 2022

I started with a nasal mask. It took about a week to get used to it and that was it. I've only skipped a few nights in the last twenty years and that was because there was no power.

My mother, on the other hand, has been an ongoing disaster. Same twenty years, god knows how many masks, how many hours spent on the phone trying to get new mask types approved, how many skipped and unskipped nights of bad sleep.

I think part of the difference is that I needed a UPPP to get my apnea down to the level that a CPAP would even be useful. I sacrificed my uvula for this; Failure is not an option.
posted by Tell Me No Lies at 3:51 PM on August 2, 2022

Response by poster: The machine is a ResMed AirSense 10 autoset. Or maybe autoset is a feature of it. I should actually google it because the Kaiser presentation about it was a bunch of admittedly not that complicated information one thing after another, and I didn't really take all of it in. If I understood correctly, the machine is monitoring for whether the pressure is working, and when I go back in for my next appointment, they'll read like a sim card or something.
posted by less-of-course at 4:39 PM on August 2, 2022

Response by poster: (It does appear to have RAMP but I think possibly it's automatic.)
posted by less-of-course at 4:41 PM on August 2, 2022

Best answer: I have a ResMed 10 Autoset too. It's a very good machine, market leading. It has a lot of settings you can configure (and is easy to get access to clinician mode) but the default settings are actually pretty great.

You didn't say what mask is giving you trouble. FWIW here are all of ResMed's masks. It sounds confusing but really there's just a few variants. The F masks are all full-face, the N are nasal mask, and the P are nasal pillow. The ones with an i like F30i are a design with the tube coming out the top (I like that better). The F20 is the basic full facial mask that is easiest to get fit and working.

You're right about the monitoring; the machine will either upload your data to the cloud or write it to an SD card. You can also download and view your SD card data yourself with the OSCAR software or a great new web app, Sleep HQ. This is kind of a deep rabbit hole. If that interests you or you want to learn more in general, I found the community at Apnea Board was helpful.

You're getting a lot of advice about all sorts of topics. I encourage you to focus on your primary stated problem; to get a mask setup that's comfortable enough you can sleep through the night with it.
posted by Nelson at 5:01 PM on August 2, 2022 [2 favorites]

Nthing other comments here - it takes a while to get used to for most people. Forums can be a great resource for "Hey, maybe this will help"

One thing you can try is wearing it while you're awake, which can help you get used to how it feels (like if you';re going to be lying down reading/watching TV/etc. for a couple of hours.) And it can help you figure out what's going weird so you can look for options.

For me, I made the switch quickly, because my body went a) Yay sleep! and then shortly after b) Wait, no stuffy nose while I sleep, this is fantastic! (allergies, oh allergies. Breathing in filtered humid air for hours every night turns out to be great for that.)

I have nasal pillows, but it took me about a month to learn how to sleep with my mouth closed again (after, y'know, decades of it being open to breathe.) After some looking at options, I spent a month taping my mouth shut with medical tape (one strip, from the top lip to the bottom lip with my jaw in a fairly neutral position. There are backup vents on the mask in case the pressure fails (like a power outage) and I could also breathe around the edges of the tape if I tried, but it helped me get used to the new position.

On masks, I have TMJ and also scalp psoriasis, and basically wanted to reduce pressure on my jaw and have as few straps as possible on the mask. I have the ResMed P10, which is nasal pillows and a strap that splits at the back. (The newer ones also have a side adjustement.)

It took me a little experimenting, but I've figured out how to make it comfy for me.

Other stuff that helped:
- Getting the right nasal pillow size (I didn't need to try different masks, but the DME guy suggested the small nasal pillow and it turns out that rubs on my nose and makes me go ow after a day, and the M doesn't do that.) It affected a lot of the general fit feel for me overall.

- Fuzzy strap pads for the cheek straps (and for the tube, which I found helped with having the humidity at a level that's comfortable for me.

- Buckwheat pillow (on top of a larger fluffy pillow) because I'm a side sleeper and that way I can shove the pillow out of the way of the mask and have it petty much stay put.

- Cotton sleeping cap to protect my hair, but also buffer some of the tightness of the straps on my head. (I have long hair, and I do it in a loose ponytail at the crown of my head, looped, with one split of the strap above and one below, which helps keeps the straps where I want them while sleeping. But there's definitely positions on my head where the straps are uncomfortable and some where it's great.)
posted by jenettsilver at 5:37 PM on August 2, 2022

I've had a CPAP for almost a year. I have a nasal mask and sleep well with my mouth closed.

I still haven't gotten completely used to it; the longest I've gone without taking it off is five hours a night, and most nights are 2-4 hours. I take it off without even realizing it most nights; I start with it on, fall asleep, wake up with it off. I also cannot get to sleep with it on without the aid of 5mg of Ambien.

All that being said, I'm no longer comfortable going to sleep without it on, and I know however many hours of night I'm sleeping with it are to my benefit.
posted by lhauser at 6:27 PM on August 2, 2022

Try the full-face mask.
posted by Hollywood Upstairs Medical College at 10:28 PM on August 2, 2022