Posted by BostonBoy on May 06, 2002 at 08:54:19:

In Reply to: Severely Bloated Abdomen posted by MrsGrumpy on May 06, 2002 at 07:26:05:

Ouch. What you describe is a common complaint from new users -- although obviously the severity differs from person to person, and the reporting of the severity is subjective.

It would be a good idea to get back to your prescribed pressure, now that you have figured that pressure alone is not the cause. Take just enough to make it easier for the air to manage its departure as you shift and turn during sleep.

But if a poorly fitting mask is giving rise to rigid sleeping, you will need to shift your attention to the mask, bed pillow, and maybe even the mattress - if it's too soft, or so aged that it sags a lot, it may be inhibiting your movement.

Are you aware of muscular back or leg pain on waking? That is also a common early complaint. It is attributed to trying to sleep without moving, for fear of dislodging the mask. I associate it with the kind of bloating you describe, because I think that it is normal to shift around and to turn from side to side quite a lot when sleeping. The movement encourages and facilitates swallowed air to move onward and outward at the other end (to put things delicately!). That's why newbies seem to stop experiencing bloating at about the time they also report experiencing better and more relaxed sleep, together with less 'mask awareness.'

Let's be clear that air in the gut is normal and essential. It does no harm. We swallow air all the time as we chew and eat - and it's not the same as the "gas" we generate when eating some foods, such as beans. The presence of air is necessary to the movement of food through the stomach and the upper intestine, where the energy, vitamins and minerals in food are extracted into our bloodstreams. The stomach is mainly a pre-processor. Very little absorption occurs there. So, if you normally tend toward the constipation end of the performance scale, and if pain from bloating coincides with more straining or frank constipation, you might try taking a half or quarter dose of a gently-acting laxative that is described as having overnight action. You don't want to cause an explosive rush to the bathroom! Sleep is to valuable to waste time there.

I've noted your comment on the very tight chin strap. There's a simple fix for mouth breathing, and you should try it. Here's what to do:

Consciously and deliberately spread your tongue broad and flat, relax and let your jaw sag so that there is a small gap between your upper and lower teeth, and push your tongue forward just a little. You will find that it makes a natural soft plug around the hard palate and rim of the inside of your upper gum and teeth, with the tip of you tongue just beginning to show between your upper and lower front teeth.

Some people do that naturally in response to putting on a mask and experiencing the air pressure. Others have to learn to do it. You can practice it during the day, trying to breathe out hard through your nose and noting how your tongue can be used effortlessly as a soft plug. Many people on this forum have reported easy success with this method, although a few have said that it took them even 2-3 weeks to get the hang of it and to develop the instinct to do it while asleep. I think I took about 3 nights, and I don't think my experience is unusual. Have a go!

I know it sounds corny, but it beats fiddling around with string, glue and tape (!)
Sometimes the oldest remedies work best ...

Please also run an eye down my newbie checklist, for other things that may help you:
There are 8 things to review in the learning & customizing process: .. water .. hose .. nose .. mask .. machine features .. sleep diary .. persistence .. hygiene. Succeeding with CPAP requires active understanding and take-charge engagement in the use and management of all eight.

- Water: use a heated humidifier. I also advocate the use of distilled water, both to simplify daily sanitation and to extend equipment life. Aluminum parts don't like the mineral salts that remain even in filtered water. But note that a heated humidifier often gives rise to winter-time condensation problems that require attention to insulation and to hose routing.

- Hose: route the hose such that there is no U-bend that can collect runback condensate that can gurgle or actually restrict the airflow. Insulate the hose to minimize rainout. Suspend the hose such that it can move freely without dragging on your headgear (this is the bungee cord fix that is often mentioned).

- Nose: use a prescription low-dose systemic steroid nasal spray if an allergic response is making your nasal tissue swell, such that it is impeding airflow and making you mouth breathe either chronically or intermittently. NEVER use an Afrin-like non-prescription oxymetazoline hydrochloride nasal spray for more than three consecutive nights. BUT an Afrin-like spray is a great way to confirm the presence of a nasal congestion problem: if one spray turns your nose in 10 minutes into a wind tunnel, your nose is congested - otherwise it is not congested, but it may instead be obstructed and the presence of polyps or other anatomical narrowing should be suspected. Learn to plug your hard palate with your tongue, or use a chin strap if you habitually mouth breathe even when using a Flonase-like steroid spray.

- Mask: keep in mind that discomfort due to over-tightening can cause arousals that impair sleep quality. The mask should float on your face and the inner skirt should have room to be expanded by the lightly pressurized air. Use a firmer pillow if a soft pillow is allowing you to "bury" your head when you turn, thereby pushing too much on the mask and starting leaks.

- Machine features: Make sure that you understand and master all the features and optional settings of your hardware. The CPAP is there to do your will, not to enslave you.

- Sleep log: My bedside pad records all the settings, mask hours, sleep hours, use of nose management meds, # of wakings, # of leaks, # of bathroom trips, together with subjective scores (on a 1-5 scale) of sleep quality, mental alertness on waking, and overall benefit felt throughout the new day. It's very encouraging to see oneself making progress - and it's the best way I know to impress the Doc or RT that a performance complaint has a basis in fact, if you have to go back to the DME or doctor. It puts on the table evidence that you are not making expected progress, gives them something to work with, and turns you into a clearly compliant, cooperative and willing patient. In the absence of a sleep log you may be perceived to be a complaining whiner - and the providers may find fault with you, rather than fault with their titration, equipment decisions and advice.

- Persistence: Some people take to CPAP like a duck to water. Most people need 3-12 weeks to acclimate to the hardware and headwear and to maximize the benefit of using it. Some need 3-12 months. Slow adapters may be people who have allergic reactions to the plastics in their mask or headgear, be people who seek or get little alternative mask/headgear selection support from their DMEs, or be people whose sleep behavior is complicated by other medical conditions and their medications. People whose sleep is not complicated by other medical factors and who are pro-active in tailoring their CPAP setup and sleep environment generally feel better faster. Now that you have had 4 weeks to get over the strangeness of CPAP, it's time for you to take charge!

- Hygiene: this comes in two forms. Hose and mask sanitation is made easiest by using distilled water and by using the CPAP to blow dry the (emptied) humidification chamber and delivery hose every day. The other form is sleep hygiene: the business of going to bed early and at the same time every night, with the aim of getting 8 zzz-free hours every night and establishing a new sleep habit.

There's little medicine and no magic in CPAP: it's physical therapy with indirect but major medical benefits. Maximizing the benefit and minimizing the hassle isn't achieved by passively lying there and 'being CPAPed' badly - only to complain later to the Doc or RT that it 'just didn't work.' Success requires you to take charge in an informed and thoughtful way - and much like giving up smoking, CPAP success requires pro-active discipline and sustained effort on your own part.

Try reviewing your setup against this checklist. It may help you to tweak your own arrangements.

Good luck!

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