New here and newly diagnosed with OSA - need some APAP guidance please!

[DanJayUK]

Hello everyone. I've been lurking here since about mid-June reading up on OSA and C/APAP and trying to absorb as much as possible. Why? Well... I've had a chronic snoring problem since I was a teenager - always been a bit of a joke with family and friends. Never really thought anything of it. My now wife was the first to point out it might be something more back in 2005 - although she can ususally sleep through my snoring pretty well, when she woke up in the night she noticed that I often would stop breathing. Once again I thought it was odd but as I felt fine I never really bothered about following it up. Fast foward to now and over the last 12-18 months I've become more and more run down. I wake up in the morning feeling like I haven't slept and often struggle in the afternoon at work. Put a new (now 2 month old) baby into the mix plus a couple of colds in succession and I could quite happily have died on some days I have felt so chronically tired. I was starting to think I was suffering a combination of diabetes and dementia! The OSA thing still never occurred to me. It wasn't until a chance conversation with an old work colleague who told me he was literally like a new man now and how he'd suffered back when I worked with him and it'd taken 20 years for various health professionals to diagnose him with OSA. I asked him what it was and of course everything then clicked into place.

My local GP was very responsive and referred me straight away to a local consultant. I was lucky that my work health insurance managed to bring themselves to cover the first appointment (though not the sleep study but that's another story) so I got seen within a fortnight. I did my sleep study Thursday night. For me this entailed picking up a breathing/chest/oxygen monitor from the local hospital, wiring myself up before bed, sleeping with it turned on and then dropping it off the following morning. Said consultant very kindly called me this (Saturday) morning and said that, whilst he'd seen worse, there was no doubt the study showed I had moderate OSA and that he was going to refer me to the London Chest Hospital early next week for putting on CPAP treatment. To be honest I am actually massively relieved - I was quite scared that the test would prove inconclusive or that I only had very mild OSA in which case what I am suffering (which looks like it has been a build up of lack of deep sleep over the long term) could be caused by so many other things.

This all leads me onto my questions which I am hoping I can get some good advice on. I am under the impression it will take a while for me to be seen by LCH (maybe people here can comment on this particular hospital?) and I really need to get this dealt with asap from a health and work perspective. It has been recommended to me that I try to wait until I'm getting treatment before I inform the DVLA - that might be ok if I am getting it within a few weeks but obviously not if it runs into months. And I need my driving licence!

I am considering potentially renting or more likely buying my first machine. As I haven't had an APAP test already (I assume when LCH get around to it that's where they'll start) I don't have pressures to be able to order a CPAP machine. I'm also very aware that my OSA is significantly worse when I have a cold or a sore throat (and truth me told if I've had a night on the booze as well). I can therefore see that I'd want to start and perhaps remain on an APAP. So... should I look to one of the rental places whilst I wait for the NHS to pull their finger out and keep the NHS machine as a a spare? Or, should I look to simply buy myself a decent APAP machine and do likewise with the NHS machine? I like the look of the Philips System One REMstar machines however I know that is only half the story. And where the hell do I start with masks? I can afford one but can't afford to buy loads of the things so I really need to if not get it 100% right first time at least get it 80%! I'm a mouth breather by the way... Do I actually need a prescription form to buy a machine? (It isn't like I am going to buy one of the bloody things if I don't need it!).

I would really value the advice of you guys who've been through all this before and likewise James @ Intus on possible options.

Now I've had this formally diagnosed I just desperately want to get it sorted out pronto.

Cheers - Dan

[James @ Intus]

Hi Dan,

Welcome to the forums, nice intro too, thanks.

It's good indeed that now you know what's causing your issues, and you have a baseline to start working from.

I'm not sure how long it will take there, best to ask them. They may be putting severe cases ahead of the queue, which makes for unreliable ETAs. But I'd simply ask them, press them on it, and if they say "X weeks" and that's too long for you, you can weigh up the private route indeed.

Technically, you should already tell the DVLA. Actually, before you were even diagnosed you already had a "I need to be fit to drive" obligation. So not telling them is a risk. A big risk if you keep driving. Indeed, you want to minimise the "between a rock and a hard place" period you find yourself in now.

Diagnosed, no treatment -> problem.

DVLA aside, you indicate rightly that you now want to get on with it. For yourself, for the people around you, for your career perhaps. From that point of view, the investment of buying one yourself may be well worth it, not least because you get choice as well as speed.

Indeed an Auto-CPAP is your only option, until such day you have data to support a fixed pressure machine. Booze, colds, X-mas excess heck even the weather has an impact on OSA so for those reasons many people enjoy the benefits of an APAP.

We don't do renting like Respironics do, because we didn't want to go down the route of handing people equipment that has been used by others before. So I can only really state the claim for buying.

You have moderate OSA. The chance of this going away fast is slim. So you've probably accepted the fact that the APAP will be your beloved bedpartner for some time to come. Mid to long term, renting is more expensive than buying. If you have the budget available to buy, you will save when you anticipate to be on CPAP at least a year or so.

When you buy your own gear, it's yours. Doesn't come from a smoke/pet friendly home, has everything working with warranty to boot. It's yours to break too, yours to take on holiday etc. Most people give it a name, you can't do that with a rental-puppy!

A new one won't have clocked any hours, the data recorded is fresh, and 100% yours. Were you to buy from us for example, you get free after sales data reporting service whenever you are curious about how you are doing.

Machine wise, you can't go wrong with the big name machines. To keep your clinic on your side, you may want to favour one that they are familiar with.

Mask wise, there are 5 types. Full Face, Nasal Cushion, Nasal Pillow, Hybrid and Oral masks. Which one suits you is very hard to say as it's such a personal thing. I can recommend one that 1000 people love and you may hate it. But the choice can be narrowed down.

Do you often wake up with a dry mouth? Are you known to be a mouth breather? Do you often get sinus issues?

If yes, a full face or hybrid will be a good safety net, as it then doesn't matter how you breathe, the air will always go in without escaping through the mouth.

If you breathe through your nose, have colds/sinus issues rarely, then the nasal ones may be easier to cope with.

Do you roll around much? Do you side sleep alot?

If yes, the nasal pillow types tend to be a better choice than the nasal cushion type as there is less material potentially interfering with your pillow when on your side.

But truth is, you are likely to end up with 2 or 3 masks anyway. Getting it perfect on your first choice is like winning the lottery. And most have a number of masks to rotate, as and when they need to or feel like. But to keep an eye on the budget, the above should help narrow things down to a safe choice. If you answer the above questions here, I can help you on your way.

To buy a machine you do need to show you need one, or at least safe to use one. So your sleep study results and diagnosis would normally do (handy to keep a copy for your own records anyway). Most clinics are happy to put in writing that "Mr Dan has been diagnosed with moderate OSA and requires CPAP". That'll do.

So you're at the stard of what should be an exciting journey. It won't be easy, CPAP never is, but with the right dose of determination and perseverence, you, like most here, will get extreme benefits, quite rapidly.

[symmit]

Hi and welcome to the club!

In my, unprofessional and personal, opinion, as you have a diagnosis I'd go ahead and buy an auto, in fact I did!

It's the best money I've ever spent, enabling me to work better and enjoy life so much more. I have a small collection of masks now and am considering buying another machine when I have the spare cash - probably the Icon - and keeping my current machine for travel. Was going to do it this month but a THX surround amp got in the way

Renting is not a good option, 6 mths rent is the price of buying from what I can see. Machines have a life of 3-6 yrs from what I read so buying is a good investment.

I'd say to anyone trying cpap, get a full face and a nasal mask and try both, there's plenty of cheaper ones around to try or just go all out and get a quattro FX and a sleepweaver

Whatever you do, give it time to get used to it and get loads of advice from here and your doctors!

[DanJayUK]

Thanks for the initial and quick replies.

Points noted with regards to the DVLA. My motorbiking days into central London are over until this is sorted out and all I use my car for is driving 1 mile to my son's nursery first thing in the morning before getting the train to work and 1 mile home at the end of the day. For a whole variety of interlinked reasons both work and family related life is going to be next to impossible if I lose that ability so forgive me if I'm not desperate to lose my licence for the sake of a week or two of wait. One of the reasons I am looking to sort treatment out as soon as I am able. Trying to take a common sense approach here.

James...

Firstly thanks for confirming APAP is the way forward. I'm in no doubt of that from everything I've read on others' situations here on the forum.

>Do you often wake up with a dry mouth? Are you known to be a mouth breather? Do you often get sinus issues?
Definitely a mouth breather. I have allergic rhinitis and have done so pretty much my whole life so often have blocked nose and it's usually with some resistance I breathe through it. This is no problem when I'm awake and I can usually breathe through one nostril fine when I doze off (I tend to at least start to sleep on my side) though when I wake up my mouth is often wide open and the drool on the pillow says it all. I often wake with a dry throat as well though not noticed it so much with my mouth. As my nose blocks easily and I definitely favour mouth breathing I think that rules out a nasal pillow/cushion type at this stage.

>Do you roll around much? Do you side sleep alot?
I think I roll around enough that I would need a mask that is designed with this in mind. I occasionally sleep on my back but most of the time I sleep on my side - though in fairness some of that might be down to my wife getting so fed up with the massive increase in snoring decibels she pokes me until I roll over onto my side though

Symmit... The Quattro FX looks good so thanks for pointing that one out. It seems to get good reviews on the eu-pap website as well.


Next question - and perhaps a suggestion to you James as an update to the website... How would I know what size mask I needed? (e.g. the Quattro FX Symmit suggests comes in three sizes, others come in 4 ). It would be good to have a guide. I know I'm not comparing like with like but if I order a new motorbike helmet there's a pretty standard sizing guide so you can measure your head in a specific place and then you know what size you need. Sure, it's best to try a few on due to manufacturer differences but you've a good idea. I wouldn't have a clue what size to order and I imagine that returns policy says you can't return if you've opened.

I still can't decide if I'm excited or horrified at the prospect of CPAP but ANYTHING that gives me some energy back and the ability to think between 1 and 6pm I will be life changing. I'm happy to be joining the club

[symmit]

>Do you roll around much? Do you side sleep alot?
I think I roll around enough that I would need a mask that is designed with this in mind. I occasionally sleep on my back but most of the time I sleep on my side - though in fairness some of that might be down to my wife getting so fed up with the massive increase in snoring decibels she pokes me until I roll over onto my side though

Symmit... The Quattro FX looks good so thanks for pointing that one out. It seems to get good reviews on the eu-pap website as well.


Next question - and perhaps a suggestion to you James as an update to the website... How would I know what size mask I needed? (e.g. the Quattro FX Symmit suggests comes in three sizes, others come in 4 ). It would be good to have a guide. I know I'm not comparing like with like but if I order a new motorbike helmet there's a pretty standard sizing guide so you can measure your head in a specific place and then you know what size you need. Sure, it's best to try a few on due to manufacturer differences but you've a good idea. I wouldn't have a clue what size to order and I imagine that returns policy says you can't return if you've opened.

I still can't decide if I'm excited or horrified at the prospect of CPAP but ANYTHING that gives me some energy back and the ability to think between 1 and 6pm I will be life changing. I'm happy to be joining the club

Sizing guides are what you need, some are downloadable PDFs, the QuatrroFX is a sizing device, go to the realsleep (resmed) website and you can order a sizing gauge from there.

They also vary manufacturer to manufacturer, so get the sizing gauge for the masks you're going to buy, but the nice thing about some is that they are one size fits most (I've got a sleepnet IQ which I keep as my emergency standby, but it's too small for my nose, and a sleepweaver which is the best thing I've tried so far, both these only come in one size).

I was excited and horrified in equal measures, and my wife was also, but she'd not give up the snore-free nights now (and will wake me if I fall asleep without masking up!)

[James @ Intus]

Thanks for the initial and quick replies.

No problem. And thank you symmit for jumping in too.

Points noted with regards to the DVLA. My motorbiking days into central London are over until this is sorted out and all I use my car for is driving 1 mile to my son's nursery first thing in the morning before getting the train to work and 1 mile home at the end of the day. For a whole variety of interlinked reasons both work and family related life is going to be next to impossible if I lose that ability so forgive me if I'm not desperate to lose my licence for the sake of a week or two of wait. One of the reasons I am looking to sort treatment out as soon as I am able. Trying to take a common sense approach here.

Yes, your approach is understandable. But we don't want to create a culture here where people get encouraged to dodge the rules. So stating the facts is the best we can all do which will then help you decide how to best maneuver the obstacles in your way.

>Do you often wake up with a dry mouth? Are you known to be a mouth breather? Do you often get sinus issues?
Definitely a mouth breather. I have allergic rhinitis and have done so pretty much my whole life so often have blocked nose and it's usually with some resistance I breathe through it. This is no problem when I'm awake and I can usually breathe through one nostril fine when I doze off (I tend to at least start to sleep on my side) though when I wake up my mouth is often wide open and the drool on the pillow says it all. I often wake with a dry throat as well though not noticed it so much with my mouth. As my nose blocks easily and I definitely favour mouth breathing I think that rules out a nasal pillow/cushion type at this stage.

In that case, a full face or hybrid type mask will be your safe-bet option. But you will also want to look up threads about the SinuPulse Elite. Highly recommended for people like you with chronic sinus problems. The reviews on Amazon spell that out!

With your sinus issues in mind, a humidifier will also be a favourable option though in the case of the REMstar System One and many others, it can be connected to the Auto-CPAP at a later date.

>Do you roll around much? Do you side sleep alot?
I think I roll around enough that I would need a mask that is designed with this in mind. I occasionally sleep on my back but most of the time I sleep on my side - though in fairness some of that might be down to my wife getting so fed up with the massive increase in snoring decibels she pokes me until I roll over onto my side though

That latter reason should diminish the moment you flick the machine on As you've established you probably need a full face or hybrid type mask, your active/side sleeping slightly clashes with this need for the bulkier mask. So you'll have to see how you go. Hopefully you will be OK on your back (though back sleeping isn't the best for OSA either) but with accessories like special CPAP pillows and Hose Lifts for example, you have other options to facilitate that type of sleeping and minimising leaks.

Symmit... The Quattro FX looks good so thanks for pointing that one out. It seems to get good reviews on the eu-pap website as well.

That's one of the smaller full face masks around so that could be a good choice indeed.

Next question - and perhaps a suggestion to you James as an update to the website... How would I know what size mask I needed? (e.g. the Quattro FX Symmit suggests comes in three sizes, others come in 4 ). It would be good to have a guide. I know I'm not comparing like with like but if I order a new motorbike helmet there's a pretty standard sizing guide so you can measure your head in a specific place and then you know what size you need. Sure, it's best to try a few on due to manufacturer differences but you've a good idea. I wouldn't have a clue what size to order and I imagine that returns policy says you can't return if you've opened.

All manufacturers tend to be very slow with making the PDF sizing gauges available. ResMed simply don't have the digital ones yet though they'll be happy to send you a physical one. But you can use the old style Quattro sizing template instead, as it closely matches according to users of both masks. See fitting template in the right hand column here.

Mask sizes, much like shoes, vary wildly between brands and even ranges though. You can never say "I'm Medium" across the board. We will have a few updates coming which make more gauges available, but there will always be an element of ambiguity in mask sizing unfortunately. Most masks come with a physical sizing gauge in the bag so before opening it, you can triple-check once more. And if you are still worried, the FlexiFit 432 is a great all rounjd Full Face mask, and comes with three size seals in the box!

I still can't decide if I'm excited or horrified at the prospect of CPAP but ANYTHING that gives me some energy back and the ability to think between 1 and 6pm I will be life changing. I'm happy to be joining the club

Many here have made their CPAP their best friend and have come to rely upon it a lot. They wouldn't want to go without. Spend any day in the office here and you'll get an American gent on business or holiday who either lost, forgot or broke his mask/machine and is in sheer panic as the holiday/business pitch will be ruined without. CPAP is a life changer but as with most things in life, you get out of it what you put in. With some homework, effort, determination, hanging out here and perhaps a bit of money invested too you can find a balance that will get you the most out of it. It's on and upwards from there.

You may even want to plan ahead for what has been dubbed here as the "lamb in spring effect". Wifes went from complaining about "him being useless, always sleepy" to "him being annoying as he has so much energy he acts like an 8 year old on Christmas morning".

[Anniett]

You may even want to plan ahead for what has been dubbed here as the "lamb in spring effect". Wifes went from complaining about "him being useless, always sleepy" to "him being annoying as he has so much energy he acts like an 8 year old on Christmas morning".

I can so identify with that! After only 2 weeks on my machine, my poor husband is no longer suffering from my disturbed sleep but is finding keeping up with my chatter and holiday plans for long walks quite difficult to adjust to! He does say that he prefers it to the 'old' me who didn't really want to do anything except 'relax' while we were away or just watch tv at home. We now wonder whether my poor sleeping was causing his disturbed nights or whether he too could have a problem with sleep apnoea as he just can't keep up with the new me!

[Grumpy]

Apap

Just taken delivery of a brand new APAP about 5 minutes ago. I've been using a hospital supplied CPAP for about 15 months now with mixed results so decided to go for one of the Rolls Royce options.

Don't let anyone kid you; you WILL need a humidifier and you WILL want a heated hose. The F&P Icon (as sold by Intus) and the ResMed S9 AutoSet (as sold by RealSleep) don't require an extra power supply for the heated hose. The RemStar claims to have an alternative method of eliminating RainOut which I am dubious about; not sure whether the heated hose sold by Intus is compatable with that machine.

[RainOut: when you add a humidifier to a CPAP/APAP machine to overcome the problem of pumping dry air into your nose and mouth then there is a potential for condensation inside the pipe. Turn over in bed and straighten out one of the kinks in the pipe and you get a faceful of water!]

I think the best chance of getting a mask that fits first go is the Quattro FX (£135 including p&p); simply ask RealSleep (www.RealSleep.co.uk) for a sizing guide and it will arrive next day.

My first recommendation though is to buy a SinuPulse which will make an enormous difference to your life; my best ever purchase. Once you can breathe easily through your nose your apnoea problem will improve. Read the SinuPulse thread for more info/plaudits.

I would wait for the hospital to supply your first CPAP/APAP kit; as they will be able to provide multiple masks for you to try. The hospital may also have a preferred machine if you decide to buy your own APAP (note that the hospital will need to view stats from the machine at least once a year for you to be DVLA compliant). If you want to view the stats yourself (on a PC) then the software for the S9 is freely available; Phillips charge £99 for the RemScan software and its hard to get hold of the ICON software (may get easier, its a new machine).
The hospital then will continue to supply you with replacement masks and possibly the filters for the machines air intake.

The total cost of my new kit was £620.15:
Resmed S9 Autoset + Climate kit (Humidifier and heated hose) with 2 spare filters and P&P
Note that the sleep clinic had to sign the order form so it will probably be difficult to buy a machine until you have been to to see them anyway.

Good luck!

[DanJayUK]

Guys, thanks a lot for the time you've taken to provide me with answers to my many questions. It's forums like this that make these things a lot less daunting and also help newbies like myself not to make (potentially costly) mistakes.

Some updates...

I do have a lot of trouble with my sinuses - pressure under my eyes, stuff moving from one side to the other whilst I am rolling around trying to get to sleep, frequent colds etc so... a brand spanking new SinuPulse was ordered yesterday afternoon and presumably will be on its way to me very shortly. I'll let you know how I get on.

I have requested a sizing guide from RealSleep for the Quattro FX mask which I am told is on its way. I'll see how I get on with that when it arrives and then make a judgement on whether I'll go down that route or get a FlexiFit 432.

I now have a confirmation from my consultant that I am referred for APAP treatment (so I can proceed and buy)

London Chest Hospital are not an easy place to deal with. Typical consultant secretary who never answers her phone (what is she being paid for?) and no return calls either. The switchboard are equally useless and just dial you through to another secretary who guess what... Doesn't answer her phone! The consultant who referred me originally, both he and his secretary couldn't be easier to get hold of so this is disappointing. Anyway, onwards and upwards.

Couple more APAP questions...

I really like the look of the SleepCube option - not in the least because of i) 3 year warranty ii) SmartFlex and iii) the whole SmartCodes/reporting thing (saving giving Philips another £99 just to use their software!). So...

I would want to start off with some very basic, potential default, settings but in the long term would want to be able to make some adjustments once I'm used to everything. Can I do this on the SleepCube easily?

Where would be a sensible place to start from a settings perspective? If I were, for example, to order through Intus then I can specify initial settings on my APAP machine. If the response is going to be "start at the default settings and see how how get on" then I'll highlight why I'm asking...

SleepCube... default min = 5, max = 15, ramp up = 20 minutes

REMstar... default min = 4, max = 20, ramp up = immediate

Quite a difference! I guess I'm surprised that two different machines have quite different default settings.

[James @ Intus]

Couple more APAP questions...

I really like the look of the SleepCube option - not in the least because of i) 3 year warranty ii) SmartFlex and iii) the whole SmartCodes/reporting thing (saving giving Philips another £99 just to use their software!). So...

Note that both the SleepCubes and the REMstars have optional software. The SleepCube indeed uses the SmartCodes which you can e-mail across and the REMstar uses an SD card which you can post in if you don't have/want to buy the software. If you know your way around PCs, you can even zip up the data and e-mail it over. Note that when the SD card is out of the machine, it'll continue to log data.

I would want to start off with some very basic, potential default, settings but in the long term would want to be able to make some adjustments once I'm used to everything. Can I do this on the SleepCube easily?

You'd normally not get the instructions to change the pressure yourself, but it's easily findable online. If you were to get the machine form us, we'd happily assist you too, suggesting any tweaks based on the stats and your own feedback. Quite often we can then indeed narrow down the Auto-range to minimise leaks, AHI and discomfort.

Where would be a sensible place to start from a settings perspective? If I were, for example, to order through Intus then I can specify initial settings on my APAP machine. If the response is going to be "start at the default settings and see how how get on" then I'll highlight why I'm asking...

Yes, default is a perfect start. You don't know yet whether you need 6 or 14.

SleepCube... default min = 5, max = 15, ramp up = 20 minutes

REMstar... default min = 4, max = 20, ramp up = immediate

Few people need over 15. If you need over 15, the SmartCode report will quickly flag this by showing a plateau time at max pressure. Avoiding the 15-20 range tends to avoid gale force winds which don't serve you too well initially. But the REMstar at 4-20 will rarely go to 20 if you really don't need it. So yes, the settings seem to vary a bit, but in practice you won't realise it much.

Quite a difference! I guess I'm surprised that two different machines have quite different default settings.

I wouldn't read too much in to it. Whether 4-20 or 5-15 the default pressure tends to be just fine for a large proportion of people and if not, the tweaks are easily applied based on the stats and your feedback.

[DanJayUK]

I am now the proud owner of a SleepCube Autoadjust (beautiful piece of kit) and a F&P 432 mask. I seemed in-between sizes on all masks I looked at (small to medium) so I thought as the 432 comes with small medium and large fittings it'd be the best place to start. Small seemed to fit the best in the end.

I had a few goes with it during the day on Saturday so I could try the experience and get the mask to fit properly. No real problems.

Went to bed at 11am and simply couldn't get off to sleep with it. Gave up at 4:30am It's a bit noisy (the valve that allows you to breathe should the machine stop being the main culprit) but no worse than being on a 'plane. Not sure it was that keeping me awake though to be fair - I guess I was just overwhelmed and a bit depressed by it all once the initial excitement had waned.

I couldn't risk it again last (Sunday) night as I need some sleep before work, even if it is of low quality, so I went without. I have this Friday off work so will try more over the coming weekend.

Any tips on how I can make this more bearable and ease me in to this?

I can see me (seriously) taking up the didgeridoo as I'm really not sure I'm going to get on with CPAP...

[Tigers Fan]

Hi

Read the forum - look for newbie threads and posts and read the 'Must read for Newbies' thread.

The answer is perseverance. The stick is that, once diagnosed, you cannot lawfully drive until you are successfully treated for OSA. The carrot is the new lease of life, the energy, the alertness and joy of being alive that returns with a few nights of good sleep.

Try practising in the evening before bedtime - several hours with mask and pressure. If you really can't get on with it, take some holiday time and tratise more till you get the hang of it. CPAP is a major adjustment for your body and brain to get used to.

TF

[James @ Intus]

Hi Dan,

It's a bit like with learning anything new. Set some small targets so you get a few "wins".

Don't aim for a whole night use. Just a few hours, increased by say half an hour every other night will set you on a good path.

It helps many people to simply wear the mask (nothing else) for half an hour before bed, when watching TV. It's argued that it will help the mind to accept this foreign contraption.

If the sound causes anxiety, some earplugs could help with that, but in truth, most people come to accept any noise levels just fine.

So aim low, I'd say. I can understand the excitement, with subsequent anti-climax, but CPAP is never easy so perhaps you jumped in slightly overenthusiastically. So scratch this weekend's experience, start again, set a small target to reach in terms of hours used and build it up from there.

I'll send you some free Small RemZzzs liners for that mask to get you up to speed with mask-bliss.

[symmit]

The F&P valve is a bit noisy, but if my experience is anything to go by you'll actually do better with the F&P at a higher start pressure, at low pressure it flaps around and is a bit noisy. You soon get used to the noises though.

Take a few days off if you can - it's going to be beneficial in the long term so try and get a long weekend.

Don't give up - it's worth it!

[DanJayUK]

Thanks for the words of encouragement guys. I guess I need to take it a little more slowly and persevere.