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Thank you SO much Sleeprider, your description of what's happening is very reassuring. Your experience & knowledge are truly so valuable. I also just spoke with my CPAP provider who was able to call the lab that did my sleep study, and my pressure is now being changed to 5-10, with a review in a week. They said not to worry about CA's or CSR because my OSA is being treated and CA's are not over 10 per hour (even though in reality they are in clusters not spread out over the whole night).
Do you think the lower max pressure will help the periodic breathing issue? I think the pressure spikes are what is causing me to wake and feel like I need to take a break from the therapy but I'm not really sure. I assume the air flow limitations are coming from my actual physical obstruction in my nose (I can only really inhale with one side especially last night). What I do not understand is how my obstructive apnea's are being controlled in that case? They definitely are being controlled as I started with an AHI of 77 with majority being obstructive, and I'm down now to about a 6.5 but those are almost all central, with my obstructive apnea's being less than 1. So CPAP is working in one way, right? But not optimized? Am I understanding that correctly in your opinion?
Hard to predict the trajectory of CA events, especially in the early phases of therapy when you are still adapting to the greater ventilation, but they are generally not very stressful. Your description of the flow limitation obstruction is really helpful. Have you tried using Flonase (fluticasone propionate)? It can reduce inflammation from many sources and is especially useful for allergies. There are few if any side-effects from long term use, and it may help your nasal obstruction.
With periodic breathing, we are trying to avoid swings of CO2 which result in increases and decreases of respiratory drive. Many times that is accomplished with a more steady pressure, or even enhancing the expiratory rebreathing space which conserves some exhaled air for rebreathing. I don't think we need to worry about that at this point and the flexibility of your revised prescription should allow us to narrow down what works best.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Ok thank you Sleeprider!
I take Avamys which from my understanding is very similar to Flonase. I also take an antihistamine every day just in case but I don’t think the obstruction is allergy related. I think it’s structural, awaiting my ENT consult in March or April.
In the meantime I’m trying to use the cpap as best I can and so far have not been able to sleep through the night.
I’ll see how the next couple nights go with the new pressure range and go from there.
Thank you again so much!
Hi all, I wanted to post a little update. After I had my pressure change last week I also decided to go to the urgent care clinic and have my nose looked at. It just seemed like my blockage was getting worse and since I have a couple months to wait until I see an ENT I wanted to make sure i didn't have an infection or something. Turns out I DO have an infection going on and lots of inflammation. I was put on antibiotics and decongestant. The Dr also reiterated that I definitely need to see the ENT as the inflammation in my right nostril is very severe. He couldn't see a polyp but he mentioned of course he can't see as far inside as the ENT will be able to. Ironically it is actually my left nostril/left side of septum that is showing signs of infection. Anyways all of this to say the Dr acknowledged that CPAP use won't be easy with these nasal conditions and perhaps the air pressure caused this infection or exacerbated existing irritation. Validating for sure but I still need to treat my sleep apnea so still trying my best to use my CPAP through the night (after giving my mask, hose, and humidifier a good clean!). I can't say that my pressure change has made much difference, I am still not able to sleep through the full night, but I did have a couple of personal bests the last two nights in terms of chunks of time with the machine going. Last night I had my best chunk yet at 2hrs 45mins. I'm posting a screen shot of my oscar data from last night.
When I look at the pressures now, I notice that aside from when I am clearly still awake, my pressure is never staying at the min (5). Previously Sleeprider had recommended a pressure of 7-9 and I do definitely agree that a smaller range with a higher minimum would work better for me. Maybe with a short ramp while I settle into the mask. My sleep dr and CPAP provider both seemed to think that either a wider range (5-10 which they approved) or a set pressure (they originally said 9 but I think now might say 10) would be better but I am not clear on why.
One other setting that I have been having trouble narrowing down is the tube temp & humidity. I prefer the humidity at a setting of 5 and I think that is better for my nose, however I keep getting condensation in the hose at that level and have to turn it down to 4. The temp in my room is about 19 degrees celsius and I have the tube set to 21 degrees celsius. Any tips to be able to increase humidity without getting condensation?
Thank you everyone for weighing in on my sleep saga here! Appreciate any advice I can get!
Another update today with screenshots from Oscar. I zoomed in a few time periods where I was having clusters of events and I think periodic breathing? I'm still struggling to understand how my events relate to my flow limitations and why I seem to be having clusters with so many CA events. For example just after 12:29 I have an obstructive apnea but showing no flow limit at that time or just before? Then in the period from 1:08-1:12 I have a cluster with all types of events and there is some flow limitation which clearly causes an RERA, but then the flow limit goes down before the obstructive event occurs? 11:26-11:40 tons of CA's, periodic breathing?
Any insights?
Thank you!!
Your pressure min looks too low but hopefully someone can look at your graphs and comment... But two thoughts. Try Sleeprider's suggested settings on your own first, he's got the experience. It makes less sense that your docs want either a wide range or a fixed pressure. They are likely trying things that sometimes work with patients.
Smart to go into the ED. It makes sense to me that the better nostril got infected; it's taking more of the load. Irritation I believe can make nasal tissue more susceptible too. That happens for me also. I recently started nasal rinsing and just started Flonase, you'll have to decide yourself if those are appropriate. I find .6-1.2g daily supplemental lysine , doubled with signs of infection, to be helpful in keeping my infections gone over time too. But I may be in a different situation so do your own research.
Thank you for your input TechieHippie! I am heading off to my CPAP supplier today as they are loaning me a different full face mask to try out while I have this infection. My current mask is the F30i hybrid full face with the nasal cradle, which still pushes air right up the nose, so I am going to see if the more traditional full face mask works any better with my nasal issues.
Saline rinse has been my best friend this past month, I have a cordless irrigator from amazon that is absolutely wonderful (let me know if you want the info on it, I find it works much better than netipot to push the rinse through both nostrils). I also use Avamys every day which I understand to be quite similar to Flonase. I will look into the lysine supplement, thank you for that tip!
Back to tube temperature, I use se8tting 4 with tube temp at 27*C (80*F). Seems to work to avoid condensation. I also use a fleece cover on the tube which makes it a lot more comfortable when it contacts my face at night.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Thanks Sleeprider! Sounds like I may have my hose temp too low, I will try turning it up a bit tonight! I've been reading about the hose covers too, seems like that would be a good addition to my set up.
Last night was my first night trying the more traditional full face mask - I tried a F&P Simplus.
So...I had my machine on for 6 1/2 hours, but the exciting part was I had my very first good stretch at 4hrs40min. I woke up around 4am and couldn't believe I'd been asleep for so long! It felt amazing lol!
Now the weird and confusing part...when I looked at my Oscar data this morning, I was shocked to see I actually had terrible flow limits and my pressure stayed close to 10 pretty much all night. I've never seen my flow limits so high, and yet I slept the most I have so far with CPAP.
I've attached some screenshots of my night plus close ups when my flow limit was at it's worse, and I was having clusters of RERA's. I slept through these though as far as I can remember.
It will be interesting to see what happens tonight. I think that this mask has put a lot less pressure on my nasal tissue, so I am going to continue to use this at least until my infection has cleared. But maybe it is not doing as good a job at clearing my flow limits?
With a full face mask, the volume of the mask airspace is greater and the machine response feels diluted by that. It is common when moving between nasal and full face that the user may benefit from a change in pressure range of +1 from nasal to full, or -1 from full to nasal. These are real flow limits and the fact they are clustered, suggests a positional misalignment of the head and neck. We could call it chin-tucking, but it's really any position that restricts airflow. While higher pressure can help keep the airway open, it generally won't overcome a severe positional misalignment, which is why so many members have to make adjustment to their bedding or use an aid to maintain better cervical alignment, i.e. lower, flexible pillow, avoid incline, use of soft cervical collar. If you have not already done so, read the positional apnea wiki https://www.apneaboard.com/wiki/index.ph...onal_Apnea
I think you would benefit from higher pressure and more EPR. Your current pressure is 5-10 with EPR 2. I would propose 7.0 to 12.0 with EPR 3. The expiratory pressure reduction of EPR 3 partially offsets the feeling of higher pressure, and I'm certain your results will be better with these higher settings that actually translate to a comfortable range of 7,0/4.0 to 12.0/9.0 (inhale/exhale) in bilevel terms.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
