Feeling like I cannot breathe

[Jay51]

Non - prescription Flonase might help and be a good place to start.

[vgrando]

[attachment=52628][attachment=52629][attachment=52630]Hi, I also have a deviated septum! I use Flonase at night and an allergy spray in AM.

Last night I changed my settings to straight CPAP with a pressure of 7 and a nasal mask. It was great. No mouth tape, no neck collar (too hot now), low leaks, and low AHI. Very low OA. I slept better but got up in the early morning to go to the bathroom. 

My oxygen readings vary.  Last night: below 90% for one hour; and 86-90% for two hours.  But the night before, below 90% for two minutes!

[Jay51]

Your OSCAR charts still show an EPR of 3 full time (even in straight cpap mode).  Reducing EPR to 2, 1, or even 0 can reduce the number of central apnea events.  Give it a try if you want to.  (I have a deviated septum also.  Difficulties with nasal breathing most likely contribute to hypoventilation then).

[vgrando]

I will raise the CPAP pressure to 10cmH20 tonight and use a nasal cap because my 02 levels are much lower since I went on straight CPAP at 7cmH20. The Titration study controlled my OA at 10cmH20.  

Most CA occurs when I wake up during the night. I am sleeping somewhat better. 

Oxygen with CPAP at 7cmH20.
07/31/23:  oxygen <90 for 1 hour 12 minutes (with supplemental 02 at 1 liter)
07/30/23:  oxygen <90 for 1 hour 36 minutes
07/29/23:  oxygen <90 for 1 hour 57 minutes
07/28/23:  oxygen <90 for 1 hour 05 minutes

Oxygen with APAP 11 to 14cmH20
07/27/23:  oxygen <90 for 0 hours 02 minutes
07/26/23:  oxygen <90 for 0 hours 33 minutes
07/26/23:  oxygen <90 for 0 hours 0minutes

[Jay51]

That made quite a difference in your SPO2 levels (going down to 7 with EPR 3 full time) vs. APAP 11-14 (with EPR 3 full time).  Lowering your pressure did decrease CA's, but at far too large a cost.  

Another experiment may be APAP 11-14 with EPR of 2 full time one night.   Then APAP 11-14 with EPR 1 full time another night.   Then finally APAP 11-14 with EPR off if you want to try this. I know you are trying to balance sleep comfort with SPO2 levels and CA's.

[Jay51]

Okay. I see your plan and thinking now.  Good plan.  Straight cpap mode is more comfortable than APAP for you.  You like the EPR of 3.  EPR is the difference in pressure when you inhale vs. exhale.  The exhale pressure lowers by 3cm to make it easier to exhale - less pressure to exhale against.  With EPR turned off (0) the pressure stays the same 100% of the time in Cpap mode.  Reducing EPR usually reduces central apneas.  But it is probably more comfortable for you to use EPR 3 full time.  

You are trying straight cpap 10 tonight (with EPR 3).  Then probably:
cpap 11 (EPR 3)
Cpap 12 (EPR 3) 
Cpap 13 (EPR 3)  then 
cpap 14 (EPR 3)

Good plan.

[vgrando]

Thank you!

I switched to straight CPAP, thinking that the APAP algorithms had difficulty interpreting what was happening when I wake-up at night.

I kept EPR on because it assists with ventilation. Maintaining ventilation is more important for me than eliminating a small number of central apneas. I am not worried about the CA because, most of the time, they are below 5. But I am worried about my 02 levels and low Tidal volume.  My Tidal volumes continue to be low while I am sleeping. 

My pressure setting was too high from the beginning: 5 to 20 cmH2O. I had an awful time. Air would fill my checks and poop out of my mouth all night. And my mouth was extremely dry. I got 3 hours of fragmented sleep out of 7 hours in bed.  

Does this make sense?

Last night I wore the F&P Evora FFM, which usually has minimal leaking. But not last night, maybe because I tried to keep the mask not as tight as I was doing. I will keep it the same as last night but switch to the Nasal cap mask. I put on a Breathe Right nasal strip for sensitive skin, but my nose was swollen in the AM. I am allergic to Band-Aids! 

Last night, my 02 was better. >90% for 25 minutes with a low 88%.  The other nights I went to a low of 83%.



 

[Jay51]

What you are doing makes sense to me.  I struggled with variable pressures early on also.  Finding your "sweet spot" for a single EPAP that works best for you may enable you to sleep better and not wake up so much during the night from the pressure changes.  I eventually got used to an EPAP with a min and max (variable); and an IPAP with a min and max (variable pressure support - PS).  

When I was first diagnosed with severe sleep apnea, my PCP got me one, single visit approved to see my ENT.  He put the camera down my nose and said nothing looked bad structurally; and the only thing he could do to help me would be to get me on Inspire.  I decided against Inspire after reading a lot of threads and independent research of my own.  

My Pulmonologist basically said that my lungs are "good enough".  He changed me to seeing him only once a year - and the main thing we do is going over a year's worth of Evo ventilator data (he is the only one who gets this data - not even my RT looks at it). 
 Pulmonologist referred me to Allergist.  Allergist found dust mite allergy.  That opened the door to 6 more visits with my ENT.  My sinuses are fine by a CT scan ENT did.  A problem for me (and maybe your problem also) is that my nasal valves (and/or nasal cartiledge) may be collapsing when I inhale (the 1st part of my nasal cavity has gotten narrower when I inhale).  I have purchased nasal dialators called "Turbine" - for athletics; and some silicone rubber (thimble - shaped) ones, and they keep my nose much more open when I inhale.  The Turbine goes farther into my nose, and the silicone one more on the lower end.  Probably 50% or more.  He may do a surgery to help this also he said.  I have been doing a little nasal rinse (distilled water and saline packet) every 2 hours and it has almost completely cleared up any mucous, etc.  All of this effort has been worth breathing about 50% better through my nose.

I wrote all of that because it may help you (we have similar nasal breathing anatomy and breathing style).

[vgrando]

I increased the pressure to 10 and used V-Con. However, my 02 levels are still low. Last night, we had loud thunderstorms that kept me awake for hours.  And as usual, I desaturate while awake and on the CPAP.

I think that I need to increase pressure to reduce desaturation.

I will set the machine to CPAP tonight, use a nasal cap mask (most comfortable for me), not tape my mouth, wear my neck collar, connect the V-Con, and set the pressure at 14, EPR 3 full-time.

Hopefully, with this configuration, the V-con will control my mouth leaking. And my 02 will be higher.

[Jay51]

This experiment tonight should prove exactly how well you are able to breathe on your own with an open airway.  It will show your:  1.  Respiratory rate, 2.  Tidal volume, and 3.  Blood oxygen saturation (SPO2).