Is a humidifier recommended?

[Snowman511]

I am a voice from the past, about 1999. Back then any humidifier, heated especially was downright rejected by insurance.

Studies were done showing pap treatment was much more sucessful with heated humidifiers.

Without a humidifiet a unusual ammount of relatively low humidity air goes thru you. Your body and lungs are about 98 deg F. Most air intake with any pap is lower relative humiditu meaning your body will add humidity, usually causing some kind of dry mouth, the highet the pressure the worse it gets. 4-6 pressure msy be ok, higher not so good.

A heated humidifier is grossly misunderstood. Every gram of water that evaporates takes about 540 cal of heat with it. Only one cal of heat is needed to cool the same ammount of water 1 degree. In other word's without additional heat the water would quickly freeze! Of course it dosen't, it just stops evaporating and you no longer have a humidifier.

My point is that a heated humidifier shouldn't make your air hotter it just keeps the humidifier working. If it is actually warming your air, turn it down, not off. The additional air pushed thru your nose is not natural and you should not expect a contraption, without proper humidity to work.

[davidcmoors]

Being able to analyse sleep data in more detail, via Rescan in my case, was beneficial.
I was troubled by early awakenings. I was able to attribute many of these to long obstructive apnoea which coincided with waking early, caused by a blocked nose. (Nasal pillows mask).
This issue only started when I changed my Resmed S8 Autoset for an Airsense 10 with climate line tubing. It's standard SD card enabled me to use Rescan to view my detailed data.

With the S8 and the humidifier set to about 75% of maximum, the water chamber would be about 10% full at the end of a typical night. I was not much troubled by early awakening with that CPAP, nor by a blocked nose at night.

I was surprised to find that with the Airsense 10 and humidification level and tubing temperature set to auto, the water chamber would always be 50% full at the end of a night, and I would often wake early with a blocked nose, or at the usual time with much more nasal dryness than with the S8. Experimenting with manual humidifier settings, I found that with humidifier set to 6 and tube temp to max, the problem was reduced but not eliminated, and the water chamber would be nearly empty.

Coincidentally I had an ENT appointment for an unrelated issue and discussed this with the surgeon. He indicated that my nasal turbinates were enlarged, one side more than the other, and might contribute to a blocked nose if CPAP temperature and humidity were not optimal. I finally (after several cancellations due to COVID lockdowns) managed to arrange turbinate reduction by RF ablation. This was a painless and quick outpatient procedure, and effective after a 3-4 week healing time. Since then I've had almost zero awakenings due to un-supressed respiratory events.

[SarcasticDave94]

You could also turn the humidifier and heated hose to manual and turn up those settings to something that gives more moisture. This sounds likely less painful than surgery. No surprise ENT would rather get out the scalpel than suggest adjusting the humidity.

[davidcmoors]

1. I found that turning up the humidity and tube temperature was effective, but caused rainout, which was fixed by a tube cover. I can't say I'm too impressed with Resmed's "improvevments" to humidification. Each new machine series gets slightly more compact, with a smaller water capacity than the previous model, and the default humidity settings are not effective for me. I have to experimentally tweak the settings to provide optimum humidity, whilst ensuring the humidifier doesn't run dry. It rather defeats the object of automated humidity sensing and climate line tubing, if the automation results in consistent nasal dryness and only ever 50% water usage. Is my machine mis-calibrated, or does everyone have that issue?
   
   I did ask Resmed the question and their answer was just to try different settings, and provided no comment on the lower water usage compared to the earlier model.
   
   I preferred my S8 model in that respect, and only changed it because the H3i humidifier lid part needed was no longer available. The H4i humidifier was also a backward design step in the sense that the water chamber would self-destruct regularly if opened for cleaning, so I reverted to using the H3i until it finally died.
   
   
   
2. No turbinate surgery or scalpel was involved, and it was actually my own suggestion. The only problem was finding a hospital with the necessary equipment. Just like a few injections after a local anaesthetic, but of radio waves, which over the next 3 or 4 weeks cause the turbinate tissue to shrink, improving nasal airflow. For the first time in my life, I can now breathe equally through both nostrils, and nasal CPAP effectiveness is improved. Previously a nasal pillows mask would sometimes pop out of one nostril if the restricted nostril became blocked. Problem now solved.
   
   
   
3. I could post Rescan results, but it would not show anything useful, as my AHI on CPAP is very low anyway, and it was only my own manual correlation of long un-supressed apnoea with the exact timing of frequent early awakenings that enabled me to prove that nasal obstruction was often causing me to wake up very early. Changing to the Airsense 10 machine + Rescan allowed me to prove that, as previously I had no means of analysing the S8 data.