Moving on from CPAP

[GaspForAir]

I've been using CPAP therapy for about 17 months. My machines have been the ResMed AirSense 10 and AirCurve 10 ASV.

I've tried 7 different masks and currently am using the ResMed AirFit F30.

Although I had some initial success after moving to the AirCurve 10 ASV, I find I am sleeping poorly and feel it during the day. The OSCAR results show that when the mask is in use my AHI is less than one, I just cannot tolerate the mask or system. I either take the mask off after a few hours of sleep or wake up after 5 or 6 hours and that's it for the night.

When I stopped using CPAP in January I instantly started feeling better, but in looking at my initial SNAP overnight oxygen study, I think I probably need to continue some form of therapy.

Has anyone stopped using CPAP in favor of mandibular advancement or Inspire? How did that work out for you?

Thanks!

[SarcasticDave94]

I've not had any other treatment. I will say I've looked into alternate treatments with an ENT as I was about to try BPAP. He told me PAP type would be best results. That was before my central apnea was revealed and then COPD as well. I've moved on from my ASV because of COPD and getting a NIV soon.

I won't attempt to talk you out of your plan, but there's been some here that's gone those other routes with mixed results. Some it's working and others it's failed. Those where it works it seems they had low apnea to combat. Those who have moderate apnea and worse those alternatives tend to disappoint.

[Crimson Nape]

Searching the Main forum, using the term, "mandibular", it returned over 300 posts on the subject.  Using the term, "Inspire" returned 240 posts.  From my (feeble) memory, it seems that the MADs created their own problems with jaw and teeth alignment.  The Inspire device just delays the use of a CPAP, at best.
http://www.apneaboard.com/forums/search....order=desc

http://www.apneaboard.com/forums/search....d=0&page=4

[GaspForAir]

Then what's a poor boy to do?

[SarcasticDave94]

Just trying to help here, I had a similar experience early on in apnea therapy that when I had plain Bilevel I was better for not using the PAP because my therapy needs were above BPAP. Mine was due to the wrong machine. Maybe your issue is similar in the sense that you are on the wrong PAP machine. I had talked to an ENT in 2015 when I was trying to avoid PAP because the first encounter with CPAP was terrible. The ENT said nothing but the right PAP machine could help me. Again maybe your best bet is to find the right PAP machine, get it, and use it. And if you need to process with insurance, you need to have a doctor that is actually working to help you get that right therapy.

[Sleeprider]

Gasp, we should have figured it out by now, but what are we treating? Why does oxygen drop? Is this an obstructive problem or central or both? I remember seeing some of your past threads, but don't recall the details. I'm sure an appropriate therapy exists that can be tailored to be less disruptive. INSPIRE and MAD have specific mechanisms of apnea that they target, and usually with about 50% efficacy. The point of sleep disordered breathing therapy is to obviously address apnea and hypopnea that may be unhealthy, but it has to resolve the sleep disorder part of the equation, or it fails.

[GaspForAir]

Thank you for working with me on this! I don't know how you guys can find the hours to do this. I started using CPAP again last night, and although I got about 8 hours in with one trip to the bathroom during the night, I still don't feel so good today. Maybe it's all the days off (since January 19, 2020). I get about zero help from my CPAP doctor. I went to using an ASV machine on the suggestions from this board. The OSCAR readings have been terrific since then. See last night's report:
   
But many nights I can't tolerate it and take it off. Usually it's because it disrupts my sleep, uncomfortable, that sort of thing.

I'm going to ask my PCP (not CPAP doc) for a nighttime oximetry study which has never been done to see if it really improves my O2 saturation from previous studies before starting CPAP.

Any other suggestions?

Thank you!

[SarcasticDave94]

Maybe it'll help if you're running ASV Auto Mode with an EPAP range. It appeared to be in ASV mode. Instead of what appeared as EPAP 6 it could be EPAP Min 6 and EPAP Max somewhere about 12.

[verysincere]

Has anyone stopped using CPAP in favor of mandibular advancement or Inspire? How did that work out for you?

After full mask problems when I was first diagnosed in 2000, I was moved from CPAP to a Thornton Adjustable Positioner for about eight years. It was adequate for that period of my life but eventually my apnea progressed beyond what the TAP device could address.  In retrospect I wish I could have had nasal surgery back then instead so that I could used nasal pillows (as I do now) and spared myself the dental under-bite that persists unto this day. (I feel fortunate that I was not among those who ended up with serious mandibular complications such as TMJ.)

[GaspForAir]

I believe I am already in auto ASV.

Here are shots of the clinical menu from the Air Curve 10:
   
   
   

These are the settings I believe you and Sleeprider suggested back in 5/6/2020.