New Member - Hello! [how long before considering adjustments?]

[skiajl6297]

Get thee to an allergist!  He or she can prescribe drugs to help control symptoms and may be able to recommend other measures that would help, depending on what you’re allergic to.

I learned in January that I’m allergic to dust mites. Two nasal sprays and two kinds of pills are helping, and I’ve started allergy shots, which may kick in later this year.

Good luck!

No worries, allergies are being treated. I take two allergy nasal sprays twice daily, the Afrin use was on top of those!

[snorybob]

AFAIK the Resmed P10 is the best pillow mask to use (beside ffm) when a person is congested if you can tolerate a pillow mask. 

The direct air flow to the sinuses does the job for many people.(decongest)  

I have a collection of masks including P30i & when I'm congested I go with the P10, more efficient than the N30i to clear my airways in a matter of minutes.  


        sb.

[Dormeo]

Good to know you're seeing an allergist! Just fyi, in addition to my two sprays, my allergist has asked me to use cetirizine (a.m.) and Singulair (p.m.).

[skiajl6297]

I had my follow up with my sleep doc, and here is where we stand. I was prescribed singulair 10mg for the first time to address my upper airway. I am deeply concerned with this rx because of the frequency it causes anxiety like side effects - anxiety which I am chronically battling. Already not keen to take this solution. Anyone with GAD think taking a medication known to cause anxiety/psychiatric events to unstuff your nose is a good idea?

He does not believe the "algorythm" used by Redmed auto cpap is superior to the one used by Phillips. He indicated that bipap would be used only for other circumstances/conditions, and that my particular scenario doesn't yet warrant bipap. He indicated that my results of sleeping a few nights using afrin, prove that he first needs to treat physiology before he can warrant any other changes to equipment, hence the singulair rx.

Also, he decided to change my auto max pressure given how many centrals and hypopneas I have had. I am now RX'd a range of 4 (low) -7 (max). I indicated that I was concerned that the Phillips machine doesn't provide the same level of pressure relief as the resmed, and he again emphasized that he isn't buying it. I was asked to try this new setup for two months, and then return to see how I am feeling.

Having now spoken with both my doctor and my DME, I get the sense that I am stuck with this machine, and that any changes will be slow going. Any thoughts from the community here? I didn't walk out of the appointment feeling like we had solved anything. I don't want more rx medications!

[ajack]

Both resmed and philips, "if" set up properly and equally able to treat apnea. Resmed is the more aggressive algorithm, they are a bit different. The EPR and flex also work differently. I agree with Resmed, Philips and your Doctor. In that cpap will treat obstructive sleep disordered breathing, including FL, Hypopnea RERA ect. Without the need to move to a bilevel for this. There are reasons for a bilevel, these aren't any of them.

See how the new pressures go, he may be waiting 2 months to see if the pressure induced CSA resolve? They resolve for most users within 12 weeks. He does have you low at 4min and 7max He is being very conservative and you may want advice sooner. I don't know how concerned I would be over 1.5 CA per hour as a new user?

I actually think a lot of the cluster of CA OA and H, are from positional apnea. If it was just a pressure induced CA, you wouldn't have the obstructive with them, nor would the pressure rise.
As well as the leaks, this is what I would work on for now. You can get a $10 foam cervical collar and read about supporting your neck to keep your head back and your airway open.

[Dormeo]

Anxiety is not a frequent side effect of Singulair. And keep in mind you’re not just trying to treat a stuffy nose; you’re trying to resolve an underlying cause of poor sleep, which affects your entire outlook on life.

So in your place I’d give it a try, but of course in the end that’s your call.

[skiajl6297]

Thanks for the encouragement all.

I plan to give the Singulair a shot, I only recalled hearing horror stories about anxiety, depression, suicidal ideation, etc. I suppose the only way to know is to try - I know many use it without issue. I am just an anxious person who already RX medicates to mitigate anxiety, so the thought of adding something to my routine that is known to exacerbate that condition is in itself anxiety inducing! Gotta love anxiety!

Finally - does it make sense to you here, given my charts, that a min of 4 and max of 7 would make sense? My 95% pressure, according to my machine, the last three nights is 7.7, 6.7, 6.5, 6.9 respectively. Just last Thursday my 95% pressure was 9, my max was 9, and my min was 5.

And finally - given this new RX of 4-7, should I try to change the A Flex setting again? I have it set to 2, after adjusting down from 3. Just curious what folks here would suggest.

[Dormeo]

I have a ResMed machine, so maybe there are some salient differences, but I have to say I found it really hard at 4 to feel that I was getting enough air when I was inhaling. In fact, anything less than 7 doesn't feel very good to me.

But everyone's different. You may find that 4 is just fine for inhaling. I would say you should give your doctor's suggestion a try and see what you think, bearing in mind that if it makes you feel you're not getting enough air on inhalation, you can experiment with raising your minimum.

Apparently your doctor wants to be careful about CAs, which seems reasonable to me. On the other hand, their frequency seems to be coming down for you, even with higher minima than 4. And as ajack says, there may be a positional element to all your events. So again, give 4 a try, but figure on changing it if you don't care for it.

I'll be curious how it goes for you with the Singulair. The one caution my allergist gave me was that at the start I might have "unusual" dreams. Perhaps through the power of suggestion, I had an amazing dream of great visual complexity the first night I took a pill -- then nothing unusual in subsequent nights.

[ajack]

I'd choose the flex setting most comfortable to you. Some find that flex on philips and EPR on resmed can increase new user CA and choose to not use them.

[skiajl6297]

Good morning all - mixed results yet again.  

I took singulair without incident, although coincidentally, I got a bad nosebleed yesterday evening and had to use afrin to staunch it, which of course left me with wonderfully open airways.  We will see how singulair works minus the afrin boost tonight.  No side effects of note after night one.

I felt air starved at times on the new pressure.  My wife noticed me making alot of noise again, and I think it was from fighting for air.  I actually adjusted pressure min from 4 to 4.5 prior to sleep just because I remember what 4 feels like - same with 7 as max - bumped to 7.5 to allow some wiggle room.  I think these charts are showing me that I bumped up against my max several times, and that the machine probably wanted to aim a bit higher than it was restricted to.  But I would appreciate insight from others.  It seems I need more pressure to prevent obstructives, but right around the 8+ pressure mark is where I see diminishing returns with increasing centrals - although I hoped to see centrals and hypopneas decrease with lower pressure ranges.

My obstructive count went up (12 total) compared to less than 5 total both prior nights.  Clear airway also went up marginally, but hypopneas remained steady.  Attaching some charts - this morning felt similar to the other mixed nights - definitely didn't improve how I feel, that is for certain.  Ugh!

Remaining patient!  Clearly made progress thus far, just want to get pressures dialed in.