Newbie - Stuffy nose turning me into mouth breather

[Bert S]

Hi

Been on CPAP for 2 months now and still struggling with nose breathing. For background, I consulted an ENT doc before starting therapy and there are no issues with my nasal passages.

Before I go into detail, I have a basic question: does a stuffy nose that restricts breathing "count" as an OA? If so, I know what my problem is.

For background, I am not a mouth breather naturally. Breathing through my nose is fine without CPAP. 
  
Since I am not a mouth breather,  I have been using an N20 mask and also a P10, with taped mouth with small slit (BSN Cover-Roll Stretch, which works great). 
The pattern is always the same: I start out fine but after 2 hours or so I wake up  because I can't breath. P10 worse than N20. I tried different humidity levels with heated hose and increased pressure. More (5-6) humidity does not really make a difference. Maybe try low??

More pressure feels better initially but after a couple hours stuffiness seems to be as bad, if not worse - also, with higher pressure my CA's are through the roof leading to high AHIs.

I do not use EPR, nor Ramp. Am tolerating masks etc well. 

Any suggestions very much appreciated. 

Thanks everyone for being here!  

Bert

[DaveCar]

Might be worth posting Oscar screens, maybe some clue as to what is happening at around the 2 hour mark.
5-18 is a pretty wide range, it's possible that events are driving up the pressure , and maybe 5 is too low to begin with ?

FWIW, I found any kind of over-the-nose-bridge mask closed off my nasal passage in short order as I fell asleep causing me to mouth breath. I switched to the F30 mask (mouth and just under nose) and love the way it pushes my nose up just a bit to help keep it open, but its still over the mouth just in case I open my yap at night.

[Bert S]

Might be worth posting Oscar screens, maybe some clue as to what is happening at around the 2 hour mark.
5-18 is a pretty wide range, it's possible that events are driving up the pressure , and maybe 5 is too low to begin with ?

FWIW, I found any kind of over-the-nose-bridge mask closed off my nasal passage in short order as I fell asleep causing me to mouth breath.  I switched to the F30 mask (mouth and just under nose) and love the way it pushes my nose up just a bit to help keep it open, but its still over the mouth just in case I open my yap at night.

Thanks, Dave. 

Yeah, the auto settings are wide - ordered by sleep doc because I only had an in-home self administered sleep study - am self pay. 
Results: 1 central apneas, 98 obstructive apneas, 0 mixed apneas, and 158 hypopneas resulting in an  REI (Respiratory Event Index) of 29.8. The supine REI was 33.0 and the central apnea index was 0.12. The mean oxygen saturation was 94%. The lowest oxygen saturation was 84 %. Oxygen remained below 90% for 5.4 minutes, below 80% for 0.0, and below 70% for 0.0 minutes.
 
I have been conducting some fixed pressure experiments. Below is a screenshot at fixed level 5, no EPR, no Ramp Humidity auto and one at fixed level 9, EPR 3, no ramp, humidity auto. Massive difference.        

[Bert S]

...I am attaching a couple of Oscar screens with auto pressure 5-18 + machine settings. 
On that day I used an F20 with Airtouch cushion - as you can see, even though setting is auto 5-18, max pressure is usually right under 10 and CA are up at those higher pressures. Everytime it got up there, I woke up took mask off, went to bathroom and started again at 5.

Maybe I should do the following:
--Continue with F20 + order the F30 you suggested
--Narrow auto setting to 6-10
--Turn off EPR - don't mind, not too hard to breath against this kind of pressure          

[DaveCar]

Ya, that does look like a narrow pressure range between O's and CA's.
The fixed 5 (or a 5-8 ?) with no ramp seems like your best bet so far, but the pros will be around soon enough for better advice then I would be able to give.

Ramp just kinda gets in the way of therapy, it's sort of good for new users if they feel too odd with pressure but after that introductory period it seems best just to turn it off.

[Bert S]

Thanks.

[Bert S]

Still struggling with the stuffy nose during the night. 

Have couple of questions:

--Is a stuffy nose and the related difficulty breathing reflected in the OA score? I would think so, since it is an obstruction, but wanted to make sure. I almost feel that I have a nose-induced obstructive apnea now

--I have read that some folks suggest to blast through it with more pressure and pillow mask, but for me higher pressures result very erratic chart, tons more CAs and stuffy nose feels even worse. What am I dong wrong? 

--Maybe it is the humidity - should I use more or less humidity than the Auto setting on my Autosense 10??? Sleep tech says use less and use Flonase (think that is a bad idea) but ENT doc says use more - what is it? 

Any suggestions much appreciated!

[PilotCPA]

Hi Newbie,

I am not a medical person or making any recommendation but sharing my experience. I saw an ENT about two years ago for stuffy nose issue and CPAP. She recommended using Flonase each day. I have not had any problems since so that worked for me. 

Kind Regards

[Gideon]

Humidity is personal, you have to try both high and low humidity and see what works for you. I'm one of those that will let the pressure and a pillow mask blast through. Hasn't failed me yet, though seriously everytime I think, this is going be the time it fails.

[Bert S]

Thank you.

---

I will try high humidity settings over next few days. I am in New England so air is getting really dry now. 

Thank you all for your support!