Positive Suggestions Please

[AngrySparrow]

New to this site, not new to C.P.A.P. treatment.

My condition is changing, Heart Failure is increasing, I am very near to having COPD.  Resistive to using inhalers.  Since 199? I have repeatedly tried full face masks, they hurt my face and feel as if they cause my teeth to shift, my whole jaw aches.  Nasal cushions were sort of okay, I just alternated the size of the nasal cushions.

Due to assorted issues I did not use a breathing device for about 10 years.  Assorted Doctors did not believe I needed a Sleep Apnea device.  Yes, I was officially diagnosed through at least three Sleep Lab Studies, along with hospital admissions statements 

Currently after two COVID attacks and my lungs completely filling with fluid, I now have a BiPap. ResMed, AirCurve10 VAUTO.  

I strongly tend to mouth breathing, stuff on my face gets ripped off during the night, I suspect exhaling is difficult, although the BiPap should have solved the issue as it did while I was hospitalized.

The issue I want to discuss is how I might manage to continue using my new N30i nasal pillows.

My throat keeps clogging with phlegm, unable to breathe until phlegm is cleared.  My stats show I am mouth breathing (reading clearing airway so the BiPap is able to pump the air to and from my lungs.

The inhaler I have causes an allergic reaction in my mouth.  Pulmonologist told me to use it anyway... I have a documented history of Anaphalic Shock in the past.  I am not using anything that causes allergy reactions.

Currently I am considering giving up the BiPap, the mouth breathing has several factors, heart stops several times a night, (Defibrillator is dead), Congestive Heart Failure since COVID X2 has become worse, I am retaining fluid.  Phlegm completely blocks my throat from time to time during the night, removing the mask to clear throat is required.  From time to time over the past year, intubating has been insisted upon while in ER.  I refuse. 

I am wondering if perhaps there is some sort of trigger to the thick phlegm build up, during the night.  Maybe certain foods?  My doctors are not giving me dialog, just demands. Using drugs with my allergy history is very concerning, due to past experiences.  Naturopathic Medicine I do not trust to keep me alive. I tetter on the line between Western Medicine and Eastern Medicine.  Twenty one years now, age and COVID have disturbed the balance I had.  I am Not COPD just a wisker away, according to the Pulmonologist.  Definitely Congestive Heart Failure since 2003 (Sudden Cardiac Arrest, multiple systems failure).

If someone has a positive suggestion on how I might manage the issue with mouth breathing due to my throat issues, please respond.

Thank you for reading through my post.

  Ironfish.

[SarcasticDave94]

Without some CPAP or bilevel data, such as the free OSCAR program, it's going to be difficult to address your bilevel settings. However, here's a few items from your information.

One, a full face mask that hurts translates into a mask that leaks and has straps that are way too tight. At least this is an indicator of tight straps to address leaking. If this is accurate, do not tighten them this much. If leaks cannot be addressed with the mask without restoring to over tight straps, you must change mask models.

Second, with your congestive heart failure, a standard bilevel may not be your best bet. I cannot be certain, but I would steer you towards a machine with backup breath rate by ResMed, such as the ST-A. Not the ST, and maybe not ASV. I could be wrong, but I'm thinking you need a more capable machine with timing.

[AngrySparrow]

Thank you for the input. The straps definitely are not too tight, learned that valuable lesson with my first C.P.A.P.

I really like my AirCurve 10 VAUTO, all the things I had problems with have been addressed, no more Rain Out, quiet, no issues around exhaling.
With my last AutoSet exhaling was a challenge, I fought the device all night, I kept removing my headgear.

I changed my settings, increasing the pressure a bit, which helped inhaling.

The throat clog ? is concerning, I do not want to use an inhaler in order to sleep.

My heart is stopping more often at night, I am concerned using a steroid to keep the throat open will cause more cardiac events. Rather a vicious circle, thanks to COVID.

I will use your suggestions toward a different ResMed Device... I am not compliant the way things are now. I sleep <3 hrs. heart is stopping a lot plus the throat blockage. I am reasonably normal when up and moving, sleep is the big issue along the low heart rate (EF of less than 20%).
I will be giving the wonderful AirCurve back since I am uncompliant and seem to be unable to become a proper BiPAP user. Throat blocking is scary, frequent heart stopping is not a good thing. Guess I am in a corner.

I will definitely look into a different device. During the second in hospital Sleep Study, the technician tried four types of devices, about 2 minutes on the AirCurve and I was asleep, like magic, I even had trouble waking up!

Thank you for the suggestions, I appreciate them.

Iron Fish

[SeePak]

ironfish

"The issue I want to discuss is how I might manage to continue using my new N30i nasal pillows."...........

There are many suggestions on causes and how to reduce phlegm on internet.
One that some here suggest is a wedge pillow to prop up your head and shoulders which could allow phlegm to drain without building up in throat.

Mouth breathing can happen from having plugged nasal airway.
Do not fully tape your mouth closed due to needing to relieve this pressure!

Try Myotape found on internet.
It allows mouth to open when needed and lips stay closed otherwise.

Patrick McKeown is the maker of this product.
He is also author on many books and information about nasal breathing at ALL times.
And..
Breathing exercises which can help reset your parasympathetic nervous system, a la vagus nerve, Rest and Digest state.
That may actually help with the phlegm production removal.

wishing you well!