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!

[srlevine1]

My condition is changing, Heart Failure is increasing,
I am very near to having COPD. 
Resistive to using inhalers. 
I have a documented history of Anaphalic Shock in the past.

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. 
Definitely Congestive Heart Failure since 2003 (Sudden Cardiac Arrest, multiple systems failure).

I do not mean to be contentious, but your issues, as described, appear to be seriously life-threatening and beyond fretting over CPAP mask issues. 

As for preventing SCD (Sudden Cardiac Death), I strongly suggest you immediately consider replacing your dead defibrillator with a modern implantable cardioverter-defibrillator/pacemaker. Are you taking antiarrhythmic medications to reduce the possibility of ventricular tachycardia and other arrhythmias? 

If you are subject to Anaphalic Shock, do you have an immediately available EpiPen and can tolerate its cardiac side effects? 

Are you taking any medication or expectorants to manage your phlegm? What is your level of humidification? Are you avoiding phlegm-producing foods and agents? Are you restricting your hydration to deal with your CHF? 

I notice you are in Canada and are probably limited in what interdisciplinary medical interventions are available. Do your cardiologist, electrophysiologist, and pulmonologist ever have a serious management conference on your status, or are they merely trading and reacting to each other's reports?


By all means, download OSCAR and post some charts. But you might clear any proposed changes with your medical team due to the severity of your condition.

Wishing you the best of luck.

[Sleeprider]

As recommended by others, please get the OSCAR software. It provides us with respiratory analytics that may allow us to leverage settings on your device such as time of inspiration and trigger or cycle settings that change how your Vauto triggers IPAP or cycles to EPAP. To make inspiration easier, you probably need higher pressure support rather than higher pressure.

[AngrySparrow]

My condition is end of life comfort.

Medical care is debatable.  My Primary Care provider, thinks she should "handle my case".  I do not agree,  she has a limited knowledge of Cardiac Care.  Let alone allergies, neurological injuries from the 2003 Sudden Cardiac Arrest, Kidney Failure and Dialysis that went the arrest.

I had a implanted Defibrillator (CRT-D),  the device was never adjusted appropriate to my lifestyle.  

When the CRT-D died I felt a significant improvement after 24 hours.   I felt free again, activity up, shoulder's constant pain and itch calmed.

I have had significant difficulties with anesthesia most of my life.  I over or under react to drugs of all types.  I have been told every time I have been anestimized that 
     A.  My heart stopped.
     B.  I required large amount of anesthesia, babbled about being resistive.

For years I have attempted to consult with a licensed Anesthesiologist in regard to my difficulties with being anesthesia.

In spite of assorted Electrologist telling me I immediately need a CRT-D replacement.  However discussion on anesthesia is not allowed.  Which translates to a Anesthesiologist walks into a client me), who has a very long history of being difficult to sedate, heart that stops, lots of allergies.   PLUS I do not look ill or so I am told.  Looking at me I am okay.  Look at my medical records not so okay.

I know I am dying, just want to be somewhat comfortable, sleep is nice and cuts down on the number of headaches.

After 21.5 years of being scolded, I am very aware of my situation.

I want to sleep, I want to be a civilized person.  My Acupuncturist helps manage pain, if I sleep ? ? life is tolerable.

If I have something on my face that itches, makes my face feel like the bones are being rearranged, not comfortable, not conductive to sleep.  I hate stuff on my face, evidently my face - head is smaller than average,  that fact seems to be part of the problem.  My hair is fine textured and masks tend to move around too much, even with my hair braided.  Tight straps hurt and just do not serve their proper function.

Anyway, I am at a loss on how to manage.  I am not a newbie.  I took a forced break from using a Apnea Device after my device was stolen from my vehicle while traveling.  Several years before I felt the need to treat my Sleep Apnea.  Now my Apnea has become serious breathing stops and heart stops several times a night.

So, my life is a gamble, comfort is what I want not length.  I am very aware of how precarious my situation is.