[Treatment] simplychillin - Request for Advice/Treatment Thread

[simplychillin]

Hey everyone! 

First, I wanted to say thanks to everyone at ApneaBoard - based on my perousal of other threads, y'all seem really helpful, and it's amazing to see this kind of support given without asking for anything in return. So, thank you!

Now, on to my own request: I started APAP therapy on the night of 2024-12-12, and have been having a couple of issues and questions. They're enumerated below, but as for some context, the 3 images attached are best representative of my therapy so far and the other days are, as far as I can tell, unhelpful or repeat the same point as another screenshot. Now, on to the meat of the post.

1. As seen in on the night of December 17th, I removed my nasal pillow mask (and tape, somehow) unconsciously! This has been a pattern in previous nights, with the same occuring (albeit with the full face mask) on the nights of December 15th and 16th. I have no idea why I do this, I have no recollection of doing this, all I know is I wake up and it's off. I've seen advice in the MyAir app that says I should try wearing gloves for a week or so, and while I'm absolutely open to doing this, I wanted to see if anyone had any other recommendations that have been more effective in your experience?
   
2. I've been swapping between the F&P Forma and the ResMed P30i, and while the P30i is undoubtedly better seal-wise, I find it makes the inside of my nose uncomfortable where the pillows contact my nostrils. Is there any way the P30i can be made more comfortable? Am I wearing it wrong? I mean, the head strap and everything feels fine, but just the inner part of my nostril hurts a bit. It normally wouldn't bother me, but when I'm trying to sleep, I find it distracting.
   
3. On the same note as #2, I'm concerned that I won't be able to use my machine when my nose is stuffy. Is the seal issue on the Forma just me? If not, has it been made better in recent years? If it has, should I buy a new full face mask to replace the Forma so that I can use my CPAP while I sleep with a stuffy nose, or is that generally a non-issue?
   
4. On a similar note to #2 and #3, I had a weird issue on the night of the 15th where my Forma was "screaming". It's really hard to describe, but basically, it's like blowing air through tightly shut lips. It hasn't returned, and that was also a night where I had bad rainout, so it's probably nothing, but I was wondering if anyone had any experience with this? Does this indicate a mask issue? (To be clear, this was different than a leak, as far as I can tell, because when I rubbed the diffusion points, it went away for about 2 minutes.)
   
5. On the same note as #4 - is it okay to turn up the ClimateLine tubing to above room temperature? My mother said it wasn't a good idea, but ever since I set it to 80 degrees Fahrenheit, I haven't had rainout issues. Any input on temperature setting for ClimateLine?
   
6. Following advice from my mother, who has been on CPAP for at least a decade, I enabled EPR @ 3 in the clinicial settings. Now that I've read some more about it, I have a sneaking suspicion that that is messing with my therapy and prescribed pressure - should I disable it? Or should I change the pressure range? Both? Neither? I have an appointment coming up on the 26th to review my initial CPAP data with a new doctor (different than the one that prescribed the sleep study), so I don't know how knowledgeable they are, and for that reason, I'm hesistant to change my pressure; however, if it is strongly recommended, then I'd be okay with it.
   

Rest assured that I'll be sticking with this; I just want to get some advice on how to make such sticking with it easier and more effective. Thanks a ton for reading all this!!

[Old Steve]

As to the pressure, I would leave the EPR on, but to start I would run your minimum pressure to perhaps 9cm as your current average is higher than that.  

I think that most of the people on the forum use EPR, it helps to control flow limits and is more comfortable as it lowers your exhale pressure.

Your hose temp is actually a bit less than I use.

As to mask issues I can't help as I haven't used any of your masks...

Welcome to the forum!

[simplychillin]

Thanks for the quick reply!

I'll be setting my minimum pressure to 9 cmH2O tonight and will update tommorow with how it goes. Will be using the P30i nasal pillows as I can get over the uncomfortableness for now.
Will also try wearing gloves/mittens to see if that makes it harder for me to get the mask off.

Good night!

[simplychillin]

Alright, we have the first night's data back!

It's generally looking good, as far as I can tell - lower AHI compared to the other valid days, low leak, and I'm feeling a tiny bit more rested (though that last part could be placebo). I've gone ahead and attached the OSCAR chart, in case anyone wants to compare it to the other days.

On the con side, I forgot to put on gloves/mittens/something to make it harder for me to take off the mask, but thankfully, I wasn't off the therapy for too long when I inevitably took it off last night. Mouth tape stayed on the entire night this time!

To anyone else taking a look at the thread - I'm still looking for input on questions 1 to 4 in my original post. Any musing is welcome!

On a sidenote, I'm super grateful for the advice, Steve, I had a small hunch the minimum pressure was too low, but you suggesting it made me feel a lot more confident that I wasn't misreading the situation, so I appreciate you taking the time to write out your thinking. I'm also glad you said you hadn't tried my masks rather than making stuff up that sounds right; in my opinion, this kind of thing is what makes this forum so amazing: people being willing to say they don't know everything in the world yet helping others with the knowledge they do have. So, thanks, dude!

As to the future, unless I get other advice, I'll probably stay on this pressure for a few more days, and I'll post if anything abnormal happens with my OSCAR data, or if the mittens work to keep my mask on two nights on a row. Again, though, this is just my current plan and I'm open to suggestions.

Thanks again for reading!

[simplychillin]

Alright, quick update before I go to sleep:

I was reading a post by Nightynite in a thread titled "DiabolikalDeux - Therapy Assistance" and I found that they stated something interesting; here's an excerpt of their post:

I also battled this congestion when I started and then from advice from this board I started using Fluticasone Propionate. Same as Flonase. I buy it on amazon, it comes in 5 little spray bottles and one spray in each nostril and I’m good to go all night. It’s a steroid and it takes a little while to work so be patient. It has turned out to be the missing part of the puzzle that made pap therapy work for me.

After doing about half an hour of research, I've found that it doesn't interact with my meds, generally isn't habit-forming, and is relatively cheap. For these reasons I went ahead and ordered a pack of bottles, as to deal with my fears of not being able to use my CPAP with a stuffy nose. This technically renders questions 3 and 4 unnecessary, as, because the P30i works better than the Forma in terms of leak, there's really no point in trying to stick to a FFM if I have no issues with nasal breathing. (Or, at least, that's my assessment; if there's hidden benefits to an FFM, I'd totally be willing to listen!) However, if anyone has spare time, I'd still be curious about the answers to questions 3 and 4 (and maybe people from the future will be curious, too.)

Anyway, that's all for now. Definitely going to try to remember the mittens tonight. As mentioned in my previous post, I probably won't be updating on here unless there's some kind of new development. Until then!

[Old Steve]

I use a nasal rinse every night and Fluticasone Propionate on some nights, both help. For me the nasal rinse works the best of the two.  It looks as if you may have to adjust you pressure up to 10cm or so. You may want to try upping it little by little and see how it goes.  Good luck.

[simplychillin]

Thanks for the input!

Since I already purchased the Fluticasone Propionate, I decided to try and use it, and it worked great; will definitely consider a nasal rinse should I start having problems with it though. The night before it arrived I set the pressure to 10cm but only got 2.5 hours of use as I forgot to wear mittens. Last night, though, I did both the spray and the 10cm pressure and got a whopping 11.5 hours of sleep. (Probably because I got very little CPAP-on sleep the previous night.)

The chart of this night, the night with good sleep, is attached; my primary question is about the events toward the end of it. (I've also attached a screenshot zoomed to the part I'm asking about.) This is giving me positional apnea vibes, but I haven't seen anything like this in any of my other charts, so I'm kind of confused on if this is a coincidence, SWJ, or actual positional apnea that's worth buying an SCC over.

Additionally, since my median pressure is 11.5 now, is a minimum pressure increase of 0.5 cmH2O warranted? 1 cmH2O? Or should I wait a few more nights to see if last night was an outlier? On a similar note, how does one know what the maximum pressure should be? How is it titrated?

That's all for now; thanks for sticking with me Old Steve!

[Old Steve]

I would increase your pressure to 10.6cm and see if it helps your flow limits which are a little high and eliminates some of your apneas. You are now having quite a bit of leaking perhaps caused by the higher pressure.  Some of the leaks are more that the CPAP can compensate for and the CPAP can not do its job effectively.  The leaks can also cause arousals.  The apneas on your chart after 8 AM appears to be what is sometimes referred to as sleep wake junk.  It also happens sometimes when you first start to fall asleep.  Unless it starts to happen every night I wouldn't worry about it too much for now.  So try the higher pressure and try to stop the leaks, then post some more charts.  Good luck.

[Old Steve]

I am sorry, I forgot to mention about positional apnea.  You may be having some, but it doesn't look like typical PA, with close clusters of apneas.  If you sleep on your back you might want to try side sleeping for a night or two and see what happens.

[simplychillin]

Got it - will increase pressure to 10.6 tonight and will update back with charts tommorow. I forgot to mention this in my previous post, but that leaking is unusual, even at the higher pressures; for the 2.5 hours I got the night before last I had a 95% leak of 9.6 L/min compared to last night's 24 L/min. For that reason I'm guessing it has something to do with me wearing the socks (yes, socks on my hands to reduce my mask removal) last night. In any case I'll also try to fix the leaks tonight, don't really know how at the time of posting but I'm sure I'll come up with ideas from browsing the forum.

Finally, about the PA - I'll try to remember to sleep on my side tonight and see if that affects things, but honestly, given the fact that, as far as I can tell, the other charts don't match the PA pattern, I'm not all too concerned about it. The data will speak for itself though!

Summary for tonight: pressure changing to 10.6, trying to fix leaks, sleeping on side, posting charts tommorow.