One week on CPAP, would appreciate some input regarding my stats

[vandownbytheriver]

Is there anything I can do to help with congestion besides using my usual nasal spray?

Either you go to the doctor and start nasal cortisone, allergy shots, or go hard-core and get surgery. Or become a true addict and learn how to use the spray right.

Speaking as a nasal spray user, xylometazoline is not as good as oxymetazoline in my experience. Unfortunately this generally means that you're in a part of the world where you can't get the good stuff (oxy). I use generic oxymetazoline HCL in the pump-mist... the squeeze bottle just doesn't get it up there. Pump-mist has that long skinny nozzle... stick it all the way up to the narrowing and pump hard while inhaling softly... the idea is to get the medicine in the sinus but not down the throat. Pick the worst nostril and dose it before bed... give it time to clear... then blow it out before retiring.

Lowering your min pressure did nothing as you can see from the graph... as soon as you went to sleep your pressure shot up to 10cm anyway and stayed there. Looks like you took off the mask for a minute and let the pressure motor back down around 06:30... or perhaps it fell off? When using Resmed EPR you're supposed to increase your base pressure the same as the EPR. You were at 10cm and moved to 7cm, then turned on EPR3? That's 6cm in the wrong direction IMO.

Obstructive problems irritate the airway... 'pissing it off' in my parlance. This is a vicious cycle that results in more obstruction, arousals etc. Not using the spray turned you into a snore-monster around 06:00... pushing the pressures high and causing you to do whatever happened at 06:30. If you start at higher pressures you get less irritation, less obstruction, less FL's, and less pressure changes... a smoother night.

I don't believe EPR helped you at all. I don't believe discontinuing the xylometazoline helped you at all. I don't believe lowering the min pressure helped you at all. See how jagged last nights' pressure graph is? That's the machine trying to take care of a problem that would have been stopped by higher initial pressures. You probably should be on 13cm to start with, no EPR. If you can tolerate 13cm with EPR3 that's a step in the right direction IMO. We can wean you off the spray later, let's get you treated first.

What do you think, Pugsy?

[Pugsy]

What do you think, Pugsy?

I did notice the reduction in the minimum. I didn't advise that....I thought he would keep the minimum at 10 and then adding EPR probably wouldn't be much (if any) factor in allowing real asleep OAs or hyponeas to pop up.
BUT even with the reduction in minimum EPAP the real asleep apnea events weren't that big of a deal and roughly at LEAST half of that (already an okay and acceptable AHI) that means even fewer flagged OAs and hyponeas were the real deal.
So I wasn't going to bust his chops over that reduction. I don't think they are his major problem.
I think his primary problem is/was the crappy sleep quality from whatever (might be the congestion rearing its ugly head) and the pressure settings at this point not THAT much of a factor. Maybe some part but not the whole part for sure.
Hell...for all I know he might have the crappy sleep even without the nasal spray use or congestion causing the spray use.
We just don't know for sure but all I know to do is pick a problem and try to fix it (the Afrin (whatever) use needs to be dealt with and then once past the rebound issue then see how the sleep quality goes without congestion or potential medication side effects.

It's all I know to do. I don't think that magical tweaks of the settings is going to fix the problem though. Wish it were that easy.

I also don't think that EPR use is going to help the FLs in this situation but it is something worth at least trying....cheap and easy to try. Besides....sometimes I get pleasant surprises when I get proved wrong and something I suggest to try (didn't hold out much hope of success) actually works a miracle.
Like the one time I was working with a friend of mine who had developed central apneas too numerous to ignore (15 per hour avg) with PS of 4 and I thought for sure she was heading to ASV but I suggested trying PS of 3 (she needed some PS because her minimum EPAP had to be 16) instead of the 4 PS and low and behold the centrals dropped to less than 1 per hour average. I was never so glad to be proven wrong.

[Rubicon]

[jclarke131000]

I've seen an ENT in the past, was told I had intrinsic rhinitis. They never gave me anything as they said it was allergic and so there was no point in antihistamine/allergy meds???

I managed to get a steroid spray on prescription, I'm going to see if I can get this represcribed now. I've also had allergen testing and I'm not allergic to anything, no mould, no mites, no pollen, no dust, no pets etc.

Didn't actually mean to do the pressure decrease to be honest. I'll take your advice and bump it up to thirteen. I seem to managed the pressure quite well.

My room was very cold yesterday, woke up at 6.30am with some liquid in the pipe and it was bubbling with my inhales making a snore sound so I'm gonna bump the humidity back down one now.

Spoke to a chemist today, they advised the spray needs to go. They said rebound rhinitis will get to me for a few days but after that it should clear up quite nicely. Got a nasal saline rinse, and also flucticasone, which they said would be the closest thing to an actual beneficial prescription corticosteroid before I can get those back on prescription too. Hoping this takes the edge of for a few days till the nose clears up.

[Pugsy]

I'll take your advice and bump it up to thirteen. I seem to managed the pressure quite well.

No....just do the 10 cm minimum. Don't do 13 minimum....that's too big of a jump and I don't see you needing it to compensate for the EPR use....at this time anyway. Now if your AHI had been 10 ish or more...yeah, need more but I just don't see it being needed. Not everyone who uses EPR has to increase the minimum to compensate for the EPR drop....yes some do need to do that but those people are most likely using a minimum that barely can get the job done.

Besides...that 13 cm minimum might invite the aerophagia monster to come in and stay a while...he's not a nice house guest.

Moisture in the hose or mask....rain out...common problem especially when it's cold outside.
You have several options...see my posts number 2 and 3 here....I think I covered most options
http://www.cpaptalk.com/viewtopic/t9403 ... -road.html

And actually I don't recommend reducing the humidity setting because your nasal mucosa might not like less moisture.
Google "cpap rhinitis" and read up on why we use added moisture with our cpap use.
You have several other options without having to risk making your congestion worse because the nasal mucosa got dried out.

[jclarke131000]

Okay great thankyou.

I'll see about lowering the machine when I go to bed. It's currently in an open bedside drawer, I'll move it into the bottom one I'm hopes the water can drain back down.

So set the min at 10 tonight, and keep EPR at 3? Someone elsewhere suggested to change the response to gentle or soft, as the harsh pressure changes could be causing arousal. Do you think that might be worth a shot?

Will be heading bed shortly but I will update tomorrow. Really appreciate the advice!

[Pugsy]

I don't like making more than one change in things at a time unless I have no choice and it's an urgent need to make more than one change at a time.
Think about it.....if something really good or really bad happens then who gets the credit or blame. When you make more than one change you can't say for sure what change caused whatever result.

Save the "soft or standard" response experiment for another day.

The machine lower than the bed thing for condensation problem...not all it's cracked up to be...so you have been warned.
I always said that idea was worth about as much as teats on a boar hog....useless but hurts nothing to try.

And to be clear...minimum of 10 with EPR at 3 and lets see what happens.

Do the best you can right now given the circumstances with the nasal congestion.
Sleep right now is your primary goal so don't do a lot of uncomfortable stuff or be uncomfortable in bed because you can't breathe.

[jclarke131000]

Okay no more changes for tonight don't worry.

Min 10 EPR 3. Nose is nowhere near as bad as last night with just a simple saline spray before bed. Cheers to a better sleep ( I hope ).

[Pugsy]

Where are you located?

What humidity setting?

Does a hot steamy shower help or hurt your nasal congestion? Important to know because your nose may or may not need more moisture.

[Rubicon]

I've seen an ENT in the past, was told I had intrinsic rhinitis. They never gave me anything as they said it was allergic and so there was no point in antihistamine/allergy meds???

Either what they're saying, or what you're hearing, is wrong.

[Rubicon]

In re: above waveforms, although one can not be really sure if you're asleep, what sleep stage you're in, or what body position, IMO those look like 4 (and perhaps 5) RERAs going to arousal despite 15 cmH2O pressure.

[jclarke131000]

Where are you located?

What humidity setting?

Does a hot steamy shower help or hurt your nasal congestion? Important to know because your nose may or may not need more moisture.

Located in the UK. I've used hot showers/baths before bed to help with sleep in the past so it's fair to said they definitely help.

I've used 5 most nights, tried 6 but woke up with water in the tube both times so I'm leaving it at 5 now.

I've seen an ENT in the past, was told I had intrinsic rhinitis. They never gave me anything as they said it was allergic and so there was no point in antihistamine/allergy meds???

Either what they're saying, or what you're hearing, is wrong.

My apologies I blame tiredness last night... Intrinsic and NON ALLERGIC. But I've still had a doctor told me intrinsic is BS and there must be something causing it lol

This morning I feel again a little better, I still have this sort of cramping headache though and a little tired still. AHI of 0.99 which is progress. Flow limit again did not decrease, 99.5 actually went up to 0.44

https://sleephq.com/public/5b0cde8e-1ac ... f15b8d2e8d

[Pugsy]

Again the bulk of your flagged events in your AHI last night (which is still low even if they were for sure all asleep) are arousal related.
So this leads me to believe that at least your OSA is well treated. If it wasn't well treated we would expect to see a lot of "real asleep" flagged events and we just aren't seeing them. There were a couple of "maybe" asleep flagged events (OAs) but the rest of them had blatant arousal related breathing just prior to the flagged event.

Increase in pressures are partly related to snores (I do wonder why you are still having snores so need to ponder on that a bit) and somewhat due to the FLs. See that big first jump in pressure???? It corresponds with a rather dramatic snore increase.
This snore thing...keep an eye on snores and see if this happens on a consistent basis. If it does happen consistently then we may want a little more minimum pressure (like 11) or maybe reduce EPR and bring EPAP up a bit and let EPAP help reduce the snores better.

I don't think using EPR is going to make much (if any) difference in your FLs because I am not so sure that your FLs are airway related and not nasal congestion related. EPR doesn't always help enough to reduce FLs even if the flow reduction is airway related and not nasal related.
Using EPR to maybe help with FL reduction isn't the only way to reduce airway related FLs.....we can also add a little more EPAP.

Evaluation is made more difficult because you are on a mission to get off the Afrin (or whatever yours is called) and that means you also have more potential disruptions in that area.

I don't know what to make of your headaches or continued fatigue. My crystal ball is lacking on those details.
It wouldn't be impossible for the headache to be unrelated and it wouldn't be impossible that the continued fatigue is caused by something the machine can't fix.

More likely guess on my part is the continued fatigue is simply a byproduct of not sleeping so great. With the frequent arousals perhaps your sleep stage cycling gets screwed up and you are continually being bounced out of the deeper stages of sleep and you aren't getting the needed amounts of deeper sleep where the restorative powers of sleep can work their magic. Is the headache also a by product of not enough "good" sleep? Maybe...maybe not.

Now don't get me wrong...I don't expect to never see arousal breathing because it is normal to wake a few times during the night anyway. So arousals are normal when in low numbers...not so normal when seen in large numbers.

Finally....you know it is also possible that you just are going to need more time on the machine before you see a reduction in those unwanted symptoms. While overnight miracles do happen they are rare. It took me over 3 months to see much of a reduction in the fatigue thing. The killer (low oxygen) headaches went away rather quickly as did the nocturia symptoms with beginning cpap.....the fatigue thing took a lot longer to reduce.