hard adjust for newbie - question about OSA

Briefly - Have been diagnosed with SA for a little over a year and immediatelly got a CPAP and nasal mask but did not use it all the time and didn't get the hang of it. I have made a strong push the last couple of months to use CPAP every night but always tear off the mask in middle of night. I'm at pressure 9. Thanks to knowledge from this board (never would have known from my doctor) - I ordered a FF mask and have been using that the past few weeks but still not using it for more than a couple of hours a night. 3 nights in the last 3 weeks I have worn the mask for about 4 - 4 1/2 hours which has been the max for me ( I stop machine, take off mask and look at the clock). SO

My doc stated that I "MIGHT" be able to get rid off my SLeep Ap if I lose some weight- presently I am 6'1", 220, work out 4 times/week and want to get under 200lbs. However, even when I was in better shape - back in the day - I always snored loudly (but back then never tested for SA) -

My issue is these devices like puresleep or other dental devices if they can stop your snoring by negating an obstruction ( i.e. getting tongue out of way...) is not that the exact same effect as the use of CPAP? I thought CPAP worked by "forcing" the air - thus relieving the obstruction (the O in OSA) - Is that correct? Can you please explain?

Sorry for the length of the letter but I am frustrated in CPAP and ready to try Puresleep but I do not want to fall into a situation where I can cure the snoring but still have the negative health effects of SA.

The appliances stop snoring. They don't usually correct OSA. You have both. Surgery could help your OSA but the percentages aren't that great. Losing weight might help but OSA is a circular thing with weight. It's hard to lose weight with untreated OSA because of the tiredness.

You might want to read this thread:

viewtopic/t36180/Can-Sleep-Apnea-Be-Cur ... rcise.html

I've grown to hate doctors that keep feeding that line to their patients. It's really disingenuous.
An anti-snoring device is not a cure for Sleep Apnea.
As far as you pulling off your mask at night......how much humidity do you use? If you use a lot, try turning your HH setting down or off. Too much humidity can actually close up your nasal passages. Do you do a nasal rinse.....and make sure your nasal passages are clear before going to bed?
The bottom line is if you can't breathe through your nose at night, you need to try to solve that problem because that's where you NEED to get your air from.

Den

To clarify, losing weight might reduce the pressure that you need, but it rarely stops it completely. You already have a very reasonable pressure. People that have the most problems are usually those needing very high pressures.

does yuor machine have some sort of pressure relief on the exhalation phase of your breathing. That made a world of difference for me. If not, ask the doc for a new scrip or at least rent a machine that can do that for a month?

dtrain84 wrote:I ordered a FF mask and have been using that the past few weeks but still not using it for more than a couple of hours a night. 3 nights in the last 3 weeks I have worn the mask for about 4 - 4 1/2 hours which has been the max for me ( I stop machine, take off mask and look at the clock). SO

SO then you put the mask back on, turn the machine back on and then go back to sleep.

Do you own that machine? Do you have a choice of which machines to get? You might find one with pressure relief like C or A-Flex more comfortable.

Do you have a humidifier? Do you wake up with dry sinuses?

Is the mask uncomfortable? Is that why you take it off?

Thanks for all the responses! After I tear off my mask and realize it - i don't put it back on - (easier said then done)
BUT still trying to understand "how" CPAP treats OSA - am I wrong that it is the air pressure forcing open the throat - thus eliminating the obstruction? or am I missing something!

dtrain846 wrote:Thanks for all the responses! After I tear off my mask and realize it - i don't put it back on - (easier said then done)
BUT still trying to understand "how" CPAP treats OSA - am I wrong that it is the air pressure forcing open the throat - thus eliminating the obstruction? or am I missing something!

My answer would be that it varies for each of us.
As far as "Obstructive Sleep Apnea" goes, some of us have issues in our throats and some of us have issues in our nasal passages.
If a person has issues with their nasal passages, they tend to mouth-breathe. When that happens, the tongue can obstruct the airway and block the breathing process. In some people, their airway collapses.
It's supposed to be "enough" air pressure to keep the person breathing through an open airway. The most efficient route is through the nasal passages. Keeping one's tongue to the roof of the mouth (it can be trained to do that) can help keep it from falling back and blocking off the airway.

Keep putting your mask back on after you catch yourself taking it off. That's a phase that most of us went through in the early months of our therapy and needs to be stopped. Persistence will pay off.

Den

dtrain846 wrote:Thanks for all the responses! After I tear off my mask and realize it - i don't put it back on - (easier said then done)
BUT still trying to understand "how" CPAP treats OSA - am I wrong that it is the air pressure forcing open the throat - thus eliminating the obstruction? or am I missing something!

This may help.

http://www.resmed.com/en-us/patients/tr ... 40x380.swf

CPAP works by supplying enough pressurized air to keep you airway from collapsing. It doesn't force open the throat, it stents it, supports it open to avoid collapses.

With the kind of machine you have, neither your doctor nor you can tell whether the pressure supplied while you sleep in bed at night is the right pressure to keep your airway from collapsing. It may be too low - and you're still experiencing obstruction, it may be too high - and bothering you.

Sure, it's supplying the pressure they found in your one night of sleep in the lab - but many of us came here because we found that one night's sleep in the lab did not find the pressure we need for sleeping at night in our own bed. Which is why you'll find data capable machines very popular, and highly recommended on this forum.

A data capable machine will register your breathing interruptions. And these machines have software that lets you see the way your breathing responded to pressure changes, and how bad your mask leaks.

In addition to being data capable, some machines are also self adjusting (aka autos) they will raise your pressure level for a while if you're having too many events - or even event precursors, and drop it if your breathing has been smooth for a while. This may be very important for people whose pressure needs change dramatically when they change their sleep position, or when they move from simple sleep (NREM) to dreaming sleep (REM).

Resmed, Respironics, Puritan Bennett and Covidien (to which Puritan Bennett belongs) all make data capable machines.

I think the idea of "we study the person for one night, and bang, we've got the right pressure" is a remnant from the times they saw sleep apnea in the lab and created a tracheotomy to help a person breathe. At home the person would then open the tracheotomy for sleep, close it when they got up - a simple yes/no solution. With cpap pressure this "bang, we've got it" policy simply doesn't work for some of us.

If I were to choose a machine today, with the pressure you have, I'd go for the Covidien Sandman Auto, with its software.

Comfort it crucial to this therapy too:

• The mask has to be comfortable
  The air temprature has to be comfortable - there are hose covers, and if necessary, heated hoses to help with that
  Humidity in the air you breathe has to be right - some need more some need less, but everyone needs it right.
  Hose management is crucial. The majority find that it helps to have the hose dangling from above your head.
  And - this is irrelevant for you but I'll add it for other newbies: If you don't use a full face mask, you have to make sure you're not mouthbreathing.

As for weight loss: Your doctor is spouting the party line. Ask your doc for studies that have shown weight loss can be maintained in the long run. Talk to him about evidence based medicine. Research has consistently shown that a body that loses weight will regain it. That's physiology, not will power. Read "Rethinking Thin" by Gina Colata, take a look at http://www.beyondahadowofadiet.com, search for studies in peer reviewed journals.
Research has shown that disrupted sleep wreaks havoc on the hormones that control a sense of satiety.

Welcome to the forum and good luck!

O.

CPAP helps to keep the airway open mainly via two mechanisms, but there is a third:

1) positive pressure acts to "splint" the airway open
2) cpap increases lung volume --> increasing lung volume reduces upper airway collapsiblity
3) continued use of cpap shifts fluid away from the neck, reducing "pressure" on the airway

In regards to "will weight loss cure my OSA?" It really is hit and miss. While there certainly is some evidence showing that weight loss led to a reduction in RDI within the normal range in some individuals, others haven't been so lucky .

Hi, dtrain84. Welcome to the forum!

This is from something I posted in a thread (viewtopic.php?f=1&t=35455&st=0&sk=t&sd=a) about PureSleep:

marshaeb wrote:

ractar28 wrote:It looks like it might work as a "dental tray" for teeth bleaching products.

You're right, it does, Ractar. It looks a lot like my ortho retainer, too. This makes it different from either, though:

The principle of PureSleep is simple: it moves your lower jaw forward, opening the passageway enough so that air moves through unobstructed.

That's from the PureSleep link that Johnny gave us. My first thought was: anything that moves the jaw forward every night needs to be overseen by someone with a degree in dentistry. I still think that, but the more important issues never even occurred to me until I started reading some articles. The following quote is from http://www.24-7pressrelease.com/press-r ... -67256.php Granted, it was written by a dentist (http://www.free-press-release.com/news/ ... 81693.html) whose livelihood comes from offering an alternative to xpap therapy. However, I think he makes valid points, some of which follow (underscored highlighting is mine):

Pure Sleep is advertising on television commercials that it is FDA approved for treating simple snoring and that it works the same as oral sleep apnea treatment appliances. Research in dental sleep medicine has shown that oral appliances are very effective in treating snoring and sleep apnea. Pure sleep is not designed for treating sleep apnea but for simple snoring.

Does the Pure Sleep appliance work? It probably will be very effective for many patients with simple snoring but should never be used to replace CPAP treatment without follow-up sleep tests. It will probably produce TMJ problems for many patients. The American Academy of Sleep Medicine recommends that dentists treating sleep apnea with oral appliances have special training in treating TMJ disorders. Patient with additional risk factors should absolutely have medical consultation prior to using a pure sleep appliance. A partial listing of medical conditions that my suggest sleep apnea include: Hypertension (high blood pressure), diabetes, fibromyalgia, gastric reflex, coronary artery disease, heart disease, lung disease, Memory problems, thyroid problems, daytime sleepiness, morning headache, and TMJ disorders including headache, earache, joint clicking or popping, eye pain, sinus pain and neck pain.

The real question is, if a patient with sleep apnea uses a Pure Sleep appliance that quiets the snoring but does not treat their sleep apnea and an innocent child is then killed in a motor vehicle accident, who is responsible? The FDA for approving the appliance without insisting on appropriate warnings, the patient who used the appliance without realizing the risks or the company who supplies the appliance to the public? The paperwork explains to the patient that the appliance is for treating snoring and not for treating sleep apnea. How does the patient know if they have sleep apnea or just snoring? There are several pages of instructions that are designed to let the company claim that patients were informed that the appliance is only meant for simple snoring but research has shown that these type of warnings are rarely read or heeded by the public. Patients assume if they are not having symptoms of tiredness that they do not have apnea. This is a dangerous assumption. A recent study presented to the American Thoracic Society showed a 300% increase in motor vehicle accidents involving serious physical injury in patients with mild sleep apnea and no symptoms of excessive daytime sleepiness.

The following quotes (with my underscored highlighting) are from this article: http://www.reference.com/browse/snore

Specially made dental appliances called mandibular advancement splints, which advance the lower jaw slightly, and thereby pull the tongue forward, are a common mode of treatment for snoring. Typically, a dentist specializing in sleep apnea dentistry is consulted. Such appliances have been proven to be effective in reducing snoring and sleep apnea in cases where the apnea is mild to moderate. Mandibular advancement splints are often tolerated much better than CPAP machines. Possible but rare side effects include gradual movement of the teeth, Temporomandibular joint disorder, excess salivation and gum irritation.

Over-the-counter mandibular advancement splints provide the same benefits if fitted correctly. They are usually made from an EVA polymer and are similar in appearance to protective mouth-guards worn for sports. One disadvantage of the cheaper devices compared to the professionally fitted devices is the difficulty in setting up the correct jaw position. An over-advanced jaw results in jaw joint pain, whilst an under-advanced jaw produces no therapeutic effect.

Devices such as nose clips can dilate the nostrils and other devices can alter jaw mechanics to keep the jaw in an optimum position. Different aids and practices may work for different people. According to a 2005 article in the British Medical Journal, playing the didgeridoo can also help, as it increases muscle usage in the throat . However, snoring is a recognized medical problem and people who snore should always seek professional medical advice before relying on techniques which may mask symptoms (i.e. snoring) but not treat the underlying condition.

My thought is that PureSleep isn't a good idea. When you wake up and rip off your mask, are you waking up with a sense of gasping for air? Any chance your pressure isn't producing that "air splint" sufficiently and that you're waking up because you're not actually getting enough air through? If you're satisfied that your pressure is correct, I'd go with what Wulfman said. I took mine off at the beginning, and so have a lot of others. It might just be a matter of deciding it's not okay to only use your mask once in a while or only for part of a night. At any rate, I hope you solve this and get to the point of getting good therapy every time your sleep.

Marsha