Feeling better despite major APAP problems.

I've had an APAP for three months, but have had big problems using it due to my nasal congestion. I just had nasal somnoplasty, but that hasn't helped much.

Even though I am only using my APAP a few hours per night if that, I am slowly feeling much better! This week I really felt human for the first time in years. This weekend I actually got out of bed without hitting the snooze alarm five times.

I have a theory about why this is working. Unfortunately, my situation is probably different than a lot of others, so don't think that a few hours of APAP per night will fix you up.

When I started using the APAP, my API plunged from 80 to less than 5 according to my readout. There are occasional nights when it is ZERO. My pressure is set from 4.0 to 9.0. This leads me to think that despite my high initial API it doesn't take much pressure to completely open my throat.

When I first started using it, the pressure felt suffocating to me. Within two weeks, my lungs had strengthened to the point where breathing against the pressure was no problem. I now have to put my hand in front of the vent to see if it is on.

My theory is that my lungs are now strong enough that they can open my air passage without the APAP. Unfortunately I don't have a bed partner now to confirm this.

It begs the question of whether a CPAP can be beneficial even if you can't use it all night. I am still striving to use it all night and I would never advise anyone to assume they can do without it.

Reactions?

SleepyGuy wrote:

My theory is that my lungs are now strong enough that they can open my air passage without the APAP. Unfortunately I don't have a bed partner now to confirm this.

It begs the question of whether a CPAP can be beneficial even if you can't use it all night. I am still striving to use it all night and I would never advise anyone to assume they can do without it.

Reactions?

People do get benefit from any PAP device even if used for only a few hours each night, since you do get restful sleep while you are using it. For full benefit you do need to use it all night long. Four hours of restful sleep is better than none, so partial usage can help as you get acclimated to PAP use. On the other hand, getting 7 or 8 hours of restful sleep is your goal!

People with obstructive apnea have problems when the upper airway collapses, somewhere between the nose and the throat, as we attempt to breathe it. The lungs don't affect the collapse or the opening of that airway after a brain arousal -- it is the tension in the body or muscle tone that is the issue. So while you have the machine turned on and use the mask, your apnea will drop to normal, but turn it off or take it off and you will still have some apnea. Now that you have had some nasal surgery/treatment, your apnea may not be as bad during those periods without PAP, but you will have apnea events. Your lungs won't prevent that tissue from collapsing.

Your pressures in a range from 4 to 9 are very mild, in the low to average range, I think, from what I hear from most patients. And yes, severe apnea patients can have low pressures, and mild apnea patients may need high pressures. It all depends on the anatomy of your airway.

Dave

That's a good point too. Maybe the few hours I'm getting with the APAP is helping. I've hear they are discovering that some important things like human growth hormone are only produced at certain sleep levels. In my sleep study I had very little stage 3 sleep and almost no stage 4 and 5 sleep. In the titration test I was getting a lot of stage 3 sleep and some sleep at levels 4 and 5. Maybe it's better to get at least some of the benefit that these stages deliver instead of none of the benefit.

And keep in mind, there are those of us who envy those of you who can even manage a FEW hours. To my recollection, I have yet to manage even a single hour ASLEEP with the hose on. Lots of hours awake and wishing. A few hours dosing lightly. But I can't recall ever REALLY sleeping.

Liam, who always knew sleeping on his hose would be painful.

(Or maybe that should be "Liam, who will apparently never tire of hose jokes")

I'm not sure what you mean by "dozing lightly". Often I think I haven't slept at all, but I look at the clock or the display on the APAP and it says I've been asleep for two hours. When I say I only sleep for a few hours with the APAP, that includes "dozing" when I don't even feel like I've slept.

During my titration test I only slept for three hours. If you had asked me, I would have thought that I only slept lightly during that time, but according to the computer readout I had spent most of that time at stage three sleep. That's a lot better than I had done without the CPAP.

If you're dozing, you may be doing a lot better than you think. Hang in there.

I'm using a nasal mask. I hate the full face mask. The main reason I give up half way through the night is that my nose simply closes off and I can't breathe through it. Is that happening to you?

SleepyGuy wrote:I'm using a nasal mask. I hate the full face mask. The main reason I give up half way through the night is that my nose simply closes off and I can't breathe through it. Is that happening to you?

I'm not sure what happens to me. I still FEEL like I can get air through my nose, my lungs fill up, but after a relatively short time, it feels like the air getting into my lungs is stale and not oxygenated, and I find myself fighting to breathe in lungful after lungful through my mouth AGAINST the pressure, or I feel like I'm suffocating.

This is on any kind of nasal mask (so far, the Activa, the disComfort Lite and the Swift).

The full face I can't really tolerate because it leaks too much (yes, the ultra mirage), and every time it does, I wake up so I can adjust it a little bit.

I'm tempted to buy an Oracle mask and see if maybe, just maybe, I'm one of those odd people who will do best with a mouth only interface.

Liam, who knew he had a big mouth, but this is a little bit rediculous.

To test my nose, I simply put a finger against each nostril and try to breathe through the other one. It might feel like I'm getting enough through both, but if one is mostly blocked, then I can't sleep. It sounds like you might have the same problem I do.

If one or both nostrils are mostly blocked, this might be a problem. There are three turbinates in each nostril. They tend to swell during the night and can block the nose. They can be reduced through a procedure called a nasal somnoplasty which is done under local anesthetic. Radio waves are used to heat them killing some of the tissue. Over the next few weeks, the dead tissue will be carried off by the body.

I just had this procedure last week. For the first three days afterwards I had a lot of inflammation from the procedure. My nose was so blocked up I felt like I had a cold, but over the last two days it has gotten better. About 20% get no improvment. I still don't know if I will have any improvement or not.

But even without this, after three months I am seeing a big improvement even if I only get two or three hours of sleep with the machine each night.

Oh, and even the Breathe-Right strips help keep my nose open a little bit.

Liam1965 wrote: I still FEEL like I can get air through my nose, my lungs fill up, but after a relatively short time, it feels like the air getting into my lungs is stale and not oxygenated, and I find myself fighting to breathe in lungful after lungful through my mouth AGAINST the pressure, or I feel like I'm suffocating.

I try not to breathe through my mouth while I have the nasal mask on. It's seems like it's defeating the purpose. If I can't breathe through my nose there's no point in keeping the nasal mask on. I'll bet your nose is closing up as I described in my previous message. When I went to my doctor and told him my nose was closing up, he indicated this is not unheard of. That's when he suggested the nasal somnoplasty.

I know it has been mentioned several times under various topics on this forum about the nose congestion. This is a natural phenomenon that happens when you lie down. The tissues of your nasal passages become congested. It is very simply to correct this by getting a prescription for a long-acting steroid nasal spray from your doctor, like Nasacort AQ (The AQ part is for aqueous and it won't dry out the tissue like some nasal sprays). If I don't use this at bedtime, I can tell immediately.

A very simple remedy to a big complaint

Thanks Janelle. I will ask my doc about that. He never mentioned it. I know that the nasal decongestants in the store always say not to use for more than a few days. Maybe the prescription ones will work better.

Janelle wrote:I know it has been mentioned several times under various topics on this forum about the nose congestion. This is a natural phenomenon that happens when you lie down. The tissues of your nasal passages become congested. It is very simply to correct this by getting a prescription for a long-acting steroid nasal spray from your doctor, like Nasacort AQ (The AQ part is for aqueous and it won't dry out the tissue like some nasal sprays). If I don't use this at bedtime, I can tell immediately.

A very simple remedy to a big complaint

This could explain why I haven't had congestion problems. I have been on nose spray for a while... I find a little bit of heated humidifier air works wonders also.

Liam, what pressure is your full face mask leaking at? I find that round 15 its met its match. When I had my sleep study the tech had to fiddle with the mask for a bit to get it to seal, (mostly tightening the straps) but once it was I was good...

Mikesus wrote:Liam, what pressure is your full face mask leaking at? I find that round 15 its met its match. When I had my sleep study the tech had to fiddle with the mask for a bit to get it to seal, (mostly tightening the straps) but once it was I was good...

Just 9. Not that high. The problem is that I toss and turn, and I have a fairly bony face. Not to distance myself from the heavier among us, but I don't have much padding on my face, which my DME commented on (she says most people seal better, because in general they're heavier and have fleshier faces).

But the combination of tossing and turning and having relatively little padding on my face means that any little pull on the straps on my head forms a little leak somewhere.

Liam, who can't seem to get away from taking a leak many times during the night.

Mikesus wrote: This could explain why I haven't had congestion problems. I have been on nose spray for a while... I find a little bit of heated humidifier air works wonders also.

I haven't been using my heater/humidifier. My nose doesn't dry out and at the start, the heat contributed to my feeling of claustrophobia. That's not as much of a problem anymore. I should try the heater/humidifier to see if it helps my congestion.

Liam1965 wrote:

Mikesus wrote:Liam, what pressure is your full face mask leaking at? I find that round 15 its met its match. When I had my sleep study the tech had to fiddle with the mask for a bit to get it to seal, (mostly tightening the straps) but once it was I was good...

Just 9. Not that high. The problem is that I toss and turn, and I have a fairly bony face. Not to distance myself from the heavier among us, but I don't have much padding on my face, which my DME commented on (she says most people seal better, because in general they're heavier and have fleshier faces).

But the combination of tossing and turning and having relatively little padding on my face means that any little pull on the straps on my head forms a little leak somewhere.

Liam, who can't seem to get away from taking a leak many times during the night.

Are you sure that they have the right seal for it? There are a few different depths for them.

Mikesus wrote:Are you sure that they have the right seal for it? There are a few different depths for them.

For the Ultra Mirage FF? I thought there was S, M and L, and that was it...

Liam who, according to a test tonight, will be NEEDING his insomnia in about 8 and a half months.