Cumulative irritation and humidity

[Dog Slobber]

I've been using CPAP for a month now and I'm looking for advice to help me find the best humidity settings for me using

• Resmed AirSense 10 AutoSet
• Airfit N20 Nasal mask
• 13 cmH20

I read The FAQ on CPAP.COM:
https://www.cpap.com/cpap-faq/Common-Si ... ml#faq-tab and read about Cumulative Irritation.

CPAP air is an irritant - to one degree or another - to everyone. The irritation may cause the nasal passages to dry out and bleed, or the mucous membranes may try to protect the nasal passages by producing excess mucous, resulting in congestion. The irritation can be cumulative, developing over time. Furthermore, dry, cracked or bleeding nasal passages are a breeding ground for infection.

I''m currently experiencing congestion issues and have tried setting the humidifier from Auto (default 4) to the maximum 8 and back again.

Specifically:

• When trying new humidifier settings, how long should I try that value before going trying a new setting?
• If the next day I'm still congested, should I try another?
• Should I just set it back to Auto and wait?
• Can I abruptly change setting or should I always gradually change?

My first two weeks on the device went very well, then when I increased the humidity up a notch to address the dry nose the congestion started.

Would love to hear your thoughts on Cumulative Irritation and the best strategies for helping to find the optimum setting for me.

[Goofproof]

Stop breathing a couple of days, you won't be bothered by breathing again! I think that might be too extreme. Jim

[LSAT]

Aside from changing settings..which you have already done...what do you expect us to suggest. See your doctor, use a nasal rinse, use a heated hose!

[Dog Slobber]

Aside from changing settings..which you have already done...what do you expect us to suggest. See your doctor, use a nasal rinse, use a heated hose!

One of the things I was wondering was:

When trying new humidifier settings, how long should I try that value before trying a new setting?

I just don't know if the humidifier changes are noticeable as soon as the next day, or take a few days to manifest.

My apologies, I should have made that clearer.

[ChicagoGranny]

My first two weeks on the device went very well, then when I increased the humidity up a notch to address the dry nose the congestion started.

Do you mean the first two weeks went very well except for dry nasal passages?

What does your leak line look like?

Do you drink enough fluids daily? https://dripdrop.com/blogs/news/chart-dehydrated

Is your diet high in salt?

Do you have an HVAC vent blowing in the direction of your CPAP machine?

[Pugsy]

My own personal experience when experimenting with various humidity settings was that when it went bad the results were immediate and readily apparent but to fix it I had to go back to what I was doing and it took 3 or 4 days for my nasal issues to return to pre experiment stage.

I don't think you will be able to have any clear cut answer to your question.
Humidity needs and reactions to either too much or not enough and how long to return to normal are just too individual to be able to come up with any time frame of any certainty that would work for everyone.

[Dog Slobber]

My first two weeks on the device went very well, then when I increased the humidity up a notch to address the dry nose the congestion started.

Do you mean the first two weeks went very well except for dry nasal passages?

Yes

What does your leak line look like?

I'll put together some graphs and post them later

Do you drink enough fluids daily? https://dripdrop.com/blogs/news/chart-dehydrated

Hadn't considered that, I'll make an effort to drink more.

Is your diet high in salt?

No.

Do you have an HVAC vent blowing in the direction of your CPAP machine?

No.

My own personal experience when experimenting with various humidity settings was that when it went bad the results were immediate and readily apparent but to fix it I had to go back to what I was doing and it took 3 or 4 days for my nasal issues to return to pre experiment stage.

Thank you for this. I'll try experimenting and with every change try it out longer.

[Dog Slobber]

What does your leak line look like?

Hi ChicagoGranny,

Here is my last three days of SleepyHead graphs.

Screen Shot 2018-03-09 at 12.16.43 PM.jpg

Screen Shot 2018-03-09 at 12.17.28 PM.jpg

Screen Shot 2018-03-09 at 12.16.07 PM.jpg

[ChicagoGranny]

As is common when starting out, your therapy needs a little tweaking. You are having a bit more leak than I like. I'll make a second post with some ideas for preventing leak.

The AHI is higher than optimal. You have an Auto machine, but the settings are straight CPAP. If it were my therapy, I would change it to Auto, minimum pressure 10/maximum pressure 20. Then we can see how high the pressure wants to go. It will not go any higher than needed. Hopefully, Pugsy will also chime in with an opinion.

Are you having any dry mouth?

[ChicagoGranny]

To reduce unintentional mask leak -

- Make sure the mask is fitted properly. (See mask manufacturer's video.)

- Make sure the headgear is adjusted properly (See mask manufacturer's video.)

- If you use a low ramp pressure or a low minimum pressure, you should fit and adjust your mask at the higher pressures it is operating at for most of the night. You would temporarily change the machine pressure settings while you do the fitting and adjusting. It's best to do this well before bedtime before you are tired and ready for sleep. Don't forget to change your settings back to the ones you prefer.

- Make sure to use good hose management - the hose should not pull on the mask. Notice how your hose is positioned between machine and mask. It should be positioned to minimize any pull on the mask. Hose management is an individual practice. How it is done depends on the mask, the position of the machine, your sleeping position and other factors specific to the individual.

- If you still have problems, learn from the forum what mask liners are available.

- Start a thread in cpaptalk asking for help. Subject: Need Help with Mask xxxxxx

- If your mask still has excessive leak, try other masks. Many people report trying several masks before they find one that works well for them.

Note: Links to just some of the mask manufacturers' instructional videos can be found on the forum host's website - https://www.cpap.com/cpap-masks.php and https://www.youtube.com/

- CG

[ChicagoGranny]

Here you can find out how to change the pressure settings - https://www.apneaboard.com/resmed-airse ... setup-info

[Dog Slobber]

Thank you for all the tips.

Here's where I'm at with my device.

The AutoSet machine I'm using is a loaner and I'm working with my DME Sleep tech to provide data for my Sleep Study Dr.

• The first two weeks the machine was set to APAP (7-13 cm H2O)
• The last two weeks based on my data, the machine was configured for CPAP (13 cm H2O). The Sleep tech also increased my humidity to 5, because I did have some dry nasal congestion. This is also about the time my congestion issues started.
• On my own, without any input from the DME, I set the machine back to its APAP (7-13 cm H20) and contact my Sleep Tech about my congestion.
• She slapped my wrist for changing the settings during the home study period, indicating the Dr would need it for the final prescription. Her only advice was to increase the humidity.
• I set the machine back to CPAP (13 cm H2O) as requested and have been adjusting the humidity.

Based on the advice I've received in this topic and other research, here's my intentions.

• Attempt to reduce leak (based on your input).
• Keep adjusting the humidity, but try it for a few days, before changing it again (based on Pugsy's advice).
• My next appointment with the sleep tech is Monday the 12th, I'll discuss with her the much better experience I've been having in APAP.
• My next followup appointment with my Dr. is Tuesday the 20th. I'll try to convince her the importance of APAP for me.
• When I buy machine, and return the loaner. I'll make sure to get an APAP, likely the same machine. And put it into APAP mode and consult the forum for tweaking.

Any other advise or suggestions appreciated.

[ChicagoGranny]

I would emphasize that the AHI you are seeing is not acceptable. Also, 13 is a fairly high pressure setting. With an Auto, you might be able to sleep at lower, more comfortable pressures for much of the night. Then the machine will raise the pressure when your airway needs it. Typically, in REM sleep, pressure requirements are higher. While backsleeping, they are typically higher as compared to sleeping on the sides or stomach.

The Sleep tech also increased my humidity to 5, because I did have some dry nasal congestion. This is also about the time my congestion issues started.

Have we already stated that higher humidity levels cause congestion in many people?

[Dog Slobber]

Have we already stated that higher humidity levels cause congestion in many people?

Yes, in another thread though.

Thus, I'll be trying a lower setting. Still not sure if I should abruptly setting it back down, or slowly bringing it down

[Pugsy]

Have we already stated that higher humidity levels cause congestion in many people?

This has been covered but he has been changing the settings each night and it might be that the nasal mucosa need to settle down a bit to see any improvement with a change.

Like when my nasal mucosa got mad at me when I changed it and didn't like what I did and I went back to the way it was before the change and it took 3 or 4 nights for the nasal mucosa to return to normal non mad at me stage.
Took a bit of time to heal up.

If 5 causes congestion...try going back to 4 that didn't cause congestion but give it a few nights for the nasal mucosa to get over being mad. I think he's been bouncing around with the humidity setting each night and not giving the mucosa a chance to return to normal.