Mouth breather in trouble

[Iseestars]

Dear friends:

Talking to my doctor he tells me that I need a turbinate and deviated septum reduction operation. I think my septum was a little deviated because I literally have slept on my stomach with my nose stick on the pillow all my life.

I asked my otolaryngologist if these operations would help me to reduce my AHI, and he told me that this is not certain, that what is certain is that I will be able to breathe better when doing exercise or sports.

I want at least to have a turbinate reduction to see if this improves my AHI, I do not expect miracles but I would like to know if someone here has gone through the same thing. I have read that 50% of the people with deviated septum and turbinate reduction operations don’t improve on their AHI.

My problem is that when my rhinitis is severe those nights my AHI goes up even to 12, and when it’s minor it can go down even to 5 AHI. My AHI is always a mix of hypopnea (partial blockage), less obstructive (complete blockage) and a little of clear airway. I have also verified that when I drink 4 or 5 tequila shoots those nights my AHI drops a lot, it opens my nose and I breathe easier. My doctor basically does not assure me that, but I suppose that with a turbinate reduction my AHI would improve.

Furthermore, I have just initiated Cpap one year ago, I’m on my mid 40s, have a wide neck, and my Cpap pressure is fixed at 11.5 cmH2O. I breathe through my mouth sometimes all night long, or sometimes I breathe mostly through my nose, it depends on each night; I use a full face (FF) mask for that purpose.

I have no doubt that when my nose is blocked totally or mostly my AHI gets worse, because the passage of air from the mouth to the throat is narrower. On the other hand, when my nose is not blocked or not that much, the passage of air from the nose to the throat works much better.

Please, could someone who has been through the same situation share their testimony? I need some encouragement on this.

Usually my AHI is between 5 and 8, but when I get 7 AHI or more the headaches are annoying or sometimes horrible. Also, after any bad night my throat hurts during the day and some days mi voice gets ruined.

Finally, I would like to add that I would not like to have surgery on my deviated septum (only turbinate reduction to start) unless it’s very necessary.

Thank you and hopefully this post will help someone else.

Cheers from South America

[Julie]

AHI from 5 to 8 is not what you should settle for as being OK even if the some OSA doctors' group arbitrarily chose 5 as a cut-off (had to be somewhere) and we mostly try to stay under 2 if possible, so that alone should push you to do better. And certainly it's good to get your nose fixed, but again, whether it helps your apnea is not the point (unless the results are dramatic - unlikely), because it still won't widen your throat passage.

You talk about severe rhinitis - just curious if you're using the humidifier on a high setting, regardless of e.g. local humidity, thinking its use is mandatory when a) it isn't, and b) could even be the cause of some congestion if not actually needed. Just a thought.

[ChicagoGranny]

Talking to my doctor he tells me that I need a turbinate and deviated septum reduction operation. I think my septum was a little deviated because I literally have slept on my stomach with my nose stick on the pillow all my life.

Gramps had turbinate reduction surgery and correction of a deviated septum. He says it was one of the best things he ever did for himself. It didn't lower his AHI or reduce his pressure requirements, but it made it much easier to use CPAP. Mouth breathing is not nearly as healthy as nasal breathing.

that what is certain is that I will be able to breathe better when doing exercise or sports.

... and when you are just sitting around. This is very important.

My problem is that when my rhinitis is severe those nights my AHI goes up even to 12, and when it’s minor it can go down even to 5 AHI.

Which model machine and mask are you using? (Please put this in your signature and you will not have to answer this again.)

[Dog Slobber]

I really wish people would stop thinking that the primary role of Septoplasty and T. Reductions for Apnea Sufferers is to address their sleep apnea. It's not, it's to address inability to breathe properly through their nose. This *might* alleviate some of the symptoms, but probably not.

You're complaining about mouth-breathing and inability to breathe through your nose, that is exactly what the role of Septoplasty and T. Reduction is for. Your lack of proper nose-breathing is interfering with CPAP therapy.

I had a septoplasty and T. Reduction, August 2018, best thing I've done in my life.

Your therapy while definitely negatively impacted by your inability to breathe through your nose may also be far from optimised. Post your graphs and see if it can be improved.

[ChicagoGranny]

Post your graphs and see if it can be optimised.

+1

[chunkyfrog]

Note: OP was given fixed setting at 11.5.
I suspect auto with a range could serve better.
A look at Oscar data could reveal any problems with settings.

[Okie bipap]

I had septoplasty and turbinate reduction in 1996 along with UPPP surgery. Immediately after the septoplasty and turbinate reduction, I was able to breath through my nose better than I had ever done even with the splints in my nose. I was truly amazed at the difference it made in my breathing. I have had far fewer sinus infections since the surgery than I did prior to it. Prior to the surgery, I would get two or three sinus infections a year, and have had very few of them since then.

[sleepcrapnea]

Holy heck you are lucky I just read your post.

Read my posts and see why!!

You talk about only getting a turbinate reduction. However, I think you need to discuss this very closely with your surgeon. and make sure you get CT scans and look through them and get the surgeon to take you through them. If you problem is only turbinates being enlarged then, as I understand it, the issue may not be an anatomical one. It might be that your turbinates are reacting to allergies or some other stumuli and you could correct it through non surgical means. However, you say you have a deviated septum. As I understand it, swollen turbinates can be caused by a deviated septum because they swell to try and compensate for uneven airflow. So, if you just got the turbinates trimmed without fixing the septum, they might just swell back again. Why not deal with the septum? That is likely the primary issue. But, done take my word for it. See your surgeon and have specific conversations about these issues and the scans. Discuss with surgeon. As to how deviated your septum is. Mine was very bent. I

It was totally impossible for me to use a CPAP. But I think my nose was VERY bent. So very blocked at night rendering cpap totally ineffective. I also had only a nasal mask and cant fathom the thought of a full face mask, especially since I get diagnoses as NOT having sleep apnea whenever I do the test, Even if I do have sleep apnea and the surgery doesnt end up fixing that, at least I will be able to actually use a CPAP anyway. Im very glad I had the surgery so far. It was a necessity one way or another. Had to be done.

[Iseestars]

Hi thank you everyone for taking the time to read and reply.

1.- Julie: Hi, my otolaryngologist assumes that my throat is partially blocked due its form and my age, so sadly it seems I will never aspire to have an AHI below 5 on a regular basis. That is why the doctor wants for now to focus on improving my nose.

About your question yes, I am using the humidifier on a high setting. Now, I'm going to try to lower it down that it's hot to see if the situation improves.

2.-ChicagoGranny: Hi, I have two Cpap machines: Resmed s9 auto and Respironics Remstar System One auto. I wear a mirage Quattro FF mask, small size. Both machines give me nearly the same results.

3.- Dog Slobber: Hello, I agree with you, septoplasty and turbinate reduction do not reduce the AHI because the main issue often times lies on the throat. However, I am a bit desperate because my doctor and I cannot lower much my AHI with the cpap machine and neither by staying fit (it helps but not a lot).

Therefore, given the bad results I have had breathing through my mouth, I am hopeful that at least I could improve my AHI a little bit having my nose in order.

4.- chunkyfrog: Hello, I have talked with my doctor and previously I have tried auto with a range (i.e. 9 to 11.5 cmH2O), nevertheless sometimes this works well but I don't know why other times switching to fixed pressures work better for me.

5.- Okie bipap: I'm happy septoplasty and turbinate reduction worked well for you many years ago.

6.- sleepcrapnea: Hi, I did not know that one of the causes of rhinitis was the deviated septum. The otolaryngologist made me take an X-ray of my sinuses, and told me that my septum was moderately deviated.

About allergies, so far my doctor has only given me loratadine, nothing more. As you explain, I think it’s convenient for me to obey the doctor and to undergo septoplasty and turbinate reduction as well. Lastly, I'm going to do what you say about doing a computerized tomography scans.

Conclusion: I will follow my otolaryngologist orders and have septoplasty and turbinate reduction. I'm happy many of you in this forum get their AHI really low, lower than 3 or 2 AHI. However, it's not my case due of genetic morphology of my throat and uvula, but I will work to improve as much as I can to have a more normal sleep.

Thank you.

[Julie]

Hi again - what mask are you using? There is so much choice (see Cpap.com for that) and you could well do much better leakwise with others.

Have you tried pressure settings of e.g. 6 or 7 min. and 15=20 max (far more typical)?

Unfortunately doctors may know the science behind apnea, but are too often ignorant of the finer points of the machines and how they may need to be readjusted at times.

[ChicagoGranny]

Again, what mask are you using?

Please read his last post.

I POST 2 AHI GRAPHS

These are not very helpful. Please use the standard format - http://cpaptalk.com/viewtopic/t158560/H ... eview.html

Also, add your machine models and mask model to the signature line in your user profile.

[ChicagoGranny]

It might be that your turbinates are reacting to allergies or some other stumuli and you could correct it through non surgical means.

At least in the U.S., standard practice is to try to eliminate turbinate inflammation through some combination of drugs and nasal sprays. Only after the surgeon is convinced the turbinates are permanently enlarged, surgical reduction will be undertaken.

[Iseestars]

Hi again - what mask are you using? There is so much choice (see Cpap.com for that) and you could well do much better leakwise with others.

Have you tried pressure settings of e.g. 6 or 7 min. and 15=20 max (far more typical)?

Unfortunately doctors may know the science behind apnea, but are too often ignorant of the finer points of the machines and how they may need to be readjusted at times.

Hello Julie, I have never put the automatic pressure of the cpap in high ranges as you say, for example 7 cm H2O of minimum and 15, 16, 17 or more of maximum. I have not done it because the doctor has told me that the pressure I need is around 11 or 11.5 cm H2O, based on my sleep study. Frankly, I don't know if a higher pressure or range (fixed or auto) could help me out.
Thanks!
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Hi chicagogranny. I have uploaded two images of my dream graphics to a host (below), the images can be enlarged. I didn't know how to do it right according to the pugsy’s manual, that's why I have uploaded two images from the same night, one showing snore flow rate and pressure. and other showing leak rate and snore.

Also, I cannot choose the cpap machine in my profile because the model I have does not exist there(I have 2, respironics system one and resmed s9). I did choose the type of mask (resmed mirage quattro FF), but I think it cannot be seen, I'm going to check that out.

About what you said, on doctors eliminating turbinate inflammation through some combination of drugs and nasal sprays, I didn’t know doctors did that. Otolaryngologists in my country don’t treat you the best, only talk to you 20 minutes and many aspects and questions remain uncovered. Finally, according to my doctor, my turbinates are chronically enlarged by several factors, therefore surgery on nose septum and turbinates is necessary.
Thanks!

** These two images below show a typical bad night of 8 or more AHI, which happen 1 out of 3 nights. As you can see I have complex apnea, however is not too severe. I present centrals, hypopnea, obstructive, and periodic breathing.

As I say before, It seems I will never get my AHI under 4 or 3, we have tried different pressures, fixed and auto, they work fine 2 or 3 days but after that suddenly my AHI goes up in the following days, even to 12 or 13 AHI.

[Julie]

Ummm - a min. pressure of 7 is still very low relative to how high some go, and the max at e.g. 15 is also below average of 20.

The machine's default low is 4 (at which no one is comfortable) so 7's not a big deal at all.

And what your MD said about '11' is not much of one either, as what happens on titration (testing) most often gets tweaked after you've lived with the machine at home for a time... rarely do you end up with the same settings as on testing.