Adjusting CPAP settings after nasal surgery - looking for advice on what to adjust!

[jc13]

Hi All,

I have been on CPAP (APAP) therapy (Airsense 10 with Airfit P10) for about four years. 43yo, 6'1, 215lbs, amateur bodybuilder, overall great health. Sleep has always been poor and I was nicknamed "sleepy eyes," but when I started getting above-average-muscular a few years ago it became too much. Falling asleep spontaneously all the time, from the outside people thought I was narcoleptic!

One of the factors was a deviated septum, enlarged turbinates, and to top it off a weak nasal valve outer wall. I recently had that fixed and am trying to refine my CPAP settings. The old settings really don't feel usable anymore and my specialist's attitude to adjustment seems to always be "We need to increase the pressure!" regardless of the situation, so I'm trying to do this on my own.

My main issue is that during the night the pressure just feels too much, my mouth gets very dry (I assume from pressure being high and opening my mouth) and I just take it off and eventually don't use it the rest of the night. I don't generally breathe through my mouth at night, so I think it's from the pressure. The main symptoms that I have from lack of good treatment is generally a bit sleepy during the day and also a sense of background and non-specific anxiety - it's hard to focus and be present.

I've read a ton of threads and think the answer lies in finding a narrower range of pressure and possibly dealing with keeping my mouth closed through tape or something.

Data from this week

2021-06-08_11-10-47.png (317.92 KiB) Viewed 397 times

In this data from a cookie nights ago, I think I started off with APAP 8-12cm, and then after it started blowing super hard and getting annoyed I changed it to CPAP at 8cm. I like the feeling of the constant 8am, but there are times that I feel like I'm not getting enough air. Looking at the data, it's likely that the frustrated point came around where the H event is, not sure if that's significant. Using my O2Ring it seems that I don't get any desaturations when I sleep on my side, but I do on my back. I'm not keen on trying to just sleep on my side, because even a few hours of untreated sleep seems to give me the tiredness and anxiety, I'd rather find a solution that doesn't have such gaps in it.

I don't mind wearing the mask (P01, what's really getting to me is the dry mouth and occasional feeling that it's just blowing so hard. This says the 95% pressure was 10.28 cm. I'm thinking of a few options:

• Keep 8-12cm but tape mouth. This is appealing but I've done this, and my mouth still ends up feeling dry?

• Pick a constant middle setting like 9.0 or 9.5cm with an EPR of 3.0 to allow easier breathing(currently at 2.0) - adjust up and down if it doesn't feel just right

Appreciate help in understanding if I'm reasoning about this data OK? Suggestions on which path (or another) to attempt?

Thanks! - J

[zonker]

Hi All,

welcome to the zoo!

instead of mouth taping, i suggest the idea that jay aitchsee came up with-


viewtopic/p1089718/viewtopic.php?f=1&t= ... s#p1086296

in conjunction with a firm foam cervical collar, i've eliminated any air in or out of my mouth. this is the collar i use-

https://www.amazon.com/Coreline-Cervica ... 580&sr=8-5

this can also be found at your local drugstore as well, but usually at a slightly higher cost. look for it where they keep canes, walkers, bed pans and so forth.

the collar helps keep my jaw from sagging. the scunci bands help keep my lips pressed against my teeth.

i'll let others speak to you about pressure adjustments.

good luck!

[ChicagoGranny]

You are going to have to deal with the mouth-breathing before you can optimize your pressure settings. A FFM is one possibility. Some of the newer models have a much smaller footprint and do not block the field of view. Another possibility is Somnifix which is a specially designed tape.

If you want to try an auto setting again, I suggest min 6.0 and max 9.0. You like a steady pressure so turn EPR off.

When do you feel like you are not "getting enough" air? Is your mouth open at these times?

[chunkyfrog]

If by "recently", you mean very recently, you may still be healing.
Good luck on your speedy healing.

[Miss Emerita]

I second Chicago Granny's suggestion about trying Somnifix, but you're right, even with tape and zero leaks, I sometimes get dry patches in my mouth. If it's very bothersome, you might try Xylimelts, which are small lozenges that promote saliva production. They stick to your tooth or gum and slowly dissolve over the span of the night.

Do try eliminating pressure variation. It sounds like you're not bothered by EPR, which changes pressure with each breath, the same way every time, so I'd keep it.

Given that you're seeing virtually no obstructive events with your current settings, I'd suggest you try setting min = max = 8, with EPR of 3, and see how you like that. The EPR of 3 might help you a little with flow limitations, in case those are part of what keeps you from more restful sleep. If a bunch of obstructive apneas or hypopneas show up, you can always go up to 9 to see if that does the trick.