High pressure to overcome nasal obstruction

[finallywakingup]

I am now 56. I broke my nose when I was 20 and after 8 surgeries it was rebuilt with a part of one of my ribs. Can't normally breath well through it so have been a mouth breather since. I find that using much higher pressures than were recommended after my sleep study allow me to use nasal pillows more easily (8 was recommended--use 15 with AFLEX set to 3). Being able to breath through my nose when I sleep is actually a very pleasant experience. Anyone else doing something similar? Any comments/advice?

[moresleep]

Whatever works for you is valid, and it sounds like you have found something that works. But, if you haven't recently, you might see an ENT specialist about possible ways to improve the airflow through your nose (if the ENT finds that it needs improving). At the time I was diagnosed with sleep apnea, I suffered from sinus infections to the extent that breathing through my nose was difficult and CPAP through a nasal mask did not work well at all. I saw an ENT and among other things, had radio frequency treatments to shrink the turbinates, used antibiotics to attack the infection, and started a regime of sinus rinses (which I continue) to keep things clear. I think the sinus rinses helped more than anything. Now, I successfully use a nasal pillow mask, and AHI is usually <3. I also use a heated humidifier, but find that anything more than the lowest heat setting does more harm than good.

[gasp]

Upon reading your story I felt good for you having been through so many surgeries and reading you are enjoying the experience of breathing through your nose.

When you say 8 was recommended (a limit of 8?) and 15 is used (a limit of 15?)? Since you're using AFLEX then I'm assuming your machine is an automatic such as mine which is a Respironics AFLEX and if so this means your machine machine picks your pressure depending upon obstructive apnea events. An AFLEX setting of 3 means you have it set for maximum exhalation relief (that's the setting I use and like : )

-What is the range your machine is set to? (Example would be 5 to 15)
-What is your average AHI? (Example would be 2.0, 5.0, 7.5, etc.)
-Does the higher pressure cause any difficulties for you? I am curious to see your answer regarding your AHI. That will tell if the higher pressure is controlling or causing events.

[finallywakingup]

Hi, Thanks for your responses.

I am a physician, but I have learned more about the practical aspects of using CPAP by reading through CPAPTALK than from any other source. I wanted to see if I could get some additional opinions about my problem and solution.

Unfortunately, nothing else can be done about my nose. It is very scarred from all of the surgeries.

Even though my machine is an APAP, I use it as a CPAP. My AHI is always less than 3. The higher the pressure, the easier it is for me to inhale, although i still don't think I inhale through my nose as easily as a normal person normally can (with my pressure set at 15). If I go any higher than 15, it becomes too hard to exhale, even with the AFLEX maxed out. I am considering getting a BIPAP machine, so I can increase my IPAP even further and decrease my EPAP.

Any other ideas would be appreciated.

Thanks.
Steve

[gasp]

Well Steve, it appears that you are getting a good handle on everything. Be sure to list your equipment in your profile so that it shows up on your posts. Knowing the equipment helps forum members to take it into consideration when answering.

An AHI around 3 is great. Are you considering raising your pressure via BiPAP just for increased feeling of breathing or are you shooting for an even lower AHI - or both : )?

[finallywakingup]

I am considering BIPAP so I can increase my IPAP to make it easier to breath through my nose. My guess is that I still suffer from UARS when I am on CPAP, which is not reflected in my AHI

[Otter]

I have a smashed nose too, and I didn't expect to be able to breath through it very much. But the machine is very good at clearing my airway. I self-titrated with APAP, so I don't have a lab titration to argue with. 11.6-16.4 cm H2O with 3cm exhalation relief.

Now and then when I'm stuffy but still breathing, I wish for a button to manually nudge the pressure up within its range for half an hour. Usually, though, I can just go to sleep. I think that blasting my nose clear every night actually helps during the day as well.

You'd probably like bipap. The S9's EPR is sometimes called mini-bipap, but the waveform looks like a saw blade. It usually just touches the target inspiratory and expiratory pressures before reversing. As I understand it, bipap gets there more quickly and stays there. But even though the pressure doesn't usually get down to 3cm below therapy pressure until I'm about to inhale, I have no trouble breathing out at 16cm. I often don't realize I have the mask on when I wake up, even when the pressure is high.

[DaveMunson]

Yea but different.

During the cold and flu season my high pressure usually clears my sinus and allows me to breath. My pressure is high (16+) and starting up can usually clear my sinus in under a minute or two if I am congested.

[finallywakingup]

Otter and Dave. Same here--my nose becomes clearer after being on high pressure CPAP for a while. I have both a Resporonics machine with AFLEX and a Resmed S9 with EPR. I find that breathing with AFLEX is much more comfortable than with EPR, but the silence of the S9 is golden.

One point Otter. How much do you think you breath through your nose with a FFM? My bet is that the machine lowers its pressure when you are breathing with your mouth open and raises it if you shut your mouth--the difference in pressure would depend on how bad your nasal obstruction is. For myself, a FFM would essentially be a mouth mask since the resistance though my nose is so high.

[Otter]

One point Otter. How much do you think you breath through your nose with a FFM? My bet is that the machine lowers its pressure when you are breathing with your mouth open and raises it if you shut your mouth--the difference in pressure would depend on how bad your nasal obstruction is. For myself, a FFM would essentially be a mouth mask since the resistance though my nose is so high.

That's how I expected it to work most of the time, but the pressure cleared my nose. Nice surprise. If I can breathe well enough to keep my mouth closed for a bit, the pressure opens my nose up. It's when I can't breathe through my nose at all that I'd like to be able to raise the pressure temporarily. If I think of it next time, I"ll try doing "mask fit" a couple times and see if that's enough. It would be nice to have a way to keep the pressure up for more than three minutes, though. But even when I fall asleep clogged up, I usually wake up clear. I suppose what happens is that eventually things shift around enough to let some air through, and then I close my mouth. I do wake up with a dry mouth sometimes, though, so it's not a perfect system.

Now that I know it's possible to breathe through my nose, I'll probably get a nasal mask too. But I only recently reached a point where my FFM seals reliably, and I still have a huge sleep debt to pay off, so the next round of mask fiddling will have to wait. I might also experiment with some sort of chin strap.

[dsm]

I am now 56. I broke my nose when I was 20 and after 8 surgeries it was rebuilt with a part of one of my ribs. Can't normally breath well through it so have been a mouth breather since. I find that using much higher pressures than were recommended after my sleep study allow me to use nasal pillows more easily (8 was recommended--use 15 with AFLEX set to 3). Being able to breath through my nose when I sleep is actually a very pleasant experience. Anyone else doing something similar? Any comments/advice?

Hi finallywakingup

Welcome to the forum. I am a bit older than you but also had great difficulty nose breathing (really difficult). At age 8 had an operation for a deviated septum & also played rugby as a youngster & as a teen had to go on the field with a nose guard.

I gave up on nasal masks & pillows die to not being able to use them consistently. So am now a F/F mask person & will switch between nose breathing & mouth breathing. Dr put me on Nasonex about 3 years ago & whilst I was skeptical he kept suggesting staying with it as it took time & now use it every night. It seems he was right.

Went to a nose specialist who after a scan said (sort of),
- take out tonsils
- ream out turbinates
- recovery will be painful
- also you have an immature glottis (still not sure what that means to respiration ?)

Never went ahead with any of it as it was too uncertain & after reading here of tyhe saga James Skinner's experiences with his nasal surgery decided to live with it.

Good luck with your therapy

Cheers DSM