Four Months Into APAP – Extreme Fatigue + Mask Issues

[alwaystired4563]

Hi everyone. I was prescribed APAP 4 months ago, and I use it every night after I was diagnosed with mild OSA/UARS (AHI<5, RDI either 10 or 16 depending on the sleep study).

I have a Resmed Airsense 11 APAP, I currently use the Airtouch N20 mask (see mask issues described below), and my setting is a minimum of 9 with EPR of 3, until last night when I bumped it up to a minimum of 10.

I'm really struggling with aerophagia, nighttime awakenings/daytime fatigue, and mask fit/nasal congestion. I'm hoping this forum can help me with my mask issue.

I have serious nasal congestion / nasal valve collapse issues. Any mask that touches my nose makes me feel like I cannot breathe.

One side note: I slept amazingly for the first three nights I wore the N30I, N20 Airfit, and N20 AirTouch masks. After the 3rd night, my nighttime awakenings and daytime fatigue returned. I'm not sure why I get three good nights of sleep with a new mask before regressing to my previous sleep/fatigue issues. Thoughts?

Here are the masks I've tried:

1) N30I: I slept really well the first 3 nights of wearing the N30I, but after the 3rd night I felt the mask restricted my nasal breathing/obstructed my nose. I've tried all sizes.
2) P30I: This one was the worst. I felt as if I couldn't breathe out of my nose period.
3) N20 Airfit (Large): I slept really well the first 3 nights of wearing the mask, but then I went back to waking up every 45 minutes and often feeling as if I couldn't breath through my nose. After a week, both the bridge of my nose and below my nose became bloody and raw.
4) N20 Airtouchv(Large): I've used this mask for 10 days. The first three nights I slept amazingly. Then, I started feeling like I couldn't breathe out of my nose. I often wake up in the middle of the night and my first thought is I cannot breathe through my nose. The foam/edge of the mask pushes against the base of the side of my nostrils, creating a nasal obstruction sensation.

Nasal dilator/strips: With all the masks, I've either used a nasal strip or an internal nasal dilator to increase my nasal breathing.

In summary, any mask that either touches my nose or puts pressure on the area around my nose causes me to feel as if I cannot breathe out of my nose.

I would very much appreciate any mask recommendations or other suggestions to get a good night's sleep with APAP.
Thanks!

[Julie]

Hi - can you fill out your Profile to go under each note (plse stick to same thread tho') with the model of which machine and mask plus pressure settings, etc? And then post Oscar results for a night or two using Imgur (hosting site) with a link here because the forum's too full to take those directly. That will let us see just what's what and help tweak anything that needs tweaking.

[alwaystired4563]

Hi Julie! Thank you so much for your reply.

1) I added my machine model, mask, and pressure to my original post. I also updated my original post with this information, plus the pressure settings.

2) It may be helpful to know my doctor ordered a Resmed BIPAP for me, which should come in a month. The BIPAP will hopefully resolve the aerophagia.

3) I've attached a couple of OSCAR shots from this past week \ here:https://imgur.com/a/bZPNxir. Last night, I bumped up to 10, and barely slept due to covid booster side effects (fever, aches, etc), so it was not a representative night for me. Therefore, I'm not including last night.

4) You'll notice on many of the nights the OSCAR flow graph will have a gap and reset to a pressure of 9. This is me turning the unit off/on to mark a full awakening. At a minimum, I turn the unit off/on after the first awakening to mark it on the graph.

Let me know if I can provide any additional information or zoomed-in OSCAR screenshots.

Thanks again!

[Miss Emerita]

You have very, very few obstructive events, and so I'd suggest you try lowering your pressure to help with the aerophagia. As an experiment, try a pressure of 7, keeping your EPR at 3, and see how that goes.

It sounds as though you might want to try the ResMed P10 nasal pillow mask. It's a minimalist mask, and it touches your nose only at the openings of your nostrils.

[alwaystired4563]

Thanks for the response Miss Emerita!

1) I should have mentioned I tried ResMed P10 at the sleep center when doing testing a month ago. It gave me the same congestion/obstructed nasal breathing sensation as the N30I and P30I. My ideal mask would be the N20 Airtouch but wider so it doesn't press against the base of my nasal walls. I need as much room between the mask and my whole nasal area as possible.

2) You're right that my numbers are low, but I often have what appear to be flow restrictions before waking. For example, I've uploaded the OSCAR charts for my first major awakening last night here:https://imgur.com/a/WGx4kJB. Also, keep in mind last night I went up 1 pressure level to 10 and had covid booster side effects.

The three uploaded charts are from the same time, with increased zoom. You'll notice before my 1:53 AM awakening, the breathing flow rate gets shallower and more disturbed.

3) Here is another OSCAR chart here:https://imgur.com/a/Fya46ou from my first major awakening two nights ago. You'll see before 2:47AM, lots of weird/shallow flow rates while the machine is REDUCING pressure.




These two charts show my usual breathing flow rate before my first major awakening.

I'm working under the assumption that I'm super sensitive to flow restrictions (I do have severe longtime daytime anxiety/emotional sensitivity issues). If I am indeed super sensitive to flow restrictions, they may be waking me up, indicating I should INCREASE pressure to eliminate them?

Feel free to challenge any of my thinking above. I'm coming to all of you for help/input!

[clownbell]

One approach is to get pressure as low as possible while still keeping apnea controlled. This would help with aero and perhaps with mask leaks too.

Regarding the p10 masks, I sed it about a year ago and did not like it. I tried it again about a month ago and absolutely love it. Go figure.

The nasal congestion may perhaps be solved by increasing humidity and/or air temperature. Some people need a warmer air, others a cooler air. Go figure.

[Julie]

Have you played with humidity settings to see how they might change things? Not everyone needs it depending on local climate or time of the year and it can make a difference in how you breathe and feel. And aerophagia can often be helped by lowering your min. setting a bit.. again, something you need to try for a few nights to see if it helps.

[GrumpyHere]

Nasal dilator/strips: With all the masks, I've either used a nasal strip or an internal nasal dilator to increase my nasal breathing.

In summary, any mask that either touches my nose or puts pressure on the area around my nose causes me to feel as if I cannot breathe out of my nose.

You might consider cloth masks. They press very lightly on the skin (much less pressure than the silicon interfaces of other masks.)

I use the 3D when I have irritated skin due to the pressure from the minimalist P10 or the Nuance Pro.

https://www.circadiance.com/sleepweaver

Given that you’re ok with nasal strips, consider the Bleep mask systems.
They attach to your nose via band-aid type adhesives.
They pull on the skin rather than press.

In the current version the Dreamports requires a bit of practice to attach the hose correctly. An improved version called the Eclipse is purportedly coming in Fall.
They attach the hose via magnets (looks a lot easier.)

https://bleepsleep.com/

Good luck.

[alwaystired4563]

Hi everyone! Thanks for all of the suggestions!

1) Masks/Congestion
I should clarify that I don't think the air is causing congestion. If I put the mask on with the machine off, I feel like I can't breathe/my nasal passageway collapses within 1-2 seconds. It's something about the mask itself touching my nose.

With the N20 Airtouch, I've also noticed the tighter it is, the more I feel like I cannot breathe. On the other hand, if I loosen the mask, I instantly feel like I have greater airflow through my nose.

Therefore, I've left the humidity and temperature on default. I have played with both to no effect, except to trigger rainout.

@ GrumpyHere: Thank you for the cloth mask and Bleep suggestions. I've looked at the Bleep, but I'm hesitant to try anything that touches my nose. However, I may try one of the cloth masks.

The mask with the least (not zero) nasal issues is the N20 Airtouch. I would ideally like a mask that is even bigger and makes contact with my face farther away from my nose. Any suggestions? Is the Whisp larger?

Edit: What Pugsy references in this:viewtopic.php?f=1&t=179619&p=1357319&hi ... i#p1357319 thread is my experience exactly. Anything touching my nose makes me feel congestions.

2) Pressure
Apneas were never an issue. My two sleep studies showed an AHI of 0 and 3; the RDI (RERAs & flow restrictions) are my issue.

Aerophagia over the last week has been better, and my doctor prescribed a BIPAP which I hope will help. I want to focus on reducing my flow restrictions.

3) OSCAR Charts/Flow Restrictions
What do people think about my OSCAR charts? In my last post, I linked to charts from two nights that showed abnormal breathing before my first awakening. Do these look like flow restrictions? If yes, would higher pressure reduce the awakenings?

Thanks again!

[ozij]

1) Masks/Congestion
I should clarify that I don't think the air is causing congestion. If I put the mask on with the machine off, I feel like I can't breathe/my nasal passageway collapses within 1-2 seconds. It's something about the mask itself touching my nose.

Never ever put you mask on without running the machine -- unless your machine autostarts.

With the N20 Airtouch, I've also noticed the tighter it is, the more I feel like I cannot breathe. On the other hand, if I loosen the mask, I instantly feel like I have greater airflow through my nose.

No need for the mask to be as tight as you seem to think. Masks should not be overtightened.

[Pugsy]

Edit: What Pugsy references in this: viewtopic.php?f=1&t=179619&p=1357319&hi ... i#p1357319 thread is my experience exactly. Anything touching my nose makes me feel congestions.

Lets be clear...my congestion happens when any mask touches the SIDES of my nose or the area where my eyeglasses would rest.
I do NOT have any congestion when I wear a mask that has an under the nostril cushion and there is nothing on the bridge of my nose are or touching the sides of my nose.

So your complaints about the P30i or N30i or the P10 can't be the same as my own personal issues since you say

I should have mentioned I tried ResMed P10 at the sleep center when doing testing a month ago. It gave me the same congestion/obstructed nasal breathing sensation as the N30I and P30I. My ideal mask would be the N20 Airtouch but wider so it doesn't press against the base of my nasal walls. I need as much room between the mask and my whole nasal area as possible.

I can or could use those masks without having any congestion problems.
I only had congestion caused by the masks themselves when I tried using any mask that touched the sides of my nose and that nasal bridge area.

The ResMed N30 under the nose cushion mask which is essentially the P10 redone to an under the nose cushion...
https://www.cpap.com/productpage/resmed ... h-headgear
I can successfully use without having any congestion issues. It's a nice little mask. It actually ranks number 3 on my list of preferred masks.
1...being the Bleep
2...being the P10
3...being the N30

The N30i and P30i...while I could use them I don't really like them. Too noisy to suit me. I have been spoiled by the silence of the BLeep or P10. I don't have any problem with moving air with them though. No congestion or air moving issues.

Have you tried just using the cushion/pillow thing up next to your nostrils without being attached to the hose or machine to see if you can breathe easily with the mask cushion/pillow resting gently against your nostrils????
I am talking about just the cushion/pillow being held up against your nostrils without headgear or machine being involved.

What do people think about my OSCAR charts? In my last post, I linked to charts from two nights that showed abnormal breathing before my first awakening. Do these look like flow restrictions? If yes, would higher pressure reduce the awakenings?

I am not sure what you are talking about. What little zooming in your did wasn't enough zooming in to evaluate flow rate optimally.
I saw a couple of sort of zoomed in segments but they were 20 minute plus in length segments...way too zoomed out.
5 minute segments at most would offer better detail.

[alwaystired4563]

Pugsy, thank you for the detailed response! I guess I misread your post.

1) Masks
When I return home, I will try putting the N30I next to my nose without turning the unit on, and I'll report back!

2) Oscar
Here is a 5-minute zoom of my chart before my first 9/2 awakening: https://imgur.com/a/Q2DAFDu
Here is a sequence of 5-minute OSCAR zooms before my first 8/31 awakening: https://imgur.com/a/deH4CcW
Here is a link to a full night chart and a sequence of 5-minute zooms before my first awakening :https://imgur.com/a/LwvCCQi

Most nights, before my first awakening, the machine increases pressure, my flow rate becomes shallower and or choppy, and then I wake up. This indicates to me either A)the increased pressure is waking me up, or B) I'm experiencing flow restrictions which I'm very sensitive to, and they wake me up.

Again, I want to express my appreciation for everyone's help! Have a great labor day weekend!

[Miss Emerita]

You may be talking about two different things.

One is decreased amplitude in your flow rate for a period of time. This means your breathing is more shallow during that interval.

Another is flow limitation. This is a limitation on your inhalation in a single breath or a series of breaths. Instead of a smooth curve, the flow rate for inhalation shows a dent, plateau, or peak. (Inhalation is the part of the flow-rate line that's above 0.)

Much of the shallow breathing I'm seeing looks to me like awake breathing, mainly because there are no pauses between the breaths. In other words, being awake (maybe partially awake) would be the cause of the shallow breathing.

With flow limitations, people who are sensitive to them have their sleep disrupted by the extra effort of completing an inhalation against the limitation on the flow. The limitation can come from swelling of tissues in the nose or from lax tissues in the pharynx.