Does CPAP tickle the back of ANYBODY else's throat?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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robysue
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Re: Does CPAP tickle the back of ANYBODY else's throat?

Post by robysue » Mon Dec 27, 2010 10:38 pm

chunkyfrog wrote:I noticed some tickling when I was coming down with an upper respiratory infection.
I also notice tickling when I get that gush of clear very salty drainage from my sinuses that precedes a cold sore outbreak.
I wish it only happened when I was coming down with something. Head colds, allergies, and cold sores all make the constant tickle even more torturous, but the tickle is ALWAYS present with me. It was there right from the start of the first titration test when the tech first turned the pressure on when fitting the mask. And it triggered some coughing and sneezing in addition to the sneezing that I had when she tried to put the nasal mask on my nose.
I take valacyclovir to nip that in the bud.
What is valacyclovir? Where do you get it? and how do you take it?

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ozij
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Re: Does CPAP tickle the back of ANYBODY else's throat?

Post by ozij » Mon Dec 27, 2010 11:28 pm

I want to try a recap of what I remember of your cpap therapy:
  • You tend to insomnia, and on both sleep studies slept very little
  • Your first Rx was for a pressure of 9; that pressure gave you aerophagia and nightmares of being force fed like a goose.
  • A trial on a Resmed auto resulted in a recommendation to run the APAP pressure at 6 to 8 IIRC.
  • You then had a new sleep study, and based on 17 minutes of sleep were Rxed a BIPAP at IPAP 8 EPAP 6
The things that bother you:
  • Aerophagia if the pressure is 9
  • EPR starting too soon on the Resmed
  • Biflex bringing air in too soon on the Respironics -- solved by a rise time of 3
  • Air tickling in the back of your throat
Furthermore: All options tried till now have resulted in worse sleep quality than you had before cpap.

Fact: When you sleep at home, there is indication of residual snoring, on both machines.

There are a number of ways of understanding this information:
I. xPAP therapy is not helping you at this point because you have not yet arrived at the proper pressure to keep your airway clear - hence the residual snores.
II. Your extreme sensitivity at the back of your throat is making xPAP therapy a cause of added arousals, instead of a cause of improved sleep.
III: Your hypopneas with arousal seen in the sleep study are a result of GERD - which has recently been identified as a cause of insomnia, arousals, irritation of the nasal mucosa and back of throat. People with a weaked lower esophagal sphincter will have more acid reflux -- and more aerophagia.

Of course, all of the above may be true.

I would do the following:
1. Have the issue of GERD thoroughly investigated.
2. Make a concerted, conscious effort to get the back of my throat used to the blowing air. I would do that by using the machine during the day when I'm awake and busy concetrating on something I like doing. This would serve me as a way of experiencing the fact that "air in my throat is something I can tolerate".

Being highly sensitive can be very difficult -- and sometimes, just knowing we are highly sensitive is a big help in going through life. Sometimes that's not enough, though. Sometimes the next step is finding the ability to tell ourselves "I'm highly sensitive, but I want to try to develop the capacity to ignore this or that irritant". It's not easy, and growing up where our sensitivities are mis-perceived or ignored often makes them clamor for our attention insistently. Learning to overcome some of them means developing the paradoxical capacity of being highly tuned to yourselves, listening to that clamoring voice giving it the attention it needs, accepting it, and yet learning to distract ourselves from it, without making that sensitive part feel betrayed and bereft. Very difficult.

3. I would search for a combination of IPAP and EPAP that would keep me from snoring consistently
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.

Antoine de Saint-Exupery

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Big S
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Re: Does CPAP tickle the back of ANYBODY else's throat?

Post by Big S » Tue Dec 28, 2010 1:10 pm

Dumb question but have you tried turning off bi-flex? Sorry, I hate to see you suffer.

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robysue
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Re: Does CPAP tickle the back of ANYBODY else's throat?

Post by robysue » Tue Dec 28, 2010 2:55 pm

Big S wrote:Dumb question but have you tried turning off bi-flex? Sorry, I hate to see you suffer.
On the PR S1, the Bi-Flex was the FIRST thing to GO! The very first day I had the S1 I turned Bi-Flex off after doing a controlled 30 minute experiment comparing Bi-Flex with settings 1, 2, and 3 to Rise Time using settings 1, 2, and 3 with the Bi-Flex and Rise Time demo features of the PR S1 (a real nice feature, by the way). It was VERY clear by the end of that 30 minute experiment that Bi-Flex was most definitely NOT for me. And that Rise Time = 3 was the most comfortable setting of all six possiblities for controlling how the increase and decrease in pressure between EPAP and IPAP feels.

I first started out using an S9 AutoSet as a straight CPAP set to 9cm and simply could not breathe out against the pressure unless EPR was set to 3. I did do some experimenting to see if I could turn EPR down to 1 or 2, but those settings just did not provide enough relief for me to start to exhale comfortably. Once my pressure with the S9 AutoSet was switched to an APAP 7--8cm, I still simply could not breathe out against 7 or 8cm of pressure with EPR turned off. (Yes, I know this makes me sound like a wimp, but it's true, and I won't apologize for not being able to breathe out at 7cm of pressure, even though I can breathe out against 6cm.) Some experimenting while I had the S9 led to the following being my default least uncomfortable setting: APAP with range 7--8cm and EPR set to 2cm. I don't think it's a coincidence that shortly after discovering this lovely fact my BiPAP titration came up with my current prescription of 8/6 either.

At any rate on the ResMed S9 running at 7--8cm of pressure, EPR = 3 caused too much of an increase in pressure during the second part of the exhale for me to be comfortable---too much tickling of the back of my throat. And EPR = 1 didn't provide enough pressure relief at the start of the exhale for me to comfortably start the exhale and get enough air out of my lungs to feel like I'd cleared enough air out before feeling like the S9 was trying to force air back down my lungs before I was ready to breath in. And EPR = OFF meant that I felt like I was running a marathon trying to breathe out with every single breath. The effort to simply exhale was overwhelming to me.

So like Goldielocks discovering Baby Bear's bed, I'm currently finding the BiPAP at 8/6 with Rise Time = 3 much, much closer to "Just Right" than anything I've tried so far. Even though I do still feel it tickling the back of my throat, at least with the BiPAP (and no Bi-Flex), it's not making a major point of increasing the tickle-rate right in the middle of each and every exhale the way I felt when I was using the APAP/CPAP with EPR. And since I really couldn't tolerate APAP/CPAP with EPR off without feeling like I was having air forced into my lungs in a way that I could only describe as "force-breathing" in an analogy to "force-feeding", I think overall maybe I do qualify as having "failed" CPAP and maybe the sleep doctor and his PA were right to suggest the BiPAP titration after all.

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Re: Does CPAP tickle the back of ANYBODY else's throat?

Post by Janknitz » Tue Dec 28, 2010 6:30 pm

I would second KTeague's suggestion of trying a throat numbing spray to see if it reduces your reaction. Or you could try drinking something very cold with ice (i.e. icewater) before bed--the idea being to overload your sensory system just a little so it will be less sensitive to these sensations. That would at least help on the "going to sleep" end of things.

You mentioned that the humidified air is too warm on your machine. Are you running the humidifier in default or "classic" mode? When my PR S1 is run in default mode, the humidified air is arctic cold, even if my bedroom is pretty cold. It's only slightly warm at the end of the night in "classic" mode. Some of this has to do with the relative humidity and temperature in your room, so those are variables to consider.

I find the PR S1 is exceedingly slow to recognize when I'm awake and fully capable of keeping my own airway open. Some mornings I wake up with it blasting at full pressure, and it doesn't seem to come down on its own even though I'm awake. (I like to stay in bed for a while and enjoy the sensation of waking slowly). I have my ramp button set at my usual starting pressure of 9 cm and I will hit that button if I find the wind tunnel to be annoying. Just set your ramp to start wherever you feel most comfortable, it doesn't have to be very low.
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robysue
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Re: Does CPAP tickle the back of ANYBODY else's throat?

Post by robysue » Tue Dec 28, 2010 7:32 pm

Janknitz wrote:I would second KTeague's suggestion of trying a throat numbing spray to see if it reduces your reaction. Or you could try drinking something very cold with ice (i.e. icewater) before bed--the idea being to overload your sensory system just a little so it will be less sensitive to these sensations. That would at least help on the "going to sleep" end of things.
Didn't get a chance to pick up the numbing spray today, but plan to as soon as I get a chance. Ice water before bed in a 62 degree house though won't work for now. I already shiver enough going to bed.
You mentioned that the humidified air is too warm on your machine. Are you running the humidifier in default or "classic" mode? When my PR S1 is run in default mode, the humidified air is arctic cold, even if my bedroom is pretty cold. It's only slightly warm at the end of the night in "classic" mode. Some of this has to do with the relative humidity and temperature in your room, so those are variables to consider.
I'm running the humidifier in the default mode, not classic. At setting 1, the air feels like ambient, forced air heat in central Illinois---a bit warm and way too dry. At setting 3, the air feels a bit like a temperate jungle: it's like sleeping on a bad night in July here in Buffalo (without A/C)--- too warm and way too humid, but no rain out due to the fact that the climate control works in the sense of preventing it. At setting 2 my reaction to the air seems to swing back and forth from the verge feeling like I'm in the heated Illinois house in winter (air a bit too dry for my tastes) to the verge of feeling like I'm in the jungle. It's got to be my reaction to the air because the whole point of the climate control system is that its supposed to keep the relative humidity and temperature more or less constant in spite of the changing conditions in the bedroom as I understand it. And maybe the reason that I find the air is coming out of the hose feels warm (even hot) is that I route the hose under the covers, which include a nice warm down comfort since our bedroom is around 62 F at night.
I find the PR S1 is exceedingly slow to recognize when I'm awake and fully capable of keeping my own airway open. Some mornings I wake up with it blasting at full pressure, and it doesn't seem to come down on its own even though I'm awake. (I like to stay in bed for a while and enjoy the sensation of waking slowly). I have my ramp button set at my usual starting pressure of 9 cm and I will hit that button if I find the wind tunnel to be annoying. Just set your ramp to start wherever you feel most comfortable, it doesn't have to be very low.
Fortunately for me I'm running the BiPAP Auto in straight BiPAP mode so the IPAP/EPAP stay at 8/6. Otherwise I'm sure I would have problems with this too. And with that EPAP fixed at 6cm, I am comfortable breathing out and taking as long as I want waking up and lying in the nice warm bed and snuggling with my hubby before unmasking. It is strange how the pressure doesn't tend to tickle the back of the throat as much when I'm waking up intentionally as it does when I'm wanting to drift off to sleep.

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Re: Does CPAP tickle the back of ANYBODY else's throat?

Post by aeonswife » Wed Dec 29, 2010 12:58 pm

YES! One of the first problems I encountered was this awful tickle at the back of my throat the entire time the machine was on. It got to the point where i started gagging and almost threw up. I talked to my wonderful pharmacist, and she recommended I try one of those throat pain sprays. I chose Cepacol (only because it had a cherry flavour, and I had used it before with tonsillitis). It's not very expensive, and it really helped. The tickle didn't disappear, but it certainly is a lot less then it was. I'm not gagging now. Problem is you can only use it for short periods of time. Maybe try for a week and see what happens?
Good luck I really hope this helps.

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Re: Does CPAP tickle the back of ANYBODY else's throat?

Post by MoonBear » Wed Dec 29, 2010 1:48 pm

Hi Robysue,

I am wondering if you are a candidate for the Pilar procedure? I have just seen a video of this surgery on Youtube, and it is very simple and about as easy as any surgery could be. I am wondering if your sensitivity at the back of the throat may not make you a good candidate for this? even if it did not totally correct your apnea, it might improve things enough that the pressure could be much lower?

I am so sorry you are having such a rough time. You have been a very bright light for us, and especially one for me. Please, keep us posted. Ranting and raving is FINE -- whatever you need to feel even a little better. Sending bear hugs,

MoonBear

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Re: Does CPAP tickle the back of ANYBODY else's throat?

Post by chunkyfrog » Wed Dec 29, 2010 2:28 pm

Valacyclovir = generic Valtrex; Antiviral medicine used for Herpes I (cold sores), and Herpes II (the other herpes)
Same drug; generic is WAY cheaper than brand name.
Resmed Airsense 10 Autoset FOR HER, p10 mask

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Re: Does CPAP tickle the back of ANYBODY else's throat?

Post by Janknitz » Wed Dec 29, 2010 3:03 pm

I'm running the humidifier in the default mode, not classic. At setting 1, the air feels like ambient, forced air heat in central Illinois---a bit warm and way too dry. At setting 3, the air feels a bit like a temperate jungle: it's like sleeping on a bad night in July here in Buffalo (without A/C)--- too warm and way too humid, but no rain out due to the fact that the climate control works in the sense of preventing it. At setting 2 my reaction to the air seems to swing back and forth from the verge feeling like I'm in the heated Illinois house in winter (air a bit too dry for my tastes) to the verge of feeling like I'm in the jungle. It's got to be my reaction to the air because the whole point of the climate control system is that its supposed to keep the relative humidity and temperature more or less constant in spite of the changing conditions in the bedroom as I understand it. And maybe the reason that I find the air is coming out of the hose feels warm (even hot) is that I route the hose under the covers, which include a nice warm down comfort since our bedroom is around 62 F at night.
That's really interesting because when I run the humidifier in default mode the air is ICE cold all the time. I believe it has to do with the relative humidity, which is moderate to high for me. As such, the PR S1 doesn't have to raise the temperature to bring up the humidity level.

People who live in drier environments do note that their humidifiers heat up. So perhaps bringing up the humidity in your room--i.e. via a room humidifier--will reduce the need for the PR S1 BiPAP to heat the water???? And, as far as keeping the hose under the covers, that's certainly a factor as well. Have you tried to leave the hose on top of the covers just to see if it helps?
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