Need help, suspect UARS. Want to try APAP - need advice and guidance.

[canyouhearmeaya]

Also, did the sleep data I posted previously suggest unusually high flow limitations?

The sleep test actually referred to is as 'Upper Airway Flow Limitation', not 'Upper Airway Obstruction' as I'd previously said.. (Whether that means two different things I don't know.)

I wonder if that's why with CPAP I was getting flow limitation?

And would things like nasal congestion CAUSE that flow limitation?

[canyouhearmeaya]

Definitely think congestion is part of my problem. I didn't end up sleeping with the machine last night, I took it off after about 15 minutes simply because I just wanted again to try and get some sleep where my sleep cycle has been totally messed up this last week.

However with the decongestant spray + the strip, it did feel easier to breathe with the machine. I did wonder if I almost needed to up the pressure, as it some ways it felt like I could of done with more air on the inhale, without having to purposely inhale with effort to get it.. if that makes sense? I presume with a higher min pressure, a light gentle inhale will deliver more air than vs a low pressure, potentially requiring less 'effort' in breathing. Is that right?

On the downside, this morning I'm super congested now... I do wonder if its 'rebound congestion' from using the spray. The spray does seem to make a big difference, the combination of that + the breathe rite strip makes my nose feel much much clearer, certainly a noicetable difference. But if the spray causes a rebound, then it's certainly not an effective solution long term. This morning i can hardly breathe through my nose at all now it's so congested, which it's not normally that bad.

Does anyone have any suggestions based off this?

I don't think congestion is my underlying problem, in that, I don't think congestion alone is what caused my RDI of 15..? I suspect I am infact generally more congested then I realised, although it certainly varies, and my sleep has never been great so I don't know if congestion alone can explain my poor sleep for so long?

but I do suspect congestion may have been a big part of the problem with me struggling to breathe with the machine.

Edit: Just to add I have the humidifer with the machine which I've used every time, with the heated hose, and humidifier on set to 'Auto'. it doesn't seem the humidifier alone clears my congestion which it sounds like for some people it might?

[palerider]

No...the machine won't try to fix a leak by increasing the flow rate or pressure. Doesn't work that way.

Technically, yes, the flow rate increases when there's a leak, otherwise the pressure would drop.
You're absolutely correct, though, that pressure does not increase... but the flow rate does increase to maintain pressure.

[Julie]

Humidity usually Causes congestion... and the humidifier's just a comfort thing - try not using it at all.

[canyouhearmeaya]

Humidity usually Causes congestion... and the humidifier's just a comfort thing - try not using it at all.

Oh really? Interesting.. I thought it was meant to help!! Lol.

Okay, so do I:

Remove the water chamber entirely and put in the blanking plate

OR

Leave the water chamber in, and just turn the humidity setting down to 0?

[Snoregone Conclusion]

Humidity usually Causes congestion... and the humidifier's just a comfort thing - try not using it at all.

Oh really? Interesting.. I thought it was meant to help!! Lol.

Okay, so do I:

Remove the water chamber entirely and put in the blanking plate

OR

Leave the water chamber in, and just turn the humidity setting down to 0?

I expect I’ll end up with an APAP machine, expect to be diagnosed, but here’s my observations without using a machine:

• If I sleep on my side, most of the time I’m not going to have a problem going dry for mouth or nose, though I’ve found I’ve drooled at times, likely showing I’ve slept with my mouth open at least part of the time

• Sleep on my back, almost certain I won’t keep my mouth shut, so it will get dry

• Visit family in Utah where it’s very low humidity (10% or lower) my nose gets stuffy from being too dry (it never gets that dry here) even when awake

I have treated high blood pressure, and one of the side effects that can happen is a dry mouth, just from the meds. You absolutely want to avoid a dry mouth because it leads to bad dental side-effects, up to and including tooth loss, long-term

If your nose gets too dry, nosebleeds are quite common. Likely (but not necessarily 100% due to complex physiology) a lot of mine have come from allergies. This gets unpleasantly messy if this happens while sleeping, something I’ve had happen. A CPAP and related machines work by blowing through far more air than you’d normally have going through you when suffocating naturally: the lower the relative humidity, the higher chance this results in a perfect storm of dry nostrils and mouth, acting like a hair dryer in low in your face.

As long as they’re still around, I do intend on visiting siblings in Utah on a regular basis, so logic tells me I’ll need a machine that can work with the higher altitude and also vary humidity: outside of comfort from a stuffy nose, I intend on not causing dental issues that are the result of a dry mouth.

[canyouhearmeaya]

Humidity usually Causes congestion... and the humidifier's just a comfort thing - try not using it at all.

Oh really? Interesting.. I thought it was meant to help!! Lol.

Okay, so do I:

Remove the water chamber entirely and put in the blanking plate

OR

Leave the water chamber in, and just turn the humidity setting down to 0?

I expect I’ll end up with an APAP machine, expect to be diagnosed, but here’s my observations without using a machine:

• If I sleep on my side, most of the time I’m not going to have a problem going dry for mouth or nose, though I’ve found I’ve drooled at times, likely showing I’ve slept with my mouth open at least part of the time
  Sleep on my back, almost certain I won’t keep my mouth shut, so it will get dry
  Visit family in Utah where it’s very low humidity (10% or lower) my nose gets stuffy from being too dry (it never gets that dry here) even when awake

I have treated high blood pressure, and one of the side effects that can happen is a dry mouth, just from the meds. You absolutely want to avoid a dry mouth because it leads to bad dental side-effects, up to and including tooth loss, long-term

If your nose gets too dry, nosebleeds are quite common. Likely (but not necessarily 100% due to complex physiology) a lot of mine have come from allergies. This gets unpleasantly messy if this happens while sleeping, something I’ve had happen. A CPAP and related machines work by blowing through far more air than you’d normally have going through you when suffocating naturally: the lower the relative humidity, the higher chance this results in a perfect storm of dry nostrils and mouth, acting like a hair dryer in low in your face.

As long as they’re still around, I do intend on visiting siblings in Utah on a regular basis, so logic tells me I’ll need a machine that can work with the higher altitude and also vary humidity: outside of comfort from a stuffy nose, I intend on not causing dental issues that are the result of a dry mouth.

I was a mouth breather for most of my life until 6 months ago, when I trained myself to nose breathe. I've not once in that time period woken up with a drool covered pillow, which used to be a frequent occasion! However, I do feel that it's made me sleep breathing issue worse in hindsight. (I had no idea I even had an issue breathing during sleep until I got my sleep study back.)

I sleep in a prone position, however I move a lot during sleep (I suspect this is caused by impaired breathing, so constant adjustment to try and breathe okay), unfortunately I have no concious control of what positon I end up in. It seems I rarely sleep on my back, I never find that very possible, but I do rotate from prone, to left, to right.

I live in the UK, I don't think it's generally considered humid here? But in the last week or two I think it has been a little.

I've never had a problem with nose bleeds, or my nose feeling particuarly dry. Maybe in my case the humidification from CPAP is making the congestion worse? Hard to say. Seems it helps some people, hinders others.

[canyouhearmeaya]

There also seems to be a lot of condensation in the water chamber, especially at the front, covered in water droplets. Is that normal?

[OkyDoky]

There also seems to be a lot of condensation in the water chamber, especially at the front, covered in water droplets. Is that normal?

Yes, for mine.

[canyouhearmeaya]

There also seems to be a lot of condensation in the water chamber, especially at the front, covered in water droplets. Is that normal?

Yes, for mine.

Ah okay, no worries then.

What does everyone think, remove the water chamber entirely, or leave it in and turn climate control off? I think I read somewhere that leaving it in would mean the air would still retain some moisture, but not be 'humid'.. Could help to prevent the nose drying out so much possibly? Or no?

[Pugsy]

Humidity can cause congestion for some....Julie is one of them so she tends to not mention very often that there are people (and a lot of them) and the humidity helps the congestion.

Here's the deal on the nasal mucosa and whether they like more or less added moisture or any added moisture.........it's all highly individualized and person. There is no way of knowing which way your nasal mucosa will end up being.
Julie lives near the coast and I suspect that she may be getting decently moisturized air just from where she lives and doesn't need any added moisture.
But there are some people who live in the high desert and they go without a humidifier and prefer it. So go figure.

Humidity preferences is something that you will just have to sort out on your own and figure it out. It doesn't matter that Julie doesn't need any added moisture and it doesn't matter that my nasal mucosa need the maximum available and I still have to use simply saline at times for dryness.

The Auto setting for humidity on the Air Sense 10 machine delivers 85% I think is what I read.
Did your water level drop much?
What is the ambient humidity in your house?

It is unlikely that bad rebound symptoms would happen from one use unless you used way too much.
But you haven't complained of bad congestion yet until this morning. So the humidity delivered didn't change...makes me wonder why it didn't happen until now.
Go get something like Simply Saline nasal spray and use it frequently during the day to get nasal mucosa back to a more balanced chemical composition. Sort of like washing out the chemicals a bit. Get things back to a more normal balance.
Once back to your normal then you can proceed with figuring out your humidity needs.
More people need/use added humidity than don't. More people use towards the higher amounts than the lower amounts.
BUT there are people like Julie who don't use any and that's what their nasal mucosa are happiest at. We have zero way to know what your nasal mucosa are happiest with.

FWIW...my nasal mucosa find that the Auto setting is borderline not enough added moisture and I don't live in a dry arid environment at all. In fact my ambient household humidity is usually somewhere around 40 to 50 percent unless it is raining. That's in my house. I have one of those gadgets that tell me.

And don't assume that your outside humidity is what is inside your house....air conditioning or heating will affect the ambient humidity in the house.

So...how much water was used from that water chamber? That tells us if the machine even added much water.

[canyouhearmeaya]

Humidity can cause congestion for some....Julie is one of them so she tends to not mention very often that there are people (and a lot of them) and the humidity helps the congestion.

Here's the deal on the nasal mucosa and whether they like more or less added moisture or any added moisture.........it's all highly individualized and person. There is no way of knowing which way your nasal mucosa will end up being.
Julie lives near the coast and I suspect that she may be getting decently moisturized air just from where she lives and doesn't need any added moisture.
But there are some people who live in the high desert and they go without a humidifier and prefer it. So go figure.

Humidity preferences is something that you will just have to sort out on your own and figure it out. It doesn't matter that Julie doesn't need any added moisture and it doesn't matter that my nasal mucosa need the maximum available and I still have to use simply saline at times for dryness.

The Auto setting for humidity on the Air Sense 10 machine delivers 85% I think is what I read.
Did your water level drop much?
What is the ambient humidity in your house?

It is unlikely that bad rebound symptoms would happen from one use unless you used way too much.
But you haven't complained of bad congestion yet until this morning. So the humidity delivered didn't change...makes me wonder why it didn't happen until now.
Go get something like Simply Saline nasal spray and use it frequently during the day to get nasal mucosa back to a more balanced chemical composition. Sort of like washing out the chemicals a bit. Get things back to a more normal balance.
Once back to your normal then you can proceed with figuring out your humidity needs.
More people need/use added humidity than don't. More people use towards the higher amounts than the lower amounts.
BUT there are people like Julie who don't use any and that's what their nasal mucosa are happiest at. We have zero way to know what your nasal mucosa are happiest with.

FWIW...my nasal mucosa find that the Auto setting is borderline not enough added moisture and I don't live in a dry arid environment at all. In fact my ambient household humidity is usually somewhere around 40 to 50 percent unless it is raining. That's in my house. I have one of those gadgets that tell me.

And don't assume that your outside humidity is what is inside your house....air conditioning or heating will affect the ambient humidity in the house.

So...how much water was used from that water chamber? That tells us if the machine even added much water.

The water level does drop noticeabley yes, so I suspect is running high, like you said.

Hose is set to 27 degrees celcius.

I didn't use it one, I used it 3/4 times, maybe it was coincedence but my congestion this morning was worse than it'd been in a LONG time. I don't think I even realise I was congested, my allergies over the last week have really started playing up, which is annoying as I thought they'd gone (nothing to with CPAP). Using the Otrivine made me realise how congested I was, because of how clear my nose felt after using it.

The fact that I was struggling to breathe with the CPAP, leads me to believe I was congested the whole time. I suspect I Have some level of chronic congestion, which is also why I need an ENT as this might be due to deviated septum, nasal polyps etc, who knows.

The problem is, the Otrivine works very well but can't be used long term. I bought some saline spray, it seems to do jack all to be honest. The otrivine is night and day difference, the saline spray did virtually nothing for me.

The times I managed to sleep with the machine (2 nights for 2 shortish periods), I woke up and removed it because the pressure had gone up and i was struggling to breathe with it. I was obviously half asleep when I removed it and just went back to sleep without thinking all too much about it, but I suspect possibly the reason the pressure was upping and the fact I felt like I was suffocating WAS Because of congestion, given the machine seemed to be using a fair bit of water then I maybe high humidity doesn't agree with me.

I think my fundamental problem is that allergies have screwed me over at the moment, they've pretty much come on AS i've started CPAP, well a few days prior. Bad timing. Anti-histamines alone don't clear my congestion up.

I think I'm going to change my diet around, and go onto a Ketogenic diet (high fat, medium protein low carb), as in past times this has massively helped with allergies. Hopefully this will help clear up my congestion, opening my airways enough to allow me to breathe with the machine.

I'd guess now, that actually the nights I've attempted with the machine so far, my nasal pathways have been too congested to even give it a fair run.

Does anyone know if there is a spray that doctors can issue that CAN be used long term, that works aswell as something like Otrivine? As that stuff really does seem to work miracles almost straight away, it's the only product I've ever used that has had such a profound effect, but again it says not to use for more than 4-5 days.

[Pugsy]

The saline spray isn't going to work immediately like the chemical spray. It just can't.
It's really more to help the mucosa get back to a normal non chemicalized state and used routinely long term it can help in that regard.
It's never going to give you the immediate results that chemicals give.
It's more of a preventative thing instead of immediate fix.

Otrivine appears to use the chemicals like we find in Afrin and similar products here in the USA....hence the warning for rebound.

For something that can be used long term for congestion without rebound we often use Flonase. Have no idea what it might be called where you live. The relief isn't as immediate as with Afrin like stuff but you don't get the rebound warnings and you can use it long term.
So look for something like that in addition to the simply saline stuff.

You still need to see the ENT doctor. Just tossing out ideas to help relieve potential symptoms in the meantime.
I know that when I can't breathe easily through my nose I simply don't sleep so good. I once tried a mask that put just a little pressure up on the nasal bridge area and that pressure caused congestion. I knew it was the mask pressure because immediately when I would pull the mask away from my nose the congestion cleared up.
I tried to sleep with it one night...woke up a gazillion times to pull it away from my nose because the congestion woke me up.
Finally said to hell with it and put my regular nasal pillow mask on and slept the rest of the night just fine.
I thought maybe I had managed to sleep the bulk of the night with the mask that was on the nasal bridge area because of the numerous wake ups. Come to find out I made it all of 90 minutes before I changed the mask. It was easy to spot the change on the software report when I stopped the machine. Longest 90 minutes of my life.

Poor sleep quality from congestion (from any cause) will sure mess with how a person feels during the day.

[canyouhearmeaya]

The saline spray isn't going to work immediately like the chemical spray. It just can't.
It's really more to help the mucosa get back to a normal non chemicalized state and used routinely long term it can help in that regard.
It's never going to give you the immediate results that chemicals give.
It's more of a preventative thing instead of immediate fix.

Otrivine appears to use the chemicals like we find in Afrin and similar products here in the USA....hence the warning for rebound.

For something that can be used long term for congestion without rebound we often use Flonase. Have no idea what it might be called where you live. The relief isn't as immediate as with Afrin like stuff but you don't get the rebound warnings and you can use it long term.
So look for something like that in addition to the simply saline stuff.

You still need to see the ENT doctor. Just tossing out ideas to help relieve potential symptoms in the meantime.
I know that when I can't breathe easily through my nose I simply don't sleep so good. I once tried a mask that put just a little pressure up on the nasal bridge area and that pressure caused congestion. I knew it was the mask pressure because immediately when I would pull the mask away from my nose the congestion cleared up.
I tried to sleep with it one night...woke up a gazillion times to pull it away from my nose because the congestion woke me up.
Finally said to hell with it and put my regular nasal pillow mask on and slept the rest of the night just fine.
I thought maybe I had managed to sleep the bulk of the night with the mask that was on the nasal bridge area because of the numerous wake ups. Come to find out I made it all of 90 minutes before I changed the mask. It was easy to spot the change on the software report when I stopped the machine. Longest 90 minutes of my life.

Poor sleep quality from congestion (from any cause) will sure mess with how a person feels during the day.

oh yeah for sure, definitely seeing the ENT.

I don't think the congestion is the primary problem, but it's the problem right now. When I did my sleep study 2 weeks ago, my allergies weren't playing up, yet I still had an RDI of 15. So I don't think the congestion is the primary cause of my disrupted sleep, equally this sleep issue has gone on for years, and isn't a seasonal thing.

But what I do think has happened is, my allergies have come on AS i've started CPAP, and so when trying to use CPAP, I was having no luck.. That suffocated / difficulty exhaling feeling, I now believe is totally down to the congestion. Because wearing the mask after using Otrivine, breathing feels much easier, especially exhaling (okay, still a little odd compared to breathing without a mask, but that's probably just CPAP, if it were no different to unassisted breathing then no one would have any teething issues right?! Lol.) But it certainly feels like I COULD potentially sleep with it on after otrivine, where as before i just felt like i was mildy being smothered the entire time.

So at the minute, i'm trying to use CPAP to see if it fixes my core breathing issue during sleep, but I can't use CPAP because of my congestion. Double edged sword.

I'm not even going to bother try CPAP tonight, as my allergies today are in FULL Swing, I think I've set a new world record for sneezing.

I'm going to make the dietary changes, which historically have cleared up my allergies, and see how I feel then (I.e. does congestion reduce enough to make CPAP tolerable with the nasal pillows), then I'll have to try CPAP again, to see if it works to fix my core sleep issue.

[palerider]

Humidity usually Causes congestion... and the humidifier's just a comfort thing - try not using it at all.

Leave the water chamber in, and just turn the humidity setting down to 0?

Just leave the chamber in, and turn to zero.

Note, It may cause MORE congestion... Julie doesn't like humidity, Pugsy loves it... but Pugsy realizes that not everybody is like her...