Yesterday night with CPAP was horrible- nose congested

[ronragus]

Hi All,

Yesterday night was horrible... only gotten cpap for 2.5 hours before waking up feeling I am not getting enough air from the cpap and realizing that my exhalation noise was sorta loud. Turns out one side of my nose was congested and cant exhale properly. Then took a long time to clear up the nose due first doing netipot (not working), and saline sprays (not working), had to look around the house for a anti-histamine nose spray(Drixoral) and that did work. Went back to bed with the cpap on, felt that the airway was clearer, but still could not get myself to sleep. out of frustration I took off the mask the rest of the night....

Now I am a little confused as to how I should proceed with my cpap treatment and what else to try:

1. Humidity Setting? Currently set to 5 and hose temp 30C. I am located in Vancouver, Canada, the I would bet last night my room temp was about 13C. Is my humidity setting too high causing nose congestion? Do I need to turn it off or dial it down to....3?? My hose already have insulation cover on. I had it at 4 for the weeks prior before my DME suggested to me to change it to at least 5 to "enhance comfort"

2. or should I just take anti-histamine prior to bed? I neti-potted prior to bed last night, so I am sure my nose was clear before getting congested during cpap.

3. I was using dreamwear nasal mask yesterday... do I have to force myself to switch to a nasal pillow? Nasal pillow I tried (P30I) was horrible in comfort lol....

I usually wake up with cpap on by 2 to 3am in the morning so yesterday waking up at 11pm ish was not a good sign... it makes me doubt whether I also had congested nose for the nights before, as I always have a hard time getting back to sleep with the CPAP on after waking up. I usually take sleeping aid prior to bed, but unfortunately they dont work for waking up in midldle of the night afterwards.... I guess its wishful thinking hoping the sleeping aid would eventually help me get used to the comfort of wearing the mask during sleep?

Thanks for all the support on this forum as always....

[Pugsy]

Here's the deal with humidity needs. Everyone's nasal mucosa is different in terms of how much humidity it takes to keep the mucosa happy. When the nasal mucosa get unhappy they react the same....swell up, congestion, runny nose, etc. Just like an allergy attack reaction.

For some people they need as much moisture as possible and would snort water if they could because the least little bit of dryness causes major congestion...I am one of those people.

BUT there are people whose nasal mucosa simply don't like so much moisture and they do the same thing when they get unhappy...swell up, congestion, runny nose, etc from too much moisture.

We have no way to know how much moisture your nasal mucosa wants or needs. This is something you have to experiment with yourself and see if you can find your happy place in terms of added moisture. It might be a little less...might be a little more...might be barely any added moisture.

Since you started at 5...I would suggest going down in terms of added moisture. Trying 3 would be a logical next step.

[Miss Emerita]

Sounds like a rocky night. I note that drixoral contains pseudoephedrine, which should not be taken for more than 7 consecutive days. You might want to try Flonase, which can reduce inflammation in the nasal tissues. You can use Flonase for as long as you like.

Optimal humidity settings vary a lot from one person to the next, so you should start experimenting to see what works best for you. And what works best for you at one time may not be the best at a later time, just to keep things interesting.

[ronragus]

Thank you guys. I looked back on my sleepy head data last night- did these marked events seems like false alarm(arousals?) or do they appear to be legit concerns? Doesnt seems like I breathed heavily before pausing breathing? thanks

[chunkyfrog]

When my nose gets stopped up, I use one squirt on each side of Mucinex nasal spray,
then I put on a Breathe Right strip.
Spread those bad boys open so they WORK!
My nasal pillows are usable EVERY night.
BTW, I take a nightly antihistamine to beat down my hay fever.

[Pugsy]

The breathing was slightly irregular right before the pause in breathing. If we are asleep our breathing doesn't do that.
I suspect maybe a bigger gulp of air right before maybe a sleep position change. Did you know we often do that when we turn over in bed or change position? We never think about it and rarely realize we are doing it and sure don't remember doing it because the timing is so brief.
The machine only knows that there is a pause in breathing. It doesn't know why.
I see this fairly often with not only central/CA flags but OA and hyponea as well. Sometimes it's a single breath or two and sometimes a lot more irregular breathing preceding the pause in air flow. I know what it is...I remember considerable wake ups changing position due to back/pelvic pain. I shrug my shoulders and move on.

Even if every single one of your centrals were the real deal though....not nearly enough of them to worry about.
It's normal to have a random central during the night that is a real asleep central and it doesn't mean anything bad.
It's only bad when in a large number and the real centrals are causing a problem with sleep in general or oxygen levels.
You are about as far as you can get from having a central problem......even if all of them were real.

[ronragus]

Thank you Pugsy!

This is my graph for last night after changing the humidity to 3. I did woke up much later in the night than before(2pm), but also noticed that there seemed to be a large increase of leak lasting roughly 25 minutes around 1~1:20AM. My question would be whether that leak is due to mouth leaking? When I woke up I didnt remember having to drink water or having to adjust my mask due to noise, but then I am not sure what else such a large leak could be attributed to...

may 1(1).jpg

Looking at my graph from nights prior, on April 29 and 28th back when my humidity was set to 5, there were also a period of large leaks before awakening- again, didnt remember to be particularly thirsty after waking up or need to drink (definitely needed to piss though!)

apr28.jpg

m Apr 29 .jpg

Thank you!

[Pugsy]

First of all your "large leak" from last night's report is still within the machine's ability to compensate easily for it. So I wouldn't give it a second thought no matter what the cause. It didn't even make it to large leak territory. If it didn't wake you up...a non issue.
Large leaks aren't always mouth opening related leaks. They can be mask movement loss of seal leaks just as easily and there is no way to tell for sure what caused them unless you want to tape your mouth shut to rule out mouth opening.

Here below is an example with large leaks....now I was trying a new nasal mask and I didn't know if these were mouth opening related or mask movement issues because I was having some fitting issues. So I elected to tape my mouth shut just to make sure what the cause was for seeing this sort of leak for several nights with this new mask. These leaks were with the mouth taped and secure in place when I got up in the morning. Obviously the only reason left is mask movement.

leakynight.JPG

[ronragus]

Hi Pugsy thanks again for your appreciated feedback.

Yesterday I came across previous threads about "palatal prolapse", and wanted to ask if the following breathing patterns looks indicative to it... as I am still having problem with waking up in the middle of the night with cpap on. I did not tape my mouth like the other did for eliminating mouth breathing from the equation, but I did not feel dry mouth upon waking up either. However, I do feel very tired even after using cpap for roughly a month...

I can find many examples of similar breathing patterns from previous nights.... thanks for your time

[ronragus]

These are from the night prior- seem to be similar breathing patterns

[Pugsy]

I am sorry but I know nothing about palatal prolapse and/or if it even shows up on the flow rate graphs.

Your flow rate scale is throwing the individual breaths looks off just a little. Making them look a bit weird so I would change from the auto fit scale to something that shows the more natural breaths.

Right click the mouse on the words "flow rate" on the left side of the graph and change the y axis to something a little smaller than auto fit. Maybe 60 or 90.

Looks like a lot of arousal breathing happening though to me at least on the bulk of what you have zoomed in on.
You may or may not be remembering the arousals but they are happening. Now why? That's the million dollar question.

[ronragus]

Hi Pupsy these are the charts with the Y axis adjusted to +/- 60. I guess what I meant to ask is- does this looks like something is still restricting me from exhaling properly even with CPAP on, looks like I am just inhaling but not exhaling nearly as much- thereby causing me more arosals? My EPR was only set for the ramp time. Thanks

[Pugsy]

Some of the breaths don't look "normal" in the shape but I don't know what it means or even if it means anything.
My limited skills with evaluating flow rate individual breaths are pretty much limited to arousal vs asleep evaluation.
Maybe someone else might comment on those breaths that are rather pointy in appearance...they don't look normal but I don't know what they mean.

They might lean towards mouth breathing though. That would be my best guess.

[ronragus]

Hi Pugsy

I taped by month shut with 2 layers of micropore yesterday, plus I had gotten nasonex right before bed (yesterday was day one of using it, guess the nasonex still need additional days to take effect?) and saline rinse right before dinner. I woke up in the middle of the night again and found that one side of my nostril is blocked again- hard for me to tell whether this is due to a real allergy problem or just the natural shifting of breathing nostrils. Either way I am not sure whether I should dial down my humidity even further (currently at 3), or do I have to try a pillow mask again (p30i) hopefully to plow through the congestion, as it feels kinda uncomfortable breathing through on nose with the dreamwear on.... Below are my SH charts- even with my mouth taped it seemed that part of the FR graph showed issues with exhalation....?

Thanks for your feedback

[DreamDiver]

Hi Pugsy

I taped by month shut with 2 layers of micropore yesterday, plus I had gotten nasonex right before bed (yesterday was day one of using it, guess the nasonex still need additional days to take effect?) and saline rinse right before dinner. I woke up in the middle of the night again and found that one side of my nostril is blocked again- hard for me to tell whether this is due to a real allergy problem or just the natural shifting of breathing nostrils. Either way I am not sure whether I should dial down my humidity even further (currently at 3), or do I have to try a pillow mask again (p30i) hopefully to plow through the congestion, as it feels kinda uncomfortable breathing through on nose with the dreamwear on.... Below are my SH charts- even with my mouth taped it seemed that part of the FR graph showed issues with exhalation....?

Thanks for your feedback

When i sleep on one side or the other, the nostril on the side closest to the bed is more likely to congest. It's just something that happens for me, no allergies involved. It resolves when I'm on my back, but that's not always comfortable, so I tend to change positions often during the night.

Consider arranging your graphs like this:

• Event Flags
• Flow Rate
• Pressure
• Leak Rate
• Flow Limitation

These graphs are generally most useful. Lose the Mask Pressure or move it below these graphs. This graph is less useful. Scrunch all the indicated graphs to fit in the pane.

Many people seem less congested when humidifier air temp is dialed down a bit. Your AHI looks well-controlled at the current pressures. Why not dial down the humidity or even turn of heat completely just to see what happens? You can always turn it back on again if it's insufferable.

Chris