How to tolerate the CPAP more than 4-5h per night?

[needairasap]

Hi everybody,

I'm using my Resmed Airsense 10 with nasal pillow since 2,5 years by now and happy my overall sleep has improved. However there is barely a night I can tolate the device for more than 4-5h before waking up and remove it before falling back to sleep. Some nights it's even only 3h. I usually wake up because I can't get enough oxygen and feel suffocating because one side of my nose is semi blocked. Enough to breath fine without the CPAP but not with it...
Using nose spray, which I cant do regularly due to dependency, before falling asleep give me an extra hour or so but it's still not possible to sleep with it the whole night.

I initially configured the device more or less by myself with information from this board since I don't have any health insurance and sleeping lab options where I'm currently living. I was happy back then to use it for 5h at a time but recently read that it really should be used all night long to reduce health risks.

Hoping that you guys have some advises for me how to tolerate it though the whole night or maybe a look and help to analyze my OSCAR data for any root cause why I always wake up around the same time of usage.
Via the export function of the tool I selected a month worth of data with selection of daily. Please ignore last night though, I played with a Diazepam and wanted to see if I keep the machine on for longer. Yep did work

https://www.dropbox.com/s/azgc6bqx7r6x4 ... 9.csv?dl=0

[ChicagoGranny]

https://www.dropbox.com/s/azgc6bqx7r6x4 ... 9.csv?dl=0

Please read the first two announcements at the top of the index page and follow the instructions for posting an OSCAR Daily Details screenshot for a typical night.

What is your humidifier setting?

[zonker]

Hi everybody,

howdy. pls do as chicago granny asks. what you've shown us doesn't give enough detail as to what's going on during your sleep. without that detail, we can only make guesses and that won't help.

good luck!

[Miss Emerita]

It will be good to see a typical night's chart, but I also have some other questions. Have you seen an eye-nose-throat doctor about your nasal blockage, or perhaps an allergist? Have you tried using (a) more and (b) less humidity?

Have you tried using fluticasone? In the U.S. you don't need a prescription for it. It takes about 1-2 weeks of regular use to kick in. You can safely use it indefinitely.

And have you tried nasal/sinus rinses? Here a popular brand is NeilMed. Doing a rinse feels a little weird, but this can help clean allergens out of your sinuses and nose.

My allergist prescribes Azelastine, a spray that I use in addition to Flonase, and Montelukast (Singulair), an asthma medication often used to help with the symptoms of allergies.

[Janknitz]

Is it the nasal congestion that makes it hard for you to breathe, or something else?

If nasal suggestion, you've already had some good suggestions. I will just add that it could be the humidifier settings and it would be worth it to try adjusting that. Do this slowly. Make ONE adjustment--1 notch up or down--and try it for a few nights (unless it makes it worse right away) before making any further changes in the same or opposite direction. Another suggestion which helps me is to use a saline nasal spray. I had a horrible time getting off OTC nasal decongestant spray--it was as bad as kicking an addictive drug, and I will never touch them again, so I understand it when you say you have a "dependency issue" with them. Steroid nasal sprays do not work the same way, they are not addictive (but I can't use those either because the smell makes me nauseated!). During allergy season I take Singulair at bedtime and a Zyrtec in the morning.

Your machine should be used every time you sleep, ALL the time you sleep. It's hard to self-discipline in the middle of the night, but essential. I suggest if you wake up because you can't breath you GET OUT OF BED, clear your nose and whatever else you have to do, then put the mask on as you are getting back in bed to go back to sleep. It may make it a little harder to go back to sleep because you have to wake yourself more fully, but it will build the habit of only sleeping with the mask on.

[Architect]

In the beginning I had the same exact problem, FFM resolved. Nasal rinse, saline nasal spray works a charm for me. Wish you well.

[needairasap]

https://www.dropbox.com/s/azgc6bqx7r6x4 ... 9.csv?dl=0

Please read the first two announcements at the top of the index page and follow the instructions for posting an OSCAR Daily Details screenshot for a typical night.

What is your humidifier setting?

Thank you, done. Will post some screenshots in a minute. For the question about humidifier, its on Level 5 with a temperature of 26 C.

[needairasap]

It will be good to see a typical night's chart, but I also have some other questions. Have you seen an eye-nose-throat doctor about your nasal blockage, or perhaps an allergist? Have you tried using (a) more and (b) less humidity?

Have you tried using fluticasone? In the U.S. you don't need a prescription for it. It takes about 1-2 weeks of regular use to kick in. You can safely use it indefinitely.

And have you tried nasal/sinus rinses? Here a popular brand is NeilMed. Doing a rinse feels a little weird, but this can help clean allergens out of your sinuses and nose.

My allergist prescribes Azelastine, a spray that I use in addition to Flonase, and Montelukast (Singulair), an asthma medication often used to help with the symptoms of allergies.

Thanks for your reply. Yes in fact I got diagnosed with chronic sinusitis on the left side a couple of times during the last 10 years. Last time was with a CT scan while they diagnosed narrow airways in my throat (which are the reason I'm on the CPAP) and also pointed out the chronical sinusitis.

I tried a few things like taking homeopathic medicine (Sinusitis Hevert SL) but figured I had to live with it. During the day I don't have any issues just at night time its getting congested slightly. Like I said not blocked completely, I can still breath more or less when covering the other side. But it's enough to feel really uncomfortable with the CPAP on.

I will check out fluticasone and try finding it here in Thailand. So I could use this every night before sleep indefinitely? I also tried to use a nasal rinse for a while without positive effects. One doctor actually recommended not to use it since you could drag infections from 1 site of the sinus to the other.

[needairasap]

Is it the nasal congestion that makes it hard for you to breathe, or something else?

If nasal suggestion, you've already had some good suggestions. I will just add that it could be the humidifier settings and it would be worth it to try adjusting that. Do this slowly. Make ONE adjustment--1 notch up or down--and try it for a few nights (unless it makes it worse right away) before making any further changes in the same or opposite direction. Another suggestion which helps me is to use a saline nasal spray. I had a horrible time getting off OTC nasal decongestant spray--it was as bad as kicking an addictive drug, and I will never touch them again, so I understand it when you say you have a "dependency issue" with them. Steroid nasal sprays do not work the same way, they are not addictive (but I can't use those either because the smell makes me nauseated!). During allergy season I take Singulair at bedtime and a Zyrtec in the morning.

Your machine should be used every time you sleep, ALL the time you sleep. It's hard to self-discipline in the middle of the night, but essential. I suggest if you wake up because you can't breath you GET OUT OF BED, clear your nose and whatever else you have to do, then put the mask on as you are getting back in bed to go back to sleep. It may make it a little harder to go back to sleep because you have to wake yourself more fully, but it will build the habit of only sleeping with the mask on.

Appreciate your advises. I think it is the nasal congestion. I almost every time feel I can't breath any more and that's what is waking me up. Sometimes I would wake up, go back to sleep, dream about breathing issues, wake up again and then take it off. It is kind of ironic, it should actually push more air into me while on the tube...
Without the nasal pillow I'm ok, can go back to sleep easily.

At the beginning of the therapy I was playing a bit with the humidifier settings and found the current settings on level 5 with a temp of 26C as ok. Back then when I increased only 1 level to 6 I got droplets inside the tube and it started to produce very loud sounds, so I went back to 5.
Decrease the settings would rather dry the nose and mucus membrane out more and have a negative effect on my sinusitis, wouldn't it?

I'm going to try fluticasone as recommended by Miss Emerita. Here in Thailand where I'm living since a few years I luckily don't have any allergies. Back in Germany especially during spring season that's a very different story...
Saline spray I also used from time to time but when the congestion kicks in I will have to use the real deal. But as you said I'm afraid of dependency and really use it carefully and as rarely as possible.

I will try to discipline myself more to put it back on when waking up in the middle of the night. It won't be easy but initially it was also not easy to put it on every night when going to bed.

[needairasap]

Here are some charts and settings of a typical night.
22.05:
https://www.dropbox.com/s/3pd72rugodi5m ... 2.jpg?dl=0
https://www.dropbox.com/s/wyrukiz4de0ny ... 2.jpg?dl=0

07.06:
https://www.dropbox.com/s/nevz2dos3mzha ... 2.jpg?dl=0
https://www.dropbox.com/s/75um3o0zix9n3 ... 2.jpg?dl=0

Sorry I tried to use the attachments function but a single sreenshot exceeds the quota.
Also used to bind my dropbox link with the insert img tags but this would also not work in the preview. So old school style, please click to open

[needairasap]

In the beginning I had the same exact problem, FFM resolved. Nasal rinse, saline nasal spray works a charm for me. Wish you well.

Thanks, but what you mean by FFM?

[Miss Emerita]

Yes, you can safely use fluticasone every evening, indefinitely.

Although it seems counterintuitive, you might try a lower humidity setting. For some people, it makes their noses and sinuses more comfortable. You won’t know for sure how it would affect you without experimenting.

You might try raising your EPR to 3 to see whether that helps you breathe more comfortably. You’ll feel a little bit more of a boost when you inhale.

[needairasap]

Yes, you can safely use fluticasone every evening, indefinitely.

Although it seems counterintuitive, you might try a lower humidity setting. For some people, it makes their noses and sinuses more comfortable. You won’t know for sure how it would affect you without experimenting.

You might try raising your EPR to 3 to see whether that helps you breathe more comfortably. You’ll feel a little bit more of a boost when you inhale.

Great I will try that tonight. Would you recommend leaving the temp. unchanged at the moment?

[ChicagoGranny]

Decrease the settings would rather dry the nose and mucus membrane out more

You say "more". In your OP, you did not mention drying. Are your nasal passages getting dry?

Would you recommend leaving the temp. unchanged at the moment?

The purpose of the heated hose is to prevent rainout - condensation in the hose that creates troublesome water in the hose. You can experiment with lower settings one notch down per night. If you get rainout, the hose temp may be too low.

There is a concern that you are using too much humidity. This can cause nasal congestion in some people.

[ChicagoGranny]

Here are some charts and settings of a typical night.
22.05:
https://www.dropbox.com/s/3pd72rugodi5m ... 2.jpg?dl=0
https://www.dropbox.com/s/wyrukiz4de0ny ... 2.jpg?dl=0

07.06:
https://www.dropbox.com/s/nevz2dos3mzha ... 2.jpg?dl=0
https://www.dropbox.com/s/75um3o0zix9n3 ... 2.jpg?dl=0

Sorry I tried to use the attachments function but a single sreenshot exceeds the quota.
Also used to bind my dropbox link with the insert img tags but this would also not work in the preview. So old school style, please click to open

Your CPAP therapy seems to be optimized on those two nights - low events, low leak level, pressure relatively stable, respiratory rate steady for much of the night. As I understand it, congestion and taking the mask off are the two problems to work on.