Results all over the place

[impatient]

I am back to trying cpap after failing 4 years ago. Now I am much better educated thanks to these boards.
A week into it and my new S9 does not seem to be the enemy like my old goodknight did. The exhale relief and the lower prescribed pressure(s) seems to be making all the difference in my ability to be compliant.

4 years back my pressure was 13. Now my cpap pressure is 9 but I have it set 7 to 10 on the auto. I have had AHI ratings on the front screen of the machine run from 3.4 to 24

I have a pulse ox that shows a similar picture. Some nights are worse than without the machine other are a marked improvement but not the magic that these machines are touted for.

The biggest factor that I can find so far is that if my nose is clear then I have a good night. If not, the machine runs up to the max pressure and still can't get the job done. It also seems that sleeping on my side makes it all work better. This is the same as when I am without the machine. I was trying to get away from side sleeping as it hurts my back. From reading other posts it looks like I should set the machine to straight cpap and see how different pressure settings work. But it seems that if my nose is not clear then no amount of pressure that I can stand has any effect. I have a full face Fisher&Paykel Flexifit 431 mask. I am not sure I am happy with the mask.

[gerakliuss]

Waiting the reply
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[Mtnviewer]

My first suggestion would have been to check your sleeping position with such varied results. My second suggestion is to find a physiotherapist that can help with your back pain so that you can continue to sleep on your side. The back sleeping position produces OSA in nearly everyone, and significantly so for me at least. My third suggestion would be to try another mask or two to find one that will allow for good results even if your nose not clear.

My routine is such that I need to start on my right side as the higher left nostril is almost always clear, then I can later switch to my left as the right one clears up from that position. I don't have as much success nose breathing starting the other way around. But I also use a full face mask, Mirage Quattro, so it also allows for mouth breathing. I did not do well with a nasal mask or nasal pillows, but I also had not worked on my side sleeping position as much with them, but I do have a mouth breathing problem anyway so I am not sure that anything other than a full face mask would be effective for me.

WHEN or IF you can commit yourself to side sleeping, you will likely get more consistant results and nearly immediately, (I get nearly zero AHI every night now), lower PAP pressure, looser fitting mask, and am feeling good. I can't prove it, but your back pain may also decrease as you start recovering your rest. I have had mysterious pains etc. that seem to have disappeared or minimized greatly once I solved my side sleeping position.

At any rate, your first excellent clue to getting excellent results is to solve your side sleeping situation, as difficult as that might be or if you aren't inhibited by a severe physical problem. I have to use restraints to keep me on my side, both at my head with my diy pillow straps and for my body using a small firm backpack, as my head will turn to it's back even if my body can't and so my AHI goes up. My results and rest have vastly improved since working hard on solving this supine position problem. When I do have back pain, I've used ibuporofen, pillows between then knees, stretching and my inversion table (the latter two done consistantly keep me back pain free, along with my physiotherapist who taught me the stretches). The alternative of accepting back sleeping will cause you pain elsewhere anyway, and if apneas stay higher, then you'll stay fatigued, your pressure will need to be higher and will be often varied, mask tension will be higher, leak rate will be higher, etc..

[KatieW]

Great advice from Mtnviewer. One other thing is to address your nasal congestion. You could try nasal rinse, saline spray, OTC allergy meds, an air purifier in the bedroom. Or, if necessary, see your medical provider for a prescription nasal spray.

[fotoguy]

I have a full face Fisher&Paykel Flexifit 432 mask and believe that it causes more problems than it solves. But I just can't use a nasal mask - don't get enough air that way. As KatieW said, side sleeping would benefit you greatly. There is a post - Most effective ways for avoiding rolling onto back? - here: viewtopic.php?f=1&t=50240&p=476445&hili ... ls#p476445. It might help you sleep on your side. Good luck!

You can also try a new mattress (pic originally posted by roster):

[impatient]

Thanks for all the info. Here what I plan to try:

OTC allergy meds. These work well for me during the day. Maybe they will at night.
Saline spray. This is pretty safe stuff. I can't see it hurting.

Look for new bed. My current bed is too firm to side sleep on.

Go back to all of my other side sleeping tactics. This is what I have been doing for the past 4 years to get by without CPAP. I am actually pretty good at it. I just don't like to do it and even when I do make myself do it my shoulders go to sleep and my back hurts. That is why I need a new mattress. I have tried all manner of pads with only moderate success.

I will try that falcon position. I will need a bigger pillow I think. I worry that my lower arm will still have the same problem with going to sleep.

I think I will try a liberty hybrid mask. I am sure that I need something that will tolerate me mouth breathing. And the liberty seems to also inflate your nostrils. I think that my nostrils are easily squeezed shut by any pressure on the outside. That could be part of the problem with my current mask. When I have it tight enough not to leak close to my eyes it puts pressure on my nose and closes my nostrils. The large size does not do that but it leaks out below my chin and does nothing to hold my mouth shut.

I worry that I am putting too much faith in the numbers from AHI and pulse-ox. But I seem to need a couple of good nights to get that great sleep feeling that some people get after only one night, and the numbers seem to be the only thing I have to go on. The software should help.

Any pressure over 10 wakes me up and causes a litany of other problems. So if I have to sleep on my side to keep the pressure down then I think that I should start with that and work from there.

Thanks

[Mtnviewer]

I'd go see a physiotherapist for back pain help before I'd get a new mattress. The physio will help short term and long term and likely be less than the cost of some mattresses. I'm skeptical that the mattress is the cause of your back pain, especially if firm and flat, vs. being horribly soft and U shaped. Or get a 2" foam pad to put on top of your firm mattress to soften it slightly AND go to the physio. Been there done that and next to PAP therapy, my physio visits are THE best things that I've ever done for my health and knowledge. Sure it's extra work and not a quick fix, but I have the knowledge and tools now to deal with back pain for the rest of my life. Whereas a mattress may or may not help, short term or long term. Think of it this way. You went to see a Dr. for your OSA and you have learned a lot through trial and error, but you're going to see a mattress sales person to fix your back and your OSA? I wouldn't trust a mattress salesman for anything, a mattress or help with my health.

My .02 cents but your back and OSA.

[Julie]

Have you tried turning down the humidifier to help with the congestion? It often works. I once tried the Flexi-Fit 432, and while it felt SO comfortable on, it was SO ineffective (for me, anyhow). I now use the UltraMirage FF, and while it's not perfect, it's a lot more consistent.

[impatient]

I had not thought of turning the humidity down.
Thanks for the idea.
I got a new liberty hybrid mask. It handles the varying pressure of the auto-set a lot better than the flexifit. I think that results are getting more consistent but I can't tell yet.

The screen on my S9 went out so I had to get a replacement from Resmed.

My back pain is gone. Between sleeping on my back more and spending a week on vacation that cleared up. I still have a new bed on the to do list.

[Janknitz]

You should also check in with your doctor about nasal steroids. These are nasal allergy meds, deliverd by a spray in each nostril. There is little to no absorption of the steroids systemcally, but they work really well to control nasal allergies. You need a prescription, though.

I take a generic version of Claritin daily at my doctor's suggestion(Loratadine costs about 1/3 the price of name brand Claritin over the counter). Claritin does not make me drowsy, dry out my nasal passages, or have the "rebound effect" of other OTC meds like Benadryl, Sudafed, and nasal sprays like Afrin, Nasonex, etc. This really helps my nose stay clear, along with saline mist and CPAP itself.

I do get congested if my humidifier is too high, and when we sleep with the windows open in the summer because we have no AC I tend to be a bit more congested, but overall, my nose is clear--something it never was before CPAP!

[kempo]

If you have a crappy mattress and a stopped up nose, a top of the line cpap and mask will not give you the relief you need for a good nights sleep.

[impatient]

Last night was my best night ever with a 2.3 AHI
I did claritin 1 hour before bedtime and made sure that my nose was clear at bedtime.

But what probably made the most difference was I added a chinstrap when things did seem to be going well about 1 hr into the night.
I am going to analyze the data after I get back from the lake and see if the timing matches the chinstrap addition.

Brian

[gerakliuss]

Ok, thanks
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