Help! Couldn't use CPAP while congested. Couldn't breathe!

[Elsh]

I'm on a pressure of 4 cm, and I had been worried about that initially. Not because of congestion, but because it seemed too low. Anyway, I came to accept it and it has actually made a bit of a difference every night already. However, this last night (I don't recall fully or when), I took off my mask completely and turned the machine off. When I fully woke later, I put the mask back on, upset that I'd taken it off hours earlier. I put it back on and could not breathe with it AT ALL. I often get very congested, but had not yet come across this problem in the last so many nights I've had it. When I had my sleep study, my nose was pretty congested then, but I was on a pressure of 6, then 7, and that was perfect. It kept me breathing despite the congestion. So, do I need to call my doctor and ask him to prescribe a higher pressure? Because I'm really hoping that's all that needs to happen. I really don't want to have to get a full face mask or something (at least not instead... maybe in addition for congested nights, but I couldn't deal with something big on my face every day)! I have heard that the doctor should prescribe Flonase or something as well, to keep the congestion away for the most part. But anyway, just wondering if I need to call the doctor up today and have them get my pressure changed. I hope they can change it straight away, because I have noticed such a difference (not as much as I would like, but a remarkable one) on the CPAP and would be devastated if I had to stop using it until they could do something about it (like until I could get an appt or a DME to my house). Thanks for any help!

[robysue]

First,

It's an absolute shame that your DME set you up with the S9 ESCAPE: It only records compliance data and gives no insight into whether your prescribed pressure level of 4cm is really enough to deal with your apnea. If you've had the machine for under 30 days, it maybe that you'll be able to exchange it for an S9 Elite or S9 AutoSet----don't bother exchanging it for an S9 Auto Escape thought.

I bring this up because you say that during the titration study the tech had you at 6 and 7cm of pressure and that you didn't have trouble breathing at that pressure even though you had nasal congestion. So why is the prescribed pressure level set to 4cm? That's a good starting question for your doc. Or is it that your ramp starts at 4cm and goes up to a prescribed level of 6 or 7cm and you are having trouble breathing during the ramp period? In that case, turning the ramp off should help you breath better with congestion. But if your prescribed pressure really is 4cm in spite of the titration sleep study's 6 or 7cm, then there's a real question of whether 4cm is bringing your AHI down to the appropriate range (below 5, and lower is typically better). And because of the fact that your're using an ESCAPE, nobody---including the doc---can really answer that question with data to back the answer up.

If congestion is a common problem for you, then you really do need to figure out how to deal with the congestion itself rather than just relying on the CPAP machine's pressure to power through the clogged nostrils.

Two good links for learning more about the importance of dealing with the congestion when you are on CPAP include:

• Nasal Breathing Video Series is from Dr. Barry Krakow's web pages
• Unstuff Your Stuffy Nose is from Dr. Steven Y. Park's web pages. Dr. Park is a forum member here who posts under the name sypark

[quietmorning]

I am at a 6 and often have a stuffy nose. I do not ramp (my ramp is set at 4) because I can't breathe if I ramp. My doc prescribed Nasonex for me, and that helps - a LOT. I also have a full face mask to use on particularly bad nights or if I'm sick with a cold or something. I was surprised to find out that my insurance actually paid for my second mask out of medical necessity due to the severity of the hypopnea. (I really cannot miss a night of CPAP treatment due to a stuffy nose.) I make sure my humidifier is at the correct setting, I found that if it's too dry, my nose closes down like there's no tomorrow, if it's too humid. . .heh. . .I drown. I take CTM- 12 hour daily year round . I also make sure my mask is not too tight. If there is too much pressure on the inside of the nostrils, this will close my sinuses down too. I have to just barely feel the nasal pillow - the difference in doing this from being too tight or pushing too much on one side is huge.

With the fine tuning, I'm doing just fine with my nose vs machine issues.

If your machine is actually set at 4 for nightly pressure - that needs to change to what you had at the sleep lab. If it's the ramp, you can go without the ramp and see if that doesn't help. I hope things work out for you!

[Pugsy]

Sometimes nasal congestion can be made worse with the humidifier setting choice.

Sometimes people need more moisture...sometimes people need less.

If you are waking middle of the night (or in AM) more congested than when you went to bed, you might consider playing with humidifier setting a bit.

[jauguston]

Just a FWIW for those with a System One Auto. If you like me were having runny nose/congestion my sleep Dr said I most likely needed a higher humidifier setting. I was already on 5. He handed me a printout instruction sheet copy from Respironics that told how to turn off the room humidity automatic sensor system. It said on units built after a certain date in late 2010 it could be shut off allowing more humidity. Mine was made 2-11 so I was able to shut it off and it was a huge help. No more runny nose. I use almost a full tank every night.

Jim

[BlackSpinner]

When congested you need a full face mask. Plus sometimes you need to increase your pressure. Often you need to adjust your humidity - mine needs to increase.

[Elsh]

First,

It's an absolute shame that your DME set you up with the S9 ESCAPE: It only records compliance data and gives no insight into whether your prescribed pressure level of 4cm is really enough to deal with your apnea. If you've had the machine for under 30 days, it maybe that you'll be able to exchange it for an S9 Elite or S9 AutoSet----don't bother exchanging it for an S9 Auto Escape thought.

Understood. Pugsy informed me of this in the first post I made in this forum, and I'm going to be switched to the S9 Elite this Friday.

I bring this up because you say that during the titration study the tech had you at 6 and 7cm of pressure and that you didn't have trouble breathing at that pressure even though you had nasal congestion. So why is the prescribed pressure level set to 4cm? That's a good starting question for your doc. Or is it that your ramp starts at 4cm and goes up to a prescribed level of 6 or 7cm and you are having trouble breathing during the ramp period? In that case, turning the ramp off should help you breath better with congestion. But if your prescribed pressure really is 4cm in spite of the titration sleep study's 6 or 7cm, then there's a real question of whether 4cm is bringing your AHI down to the appropriate range (below 5, and lower is typically better). And because of the fact that your're using an ESCAPE, nobody---including the doc---can really answer that question with data to back the answer up.

I will definitely be asking a sleep specialist, which I unfortunately won't see for another few weeks, because the 4 cm doesn't seem to be helping. Spoke to my doctor yesterday and he did not want to go up at all.

If congestion is a common problem for you, then you really do need to figure out how to deal with the congestion itself rather than just relying on the CPAP machine's pressure to power through the clogged nostrils.

Two good links for learning more about the importance of dealing with the congestion when you are on CPAP include:

• Nasal Breathing Video Series is from Dr. Barry Krakow's web pages
• Unstuff Your Stuffy Nose is from Dr. Steven Y. Park's web pages. Dr. Park is a forum member here who posts under the name sypark

Thanks!

[Elsh]

If your machine is actually set at 4 for nightly pressure - that needs to change to what you had at the sleep lab. If it's the ramp, you can go without the ramp and see if that doesn't help. I hope things work out for you!

I think so, too. I will have to ask my sleep specialist. Thanks!

[Elsh]

Sometimes nasal congestion can be made worse with the humidifier setting choice.

Sometimes people need more moisture...sometimes people need less.

If you are waking middle of the night (or in AM) more congested than when you went to bed, you might consider playing with humidifier setting a bit.

No, I went to bed congested.

[Otter]

Respironics lists the following contraindications for CPAP therapy:
severe bullous lung disease
pneumothorax
pathologically low blood pressure
cerebrospinal fluid leak, recent cranial surgery, or trauma

Resmed lists those four and adds dehydration.

From conversations with my RT, I know that chronic congestive heart failure is also a contraindication, as are some ENT surgeries.

Do you have any of these? You'd know if you did.

If you don't have any of those contraindications, and your doctor has not discussed any other reason why CPAP is unusually dangerous for you, I see no reason not to turn the pressure up until you can breathe. Keep your doctor in the loop, certainly, but don't be afraid make adjustments. Your doctor and the techs who titrated you initially aren't there every night.

Your titrated pressure of 7 cm h20, btw, is what they use for premature infants. In the hospitals, preemies are put on 7 cm CPAP automatically, without any tests. If it's safe for them, that's definitely not going to hurt you. So if your machine is really set for 4 cm and that's not the ramp, I'd go ahead and turn it up to 7. CPAP at 7 cm is safer than taking a shower. If your doctor is afraid to let you go above 4 cm, I suspect he's just very unfamiliar with this therapy.

You may have been told that CPAP is very dangerous. Many RT's are taught this. But I have yet to meet anyone who can back this claim up with any actual medical science or case histories. My doctor had no problem with me titrating myself on APAP without a sleep study. And when I asked my RT, who has 22 years of experience, about the "dangers of CPAP", he told me it was hogwash.

[Pugsy]

If you go to bed congested to the point there is no air movement and you are suffocating, you either have to treat the congestion or use a full face mask so that you can breathe through your mouth.

Since I refuse to go down the full face mask road I choose to treat the nasal congestion. Oral decongestants, Flonase and/or Afrin in moderation.

[Elsh]

Your titrated pressure of 7 cm h20, btw, is what they use for premature infants. In the hospitals, preemies are put on 7 cm CPAP automatically, without any tests. If it's safe for them, that's definitely not going to hurt you. So if your machine is really set for 4 cm and that's not the ramp, I'd go ahead and turn it up to 7. CPAP at 7 cm is safer than taking a shower. If your doctor is afraid to let you go above 4 cm, I suspect he's just very unfamiliar with this therapy.

I am not familiar with how to change the pressure.

[Elsh]

If you go to bed congested to the point there is no air movement and you are suffocating, you either have to treat the congestion or use a full face mask so that you can breathe through your mouth.

Since I refuse to go down the full face mask road I choose to treat the nasal congestion. Oral decongestants, Flonase and/or Afrin in moderation.

I don't want to go with a full face mask, either. My doctor has now prescribed Flonase. I'm just not sure I'll have a choice down the road, because my allergies do get so bad at times.

[Pugsy]

I am not familiar with how to change the pressure.

http://www.apneaboard.com/ResMed/ResMed ... Setup.html

Disregard my comment about software in other thread. I forgot you haven't got the Elite yet.
Above link gets you to clinical menu instructions to change pressure.

[Elsh]

I am not familiar with how to change the pressure.

http://www.apneaboard.com/ResMed/ResMed ... Setup.html

Disregard my comment about software in other thread. I forgot you haven't got the Elite yet.
Above link gets you to clinical menu instructions to change pressure.

Thank you. Now I'm just a little nervous if it's completely safe to change pressure, or how I would explain to either my doctor or the sleep specialist WHY I changed pressure. I don't think they'd be very happy with me for going against doctor's orders..