Seeking Advice On Treating My Sleep Apnea

[ark345]

Hi, I'm a man in his 20's who was diagnosed a few months ago with severe sleep apnea. Since then I've been getting CPAP treatment. I have tried a lot of different masks (they all have pros and cons) but couldn't fall asleep most of the time with any of them. Initially I thought it was because they were leaky, however once I learned how to effectively seal them and even wearing sleeping mask and goggles I could still feel air moving over my right eye which really irritates it and keeps me awake. I believe now (although my ENT doctor isn't sure) that the air is moving inside into my right eye and not from outside leaks. I tried eye gels but those wear off pretty fast and I feel the irritation to my eye. Only nasal pillows seem not to irritate my eye. However those make my ears pop constantly and it becomes painful when my machine ramps up to higher pressures so I can't fall asleep with those. I tried full face masks as well and they seem not to irritate my eye, however the company that makes them only makes them in large and small, no medium, so neither of them fit my face well and always sprang large leaks. My ENT referred me for a second opinion to another doctor on getting surgery to try to fix the apnea. However it doesn't have a high success rate (at best 50%) and I would appreciate any advice on finding a sleep apnea treatment that works. I would rather not resort to surgery if I don't have to and if it doesn't work it is back to CPAP anyway. Any advice on dealing with my irritated eye, or with avoiding ear pops with my nasal pillows, or a different sort of full face mask, or any other advice is appreciated.

[caffeinatedcfo]

Welcome!

I have yet to see an obstacle that this board can't work through.

Please post your equipment and some data and I'm sure we can help you.

[Stormynights]

List you pressure and equipment in your profile and then look this over. viewtopic/t89008/Pugsys-Pointers-Collection.html

[Stormynights]

Welcome!

I have yet to see an obstacle that this board can't work through.

Please post your equipment and some data and I'm sure we can help you.

You beat me and even said Welcome. I am so rude.

[Sir NoddinOff]

Whew, you crammed a lot into one paragraph. I'm going to have to think about your issues a little bit... maybe go online to do some research. I'll get back to you on this. I won't be long. Hang in there. Edit: it would be nice if you'd add all your equipment to your profile, as suggested already. One quick thing to add on the 'ear pops' issue. My sleep doctor said he's seen a rise in problems from nasal pillows. Don't know if it's true, but he says the air shooting directly into ones nasal sinuses can cause problems with the eustachian tubes and inner ear canals. He recommended trying nasal masks and especially the new Wisp mask. For what it's worth.

[Sir NoddinOff]

Leaks that spill over into one's eyes can be very annoying and I've found can wake me up. However, you are on the right track with mask experimentation... it can be a long search. I"m currently searching for a new type of mask.

Regarding surgery to cure apnea: it's been discussed here and my conclusion, perhaps unfounded, is that it appears to work for about half the patients. I've also read that it only lasts a few years, however, as I already noted, this is all hearsay from this forum. Doctors also like to lump in fixing a deviated or perforated septum, should you have either of those. I had a perforated septum... not a walk in the park getting that fixed. Only your doctors and you can decide if you are likely to be a candidate for these procedures.

[chunkyfrog]

If there is air leaking through your nasolachrymal duct via the puncta, the are two non-invasive ways to handle it.
Your eye doctor may fit you with a punctal plug; or you could try a total face mask.
https://www.cpap.com/productpage/respir ... dgear.html
no eye leakage possible, either inside or out. Sheriff Buford wears one; and swears by them.
Trying it may be daunting at first, but might be your solution.

[ark345]

Hello, I appreciate the replies, I am digesting them and hope to have responses in a few days. For my equipment, I am using a Resmed S9-H5i. For masks, I have used probably around 10 so far, various types and sizes. I was diagnosed at 30 apnea events/hour and I'm being treated at 15 cm H20. I hope this information helps.

[Todzo]

Hi, I'm a man in his 20's who was diagnosed a few months ago with severe sleep apnea. Since then I've been getting CPAP treatment. I have tried a lot of different masks (they all have pros and cons) but couldn't fall asleep most of the time with any of them. Initially I thought it was because they were leaky, however once I learned how to effectively seal them and even wearing sleeping mask and goggles I could still feel air moving over my right eye which really irritates it and keeps me awake. I believe now (although my ENT doctor isn't sure) that the air is moving inside into my right eye and not from outside leaks. I tried eye gels but those wear off pretty fast and I feel the irritation to my eye. Only nasal pillows seem not to irritate my eye. However those make my ears pop constantly and it becomes painful when my machine ramps up to higher pressures so I can't fall asleep with those. I tried full face masks as well and they seem not to irritate my eye, however the company that makes them only makes them in large and small, no medium, so neither of them fit my face well and always sprang large leaks. My ENT referred me for a second opinion to another doctor on getting surgery to try to fix the apnea. However it doesn't have a high success rate (at best 50%) and I would appreciate any advice on finding a sleep apnea treatment that works. I would rather not resort to surgery if I don't have to and if it doesn't work it is back to CPAP anyway. Any advice on dealing with my irritated eye, or with avoiding ear pops with my nasal pillows, or a different sort of full face mask, or any other advice is appreciated.

Hi ark345!

I think, for now (there are a million masks to try - some made to fit your specific face) I think I would try the nasal pillows. I think the trick to making this all work is quality time spent with the machine running during the day. Some time in bed, laying quietly in all the usual positions, and learning to breath quietly and gently with the machine. The pressure of the machine will tend you to use more air and this can easily move toward a kind of "runaway" situation. If anything CPAP use should make your night quieter so learn to breath quietly with the machine.

Part of the time should also be spent with mild distraction. Watching light TV, listening to music, reading a book... The time in bed is to solve all the little problems that come up as you move from position to position (mask fit, hose management, breathing quietly). The time with distraction is to normalize the reflexes being developed to deal with the constant pressure of the machine, as well as wearing the mask, as well as ear equalization and all. I think this works well because we are distracted but still awake - so - problem with breathing - awake resources - problem solved . . . now back to the TV show.

Have a great week!

Todzo

[ark345]

Hello, I saw the second ENT and they gave me a prescription nasal spray (takes about a week to take effect) to reduce inflammation in my nose so my ears don't pop. I have started using the nasal pillows again and while I need to readjust to them, I have noticed a difference. I am seeing some other specialists regarding the surgery. This ENT said the reason I should consider surgery to have my tonsils and some other tissues removed is that besides they are part of the reason for my sleep apnea, as I get older these muscles will weaken and make it worse. The ENT also said the surgery might not cure the apnea, hopefully should help it, but I need to think of it as a preventative measure for the future since I already have severe apnea now.

[ncgncg]

I'm not a medical professional and I can't really say anything useful about your particular case, but frankly, given what you said, I would want a second opinion before committing to surgery. Let me explain my logic.

The first reason the surgeon gives for the surgery is that it might alleviate your apnea to some extent. That may be the case, but to what extent does the CPAP fix the apnea? If I had 20/40 vision that could be corrected to 20/20 by glasses, and a surgeon told me they could get it to 20/38 with surgery, I would see little point in the surgery—I'd still have to wear glasses either way. But if the surgeon told me that with glasses, I could never see better than 20/30, and doing the surgery as well could get me up to 20/20... then that would be interesting. In other words, to come back to CPAP and tonsils, I would want to know (a) whether the expected outcome still involves CPAP, and if so, (b) whether the combined effect of CPAP and surgery is significantly better than CPAP alone. Or is your sleep apnea so severe that occasional failure of the CPAP to be effective is directly life-threatening?

The second explanation the surgeon offers is for the proposed surgery is that it might prevent future problems. That makes it sound like the responsible thing to do, but I would want to know whether there is any reason treatment now would be inherently superior to treatment when it becomes needed. I'm not saying the answer to that is necessarily "no." Sometimes, the surgery really is better done earlier for other reasons than the surgeon's cash flow.

For instance, I never had my wisdom teeth taken out until half a year ago, because no dentist had told me a reason why doing so preventatively would bet better than doing so if and when it became necessary. The only thing that my old dentist had ever mentioned as a possible consequence of leaving them in place was crowding of my lower teeth, so I always figured that as long as there seemed to be plenty of space in my lower jaw, the wisdom teeth wouldn't hurt.

Boy was I wrong. It turned out that my dentist never told me that wisdom teeth extractions, which are a routine matter in teenagers, can become harder and harder to do with age, and that mine were impacted in a particularly nasty way, that to take those out after age 25 would be a major challenge, with a much increased chance of complications compared to doing it early on.

So as I said, there are cases where preventative surgery makes sense, but I would want to hear some argument other than "might as well do it now." Every time they start cutting bits of your body off or sewing them together in creative ways, there's a chance of complications, and the need for some period of recovery. That doesn't mean you should panic whenever a doctor says a surgery is indicated, but I would want to hear a more convincing rationale than "it might come in useful."

[mgaggie]

I have problems with my left ear drum bursting when using cpap, I have found using pressure reducing earplugs has helped greatly. No more bursting, my ears do pop occasionly but they don't hurt.

[ark345]

I will be a getting a second opinion. This ENT did mean that depending on my future health that it may be much more difficult in the future to do this surgery. I am carefully weighing the pros versus the cons.