Really new, left in dark by doctors

Conor2612 · Post by **Conor2612** » Mon Nov 01, 2021 5:11 pm

Pugsy wrote: ↑
Mon Nov 01, 2021 5:03 pm

Conor2612 wrote: ↑
Mon Nov 01, 2021 4:48 pm
why would people with UARS need a higher pressure?
I don't know and not everyone does end up needing markedly higher pressures. I have just noticed over the years that when people with UARS come here...seems like that's what happens.
Remember....UARS as a real medical problem in still in its infancy in terms of just about everything.
More research is now being done but for years no real exacting research was even done.

I assume the OAT is some sort of oral appliance....sorry but I know nothing about them other than sometimes they work well for some people and totally useless for others.

Your AHI is relatively low in the grand scheme of things and it might work well for you.

I think a lot is going to depend on what exactly was causing your crappy sleep to start with....and that's a real big unknown right now.

Well Pugsy you have done more for me tonight then my overpriced private doctor has done in 6 months. Mainly in mental clarity and understanding that there's more to a person than data, so I thankyou so much for answering all of these questions!

clownbell · Post by **clownbell** » Mon Nov 01, 2021 8:58 pm

I notice that most of your apneas are Centrals. If you have been on PAP for three months, it is possible (possible, not certain) that there may be some treatment-emergent apneas that will go away as your body becomes accustomed to PAP therapy. Some users see them go away in three months, other users take longer. YMMV.

@Pugsy and Palerider - do you think the Centrals could be pressure-induced, requiring lower pressures and a narrow range? Just wondering what you think.

tlohse · Post by **tlohse** » Mon Nov 01, 2021 9:32 pm

If you have a Resmed Airsense 10 CPAP you can use their My Air app. It gives you quite a bit of info and even coaches you and gives you advice.

Pugsy · Post by **Pugsy** » Mon Nov 01, 2021 9:44 pm

clownbell wrote: ↑
Mon Nov 01, 2021 8:58 pm
@Pugsy and Palerider - do you think the Centrals could be pressure-induced, requiring lower pressures and a narrow range? Just wondering what you think.

No. Not at this time.

1....I do think that with the history of being a light sleeper and fragmented sleep that one should investigate the chance those centrals are false positives...first.
2....not enough centrals to worry about
3....I do NOT think they are pressure related at all though. If I thought they were real and numerous enough to be a worry the first thing I would suggest is reducing or eliminating EPR.

Before anyone starts hitting the panic button they first have to be determined to be the real deal asleep flagged events and we need a LOT more of them than what we are seeing.

Remember it's normal to have an few real centrals anyway.

palerider · Post by **palerider** » Mon Nov 01, 2021 9:53 pm

clownbell wrote: ↑
Mon Nov 01, 2021 8:58 pm
I notice that most of your apneas are Centrals. If you have been on PAP for three months, it is possible (possible, not certain) that there may be some treatment-emergent apneas that will go away as your body becomes accustomed to PAP therapy. Some users see them go away in three months, other users take longer. YMMV.

@Pugsy and Palerider - do you think the Centrals could be pressure-induced, requiring lower pressures and a narrow range? Just wondering what you think.

This is where 'statistics' can be used to deceive. While you're completely correct that "most" of the apneas are centrals, what that doesn't convey is that the total number of centrals is completely insignificant.

Even 5 times as many wouldn't be worth paying any attention to.

It's more likely that the centrals are just disturbance induced, and therefore should be ignored completely.

palerider · Post by **palerider** » Mon Nov 01, 2021 9:54 pm

tlohse wrote: ↑
Mon Nov 01, 2021 9:32 pm
If you have a Resmed Airsense 10 CPAP you can use their My Air app. It gives you quite a bit of info and even coaches you and gives you advice.

Because myair is useless at trying to improve one's treatment, as is this suggestion.

Conor2612 · Post by **Conor2612** » Fri Nov 26, 2021 7:19 am

Hi all, continuing my thread. Hope you can help.

Have found a little more relief of symptoms from having min pressure 10 max 12 and EPR at 3. But I am finding myself severely congested and 'black eyed' the next morning. The best way I can understand it is imagine holding your nose and blowing out, your eyes/sinuses and head would fill up with pressure.

It's definitely on these higher settings. Never had it before when I had ipap around the 7-8.5 mark.

Any one had this experience? Does it go away? Or am I forever cursed with sinus pressure issues because of these higher pressures I need.

I have humidity on 4. Which has always been really comfortable.

Julie · Post by **Julie** » Fri Nov 26, 2021 9:27 am

Did it not occur to you that your sinus problem might be caused by such high humidity = depending on where you live, Arizona vs Seattle, you may not need that humidity at all, or only on a lower setting at most.

Conor2612 · Post by **Conor2612** » Fri Nov 26, 2021 9:35 am

Julie wrote: ↑
Fri Nov 26, 2021 9:27 am
Did it not occur to you that your sinus problem might be caused by such high humidity = depending on where you live, Arizona vs Seattle, you may not need that humidity at all, or only on a lower setting at most.

I live in London, the air is generally neutral/to humid cos of the rain. I truly think this is a sinuses getting used to breathing on 10cm of air pressure thing. Especially if they were completely fine on 7-8cm of air pressure.

I just want to know if anyone has experienced this and it's just my sinuses adjusting?

Pugsy · Post by **Pugsy** » Fri Nov 26, 2021 10:39 am

A setting of 4 on a ResMed machine really isn't all that high of a setting and if one lives in a relatively humid area that setting probably doesn't really add much (if any) moisture to the cpap provided air.
Here's how it works...the setting (whatever it is) for humidity is what the machine is supposed to ultimately deliver...not added on top of what the incoming humidity might be.
A setting of 4 is sort of the middle of the road and I forget exactly what it translates to but probably something around 80%...so lets say that is the target.
If the incoming air is say 65% humidity then the machine only needs to add 15% more moisture and then it stops once the air contains 80% moisture. If the incoming air is 75% humidity then the machine only adds 5 % more...
If the incoming air is 90%...like it is raining outside and the windows are open...the machine won't add any extra moisture and won't use much, if any, water.

Don't assume that one's ambient humidity in the house is the same as what it is outside.....when we heat (or cool) our homes the ambient humidity inside will change. Example...suppose we lived in a high humidity locale...say the middle of the rain forest but we used air conditioning all the time because it was always really hot in that rain forest....using A/C dries out the air inside the home so the humidity inside the house is going to be a lot lower than outside the house.
Or another example....suppose we lived in the state of Washington in the US...don't assume it is high humidity for everyone...those mountains in Washington cause for a marked difference in ambient humidity. People on the west side of the mountains will have high humidity but the people on the east side of the mountains actually have a very arid/dry ambient humidity. This is what they start with but add in heat during the winter they both will have even drier air to start with even before getting to the cpap machine for the machine to do whatever it is going to do.

Nasal mucosa are funny little guys and very easily upset when something changes the least little bit.
Yes...we breathe the ambient humidity where we live all day long so our mucosa is adjusted to their "normal" but adding cpap flow rate per the pressures can upset the balance. It can simply dry the mucosa out a bit and when the mucosa experiences anything different from their "normal" it can respond with histamine production and we get those typical allergy like symptoms that we don't like....congestion, drainage, stuffiness, pressure, itching, swelling, etc.

This can happen with any change...be it too much moisture or too little moisture. The nasal mucosa are simply unhappy from the change no matter what the change might be.

Conor2612 wrote: ↑
Fri Nov 26, 2021 9:35 am
I live in London, the air is generally neutral/to humid cos of the rain. I truly think this is a sinuses getting used to breathing on 10cm of air pressure thing. Especially if they were completely fine on 7-8cm of air pressure.

I just want to know if anyone has experienced this and it's just my sinuses adjusting?

The flow of air from the change in pressure from 7 or 8 to 10 cm is actually relatively small but it is enough to potentially dry the mucosa out a bit quicker. In the end though it does fall back on the mucosa and whether or not the change makes them happy or unhappy.
So we have to back up and factor in the ambient humidity in the bedroom (not necessarily outside the house because remember we have to factor in heating or cooling) and what the machine is doing or not doing at that setting of 4. It's going to try to maintain that 80% (assuming that the setting of 4 is what gets delivered) but with that little bit of increased air flow from the higher pressures that 80% might not be enough to keep the nasal mucosa happy.

So while you want to blame the pressure change...it might be the moisture itself still being the underlying real cause brought on by the slight change in pressure.

Since the machine will only deliver the humidity it is set to and not more....the chances of your getting too much humidity is slim to none but the chance of your not getting enough moisture to keep your nasal mucosa happy have increased a bit with the slightly higher pressures and the no change in delivered humidity.

If it were me...I would slightly increase the humidity setting and see if that helps with the congestion or not.
Nasal mucosa are funny little guys and sometimes the least little change will set them off into a really unhappy mood.
When they are unhappy....they make us pay with some really nasty allergy like symptoms.

If a hot steamy shower seems to help relieve nasal congestion...you have your answer right there.

Conor2612 · Post by **Conor2612** » Fri Nov 26, 2021 11:26 am

Pugsy wrote: ↑
Fri Nov 26, 2021 10:39 am
A setting of 4 on a ResMed machine really isn't all that high of a setting and if one lives in a relatively humid area that setting probably doesn't really add much (if any) moisture to the cpap provided air.
Here's how it works...the setting (whatever it is) for humidity is what the machine is supposed to ultimately deliver...not added on top of what the incoming humidity might be.
A setting of 4 is sort of the middle of the road and I forget exactly what it translates to but probably something around 80%...so lets say that is the target.
If the incoming air is say 65% humidity then the machine only needs to add 15% more moisture and then it stops once the air contains 80% moisture. If the incoming air is 75% humidity then the machine only adds 5 % more...
If the incoming air is 90%...like it is raining outside and the windows are open...the machine won't add any extra moisture and won't use much, if any, water.

Don't assume that one's ambient humidity in the house is the same as what it is outside.....when we heat (or cool) our homes the ambient humidity inside will change. Example...suppose we lived in a high humidity locale...say the middle of the rain forest but we used air conditioning all the time because it was always really hot in that rain forest....using A/C dries out the air inside the home so the humidity inside the house is going to be a lot lower than outside the house.
Or another example....suppose we lived in the state of Washington in the US...don't assume it is high humidity for everyone...those mountains in Washington cause for a marked difference in ambient humidity. People on the west side of the mountains will have high humidity but the people on the east side of the mountains actually have a very arid/dry ambient humidity. This is what they start with but add in heat during the winter they both will have even drier air to start with even before getting to the cpap machine for the machine to do whatever it is going to do.

Nasal mucosa are funny little guys and very easily upset when something changes the least little bit.
Yes...we breathe the ambient humidity where we live all day long so our mucosa is adjusted to their "normal" but adding cpap flow rate per the pressures can upset the balance. It can simply dry the mucosa out a bit and when the mucosa experiences anything different from their "normal" it can respond with histamine production and we get those typical allergy like symptoms that we don't like....congestion, drainage, stuffiness, pressure, itching, swelling, etc.

This can happen with any change...be it too much moisture or too little moisture. The nasal mucosa are simply unhappy from the change no matter what the change might be.

Conor2612 wrote: ↑
Fri Nov 26, 2021 9:35 am
I live in London, the air is generally neutral/to humid cos of the rain. I truly think this is a sinuses getting used to breathing on 10cm of air pressure thing. Especially if they were completely fine on 7-8cm of air pressure.

I just want to know if anyone has experienced this and it's just my sinuses adjusting?
The flow of air from the change in pressure from 7 or 8 to 10 cm is actually relatively small but it is enough to potentially dry the mucosa out a bit quicker. In the end though it does fall back on the mucosa and whether or not the change makes them happy or unhappy.
So we have to back up and factor in the ambient humidity in the bedroom (not necessarily outside the house because remember we have to factor in heating or cooling) and what the machine is doing or not doing at that setting of 4. It's going to try to maintain that 80% (assuming that the setting of 4 is what gets delivered) but with that little bit of increased air flow from the higher pressures that 80% might not be enough to keep the nasal mucosa happy.

So while you want to blame the pressure change...it might be the moisture itself still being the underlying real cause brought on by the slight change in pressure.

Since the machine will only deliver the humidity it is set to and not more....the chances of your getting too much humidity is slim to none but the chance of your not getting enough moisture to keep your nasal mucosa happy have increased a bit with the slightly higher pressures and the no change in delivered humidity.

If it were me...I would slightly increase the humidity setting and see if that helps with the congestion or not.
Nasal mucosa are funny little guys and sometimes the least little change will set them off into a really unhappy mood.
When they are unhappy....they make us pay with some really nasty allergy like symptoms.

If a hot steamy shower seems to help relieve nasal congestion...you have your answer right there.

You're so bloody helpful you know that! Thank you for this. It makes a lot of sense. I actually have a heated tube which I'm yet to try out (mainly because I wasn't getting congested and felt fine) so I shall get a little bit more heat humidity going and see if it helps. I was hoping it was actually to do with humidity and air because you see people on here inhaling and exhaling on ridiculously high pressures and it made me think they must have combated it somehow...so makes sense that it's a mucosa thing. Thankyou

Pugsy · Post by **Pugsy** » Fri Nov 26, 2021 12:05 pm

Bear in mind that the heated tube/hose doesn't change the actual amount of humidity being delivered..
all it does is help control condensation of that humidity in the hose or mask.
So whatever hose temp you select will NOT impact the amount of humidity that the machine cranks out. Amount of humidity/moisture is controlled by the humidity setting and not by the hose air temp setting.
All it (heated hose) does is help eliminate the chance of that humidity condensing in the hose or mask.
Warmer air will hold onto moisture better than colder air. So the warmer the hose air temp the less chance of the ambient bedroom temps cooling off the air in the hose to a point where it releases the moisture in the air in the form of condensation.

Example...that setting of 4 we talked about before (assuming again an 80% humidity delivery) is going to deliver 80% no matter if the hose air temp is set at 70 degrees or the max of 86 degrees.
You can't change the humidity delivered by changing hose air temps.
What you can change is comfort of the air and the chance of humidity being delivered condensing and giving you a cold shower or snorting drops of water up the nose...which while it won't kill you...it is highly annoying because it can wake a person abruptly and rudely and sometimes cause great difficulty getting right back to sleep.

Heated hoses are for comfort and condensation prevention only. They don't actually change the amount of humidity in that hose at your given humidity setting.

Conor2612 · Post by **Conor2612** » Fri Nov 26, 2021 12:11 pm

Pugsy wrote: ↑
Fri Nov 26, 2021 12:05 pm
Bear in mind that the heated tube/hose doesn't change the actual amount of humidity being delivered..
all it does is help control condensation of that humidity in the hose or mask.
So whatever hose temp you select will NOT impact the amount of humidity that the machine cranks out. Amount of humidity/moisture is controlled by the humidity setting and not by the hose air temp setting.
All it (heated hose) does is help eliminate the chance of that humidity condensing in the hose or mask.
Warmer air will hold onto moisture better than colder air. So the warmer the hose air temp the less chance of the ambient bedroom temps cooling off the air in the hose to a point where it releases the moisture in the air in the form of condensation.

Example...that setting of 4 we talked about before (assuming again an 80% humidity delivery) is going to deliver 80% no matter if the hose air temp is set at 70 degrees or the max of 86 degrees.
You can't change the humidity delivered by changing hose air temps.
What you can change is comfort of the air and the chance of humidity being delivered condensing and giving you a cold shower or snorting drops of water up the nose...which while it won't kill you...it is highly annoying because it can wake a person abruptly and rudely and sometimes cause great difficulty getting right back to sleep.

Heated hoses are for comfort and condensation prevention only. They don't actually change the amount of humidity in that hose at your given humidity setting.

Amazing to know, thankyou kindly!

Really new, left in dark by doctors

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