CPAP journey starts but still high Central Events

johncray wrote: ↑

Thu Aug 14, 2025 2:44 pm

I tried sinus rinse, moisturizing gel, Ryaltris (steroid + antihistamine) - nothing helped.

I don't normally have a nasal congestion problem but on occasion I will and can't blame it on a bad cold or flu...
for those times I cheat....I use Afrin. Emergency use only and I know the dangers because I have been down the Afrin Rebound road on more than one occasion. Still at 10 PM and I can't breathe through my nose (and I absolutely must be able to nose breathe to sleep) and nothing I tried helped at all...the last thing on my mind as I squirt a little teeny tiny bit of Afrin up my nose is Afrin Rebound...my thought is..."I will worry about that later. For now I have to be able to sleep".

I don't know what to make of the O2 graph...the couple of quick drops could simply be movement artifacts.
I don't think that the bulk of your apnea events seen are real asleep events so those shouldn't cause a drop in O2...and the handful that might be asleep real events aren't of a prolonged duration enough to cause O2 drops.

Hold your breath for 15 seconds...wearing the O2 device...watch your O2 and see when or if it even drops.
Give it 5 minutes after you resume breathing before you quit the experiment. Watch to see if there is a delayed response.
A single non breathing event of 15 seconds isn't enough to cause the drop....now if you had 4 or 5 of those in say 3 minutes then yeah it might drop.

@pugsy,

I just watched https://youtu.be/dwCxGl3_7JQ?t=1226 where they talked about "anxiety" against the CPAP machine which then messes up the patient's sleep structure and quality because of the pressure during breathing out. I wonder if that might be a thing in my case, although I don't really feel anything consciously. What Barry is saying basically is that BiPAP is much better in this regard (or ASV for that matter).

Did you know that using EPR creates a bilevel pressure situation? And you didn't like using EPR.
That's really the main thing a bipap does....one pressure for inhale and one for exhale. Only thing is EPR is limited to a 3 cm pressure difference and a bipap has the ability to use a higher PS or pressure support which is the difference between inhale and exhale.

johncray wrote: ↑

Thu Aug 14, 2025 1:32 pm

ChicagoGranny wrote: ↑

Thu Aug 14, 2025 11:37 am

johncray wrote: ↑

Thu Aug 14, 2025 12:16 am

I'll need to do the surgery (turbinate surgery) along with fixing the septum.

Gramps had that done years ago. Not only did it make it easier to use CPAP, his daytime breathing is also healthier.

Thank you for sharing that. I'll start collecting more information on this subject soon to try and gauge risks.
Did he do both septum and turbinate reduction? Any problems/side effects afterwards?

Six turbinates "cut down" and his S-shaped septum straightened. Surgery on a Monday morning. Wore a mustache bandage to catch small amounts of blood drip. Didn't miss a minute of CPAP. Had the clips removed on Thursday morning. Went to lunch and shopping. Was careful about lifting anything heavy for about 10 days.

Pugsy wrote: ↑

Fri Aug 15, 2025 5:10 am

Did you know that using EPR creates a bilevel pressure situation? And you didn't like using EPR.
That's really the main thing a bipap does....one pressure for inhale and one for exhale. Only thing is EPR is limited to a 3 cm pressure difference and a bipap has the ability to use a higher PS or pressure support which is the difference between inhale and exhale.

Very good point! I was indeed thinking about that. It seems like pressure variability is indeed making it worse for me.
Specifically regarding pressure, would ASV be just as bad, since if I understand it correctly, it adjusts pressure more precisely.

ChicagoGranny wrote: ↑

Fri Aug 15, 2025 10:22 am

Six turbinates "cut down" and his S-shaped septum straightened. Surgery on a Monday morning. Wore a mustache bandage to catch small amounts of blood drip. Didn't miss a minute of CPAP. Had the clips removed on Thursday morning. Went to lunch and shopping. Was careful about lifting anything heavy for about 10 days.

Sounds very straight-forward and encouraging. Did he have any "empty nose syndrome" problems afterwards? Any dry-nose?

johncray wrote: ↑

Fri Aug 15, 2025 2:23 pm

Specifically regarding pressure, would ASV be just as bad, since if I understand it correctly, it adjusts pressure more precisely.

Just as bad and maybe worse. More precise and definite more quickly and much more PS if it thinks it it needs to go central killing.
Like it can increase the PS with a single breath by quite a lot...10 to 12 cm increase in one breath. Wanna go from 4 cm PS to 12 PS in one breath??? Like exhale 6 cm and inhale 15 cm and that's just 9 cm PS.

If you didn't like 3 cm drop for EPR you would hate PS that is larger than 3 cm and despite what gets said....ASV isn't the cure all for crappy sleep. There's no button or setting on any of these machines that guarantees to fix crappy sleep.

johncray wrote: ↑

Fri Aug 15, 2025 2:26 pm

Any dry-nose?

No.

johncray wrote: ↑

Fri Aug 15, 2025 2:26 pm

"empty nose syndrome"

Those were the old days when ENTs weren't aware of the danger. They are now careful not to remove entire turbinates.

That reminds me of the incident in a small town where ENTs asked the State Medical Office to investigate why they were having to do a large number of surgeries for deviated septums. The State discovered that a great majority of the patients had their tonsils removed by one particular doctor when they were children. That doctor's standard practice was to do the surgery through the nose and pull the tonsils out through the nose.

Doctors and medical schools have learned a lot over the years.

ChicagoGranny wrote: ↑

Fri Aug 15, 2025 2:50 pm

That reminds me of the incident in a small town where ENTs asked the State Medical Office to investigate why they were having to do a large number of surgeries for deviated septums. The State discovered that a great majority of the patients had their tonsils removed by one particular doctor when they were children. That doctor's standard practice was to do the surgery through the nose and pull the tonsils out through the nose.

Doctors and medical schools have learned a lot over the years.

surely he applied leeches first?

Pugsy wrote: ↑

Fri Aug 15, 2025 2:34 pm

If you didn't like 3 cm drop for EPR you would hate PS that is larger than 3 cm and despite what gets said....ASV isn't the cure all for crappy sleep. There's no button or setting on any of these machines that guarantees to fix crappy sleep.

Makes sense. Appreciate your thoughts! I gotta figure out where the bad sleep is coming from first and foremost.

Thank you for your guidance

ChicagoGranny wrote: ↑

Fri Aug 15, 2025 2:50 pm

johncray wrote: ↑

Fri Aug 15, 2025 2:26 pm

Any dry-nose?

No.

johncray wrote: ↑

Fri Aug 15, 2025 2:26 pm

"empty nose syndrome"

Those were the old days when ENTs weren't aware of the danger. They are now careful not to remove entire turbinates.

Much appreciated.

Doctors and medical schools have learned a lot over the years.

And yet it feels like there's so much more left to learn!

Cheers

August 15th - Ramp: 5.0, EPR: off completely (not even Ramp), Pressure: 9.0, OA: 0.00, H :0.81, RERA: 0.12, CA: 4.62 - https://sleephq.com/public/31096d2d-41e ... 4215287d69

I feel a bit more rested as compared to the last two days, without the machine. I suppose it does help with the obstructive component.
Lots of leaks at these high pressures though. I felt through the night air was leaking through my mouth and my whole mouth very dry.
I don't really know if it was leaking from the mask itself. Previously I tried tightening up the mask without a significant benefit but it irritated
the skin under my nose. Do you have any suggestions? Mouth tape?

Cheers

FWIW https://pmc.ncbi.nlm.nih.gov/articles/PMC7927326/

johncray wrote: ↑

Sun Aug 24, 2025 10:31 pm

FWIW https://pmc.ncbi.nlm.nih.gov/articles/PMC7927326/

It's worth a lot.

I've gone cold turkey before and I know the terrible side effects. Last summer I tried reducing the dose from 75mg to 50mg over a period of 3 months but eventually had to go back up to 75 because I don't think 50 was enough. So, I can go for a day or two without feeling the side-effects, just as a test, but doubt that anything will change for such a short period.

But ... that was when your sleep apnea was undiagnosed/untreated. I wonder how a slow taper would go while treated with CPAP.

ChicagoGranny wrote: ↑

Mon Aug 25, 2025 11:22 am

But ... that was when your sleep apnea was undiagnosed/untreated. I wonder how a slow taper would go while treated with CPAP.

Tempting to repeat, indeed.

I talked to my psychiatrist and explained this hypothesis to her. At first blush, she does not think that there could be any correlation but she'd do more research.
I also asked about changing the Sertraline (Zoloft) for another SSRI. Her opinion is that the change itself will cause sleep disturbances that we have to account for but it's not out of the question if I decide to do so.

Meanwhile:
* I tried an F40 full face mask to see if I can reduce the leaks. I could not stand it. It bugged me to no end. I slept for 1.5 hours and the AHI was around 12. I gave up.
* Started taping my mouth now and I have seemingly better leak control and slightly better O2. However, there are still some large leaks here and there and I can tell that air is coming out at the corners of my mouth. I need better tape. Ordered another brand and waiting to arrive. Will try two overlapping stickers tonight to see if it helps. Any suggestions for good mouth tape welcome!
* Talked to the sleep clinic and my GP and have the following coming up:

1. In-lab PSG with titration study
2. Referral to a respirologist
3. 24h Holter monitor and a follow up for a heart ultrasound with a cardiologist to rule out any heart issues. I have history of dysrhythmia (arrhythmia) in the family
4. The clinic is going to get me an ASV machine to try and see if it makes any difference

That's me for now ...