CPAPtalk.com

Morbius wrote:ALL them things:

While data have been reported most extensively for fluoxetine and paroxetine, class effects of SSRI therapy appear to include increased sleep onset latency and/or an increased number of awakenings and arousals, leading to an overall decrease in sleep efficiency. Virtually all of the SSRIs examined have been noted to suppress REM sleep.

And people wonder why one of the first questions I ask is the "meds" question.

Ok so im getting a ResMed APAP tomorrow. I can use it for a week for free to see how it works for me.

I might just get one after the trial period, even if I don't feel much of a difference since one week might not be enough to feel better.

Minky, what settings are you using for UARS? Also, what kind of mask do you have?

I definitely want to change or suppress my depression med, specially as I don't feel too depressed, just very tired and anxious. What would you guys do, change or suppress it now, or see how the APAP works first? Otherwise I won't know if what is making me feel better is the machine or the med.

Thanks a lot.

pablmd wrote:I definitely want to change or suppress my depression med, specially as I don't feel too depressed, just very tired and anxious. What would you guys do, change or suppress it now, or see how the APAP works first?

With those meds it isn't advisable to make changes quickly....I would suggest seeing what APAP does first...if it helps it might make changing those meds or reducing dosage go much easier.

What settings or masks to use? Pressure needs are individual and what works for one person won't necessarily work for another but from what I have seen with UARS (if that is what is going on with you) most people need more pressure to feel better beyond what gives a good AHI and you aren't going to be able to use AHI as much of a guideline since it is already low.

Mask choice....can you breathe easily through your nose most of the time or do you have problems with chronic nasal congestion that can't be resolved.
If you can breathe through your nose...try a nasal mask..either nasal pillow or nasal cushion as they are the easiest to get and keep a good seal...nasal pillow being the simplest because less area needing to seal.
It doesn't make any difference which mask is used in terms of OSA or UARS...meaning there's no special mask that works best for UARS. What works best for anything is the mask that lets you sleep the best.

My pressure range is currently 6-12, but I think it may be a little bit low on both ends.

For masks I switch off between the Airfit P10 and the Eson nasal mask. I don't mouth breathe, so they both work for me. Also, they're both comfortable and they both work well for side sleeping. As Pugsy said, there are no masks that are better or worse for UARS, so you just want to find a mask that is comfortable for you and doesn't leak.

Good luck. I hope you get to love your APAP as much as I love mine.

I got my APAP today! Im so excited to sleep with it.

I get to use it until tuesdsay and then the doctor will look at my stats and see how I have rested with it.

It is a Resmed APAP, with a nasal mask and a humidifier.

Also, my doctor told me to slowly stop taking Citalopram if I feel better with the machine.

Lets see how I wake up tomorrow...

Glad things are moving forward for you. When the doctor assesses how you've done your first week, ask questions on the specifics. Some look only at how much you were able to use it and consider that your measure of success. You'll want to know your AHI, and the breakdown if the numbers are significant, and how your leaks look. Do stay mindful that if your limb movements happen to worsen, how you feel may not be a reliable measurement of your need for the med. If your sleep is still fractured by your legs, even if the sleep apnea is resolved, you could have daytime symptoms of sleep deprivation that look like depression. You're on the right track, just keep your eyes open for the interactions of your disorders.

First night on the APAP was horrible.

I inhale through my nose but I exhale through my mouth so that was provoking a big leak, the machine made huge noise and increased the amount of air provided every time I exhaled through my mouth so i could not fall asleep.

I taped my mouth so I wouldn't open it and managed to fall asleep, but in the middle of the night I woke up as I managed to exhale through the tape. Also my belly was full of air so I removed the mask for the rest of the night.

Should I try a mouth and nose mask? My settings are 4-14.

Practice using the machine while awake and watching TV. Practice holding your tongue to the roof of your mouth so that no air enters your mouth and you can keep the lips closed. Do it while watching TV or reading or something where you aren't under the gun to go to sleep.

Get the software...let's see just how high that pressure went to cause the aerophagia (that's your belly pain from air in the gut).
May need to make an adjustment to prevent that or you have zero chance of getting any quality sleep to see if this therapy has a remote chance of helping.

You may need a different mask...can you get one today? Sometimes not so easy to find different masks on the weekend...
and besides you could still maybe use the nasal mask if the tongue will learn to keep the door closed and not let air enter your mouth.
A chin strap might help...good quick easy and cheap way to try out chin strap idea is to get an ace bandage and use it for support.

See why we were saying 1 week isn't long enough? It's hard enough to get this mask and leak and mouth stuff...and you have the aerophagia stuff too....all well managed so you have an chance of feeling better.
Until you can sleep quite well without mask and aerophagia issues....no way can you expect to feel better.

Aerophagia...belly pain from air in the gut...quite common.
wiki/index.php/Aerophagia
and a full face mask won't necessarily fix it

Thanks Pugsy

That aerophagia thing is horrible.

I can't get another mask until tomorrow so I tried the nasal one again.

I managed to use it for like 3 hours. I taped my mouth again not to mouth breath.

I managed to fall asleep very quick but I woke up after like 3 hours with my mouth inflated like a balloon full of air, my belly hurt because of the air too, and I had a lot of flatulence. Some air was leaking from the mask (that wasn't happening when I fell asleep)... Was that causing the problems? I removed the mask for the rest of the night.

As a positive note, when I woke up in the middle of the night my nose felt nice and moistured (I guess because of the humidifier), same as my throat (no throat pain).

I have been lucky in that I can count on one hand the number of times I have had really bad aerophagia. So while not a huge frequent problem for me I can sympathize for sure. It was so bad I was physically ill the next day with nausea along with the pain.

The cheeks being inflated like a balloon. We call that chipmunk cheeks. The tongue drops down and doesn't block the airway and air goes up the nose and enter the mouth because the tongue dropped down and no longer is keeping the door to the airway closed.
Lips are closed...cheeks inflate. Highly annoying for sure. The trick is to get the tongue to stay in the roof of the mouth and not open the doorway. Easy to do while we are awake but not so easy once we fall asleep. With time and practice the tongue can usually learn to stay where we want it but it does take some time and a lot of practice to learn a new habit.
It's not fair...bad habits are really easy to make and very hard to break....good habits are hard to make and easy to break.

Did you get SleepyHead up and running yet? We really need to see those pressures.

Pugsy wrote:I have been lucky in that I can count on one hand the number of times I have had really bad aerophagia.

OK, but...

Morbius wrote: OK, but...

Good one Morbius. I see you have been sneaking over here again taking pictures on the sly. Caught me.

It can be really hard to train the tongue to keep a seal on the roof of the mouth if the jaw goes slack when relaxed. I was not successful taming my tongue until I used a chin strap for a while. At some point I was able to stop using the chin strap, but I still do best if I'm careful to sleep in a position where my jaw can't fall slack. As to the air in the belly, hopefully you'll be able to hone in on what is the lowest pressure to effectively treat most of your breathing issues. You may end up finding a set pressure with exhalation relief works better for you. Things should fall in place in time. Doesn't help much now, but maybe soon.

Just came back from the doctor, we looked at my graphs.

I have many air flow limitations, so the doctor said I have UARS.

My settings are 4-14 and I stay between 10 and 12 most of the night (I use the machine for 3 hours average).

Aerophagia could be due to GERD. Ill visit the digestive doctor.

So I got a full nose and mouth mask, and an appointment for friday to look at the graphs again. He set the expiratory pressure relief too.

Also I have several central apneas per night, the doctor said that my brain has adapted to OSA so it forgets to breath sometimes.

I have the graphs on a PDF, is there anyway I can post them here?

So here are my stats, its only 3 days and not much use, just so that you see the pressures and leaks:

06/02/2015 - 08/02/2015 S9 AutoSet (S/N: 23142288836)

AutoSet APE: RAMP_ONLY APE: 1,0 cmH20

Min pressure: 4,0 cmH20 Max pressure: 14,0 cmH20

Pressure - cmH20
Median: 8,6 Percentil 95: 11,8 Max: 12,4

Leaks - l/min
Median: 2,4 Percentil 95: 12,0 Max: 34,8

Respiratory index - episodes/h
Apnea Index: 2,8 Hipoapnea Index: 0,6 AHI: 3,4
Obstructive: 0,3 Central: 2,2

Total use
Days >= 4 horas : 0 Days < 4 horas : 3 % days >= 4 horas : 0

Days not used: 0 Total days: 3 Total hours: 9:24
Median of use: 3:08 Average use: 3:08