CPAPtalk.com

palerider wrote: the aerophagia complicates things though

Yep. It sure does. If it weren't for that I was going to suggest the same thing you were thinking...be more aggressive with dealing with the FLs and see if it helps or not.
But we sure don't want to make the aerophagia worse...just swapping problems and swapping for a potentially worse problem at that with no guarantee that fixing the first will give the desired results anyway.

Always something it seems.

Anatomically if your nasal airway is narrow and hard palate (the floor of nasal airway) is high, nocturnal nasal congestion could be the likely culprit.

One way to test it out is to buy Afrin and use it before sleep for a few nights (don't use it two nights in a row to avoid rebound effect) and see if the quality of sleep improves.

BTW I think you are a very typical UARS not subtle at all

musculus wrote:Anatomically if your nasal airway is narrow and hard palate (the floor of nasal airway) is high, nocturnal nasal congestion could be the likely culprit.

One way to test it out is to buy Afrin and use it before sleep for a few nights (don't use it two nights in a row to avoid rebound effect) and see if the quality of sleep improves.

BTW I think you are a very typical UARS not subtle at all

If Afrin does help, what would be the course of action? Knowing that I couldn't use it forever (especially with thyroid disease), would it mean that I should use a full-face mask instead?

I'm always wondering about UARS... Would my SleepyHead results be that good if I had it? Wouldn't we be able to see something during the sleep study at least? Or is it a very "silent" problem? (So many questions, sorry!)

SleepyHead just shows whatever the machine reports and UARS isn't something that is real easy to spot on a machine that is mainly designed for OSA.
The flow limitation correlation is a maybe thing.
We have had several discussions lately about this sort of thing but I didn't save any of those threads so I don't have them handy. If you search forum member Morbius and his posts...he has posted in some of those threads recently.
If it is UARS cpap therapy is still the generally accepted therapy as far as I know but it's harder to evaluate using these machine's data reporting because it isn't something that is clear cut and shows up easily.

Sometimes flow limitations are in the nasal area...and sometimes they are in the airway behind the tongue. Using Afrin might help you isolate where the FLs are coming from..if you use it and they go away then your flow limitations are more in the nasal passageway as opposed to the airway down and back of the tongue where we normally think of OSA itself.
Think of it this way...if I had a bad cold and could barely breathe through my nose my FLs would probably be off the charts but they wouldn't be UARS or related to OSA...they would be flow reductions because of my stuffy nasal passages.

That makes perfect sense and it seems like Afrin would be a good thing to try! I'm going to try one thing at a time though to make sure I can pinpoint the problem, but I'm definitely keeping Afrin for the next step. Thank you!

JissaP wrote: If Afrin does help, what would be the course of action? Knowing that I couldn't use it forever

if you only use it once a day, instead of twice, you can use it for much much longer without getting addicted to it, and suffering the rebound congestion. (learned that from a sharp ENT.)

Thanks to Pugsy's suggestion to increase the EPR, the swallowing of air decreased dramatically and I was able to increase the pressure until it didn't reach the max during the night! It seems like I found the correct pressure last night:



Sadly, it didn't seem to do much for the FLs, so I will move on to the Afrin and see if it changes anything.

I am still having problems with nasal passage dryness and I had to take a break in the middle because it felt like it was kind of burning and uncomfortable. I did purchase the saline mist and I am using it in the morning and before bed. Should I use it in the middle of the night if I wake up with the sensation again?

I could also try to increase the humidity again, but it's almost at the max and I'm worried I'll start getting condensation and water up my nose instead. I guess I could just give it a try and see for myself

Anyway, I just thought I would give a little update. Thank you SO MUCH Pugsy for suggesting the increase in EPR! I can't believe that's all I needed to help with the aerophagia!

Do you have the heated hose? I forget. If you do have the heated hose turn up the air temp and turn up the humidity setting and let's see what happens.
If you don't have the heated hose...get one.

If more moisture helps the burning sensation (yes use the saline spray in the middle of the night too) let's try to prevent it from ever happening and if we get moisture in the nasal pillows from rain out lets try to fix it.
No sense in your nose being uncomfortable when there's several options available for preventing moisture in the nasal pillows.

I think I found the problem with my burning nose... I just went to adjust the temperature of my heated tube, but the "Climate Control" option is not in the menu anymore (user OR clinical). I tried unplugging the tube and plugging it again, and unplugging and plugging the machine, to no avail It must be defective!

That explains a lot then. Thinking back, it does seem like the air used to be quite a bit warmer than it is nowadays. I can't believe I didn't think of this!

I'll see if I can get a replacement.

Most of the time the ClimateLine hoses are pretty sturdy and can take a good bit of abuse (lord knows I abused mine a lot) but sometimes they do fail.
Hopefully a new hose will fix the situation. If the machine won't/can't recognize the hose and you get a new hose and it doesn't fix the issue then entire machine needs to be evaluated.

Very curious if Afrin helped your flow limitations at all, I'm somewhat in the same boat myself.

Hi There,
Brain fog, memory problems, daytime drowsiness, headaches, poor concentration, acid reflux, can ALL be symptoms of hypothyroidism. Once I got on the proper thyroid meds----all those problems went away and I lost 35 pounds. You should have a simple blood test to see how your thyroid is functioning. it might not all be sleep apnea related.

JissaP wrote:

musculus wrote:Anatomically if your nasal airway is narrow and hard palate (the floor of nasal airway) is high, nocturnal nasal congestion could be the likely culprit.

One way to test it out is to buy Afrin and use it before sleep for a few nights (don't use it two nights in a row to avoid rebound effect) and see if the quality of sleep improves.

BTW I think you are a very typical UARS not subtle at all

If Afrin does help, what would be the course of action? Knowing that I couldn't use it forever (especially with thyroid disease), would it mean that I should use a full-face mask instead?

I'm always wondering about UARS... Would my SleepyHead results be that good if I had it? Wouldn't we be able to see something during the sleep study at least? Or is it a very "silent" problem? (So many questions, sorry!)

JissaP, as pugsy said, Afrin is a diagnostic tool to see if your problem is mostly a congested nasal airway (nose can be more congested at sleep due to blood pressure drop and more blood flow to head during REM).

If UARS, AHI number is not useful to you. Instead, you should pay special attention to your airflow patterns throughout the night, especially around flow limitations. It is silent but not that silent.

Sorry for not updating for a while!

I finally got a new heated hose and it helped, but I was struggling a bit with air swallowing again so I held off on trying Afrin. Yesterday I finally had an 8 hour night with the machine on the whole time, so yay! I'm still seeing a lot of flow limitations though, so I'll start with breathe right strips and see if it helps at all, then move on to Afrin. I have to admit, I'm a bit cautious about using it because as a long, long time Grave's Disease patient (diagnosed at 8 years old), I never ever use decongestants as instructed by my doctor. I know 1-2 nights if my levels are stable won't really be a problem but I'm still paranoid I guess I'll get to it eventually.

@sleeplessinaz: It is definitely not hypothyroidism. I have grave's disease and I am already on replacement hormones after burning the thyroid with radioactive iodine, so the first thing I did was to explore all possibilities related to my thyroid problems, but everything was perfectly ok on that side. I get it tested every 6 months and it's still good. Thanks for the suggestion though! It's definitely the first thing to watch for

JissaP wrote:I am still having problems with nasal passage dryness and I had to take a break in the middle because it felt like it was kind of burning and uncomfortable. I did purchase the saline mist and I am using it in the morning and before bed. Should I use it in the middle of the night if I wake up with the sensation again?

Yes, it's fine to use the saline spray in the middle of the night to help your nose. You might also consider putting some Lansinoh lanolin nipple cream along the inside edges of your nostrils if they're burning and irritated. While Lansinoh is usually recommended around here as a way to soothe nostrils that are sore from trying to make nasal pillows masks work, it is very good as soothing nostrils that are just plain irritated.

Thank you SO MUCH Pugsy for suggesting the increase in EPR! I can't believe that's all I needed to help with the aerophagia!

I am really glad to hear that increasing the EPR relieved your aerophagia problems.