Another newbie

Hi all:

This forum has been very helpful in the past month or two as I've been starting OSA treatment, and I have a couple questions (scroll to bottom if you don't care about verbose background info).

There was some suspicion most of my adult life that I had sleep apnea, partly because my mom was pretty sure my dad had it, and I inherited the snoring gene and the tendency toward being overweight. I was originally formally diagnosed with sleep apnea in 2010 -- I took the sleep study, but I didn't go back for the follow-up appointment. [Note: I have Kaiser.] Fast-forward five and a half years, after successfully being treated for depression, then meeting my now-wife and getting married, I finally do another sleep study this February 4th after my wife urges me to do so. I go to the group appointment, bring home the thing, strap it on before bed, have an awful night of sleep (naturally), and soon get a call to schedule the followup for my mild sleep apnea. (My sleep study AHI was 13.1, so it's on the high end of "mild," but still not the worst ever.)

I go to the next group appointment (February 17, 2016), get my results (including the fact that my O2 only went below 90% briefly, which was both frightening and a bit of a relief), watch a video about PAP, then opt to stay for Part 2 and try out a loaner APAP. Loaner machine number 398, like the rest of them, was a System One A-flex, and I got an Eson mask, size small. The machine was set to go between pressure levels of 5 and 20. So, pretty good.

And lo and behold, it all worked -- I used it until my follow up appointment yesterday, and my AHI was consistently between 1.5 and 1.8, which I think is a pretty big success. The pressure stayed pretty consistently between 7 and 11. I could probably show some stats from Sleepyhead (yes, I've been downloading my stats -- thank you for letting me know this was possible). This was with just a nasal mask and no humidifier, and a beard. It did sort of hurt when I started using it, especially where the mask overlapped my mustache, but I got used to it in a few days.

I haven't in all honestly felt much different on a day-to-day basis -- maybe a modest improvement in my level of alertness -- but the biggest thing I have noticed is that I no longer wake up with my heart racing anymore, and that has to be good for me. Most importantly, my wife has been sleeping better (yay!) due to my lack of snoring.

So, here comes the part with questions. I got a second longer-term loaner* from the tech at my follow-up yesterday, because I really didn't want to go a night without the APAP. As before, it was a System One A-flex, this time with the heated humidifier. She also gave me a different mask, the Amara View mask in medium. That one lasted me about three hours last night -- I woke up at 2:25 with it leaking all over the place. I put the Eson back on and slept great the rest of the night. I didn't notice much difference with the humidifier, but I'm sure it's more comfortable, and maybe it's good for combating nasal congestion.

This is one thing I have a question about. I do experience a fair bit of nasal congestion, probably allergies, probably to my cats. We love our cats as if they are our children, and we're not having any children, so this is something I'm just going to have to adjust to. Obviously I got through a whole month with a nasal mask, so, again, it can't be the worst problem in the world. I am using breathe-right strips most nights (actually, the CVS equivalent), and I think that doesn't hurt. On occasion I have used Afrin spray decongestant (...actually, the Walgreens equivalent), and that also is very effective, but I don't really want to have to rely on that a few times a month long-term. Again, maybe that's not a big deal. And I suppose I ought to go to the allergist (one of the few self-referrable specialties at Kaiser).

But -- what is your, the community's advice, on fighting nasal congestion?

Secondly, I guess I will try the Amara View mask again, this time with looser straps as Janknits has suggested elsewhere, and maybe I'll cut up a t-shirt as a mask liner. Any other tips for that mask?

Finally, I do like the System One A-flex so far -- I can't argue with results -- but is there anything that works just as well that is smaller? It's just such a big thing to carry around when traveling. I guess that's only a minor concern. I am glad to have gotten a prescription for an APAP (signed by a doctor I have never met... ah, Kaiser).

Note that I also don't have DME coverage on my particular Kaiser plan. My employer pays 100% of my premium, and I never have to deal with Apria, so it probably works out well. Given the importance of this treatment and the fact that my wife and I are DINKs, I am lucky enough that cost won't be a major concern when I pick a machine to buy. I assume I will buy it from cpap.com or something similar.

Your input will be appreciated, and all of your previously posted wisdom has really helped me go into this feeling confident and prepared. Thank you.

____________________
* This long-term loaner machine appears to be sort of a gray-market kind of thing. The tech said it was donated by a patient or something, and that I should bring it back whenever I buy my own. But there was no time limit set on it. I didn't ask any more questions about it.

I use an amara view ... and have facial hair ..(can't see it in my avaitar)
I use a strip of surgical tape on my upper lip and the helps with leaking in that area ... I also have to use a cervicle collar to hold my jaw up and mouth closed.
I also find that a boil and bite mouth guard helps to hold my jaw in a slightly forward position and helps to keep mouth closed.

http://www.ebay.com/itm/Anti-Snore-Mout ... SweW5VNMXS

Jason G wrote: But -- what is your, the community's advice, on fighting nasal congestion?

Many CPAPs have air filters that are fine enough to filter out many common airborne allergens, so some people find that they have less trouble with congestion at night breathing the filtered air in the cpap than during the day when exposed to their allergens.

Humidity plays an important role in nasal congestion problems. Some people's noses start to get congested if the heated humidifier is set too high. Other people's noses clog up when the humidity is too low. You can get an idea of whether you might need a lot or a little humidity based on what happens when you take a hot steamy shower: Does your congestion clear up or get worse?

Saline nasal sprays during the day and using a neti pot or a nasal rinse about an hour or so before bedtime can help.

Steroid nasal sprays like Flonase can help some people.

Finally, I do like the System One A-flex so far -- I can't argue with results -- but is there anything that works just as well that is smaller? It's just such a big thing to carry around when traveling. I guess that's only a minor concern. I am glad to have gotten a prescription for an APAP (signed by a doctor I have never met... ah, Kaiser).

You can compare the sizes of all the APAPs that CPAP.com sells on the web site. Of the most commonly seen machines here on the forum, the lightest one is the PR DreamStation (blower is 1.56 lbs, whole package, including the humidifier is 4.37 pounds; the S1 blower you currently has weighs 2.8 lb and the whole package, including the humidifier is 6.8 pounds) But the footprint of the PR Dreamstation bigger on the bedside table with horizontal dimensions of 11.7" x 7.6". The travel bag for the PR Dreamstation is much less boxy, and (as someone who has been toting around an PR S1 for 5 years) that less boxy shape should make it much, much easier to travel with.

The Resmed AirSense 10 AutoSet has a footprint (10.04" x 4.75") that's smaller than the DreamStation , but the AirSense is taller than the Dreamstation: 5.91" for the AirSense vs. 3.3" for the DreamStation. The AirSense weighs more as well: the blower is 2.8 pounds, and the whole package is 6.8 pounds.

The smallest APAP on the market is probably the Z1 Auto by Human Design Medical. It's quite small: the footprint is 6.48"x3.3"x2.02", the blower weighs 0.625lbs, and the whole package weighs 3.76 pounds. But the Z1 Auto does not have a humidifer. And it's not compatible with the SleepyHead software that is so commonly used around here. The Z1 apparently only records limited efficacy data and the app that is needed to read the data is available only for iPads, iPhones, and the newest Android devices.

I use Flonase, am allergic to dogs and cats and have both, although only the dogs sleep with me and I no longer let the cats in the bedroom. We suffer because they are worth it, right You can also put essential oils that specifically deal with respiratory symptoms on a cotton ball and place it by your filter, helps me to breathe it in.

I used to wake up with awful congestion but that has gone away since I started CPAP treatment three weeks ago. I credit the humidifier in my Resmed system. I fill it with distilled water every night. I use only the nose pillow system. I don't seem to have a problem with my mouth opening during the night but I have a chin strap just in case it develops. I depend on my wife to give me reports on that.