Dealing with nasal congestion while using a CPAP machine?

DaRef · Post by **DaRef** » Wed Jan 02, 2019 11:54 am

I often take a Benadryl at bedtime to keep the nasal congestion down overnight. If you have access to a Costco membership a bottle of 600 tablets is less than $5.00 - and no, that's not a typo!

But please double check that it won't adversely interact with any other meds you may be taking.

Muse-Inc · Post by **Muse-Inc** » Thu Jan 03, 2019 12:50 pm

Might try a hybrid-style FFM like mine (click on it to view on our host's website) with pillows and covers mouth -- nothing on nose. I have year-round nasal allergies and often get completely congested, a hybrid FFM allows breathing thru nose or mouth or combo.

MNsleeplessnights2 · Post by **MNsleeplessnights2** » Mon Aug 26, 2019 3:34 pm

Hi, I recently downloaded OSCAR to track my progress with my ResMed Airsense 10 Autoset. I have used it for about half a year (unfortunately on and off...haven't been the best with consistency) and I unfortunately haven't really felt my sleep has improved. I don't really understand how to interpret the OSCAR data and was hoping I could have my results interpreted and I will hopefully be able to understand how to interpret on my own from there.

I will appreciate any feedback and suggestions on what to try to improve my CPAP therapy! Thank you.

MNsleeplessnights2 · Post by **MNsleeplessnights2** » Mon Aug 26, 2019 3:35 pm

Last part with "Time at Pressure" at the bottom.

Pugsy · Post by **Pugsy** » Mon Aug 26, 2019 5:02 pm

You have made more work for yourself with so many images trying to show all the graphs when all the graphs aren't really useful.
Review this thread for formatting tips. You can get all we need to see in one screenshot.
No need to redo any of these but I mention it to save you (and us) a bit of work if you post something else again.
viewtopic/t158560/How-to-post-images-for-review.html

I see that you are limiting the max to 10 and it is hitting the 10 briefly....any special reason for limiting the max?
It wants to go higher and can't.

MNsleeplessnights2 · Post by **MNsleeplessnights2** » Mon Aug 26, 2019 5:36 pm

Pugsy wrote: ↑
Mon Aug 26, 2019 5:02 pm
You have made more work for yourself with so many images trying to show all the graphs when all the graphs aren't really useful.
Review this thread for formatting tips. You can get all we need to see in one screenshot.
No need to redo any of these but I mention it to save you (and us) a bit of work if you post something else again.
viewtopic/t158560/How-to-post-images-for-review.html

I see that you are limiting the max to 10 and it is hitting the 10 briefly....any special reason for limiting the max?
It wants to go higher and can't.

Thanks for the reply. Sorry about that! I wasn't aware of which charts were most helpful. I will for sure cut down and only include the relevant graphs next time.

I don't really have a great reason for limiting my max to 10 except that 5.0-10.0 was the range that my sleep physician prescribed and set for me. I also always found myself waking up at around 8.0-9.6 range so I always thought that perhaps that was as high as it went and was adequate because my AHI was still low. I am open to increasing my max and adjusting my range if that would help. I am really open to changing/adjusting anything to improve my results!

Pugsy · Post by **Pugsy** » Mon Aug 26, 2019 5:56 pm

How many hours of real sleep do you think you are averaging?
Are those hours fragmented with very many wake ups? If so approx how many?
Do you take any medications of any kind? If so, what?
Do you have any other health issues that might affect how you feel during the day or might effect sleep quality?
Exactly what kind of symptoms are you still having that you wished you didn't?

And exactly what do you mean by

haven't really felt my sleep has improved

....what do you feel still needs improvement and why do you feel that way?

I just want to get on the same page as you are on because people sometimes say something and mean something else and it might mean something entirely different to me anyway.
I flunked mind reading in college.

MNsleeplessnights2 · Post by **MNsleeplessnights2** » Mon Aug 26, 2019 7:37 pm

Pugsy wrote: ↑
Mon Aug 26, 2019 5:56 pm
How many hours of real sleep do you think you are averaging?
Are those hours fragmented with very many wake ups? If so approx how many?
Do you take any medications of any kind? If so, what?
Do you have any other health issues that might affect how you feel during the day or might effect sleep quality?
Exactly what kind of symptoms are you still having that you wished you didn't?

And exactly what do you mean by
haven't really felt my sleep has improved
....what do you feel still needs improvement and why do you feel that way?

I just want to get on the same page as you are on because people sometimes say something and mean something else and it might mean something entirely different to me anyway.
I flunked mind reading in college.

All fair questions!

I think I'm averaging around 5-6 hours of sleep a night. I don't feel any of it is deep or refreshing sleep

I always wake up to use the bathroom at least once or twice a night after about 3-4 hours of sleep, sometimes less time in between.

Only medication is Levothyroxine @ 25 mg for VERY mild hypothyroidism. Endocrinologist said at my TSH levels, symptoms should be just about non-existent.

Health issues are: Asthma, insomnia (trouble remaining asleep, no issues falling asleep), high blood pressure, very mild hypothyroidism, anxiety and depression

I have trouble waking up and when I wake up I am still very drowsy and foggy-headed for the next couple of hours at least. From there, the rest of my day I am very tired and lethargic. A lot of times an eye will twitch. Sometimes both will twitch if I'm lucky and now some other muscles also twitch occasionally, specifically my triceps and my shoulders a little bit.

On what I would like improved: I would like to feel mentally present after sleeping. Right now, after waking, I feel like I'm more exhausted and fatigued than I was prior to sleeping. I also find it very difficult to get up in the morning because I am just so drowsy. Once I get up, I am still just a walking zombie for several hours until I can kinda function, but I still find myself yawning and feeling miserably foggy-headed the whole day. I know that a large part of my sleep issues is related to the difficulty remaining asleep, but my sleep physician was insistent that there are apnea concerns, too.

I don't have trouble falling asleep with the mask and the pressures are fine at the moment. I am at a bit of a dead end on what I should do with regards to my CPAP therapy.

Pugsy · Post by **Pugsy** » Mon Aug 26, 2019 8:36 pm

Okay...some more questions.

Are you male and of an age that the bathroom breaks in the middle of the night might be related to the prostate?

Do you have any pain issues that might be a factor in sleep quality and/or how you feel? Chronic pain is a real killer in terms of sleep...this one I have personal experience with. Doesn't have to be severe pain either...just little vague aches and pains can do it.

You have trouble staying sleep during the night????? How many time do you think you are waking up besides the bathroom break?
How long does it take you to go back to sleep?

5 or 6 hours of even solid sleep is probably not enough...for sure not enough if it's fragmented with multiple wake ups because the wake ups mess with the sleep cycles or sleep architecture. You don't get the need amounts of each sleep stage in the nice normal progression that the body needs for the restorative powers of sleep to work their magic.
Read this but just disregard the alcohol part of the discussion...substitute anything that disturbs sleep for the alcohol part.
It is a good explanation of why we need the normal cycles and quantity of sleep in the normal amounts.
https://www.sleepfoundation.org/article ... tity-sleep

I know we would all like to do some magic tweaks of the settings on the cpap machine and fix all our sleep problems and sometimes we can and sometimes we can't.
Doesn't stop us from at least trying though....The only thing that I see on your report that really stands out as a potential culprit is the pressure variations. Not so much that the pressure changes are disturbing the sleep but that the whatever the machine is responding to by increasing the pressure might be disturbing your sleep. Airway disturbances that maybe don't show up in the AHI or other data the machine gathers. It's not ranging around an awful lot but it is moving around within its range quite a bit.
If it were my report and I wanted to try tweaking things to see if it helped with my sleep or how I felt....I would increase the minimum and see if it stabilizes the pressure and prevents whatever is causing the machine to roam around.
I can't guarantee that it will help but it is something to try that might help and won't hurt...and thus worthwhile to try.
I would start with increasing the minimum to 7 cm if at all possible...if not start lower and work up to 7 cm. See what happens...give it at least a week unless something bad happens (like air in the belly).

Also in the meantime take a hard look at your sleep hygiene...good and bad and be honest with yourself. Most people need more than 5 or 6 hours to feel their best. You need to get more sleep.

Finally...I want you to watch all the videos here because I want you to learn how to spot arousal breathing in your flow rate graphs even if you aren't having flagged events.
http://freecpapadvice.com/sleepyhead-free-software
It's quite an education and not fast and I will help you try to learn to spot the differences.
The reason I want you to be able to spot arousal breathing is because just having arousals messes with sleep and we don't always remember the arousal...but the damage to the sleep quality is still done.
My AHI is always really low....and the few flags I might get are 90% arousal related BUT I always have a lot more evidence of arousals happening without events. Sometimes 20 to 25 arousals and that's part of the reason I don't feel so great but in my case I know what is causing the arousals. You may not know the culprit's name but it still messes with sleep if you have a lot of arousals.
Now some wake ups are normal....like it's normal to wake after a REM cycle...but if your sleep quality is really crappy you may not even get much REM.

I can't promise to fix your problem...but we can still try some stuff and learn some stuff to see if we can stumble onto anything that might help or at least might explain why things aren't so great. Sometimes it does help just to know a reason behind something.
Like I discovered that my blood pressure medication which I always thought was rather benign without much in side effects...fatigue and trouble sleeping is a known side effect. I don't know how much of a factor it is in my fatigue or sleep issues but it is a potential factor and thus knowing it helps me accept things a bit...at least until I can either get off the meds or change the meds.

Thyroid meds are not well known to mess with sleep but it wouldn't be totally impossible for them to be a factor in sleep quality.
https://hypothyroidmom.com/18-things-th ... -insomnia/

https://www.verywellhealth.com/thyroid- ... rs-3014705

Did you know that your thyroid medication has a long list of potential side effects and one of them is fatigue?

https://www.mayoclinic.org/drugs-supple ... g-20072133

Damned if you do and damned if you don't kind of thing....I have first hand experience with that myself. My pain medication which comes with a may cause drowsiness sticker also has a little known and uncommon side effect of causing insomnia in some people.
I drew that short straw. If I take it at bedtime I sleep maybe 2 hours and then I am wide awake cleaning house at 2 AM....if I don't take it I am wide awake because of the pain but not cleaning house.

For that reason I have had to add something else for the pain at bedtime to help me sleep through pain better.

Is your thyroid med solely to blame for your issues...probably not solely but it might be a factor.

MNsleeplessnights2 · Post by **MNsleeplessnights2** » Mon Aug 26, 2019 10:16 pm

Pugsy wrote: ↑
Mon Aug 26, 2019 8:36 pm
Okay...some more questions.

Are you male and of an age that the bathroom breaks in the middle of the night might be related to the prostate?

Do you have any pain issues that might be a factor in sleep quality and/or how you feel? Chronic pain is a real killer in terms of sleep...this one I have personal experience with. Doesn't have to be severe pain either...just little vague aches and pains can do it.

You have trouble staying sleep during the night????? How many time do you think you are waking up besides the bathroom break?
How long does it take you to go back to sleep?

5 or 6 hours of even solid sleep is probably not enough...for sure not enough if it's fragmented with multiple wake ups because the wake ups mess with the sleep cycles or sleep architecture. You don't get the need amounts of each sleep stage in the nice normal progression that the body needs for the restorative powers of sleep to work their magic.
Read this but just disregard the alcohol part of the discussion...substitute anything that disturbs sleep for the alcohol part.
It is a good explanation of why we need the normal cycles and quantity of sleep in the normal amounts.
https://www.sleepfoundation.org/article ... tity-sleep

I know we would all like to do some magic tweaks of the settings on the cpap machine and fix all our sleep problems and sometimes we can and sometimes we can't.
Doesn't stop us from at least trying though....The only thing that I see on your report that really stands out as a potential culprit is the pressure variations. Not so much that the pressure changes are disturbing the sleep but that the whatever the machine is responding to by increasing the pressure might be disturbing your sleep. Airway disturbances that maybe don't show up in the AHI or other data the machine gathers. It's not ranging around an awful lot but it is moving around within its range quite a bit.
If it were my report and I wanted to try tweaking things to see if it helped with my sleep or how I felt....I would increase the minimum and see if it stabilizes the pressure and prevents whatever is causing the machine to roam around.
I can't guarantee that it will help but it is something to try that might help and won't hurt...and thus worthwhile to try.
I would start with increasing the minimum to 7 cm if at all possible...if not start lower and work up to 7 cm. See what happens...give it at least a week unless something bad happens (like air in the belly).

Also in the meantime take a hard look at your sleep hygiene...good and bad and be honest with yourself. Most people need more than 5 or 6 hours to feel their best. You need to get more sleep.

Finally...I want you to watch all the videos here because I want you to learn how to spot arousal breathing in your flow rate graphs even if you aren't having flagged events.
http://freecpapadvice.com/sleepyhead-free-software
It's quite an education and not fast and I will help you try to learn to spot the differences.
The reason I want you to be able to spot arousal breathing is because just having arousals messes with sleep and we don't always remember the arousal...but the damage to the sleep quality is still done.
My AHI is always really low....and the few flags I might get are 90% arousal related BUT I always have a lot more evidence of arousals happening without events. Sometimes 20 to 25 arousals and that's part of the reason I don't feel so great but in my case I know what is causing the arousals. You may not know the culprit's name but it still messes with sleep if you have a lot of arousals.
Now some wake ups are normal....like it's normal to wake after a REM cycle...but if your sleep quality is really crappy you may not even get much REM.

I can't promise to fix your problem...but we can still try some stuff and learn some stuff to see if we can stumble onto anything that might help or at least might explain why things aren't so great. Sometimes it does help just to know a reason behind something.
Like I discovered that my blood pressure medication which I always thought was rather benign without much in side effects...fatigue and trouble sleeping is a known side effect. I don't know how much of a factor it is in my fatigue or sleep issues but it is a potential factor and thus knowing it helps me accept things a bit...at least until I can either get off the meds or change the meds.

Thyroid meds are not well known to mess with sleep but it wouldn't be totally impossible for them to be a factor in sleep quality.
https://hypothyroidmom.com/18-things-th ... -insomnia/

https://www.verywellhealth.com/thyroid- ... rs-3014705

Did you know that your thyroid medication has a long list of potential side effects and one of them is fatigue?

https://www.mayoclinic.org/drugs-supple ... g-20072133

Damned if you do and damned if you don't kind of thing....I have first hand experience with that myself. My pain medication which comes with a may cause drowsiness sticker also has a little known and uncommon side effect of causing insomnia in some people.
I drew that short straw. If I take it at bedtime I sleep maybe 2 hours and then I am wide awake cleaning house at 2 AM....if I don't take it I am wide awake because of the pain but not cleaning house.
For that reason I have had to add something else for the pain at bedtime to help me sleep through pain better.

Is your thyroid med solely to blame for your issues...probably not solely but it might be a factor.

Firstly, thanks for taking your time to be thorough in your feedback and input.

I am a male in my mid to late 20s and I have ruled out prostate issues/any serious urological issues via several urologist appointments. I have an issue with pelvic floor tightness, but even on days that I'm not dealing with frequent urination issues, I still find myself waking up every 2-3. Sometimes I can be lucky and make it to 4-5 consecutive hours without getting up to use the bathroom, but 5 hours is usually the maximum amount of time. I can usually get back to sleep quickly after I get up to use the bathroom. I really don't usually have issues with difficulty falling asleep funny enough. I just have issues of jerking awake after a couple hours of sleep. I have also had people tell me that I am a very restless sleeper. I twitch and I roll and I jerk around a lot when I sleep.

I am just frustrated because the urination issues are annoying, but my physicians have said that it's fairly normal for people to get up once or even twice nightly to use the bathroom. What my issue is is that I just feel like I never achieve deep sleep. The type of sleep that I think is necessary to repair myself physically and mentally...I can't recall a night in the past 5-6 years where I feel I actually got that type of sleep. With that, I think that you are right in that maybe my issues aren't necessarily due to obstructions but there are definitely some arousals that hamper my ability to sleep.

As for my thyroid issues as being possibly influencing my sleep troubles, I think that's possible but I really doubt it. I had tried a period of a month without taking my thyroid medication to see if I felt any different and things largely remained the same. I am more or less taking my thyroid medication just in the off chance it improves things somehow

Finally, on the issue of sleep hygiene...I really think this is probably an issue for me. I improved all the things that are usually suggested like no blue light within 2 hours of sleep, sleep in a cold bedroom, keep the bedroom for only sex and sleep, keep the bedroom completely dark and expose myself to natural light as soon as I wake, etc. Nothing helped, but my work situation is kinda erratic and that makes keeping a sleep routine a bit difficult. I work the graveyard shift USUALLY, but my hours shift a lot and I think that probably hurts my sleep. I also have anxiety and depression issues that are a bit of a "chicken or the egg" issue with regards to my sleep issues.

To be frank, the goal of posting my OSCAR data and to get help interpreting my data was to either (preferably) get an answer on what I can physically change to improve my CPAP therapy, OR to reaffirm my belief that my issues probably aren't hugely related to apnea issues but instead are probably due to psychological issues like stress and lack of routine. The general gist I'm getting is that my OSCAR results aren't really screaming any glaring apnea issues and that makes me believe that I have to fix something else. I suspect it to be stress-related.

Pugsy · Post by **Pugsy** » Mon Aug 26, 2019 11:03 pm

You know it is very possible that some of your issues are related to stressors in life...it is very possible that it could be a combination of little things that add up to something where just one single little thing might not be such a big deal.
The mind is a powerful tool but sometimes it doesn't do us any favors with what it does to us.
If you go looking at causes for fatigue....anxiety or depression are on the list.
Same thing for mental clarity issues. It's a potential mental health issue...and just as real as any physical health issue.

Did you have an in home sleep study for your OSA diagnosis or an in lab study?

Your mention of being a restless sleeper makes me wonder a bit about PLMD
https://my.clevelandclinic.org/health/d ... -in-adults
it can definitely be a factor in frequent arousals and impact sleep quality.
An in lab sleep study would have had limb leads attached and PLMD would be a potential something that could be spotted in the in lab study. It's not normally part of a home study though.

The bathroom breaks...that is from something unrelated to sleep apnea and other than disturbing sleep briefly...not much of a factor.
Something else going on there and sleep apnea or the prostate aren't the only things in life that can cause nocturia.
Though I disagree with a doctor who says its normal for a 20 something person (male or female) to get up to pee a couple times a night.

But a lot of time people wake up...not necessarily because of a full bladder and just decide they might as well go pee since they are awake. That becomes more of a habit thing and not necessarily a need thing.

From all you have said and what is seen on the software reports...
The arousal thing might be something to look into and it is worth at least trying more minimum pressure on the off chance that it might help....it won't hurt to try it.
I don't see anything else that stands out except you aren't getting enough hours of sleep on a consistent basis.
You would very likely feel like crap even without OSA with such little sleep.
Your work schedule isn't helping but that's not so easy to fix...we understand that.
Your own admitted potential mental health issues could be a factor...and those are a bitch to deal with. That brain/mind tool is a tough tool to get it to working right sometimes. Been there and done that myself. We know we shouldn't worry or stress over something but it's really hard to turn off that switch despite knowing it.

Finally there are things called spontaneous arousals. They are caused by something unknown but they are not related to airway issues...an in lab sleep study will usually note arousals and whether they are breathing related or spontaneous.
If you had an in lab sleep study and don't have a copy of the report...get it.
If you had a home study...get a copy of it if you don't have it. They aren't usually as comprehensive as a lab study but there might be something in either report that might gives us some clues.

Lots of stuff to think about....lots of detective work for sure.

I do believe it is at least worth trying the increase in minimum pressure that I mentioned above.
Sometimes when we have a problem that is likely caused by a combination of things....sometimes when we do a combination of things to try to make things better it will work out when maybe no one single thing alone would work.
Work on your hours of sleep for sure...as best you can. If you are having very many arousals...double whammy in terms of what they do to a person when you aren't getting enough hours of sleep in the first place.

5 hours of sleep simply isn't enough even if it is the most perfectly sound 5 hours hours of sleep...6 isn't much better.

Dealing with nasal congestion while using a CPAP machine?

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