Root cause of my OSA?

For what little it might be worth....I have personally seen maybe a half a dozen people who say that their Flow limitations reduced when adding in EPR and a lower pressure. 2 or 3 here and 2 or 3 over on Jason's forum. I don't participate in the apneaboard forum.....there's simply not enough hours in the day.

But even if I had seen a dozen or 2 dozen....MOST people will have the opposite reaction happen...myself included. Thousands of people vs maybe a dozen that I have seen....all it proves is that with some people it can happen that way and reinforces something I have said a gazillion times.....YMMV....everything with cpap comes with that sticker.

By all means try it if a person wants to try it. It is not a common response but it isn't an impossible response to have when EPR is added in and the pressure is reduced and fixed.

SleepyPaolo wrote: ↑

Wed Mar 04, 2020 8:09 pm

This might offend pugsy and I'm sorry if it does, but I just wanted to show personal experience which might help you.

My issue was also flow limits (not as bad as yours) and hypopneas.

I'm not going to make any claims that might offend anyone's knowledge, I'm just going to let the graphs do the talking. Both setups produce similar results for me for weeks at a time.
I have also seen many people with similar results over on apneaboard forum.
You can guess which is the better night's sleep.


No EPR.jpg
With EPR and fixed pressure.jpg

So, what you're saying is that for YOU, having EPR turned on helps quite a bit.

palerider wrote: ↑

Wed Mar 04, 2020 9:13 pm

So, what you're saying is that for YOU, having EPR turned on helps quite a bit.

I guess if it works for one person or half a dozen then that negates what hundreds and thousands of others have happen.
Sure as hell doesn't work for me...lower pressures equal higher FLs for me
I can't help but wonder how much nasal congestion we might be seeing going on as well....there's that variable as well.

Oh well...
Shrugs and moves on...not worth any more of my time. Weird and uncommon stuff happens all the time. Tell me something I didn't know.

You mention you are using a nasal spray but not what kind. Is it one with a steroid? Or is it a decongestant? Decongestants are temporary and cause rebound inflammation and a lot of long term problems. If you are using a steroid, make sure you are consistent in its use and if you think the brand you're using isn't working well, try another one. My allergist told me that the earliest ones to come out are actually the best--the subsequent releases were slight variations on the original molecules and were simple money grabs. Flonase and Rhinocort were probably among the earliest if I remember correctly.

45 degrees is probably way too high of an incline for most people and I'm not surprised you had a back ache. I think, if memory serves (and it may not) that elevating the head 6 to 8 inches is the standard which I think works out to something like 20 degrees. Here's the wedge I use--I'm a repeat buyer. According to my research it's one of the absolute best on the market and worth every penny in my opinion: https://www.amazon.com/gp/product/B00E3 ... UTF8&psc=1

If nasal congestion is indeed the problem, and it sounds like it is, you may also need to turn up your humidifier.

Hope that helps a bit.

chunkyfrog wrote: ↑

Wed Mar 04, 2020 8:44 pm

loopib wrote: ↑

Fri Feb 21, 2020 3:21 pm

. . . I had a tonsillectomy, turbinectomy, and a UPPP. . . .

With all those surgeries, I am confused.
You mention a deviated septum.
Why was that not fixed?
Deviated septum is quite often a significant obstruction.
I have bad thoughts about your surgeon's motives.

Pulling this up so it will not get lost.
It reminds me of the shady mechanic who "fixes" everything he can get away with
before replacing the part he removed in the first place.

I have a big update, but first to respond to some of the posts above:

1. @chunkyfrog: The advice I was given by my surgeon at Stanford was that septoplasty would help with nasal patency, but wouldn't necessarily resolve sleep apnea. The septoplasty was deferred to preserve the nasal cartilage for a combined septo/rhino. The advice I got from the surgeons who specialize in the combined surgery is that the 'open' septo is more appropriate for my type of septal deflection. I still haven't done this yet.

2. @socknitster: Nasal spray is generic Flonase (fluticasone propionate). Used to take this regularly in childhood for post-nasal drip. Have been taking it again last couple of years. Have been advised by allergy specialist and ENT that there's no real issue with long term use. Thanks for the pillow suggestion! Decreasing the incline definitely helped with muscle soreness!

3. As for EPR debate, I set the EPR to 2 and it decreased my AHI slightly from approx 5 to 3, though I wouldn't draw too much of a conclusion from this: As I noted above though, reducing to the lowest fixed pressure of 4 actually reduced my AHI overall... which makes me think something else is going on. I'm still convinced my sleep apnea's root cause is nasal congestion which cascades into mouth breathing/tongue collapse, not treated by CPAP, in fact might be making it worse.


So for the update: I randomly started taking 6000IU vitamin D supplements last week and my nasal congestion has almost entirely resolved itself. I immediately noticed an impact on my mood and could feel my nasal breathing improving almost right away. I searched papers for links between vitamin D and nasal congestion/rhinitis/post-nasal drip, and there seems to be research indicating a link.

I've had amazing sleep last few nights without CPAP and without mouth tape. I have no evidence of mouth breathing (no dry mouth, tongue deposits, drooling) as I have for as long as I can remember. I'm well aware this is entirely anecdotal at this point and potentially placebo effect in part, but the subjective results have been amazing: no brain fog, no fatigue, no appetite issues. I'm going to follow up with blood testing, sleep test for some more data, and will report back.

Hopefully this helps those in similar situations as me!