CPAP not helping

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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ChicagoGranny
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Re: CPAP not helping

Post by ChicagoGranny » Tue May 12, 2020 6:45 am

KarSans wrote:
Tue May 12, 2020 2:24 am
I use a memory foam pillow right now. It is high and not flat. Should I try using a flatter pillow?
If the pillow causes the chin to be pushed toward the chest, it is compromising your airway patency.
a medium firmness and height that positions the head slightly upward from the spine. The neutral spinal alignment for back sleepers maintains an S curve.

Additionally, as a general rule if your pillow is too low, you’re going to be straining muscles as they have to work maintain alignment. If your pillow is too high, you can be constricting your air flow, essentially a crimp in your airway.

Full article: https://sleepsherpa.com/proper-pillow-h ... st-pillow/
KarSans wrote:
Tue May 12, 2020 2:24 am
I can’t get hold of a soft collar right now as most of you suggested because of a complete martial law where I live.
-----------> https://www.walmart.com/ip/DMI-Orthoped ... e/36782313

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ChicagoGranny
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Re: CPAP not helping

Post by ChicagoGranny » Wed May 13, 2020 8:36 am

Just stumbled across this good graphic.
pillow height.JPG
pillow height.JPG (29.29 KiB) Viewed 12898 times

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Miss Emerita
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Re: CPAP not helping

Post by Miss Emerita » Wed May 13, 2020 8:55 am

Karsans, those more recent charts aren't pretty, but they are definitely better. How is the aerophagia with a minimum of 10? Do you feel you can inch your minimum up?
Oscar software is available at https://www.sleepfiles.com/OSCAR/

lrob123
Posts: 79
Joined: Sun Apr 02, 2017 11:14 am
Location: Indiana, USA

Re: CPAP not helping

Post by lrob123 » Thu May 14, 2020 5:24 pm

You might need to see a different ENT (Ear, Nose, and Throat) doctor since maybe the doctor you saw before missed something. It is important to see a specialist (not just a primary care doctor) and it is good to get a second opinion. You might have a deviated septum or something similar : https://www.mayoclinic.org/diseases-con ... c-20351710 and you might need surgery, although that might not be doable until after the pandemic.

In the meantime, while waiting to see a different ENT, I agree with the other advice. Try a flat pillow, a cervical collar, and Flonase nasal spray ( if your doctor agrees about the Flonase). I use no pillow at all, but due to a back condition, I sleep flat on my back all night. No pillow works for back sleeping, but might not work for side or stomach sleepers.

If you and your family have enough money to spare, maybe try buying a Bi-level (BiPap) machine because the exhale pressure is reduced. For me, it helped with my aerophagia. I suggest the ResMed AirCurve 10 VAuto. I have the Philips Respironics Dreamstation BiPap and I don't like it because the water chamber is too small, half the time it wakes me up with a burning smell when the water runs out.

I need a minimum pressure of 12.5 cm to help my apnea, I would do poorly if I used a minimum of 10.5, but everyone is very different.

Keep trying different pressures, and try straight CPAP versus APAP. If a straight pressure of 10 didn't work, maybe a constant pressure of 12 would.

I agree with everyone that it is important to try wearing a cervical collar. If I forget to wear my cervical collar, my AHI is about 15 or 18 (even though I'm using CPAP), whereas it my AHI between 0.5 to 2.2 if I wear it. I tried so many different styles of chin straps but they didn't help, my jaw was still able to drop I guess. The cervical collar really helps. I like this one: https://smile.amazon.com/Velpeau-Brace- ... B072Q93K6Y . But you have to experiment with different height collars, because some people need height 3", some 3.5", some 4". If you get the wrong height collar, it either won't work or it will be uncomfortable. So you might need to buy a few to see what works. You need a flat pillow for this to work. Your neck should be as straight as possible when sleeping. Don't let your head hang back either, I don't think you need to stretch your chest.

Also, if you are wearing a nasal mask, try a full face mask. During sleep, I become a mouth breather and that defeats CPAP, so I need to wear a full face mask. I love my Resmed Airfit F20 full face mask (even though I look dorky like a fighter pilot). I know all this costs $$$ but you are still having terrible apnea, and you need to spend whatever it costs to resolve that problem.

You say there is martial law preventing you from buying a cervical collar. Is it possible to mail order one? Do they have eBay or something like it in your country?

I really hope you are able to be looked at by a nose specialist to look for structural problem such as a deviated septum. You are relatively young to have apnea. Plenty of thin people have apnea though. I was skinny and underweight (female) when diagnosed and my sleep specialist took one look at me at our first meeting and said, "You don't have sleep apnea". But I had the sleep study done and had an AHI of 24 so he had to eat his words. But since your nose is always stuffed up, that is the problem that needs to be solved. If you need nasal surgery and have it done, you may not need a CPAP anymore. I've heard many people say they had some sort of throat surgery for apnea and it didn't help, so I'm skeptical of those types of operations. It is possible that allergies are blocking your sinuses and it is not easy to determine what is the thing you are allergic to. But first, check for a nasal structural problem, it might be that simple.

_________________
Machine: DreamStation BiPAP® Auto Machine
Mask: ResMed AirFit™ F20 Full Face CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: IPAP 15 EPAP 13.5

KarSans
Posts: 10
Joined: Mon Feb 19, 2018 9:04 am

Re: CPAP not helping

Post by KarSans » Sun May 17, 2020 6:26 am

Thank you all for your replies really appreciate it.
lrob123 wrote:
Thu May 14, 2020 5:24 pm
You might need to see a different ENT (Ear, Nose, and Throat) doctor since maybe the doctor you saw before missed something. It is important to see a specialist (not just a primary care doctor) and it is good to get a second opinion. You might have a deviated septum or something similar : https://www.mayoclinic.org/diseases-con ... c-20351710 and you might need surgery, although that might not be doable until after the pandemic.

In the meantime, while waiting to see a different ENT, I agree with the other advice. Try a flat pillow, a cervical collar, and Flonase nasal spray ( if your doctor agrees about the Flonase). I use no pillow at all, but due to a back condition, I sleep flat on my back all night. No pillow works for back sleeping, but might not work for side or stomach sleepers.

If you and your family have enough money to spare, maybe try buying a Bi-level (BiPap) machine because the exhale pressure is reduced. For me, it helped with my aerophagia. I suggest the ResMed AirCurve 10 VAuto. I have the Philips Respironics Dreamstation BiPap and I don't like it because the water chamber is too small, half the time it wakes me up with a burning smell when the water runs out.

I need a minimum pressure of 12.5 cm to help my apnea, I would do poorly if I used a minimum of 10.5, but everyone is very different.

Keep trying different pressures, and try straight CPAP versus APAP. If a straight pressure of 10 didn't work, maybe a constant pressure of 12 would.

I agree with everyone that it is important to try wearing a cervical collar. If I forget to wear my cervical collar, my AHI is about 15 or 18 (even though I'm using CPAP), whereas it my AHI between 0.5 to 2.2 if I wear it. I tried so many different styles of chin straps but they didn't help, my jaw was still able to drop I guess. The cervical collar really helps. I like this one: https://smile.amazon.com/Velpeau-Brace- ... B072Q93K6Y . But you have to experiment with different height collars, because some people need height 3", some 3.5", some 4". If you get the wrong height collar, it either won't work or it will be uncomfortable. So you might need to buy a few to see what works. You need a flat pillow for this to work. Your neck should be as straight as possible when sleeping. Don't let your head hang back either, I don't think you need to stretch your chest.

Also, if you are wearing a nasal mask, try a full face mask. During sleep, I become a mouth breather and that defeats CPAP, so I need to wear a full face mask. I love my Resmed Airfit F20 full face mask (even though I look dorky like a fighter pilot). I know all this costs $$$ but you are still having terrible apnea, and you need to spend whatever it costs to resolve that problem.

You say there is martial law preventing you from buying a cervical collar. Is it possible to mail order one? Do they have eBay or something like it in your country?

I really hope you are able to be looked at by a nose specialist to look for structural problem such as a deviated septum. You are relatively young to have apnea. Plenty of thin people have apnea though. I was skinny and underweight (female) when diagnosed and my sleep specialist took one look at me at our first meeting and said, "You don't have sleep apnea". But I had the sleep study done and had an AHI of 24 so he had to eat his words. But since your nose is always stuffed up, that is the problem that needs to be solved. If you need nasal surgery and have it done, you may not need a CPAP anymore. I've heard many people say they had some sort of throat surgery for apnea and it didn't help, so I'm skeptical of those types of operations. It is possible that allergies are blocking your sinuses and it is not easy to determine what is the thing you are allergic to. But first, check for a nasal structural problem, it might be that simple.
My sinuses have been really bad from January of this year I think, prior I had some on and off problems but not this long lasting. I also think the doctors have been neglecting the role my nasal blockage can play into the apnea but I have been to numerous ENTs and have done scans which showed some polyps but they said its nothing significant. If the upper airway is really the cause shouldn't a sleep endoscopy show that? My parents wont agree to another surgery anyway I think. I don't have aerophagia anymore. Ecom sites here are only delivering "essentials" by edict.
Miss Emerita wrote:
Wed May 13, 2020 8:55 am
Karsans, those more recent charts aren't pretty, but they are definitely better. How is the aerophagia with a minimum of 10? Do you feel you can inch your minimum up?
Yes, the aerophagia is alot better. I'll raise my min to 12 tonight and see.
ChicagoGranny wrote:
Tue May 12, 2020 6:45 am
KarSans wrote:
Tue May 12, 2020 2:24 am
I use a memory foam pillow right now. It is high and not flat. Should I try using a flatter pillow?
If the pillow causes the chin to be pushed toward the chest, it is compromising your airway patency.
a medium firmness and height that positions the head slightly upward from the spine. The neutral spinal alignment for back sleepers maintains an S curve.

Additionally, as a general rule if your pillow is too low, you’re going to be straining muscles as they have to work maintain alignment. If your pillow is too high, you can be constricting your air flow, essentially a crimp in your airway.

Full article: https://sleepsherpa.com/proper-pillow-h ... st-pillow/
KarSans wrote:
Tue May 12, 2020 2:24 am
I can’t get hold of a soft collar right now as most of you suggested because of a complete martial law where I live.
-----------> https://www.walmart.com/ip/DMI-Orthoped ... e/36782313
I switched to a more flatter pillow but don't see any difference. Thank You!

In most of my charts I am seeing a repeating patter which is for most of the night like 2-6/7 AM, there are very few events as compared to the morning when I am in a light sleep or less deep sleep?
And my isn't very bad in the day or when I goto sleep but when I wake up its always blocked. I haven't changed the filter in the machine since I bought it but have washed it twice or thrice and I didn't used to change or wash it in my previous machine either which I had for 1 1/2 year( it got water damaged)but I didn't have allergies then .Could this be causing the sinus problem?
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Miss Emerita
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Re: CPAP not helping

Post by Miss Emerita » Sun May 17, 2020 10:42 am

KarSans, It's great that the aerophagia is not bothering you. Yes, try inching up your minimum. Three other thoughts:

* See how your nose does if you add some humidity; experiment with both lower and higher levels. Even if you tried it in the past and had reasons to turn it off, it's worth seeing whether it'd help now. Your needs may have changed.

* Try rolling up a towel as an improvised cervical collar. Your ingenuity may suggest ways of fastening it, adjusting it, etc.

* It looks like you have the ramp function on. Try turning it off so you get the benefits of the higher pressure right from the start.

Keep us posted!
Oscar software is available at https://www.sleepfiles.com/OSCAR/

lrob123
Posts: 79
Joined: Sun Apr 02, 2017 11:14 am
Location: Indiana, USA

Re: CPAP not helping

Post by lrob123 » Tue May 19, 2020 1:34 pm

Hi KarSans, I strongly agree with Miss Emerita's suggestions of improvising a cervical collar, turning off ramp, and adding humidity.

Regarding aerophagia, it does get better but it still will come and go. Some nights aerophagia still bothers me and my stomach is painful, but most nights it is only that I have to pass a lot of gas towards the morning, but no pain. Don't assume that you cannot get used to a higher pressure, I think your body will adjust and you will have less frequent or non-painful aerophagia (the extra gas won't go away completely, it is livable though).

It sounds like you do need to pay much more attention to your filters. The blue one is supposed to be replaced every 6 months but rinsed almost daily, and the thinner ones are supposed to be replaced every month. My DME is supposed to send filters to me with 'autoship' but it never happens for some reason, so I have given up and just buy them myself on Amazon or eBay. They are not expensive. Hopefully during your martial law, you can still do mail order?

I don't actually rinse the bigger blue filter every day like we are supposed to, often it is more like every 7-10 days, but I always rinse it if my numbers creep up. You are only supposed to rinse it but not wash it with soap. For the thinner filter, you are not supposed to rinse it with water or wash it, only replace it every month.

I don't know if not changing filters could be contributing to your sinus problems.

But from your charts, I agree, it appears your worst breathing problems are when you are awake at the very beginning and end, and during any period where it looks like you are have smaller awakenings in the middle of the night. Maybe your blocked sinuses are causing these awakenings. The good news is that your events are a lot fewer during the periods that you are in a deep sleep. You are having difficulty breathing when trying to go to sleep at the beginning of the night, maybe you are sniffling a lot?

Can you try bumping up the minimum pressure to 11 for a while and then to 12? And give your body a chance to adapt to this, the aerophagia may increase at first but then get better.

For myself, I need at least 12.5 mininum pressure, and I'm getting more events so am thinking of increasing my minimum to 13 or 13.5.

_________________
Machine: DreamStation BiPAP® Auto Machine
Mask: ResMed AirFit™ F20 Full Face CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: IPAP 15 EPAP 13.5

chris_lucy@live.com
Posts: 17
Joined: Sun Apr 19, 2020 10:21 pm

Re: CPAP not helping

Post by chris_lucy@live.com » Thu Jun 11, 2020 5:36 am

Hey mate, sorry to hear about your symptoms. Did you have any teeth extracted around this time?

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Julie
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Re: CPAP not helping

Post by Julie » Thu Jun 11, 2020 7:17 am

Chris - this is your third post today in someone else's thread bringing up irrelevant stuff and asking for info from newbies. Not a good idea!