AirCurve 10 VAuto for UARS - Congestion Issue

Night One Summary:

I just tried the AirCurve 10 VAuto for the first time last night. While I was using it, lying down but still awake, my nose was open and I noticed a significant improvement physically. This is hard to describe but I'm guessing it was the result of being able to breathe better. My head was much clearer and the edema I ordinarily experience was considerably abated. Pretty amazing feeling. I managed to sleep for about 7.5 hours and didn't wake up at any point during the night.

That's the good news.

The bad news is the machine didn't in fact improve sleep quality. I woke up with horrendous nasal congestion (and I'm assuming this is the reason I didn't benefit from it). My nasal bridge was also really sore and red from contact with the mask. I'm guessing this is because I had to really tighten the straps to get a good seal at the high pressure setting.

Settings:

- Max IPAP: 25
- Min EPAP: 11
- PS: 5.6
- Humidity: 7
- Trigger: High
- Cycle: Medium
- TiMax: 2.5
- Ramp: Off
- Default for everything else

Notes/Questions:

- The machine reported ~19 IPAP and ~11 EPAP for the sleep session.

- I don't think having the mask press against the nasal bridge is helping. I experience increased congestion even while wearing glasses, and the full face mask is certainly posing the same problem. Does this mean I should be trying a nasal mask? Are there any decent full face masks that don't apply significant pressure to the nasal bridge? I think I may need the latter because I do in fact breathe through my mouth when my nose is blocked.

- I'm going to try a lower humidity setting tonight. Should I just try dialing humidity all the way down to a 3?

- I just ordered the Climate Line Air tubing and will probably get to try that tomorrow night.

- I ordinarily use fluticasone but didn't do so last night. Going to resume tonight. Will also use BreatheRight strips.

- I know that sleeping with my head on its side and with no pillow elevation does cause noticeable nasal congestion in my case. In fact, the only reliable way I've gotten complete remission (about 3 times in the past year) is by sleeping upright on my back. I'm going to try elevating by stacking up pillows and see if that helps.

- Going to also try TiMax: 3.0 and Trigger: Very High tonight. Good idea/bad idea?

- Any other tips to deal with congestion?

I really feel like using the bilevel could fix my sleep problem, but I just need to clear this nasal congestion hurdle. Any insight here would be much appreciated. Thanks!

Use a mask that doesn't put pressure on the sides of your nose where the turbinates rest.
If you need a full face mask there are full face masks that don't put pressure up on the sides of the nose where eyeglasses rest.
I thoroughly understand this problem. Even my sunglasses cause nasal congestion for me. This is the reason I avoid any and all masks that touch the sides of my nose where the eyeglasses rest.

Please...try to avoid the yellow color. I simply can't see it. Small thing I know but I can't read what you write. I think I get the gist of it.
Maybe use a darker color or bold it or italics or something.

Use a mask that doesn't put pressure on the sides of your nose where the turbinates rest.
If you need a full face mask there are full face masks that don't put pressure up on the sides of the nose where eyeglasses rest.
I thoroughly understand this problem. Even my sunglasses cause nasal congestion for me. This is the reason I avoid any and all masks that touch the sides of my nose where the eyeglasses rest.

Do you have any particular recommendations? Sounds like you may have tried a bunch of options. Is the Bleem Dreamport working well for you?

Please...try to avoid the yellow color. I simply can't see it. Small thing I know but I can't read what you write. I think I get the gist of it.
Maybe use a darker color or bold it or italics or something.

Switched to bold italic. I use a dark mode extension and didn't realize there was a contrast issue. Sorry about that.

Well, obviously since I have been using the Bleep for well over a year and a half it has worked well for me but then I don't need or want to use a full face mask because I don't have any real nasal congestion issues or a need to mouth breathe.

Now if I did have a need to mouth breathe then I would use one of the full face masks like the
Respironics DreamWear Full face mask (which I have actually tried and actually could sleep with)
or the ResMed AirFit F30 or F30i (which I haven't had a chance to try).
They all have under the nose interfaces as well as the oral interface and don't squish the sides of the nose.
I don't always get a chance to try these new masks...they are pricey and unless I am extremely interested...I don't fork over the cash....and since using the Bleep and the fact that in over 11 years on cpap I haven't yet been in a situation where I just HAD to use a FFM because of nasal problems...I just haven't been real keen on spending the money on a FFM. The DreamWear FFM I got to try...I was part of a demo trial group. It was a freebie.

But there are masks out there that don't cover the nose but do cover the mouth if you just have to use a full face mask.
The Innomed Hybrid is another...it covers the mouth and uses nasal pillows.

I'm curious: have you been diagnosed with sleep apnea? And how were your settings determined?

Do you know what causes your congestion? If it's allergies, have you seen an allergist? I got some pretty good symptomatic relief with prescription-strength Flonase, plus Azelastine spray, plus a Singular pill at bedtime. I also use NeilMed nasal rinse from time to time, at the recommendation of my allergist.

Miss Emerita wrote: ↑

Wed Jul 29, 2020 8:29 pm

I'm curious: have you been diagnosed with sleep apnea? And how were your settings determined?

Do you know what causes your congestion? If it's allergies, have you seen an allergist? I got some pretty good symptomatic relief with prescription-strength Flonase, plus Azelastine spray, plus a Singular pill at bedtime. I also use NeilMed nasal rinse from time to time, at the recommendation of my allergist.

Not diagnosed yet. Definitely not OSA (AHI and ox sat don't come nearly close enough to qualify) but likely UARS.

I just completed a WatchPAT with a pRDI of 15 and over 100 detected arousal events over the course of a night.

I also have predisposing maxillofacial complications: long triangular face, extremely narrow high-arched upper palate, and mild to moderate maxillary and mandibular retrognathia. An oral surgeon said the maxilla can come forward by at least 5mm. I've experienced some relief and noticeable improvement in breathing with a MAD, implying that the mandibular retrognathia is certainly causing a problem as well.

Lastly, I've isolated my issue to sleep disturbance by observing that certain head postures can dramatically improve sleep quality and alleviate symptoms. Specifically, the best head posture is inclined and facing more "outwards", instead of on its side. Relatedly, I've found the best sleep posture for me personally is being seated upright, but this is hard to achieve and not sustainable.

So there's a lot of evidence in favor of UARS so far and I do know that my problems stem more or less entirely from disturbed sleep. In fact, all of my symptoms can disappear with just one night of quality sleep. Sadly, the medical community has chosen to abandon patients with non-hypoxic sleep apnea, so it's been very difficult to get this far and nearly impossible to have any kind of certainty. But I'm seeing two doctors familiar with UARS and presumably qualified to offer that diagnosis next week; fingers crossed.

To address your other questions: My nasal congestion is principally caused by head posture. My nose completely blocks up when I rest my head on its side. I've also tried every single spray, medication, and therapy you listed. None of them have helped in any noticeable way.

It's very good to hear you're working with doctors who are knowledgeable about UARS.

I bet you'd benefit from starting to use the OSCAR software:

https://www.sleepfiles.com/OSCAR/

Does that look feasible for you?

If you're open to the Bleep, there are also many nasal pillow masks for you to consider. The ResMed P10 is very minimalist; take a look and see whether it looks like something that would be kind to the sides of your nose. Bear in mind that the pillows rest on the rim of the nares; they do not go into the nose. It's conceivable, however, that the slight upward pressure needed to keep them in place would be a problem for you. No way to know for sure without experimenting. I'm certain that the less you're bothered by nose/congestion issues will contribute to solving you sleep problems.

Miss Emerita wrote: ↑

Thu Jul 30, 2020 10:13 am

It's very good to hear you're working with doctors who are knowledgeable about UARS.

I bet you'd benefit from starting to use the OSCAR software:

https://www.sleepfiles.com/OSCAR/

Does that look feasible for you?

If you're open to the Bleep, there are also many nasal pillow masks for you to consider. The ResMed P10 is very minimalist; take a look and see whether it looks like something that would be kind to the sides of your nose. Bear in mind that the pillows rest on the rim of the nares; they do not go into the nose. It's conceivable, however, that the slight upward pressure needed to keep them in place would be a problem for you. No way to know for sure without experimenting. I'm certain that the less you're bothered by nose/congestion issues will contribute to solving you sleep problems.

Will definitely start using OSCAR as soon as I can. Just waiting on an SD card and card reader to be delivered.

I'm also going to look into the nasal pillow masks, as you suggest. I think that might be a better direction. Thanks!

Keep us posted, would you?

Definitely!

First post here but I have been reading the forums for some time. I have a very similar issue, sleeping upright tends to help significantly (otherwise, extremely exhausted) and sleeping with the head on the side causes congestion, and even worse sleep. Formally diagnosed with UARS. Have tried APAP, but it does not seem to help at all. Looking at other options, including different PAP machines. Wanted to see if the OP had an update to his situation?