Noobie Question - CPAP or BiPAP? UARS, allergies

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
newuser1002
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Noobie Question - CPAP or BiPAP? UARS, allergies

Post by newuser1002 » Wed May 25, 2022 5:47 pm

Hi all,

I'm a 22 year old guy (145 lb 5'8), suspecting that I have UARS since my AHI is low with higher RERAs / RDI. My symptoms include fatigue and brain fog symptoms: cannot concentrate/focus... poor memory, lack of internal monologue at most parts of the day, every day. My symptoms started when I moved into a new apartment that I was super allergic to (likely mold and dust, maybe pet dander), and I have had them for two years. My ENT said I have swollen, enlarged inferior turbinates, likely from the allergies, and I have nasal congestion when I sleep. I recently had a sleep study and a titration test, and they diagnosed me with sleep apnea (though my AHI < 5).

I was mainly wondering, should I get a CPAP or a BiPAP? In my titration study, I used a CPAP (pressure 4, 5) and it helped a lot, but over the 5 hour night, I still had 4 RERAs and 1 apnea event (compared to ~20 RERAs and 10 OA/CA/hypopnea events). Subjectively, I felt a fair amount better the next day, but not substantially so (though I also understand it takes weeks/months in many instances). I read online in forums that BiPAP is better for UARS anecdotally. Would getting a BiPAP (or ASV even? That has been recommended as well) allow me reduce my 4 RERAs and 1 apnea down to zero?

Here's my graph for my sleep study and titration test for reference:

https://imgur.com/a/V6go1dV

(Notes: I went to sleep at pretty much exactly 12 am for both of them. For the titration test, I used a full-face mask for the sleep study and my nose felt really congested. For both, this is earlier than I usually sleep, which is 2-3 am in general. But I had no issues falling asleep at all.)

Thank you so much for the help!

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ChicagoGranny
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Re: Noobie Question - CPAP or BiPAP? UARS, allergies

Post by ChicagoGranny » Thu May 26, 2022 4:38 pm

1. Are you in the US?

2. Will you be using insurance to buy a machine?

3. Is your ENT treating you for allergies/swollen turbinates?

newuser1002
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Re: Noobie Question - CPAP or BiPAP? UARS, allergies

Post by newuser1002 » Thu May 26, 2022 8:46 pm

ChicagoGranny wrote:
Thu May 26, 2022 4:38 pm
1. Are you in the US?

2. Will you be using insurance to buy a machine?

3. Is your ENT treating you for allergies/swollen turbinates?
Thanks for the response!

1. Yes - usually bay area California, but going to be in Chicago for 3 months starting next week.

2. If possible, but judging from these forums it seems unlikely that they'll cover it since my AHI < 5? I'm meeting with my sleep doctor next week and they'll tell me more information. I don't mind paying out of pocket if I have to.

3. A few months ago, my ENT prescribed me Azelastine (a nasal antihistamine) and Nasacort (something similar to flonase, which I've used for years), along with a recommendation to use Nasal rinses (Simply Saline). I've been using those, but it doesn't seem my turbinates have reduced at all within the last month. I've also tried containing my allergies more by buying dust-proofing my mattress/pillows. From doing research online, it doesn't seem like there's many other non-surgical options for me at this point, and I am too scared to do turbinate reduction surgery because of ENS risk (read too many scary stories online), so I'm operating with the assumption that my turbinates will not reduce in size in the foreseeable future. Hopefully maybe PAP treatment could help? :))

Let me know if you have any advice in my situation overall, or any tips to reduce my remaining RERAs/apneas down to zero.

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ChicagoGranny
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Re: Noobie Question - CPAP or BiPAP? UARS, allergies

Post by ChicagoGranny » Fri May 27, 2022 6:16 am

newuser1002 wrote:
Thu May 26, 2022 8:46 pm
... Nasacort (something similar to flonase, which I've used for years), along with a recommendation to use Nasal rinses (Simply Saline) ...
You want to get a good rinse of the nasal passages before applying Nasacort. If there is too much mucous in the nasal passages, Nasacort will not be well absorbed. It can take up to two months for inflamed turbinates to heal and the swelling to be gone. This should be done before considering turbinate reduction surgery. Simply Saline is convenient. A saline neti pot rinse may be more effective.
newuser1002 wrote:
Thu May 26, 2022 8:46 pm
I am too scared to do turbinate reduction surgery because of ENS risk (read too many scary stories online)
That's history. Surgeons didn't understand ENS when turbinate surgery was first being performed. They are very aware of this now and take the proper precautions. By all means, if the swelling of your turbinates isn't reduced, tell your doctor about your concerns about ENS.
newuser1002 wrote:
Thu May 26, 2022 8:46 pm
Let me know if you have any advice in my situation overall, or any tips to reduce my remaining RERAs/apneas down to zero.
I wouldn't do anything, except maybe switch to neti pot rinses until you have that discussion with the doctor next week.

BTW, zero events is not the target. Sufficient, restful sleep is the target.

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ChicagoGranny
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Re: Noobie Question - CPAP or BiPAP? UARS, allergies

Post by ChicagoGranny » Fri May 27, 2022 6:20 am

BTW, as your situation progresses, keep posting in this one thread. It allows members to easily see your history.

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Miss Emerita
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Re: Noobie Question - CPAP or BiPAP? UARS, allergies

Post by Miss Emerita » Fri May 27, 2022 11:40 am

+1 to all of what Chicago Granny has written.

I'm really torn about advice on what machine to get. If you can get a ResMed Airsense 10 (or 11) Autoset with good coverage from insurance, that's worth a shot. You showed improvement during titration and felt somewhat better the next day -- both encouraging results.

On the other hand, that was just one night. You also need to understand the terms of your insurance: will you own the machine outright after a period of time? How long a period? What is the compliance requirement?

In favor of a ResMed Aircurve VAuto is the fact that it will do most or all of what the regular machine will do, if that's all you really need; but it will also do more, if you need more. (It doesn't have a "For Her" option, with the Airsense 11 Autoset has, but I don't think of that as a big negative.)

But you're right: your insurance is very unlikely to cover it given the results of your sleep study. It's even conceivable your doctor won't write a prescription for it. If you go the VAuto route, a prescription would be handy, and a new machine is ideal, but you can sometimes find a lightly used machine available for private sale. Forum member LSAT offers them from time to time, and you could PM him to keep you in mind. (I got my VAuto from him, and it all went very well.)

Stepping back a little: UARS is a fairly recently established diagnosis, and the condition is not yet well understood. Bilevel support of over 3 is often recommended, which is beyond the capacity of a regular machine. But this is fairly new territory for research and even clinical experience. I'll be curious what your doctor has to say about it.
Oscar software is available at https://www.sleepfiles.com/OSCAR/

Architect
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Re: Noobie Question - CPAP or BiPAP? UARS, allergies

Post by Architect » Fri May 27, 2022 3:12 pm

3. A few months ago, my ENT prescribed me Azelastine (a nasal antihistamine) and Nasacort (something similar to flonase, which I've used for years), along with a recommendation to use Nasal rinses (Simply Saline). I've been using those, but it doesn't seem my turbinates have reduced at all within the last month. I've also tried containing my allergies more by buying dust-proofing my mattress/pillows. From doing research online, it doesn't seem like there's many other non-surgical options for me at this point, and I am too scared to do turbinate reduction surgery because of ENS risk (read too many scary stories online), so I'm operating with the assumption that my turbinates will not reduce in size in the foreseeable future. Hopefully maybe PAP treatment could help? :))

From my experience, my allergist tried everything, Azelastine, Nasacort, Singulair, list goes on. Nothing worked.... I had 4 sinus ct scans reveal, severe maxillary sinus disease.

1.5 years later, he gave me a few samples of Bayer simply saline spray, instructs me to add baby shampoo and baking soda to nasal rinse.

Amazingly, I rarely have chronic nasal congestion anymore, i use spray several times a day, nasasl rinse, morning/night. Allergist was super happy :D I haven't returned to allergits in 2 years.

I was always congested.... frequent sinus infections. i'd get 5 to 6 sinus infection a year. I was scribed AB/Prednisone every other month.

Amazing, sometimes simple solutions do wonders. I've only had one sinus infection past year.

Good luck friend....

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ChicagoGranny
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Re: Noobie Question - CPAP or BiPAP? UARS, allergies

Post by ChicagoGranny » Fri May 27, 2022 4:55 pm

Architect wrote:
Fri May 27, 2022 3:12 pm
instructs me to add baby shampoo
I checked the date to see if it is April 1.

Then,
Johnsons Baby Shampoo. Biofilms are essentially thick tenacious snot that protects bacteria and fungi from the effects of antimicrobials and irrigants. It has been hypothesized that the use of 1% Johnsons baby shampoo (1/2 tsp in 1 NeilMed Sinus Rinse bottle bid) helps emulsify the biofilms and allows for irrigation and removal of the offending organisms. It is essentially a detergent or surfactant that allows for the dissolution of the thick ropy mucous and crusting.

https://doctorkrueger.com/nasal-treatment/
Baby shampoo nasal irrigations for the symptomatic post-functional endoscopic sinus surgery patient

https://pubmed.ncbi.nlm.nih.gov/18284857/

Architect
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Re: Noobie Question - CPAP or BiPAP? UARS, allergies

Post by Architect » Fri May 27, 2022 7:26 pm

At first, I thought my allergist was joking, I asked are you serious ? apparently it worked, prior I was rinsing with just salt. Does take a bit, getting used to :D

newuser1002
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Re: Noobie Question - CPAP or BiPAP? UARS, allergies

Post by newuser1002 » Sat May 28, 2022 12:50 pm

That is really interesting. Thank you all for your help; I truly appreciate it! I will meet with the doctor on Monday and update this thread. I'm relatively hesitant about the baking soda in saline rinse thing, but I'll give it a try if PAP isn't as effective as I hope :).

newuser1002
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Re: Noobie Question - CPAP or BiPAP? UARS, allergies

Post by newuser1002 » Mon May 30, 2022 7:56 pm

ChicagoGranny wrote:
Fri May 27, 2022 6:20 am
BTW, as your situation progresses, keep posting in this one thread. It allows members to easily see your history.
I just spoke with the doctor, and they prescribed me an Airsense 10. But, I saw here: http://www.apneaboard.com/wiki/index.ph ... ded_Models that Airsense 10 Autoset was recommended, Airsense 10 Elite was okay, and Airsense 10 CPAP is to be avoided. I tried clarifying with the doctor's assistant which one I would be getting, but I don't think they understood my question, just telling me repeatedly that they were going to preset my pressure as 5 (maybe this implies I'm probably just getting the Airsense 10 CPAP?). They said insurance won't support Bilevel. Furthermore, it only arrives in 2-5 months, which is soooo long from now :(. They said I could get a travel Airsense mini though in around 1 month for $1200.


Should I just find a used one on Craiglists/Facebook marketplace for an Airsense 10 autoset? I'm willing to pay up to $1000 to get it earlier than 2-5 months... To be fair, I was fine with the CPAP during the night of the titration study, and it did seem to help a lot - perhaps I don't need Bilevel for now. Though if it has lower data capability, perhaps that's an issue? Thanks so much for your advice.

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Pugsy
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Re: Noobie Question - CPAP or BiPAP? UARS, allergies

Post by Pugsy » Mon May 30, 2022 8:15 pm

The model to be avoided is the AirSense 10 CPAP and the main reason to avoid it is because it doesn't record any detailed data and there are times when that detailed data could be a critical issues.
So while it is a fixed pressure machine that really isn't the reason we want to avoid it. Lack of detailed data is the reason.
It will give you a generic AHI and 95% leak numbers but if that AHI is high it can't tell you what kind of events are making up and that AHI and it's real important to know because some apnea events need more pressure to reduce them and some apnea events can be made worse with more pressure and more pressure won't help them anyway.

You might check seconwindcpap.com and see if they have any ResMed AirSense 10 AutoSets...sometimes gently used or new open box specials. What with the Respironics recall it has created a shortage in the ResMed brand but you never know what they might have on hand and inventory is starting to loosen up on the ResMed machines now.

And yes...you can try craigslist or Facebook MarketPlace.....I don't know where you live but OkieBiPap found this one
and posted a link in this thread
viewtopic/t184425/Refurbished-ResMed-Ai ... eeded.html

https://www.facebook.com/marketplace/it ... 05f77e6a32

That is the bilevel version and a heckuva good price.
You may not actually technically need the bilevel but it can certainly be used anyway. It's what I use and I don't technically need it either. I just like having a little more exhale relief than I can get from the AutoSet.

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Miss Emerita
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Re: Noobie Question - CPAP or BiPAP? UARS, allergies

Post by Miss Emerita » Mon May 30, 2022 11:14 pm

Try asking for a copy of your prescription. That will clarify which machine you’re in line for, and it’ll be handy to have if you buy one from an online company.
Oscar software is available at https://www.sleepfiles.com/OSCAR/

newuser1002
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Re: Noobie Question - CPAP or BiPAP? UARS, allergies

Post by newuser1002 » Tue May 31, 2022 12:47 am

Hi Pugsy and Miss Emerita,

Thanks so much for the help! I'm looking into secondwind and facebook marketplace right now, and will probably get an AirSense 10 CPAP Autoset ASAP. How should I set this up? I had a pressure of 5 during my titration study - should I set both inhale and exhale pressure at 5?

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ChicagoGranny
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Re: Noobie Question - CPAP or BiPAP? UARS, allergies

Post by ChicagoGranny » Tue May 31, 2022 9:07 am

Miss Emerita wrote:
Mon May 30, 2022 11:14 pm
Try asking for a copy of your prescription. That will clarify which machine you’re in line for, and it’ll be handy to have if you buy one from an online company.
+1

Yes, newuser1002, make sure to get a copy of your script. It's your legal right. You should also get a copy of your sleep study summary. You have rights to copies of all your medical records. Keep them in a safe place. If you don't need them now, they might come in very handy at some point in the future.