Noobie Question - CPAP or BiPAP? UARS, allergies

newuser1002 wrote: ↑

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?

From reputable seller posted this morning -----> viewtopic.php?p=1412761#p1412761

Given what you've written, I'd suggest starting with a pressure range of 7 to 10, with EPR set at 3. It will be very important for you to get yourself set up with the Oscar software on your laptop or desktop computer. Be sure you have an SD card in your machine and a way to read the card. With Oscar data to look at, we'll have crucial data to inform further advice. What I'm suggesting is just to get going with.

With EPR of 3, your exhale pressures can range from 4 to 7, because your pressure will drop by 3 when you exhale. If you have a lot of flow limitations derived from what's going on in your nose, the machine will try to increase pressure to overcome them. This will be futile if the FLs are nasal in origin, and the pressure increases could be disruptive to your sleep. That's why I suggest capping your pressure at 10.

Thanks for the response! 7-10 seems kinda high to me - my doctor recommended me to have 5 at most (which is what I used in my titration study in the second picture in the link below). I’m not sure why exactly, but she seems hesitant to raise the pressure any higher than that. I still had 1 apnea and 4 RERAs though, so maybe a pressure of 6 would be good?


Btw I’m not too familiar with flow limitations - if the problems stem from my nasal congestion, why wouldn’t increased pressure help overcome flow limitations? Not sure if this is relevant, but I’m planning on using a full face mask (that’s what I used during the titration study)

https://imgur.com/a/V6go1dV

newuser1002 wrote: ↑

Tue May 31, 2022 3:10 pm

if the problems stem from my nasal congestion, why wouldn’t increased pressure help overcome flow limitations?

Nasal congestion is caused by swollen nasal mucosa and other nasal tissues and more pressure simply can't blow past the swollen tissues or move them. You have to deal with nasal congestion by the other traditional means. Meds, sprays, rinses, etc.

Even a pressure of 20 cm can't fix flow limitations that originate as nasal congestion.
Even a pressure of 20 can't blow open and move airway tissues that have collapsed either and in fact the machine won't even try to blow open a collapsed airway when the apnea event is actually occurring. Instead it waits until the airway is back open again and then decides how best to increase the pressure to prevent another collapse.

As for 7 cm being high...20 cm can't even blow up a balloon.

These machines work with the goal of preventing airway collapses from ever happening. They don't/can't generate enough pressure to blow open any collapsed tissues....or in the case of swollen nasal mucosa they can't generate enough pressure to move those swollen tissues.

I see; sorry if this is a dumb question, but if the pressure cannot move the swollen tissues at all, how come my titration study showed such an improvement?

Currently, my mental model is that the CPAP pressure of 5 helped open up my nasal airway to some extent, which allowed me to have much less apneas and hypopneas. Perhaps raising it above 5 would help further reduce the RERAs and remaining 1 apnea, but raising it too much is bad for whatever reason (at least, it would be going against the wishes of my doctor).

newuser1002 wrote: ↑

Tue May 31, 2022 5:45 pm

if the pressure cannot move the swollen tissues at all, how come my titration study showed such an improvement?

Couple of possibilities...perhaps if humidity was added to your cpap air pressure the humidity helped reduce the swelling.
That is a possibility.

Also it is possible that swollen tissue wasn't the problem.

No way to know for sure but pressure all by itself doesn't move swollen nasal mucosa.
I suspect something else was going on.

I’d really like to see the results of EPR for you, but that can certainly wait until there are some Oscar data to look at. Fine to start with min=max=5 and no EPR if that would be your preference.

Sounds good, thank you so much for the advice! I’ll make sure to update this thread frequently once I get my machine .

My ENT suspects this:

Prolonged allergy exposure at new apartment -> Swollen, enlarged turbinates -> mouth breathing rather than nasal breathing at night. And since you can’t really see my throat when I stick out my tongue (I was in the 3rd picture out of 4 that he showed me), mouth breathing -> apnea/hypopneas/RERAs.

Does this seem reasonable? Perhaps PAP helped in the titration study by helping keep my nasal airway open.

Though if PAP is truly useless for opening the nasal airway, then I don’t understand why PAP helped my sleep

newuser1002 wrote: ↑

Thu Jun 02, 2022 11:45 pm

Though if PAP is truly useless for opening the nasal airway, then I don’t understand why PAP helped my sleep

In front of the mirror with my mask on; turn on the machine; watch the nostrils inflate - basic physics and basic anatomy.

newuser1002 wrote: ↑

Thu Jun 02, 2022 11:45 pm

Does this seem reasonable? Perhaps PAP helped in the titration study by helping keep my nasal airway open.

Though if PAP is truly useless for opening the nasal airway, then I don’t understand why PAP helped my sleep

With Positive Airway Pressure, be it CPAP or APAP and a hypoallergenic filter you get the benefit of breathing air without allergens during the night. This could reduce the swelling of your tissues and make your breathing easier.
The filtration and not the high pressure could be doing what is necessary for you.

newuser1002 wrote: ↑

Tue May 31, 2022 5:45 pm

Currently, my mental model is that the CPAP pressure of 5 helped open up my nasal airway to some extent, which allowed me to have much less apneas and hypopneas. Perhaps raising it above 5 would help further reduce the RERAs and remaining 1 apnea, but raising it too much is bad for whatever reason (at least, it would be going against the wishes of my doctor).

When pressure is too high for your need, a person's CO2 to O2 balance may be disturbed - and their body could stop breathing because the CO2 in not high enough. The cessation of breathing that is not the result of a obstruction is called a central apnea.

Got it, that makes sense as well! I just got my hands on a used Airsense 10 Autoset from facebook marketplace (supposedly only used 10 times according the post - I don't know how to verify if that is true but the seller seemed fairly trustworthy) and was wondering if y'all helpful experts can help me with setting it up

I have the machine, the tubing, an elbow thing, the water tank, the wires for plugging it in. I ordered a Dreamwear full face mask from Cpap.com but idk how long it will take to arrive since

1. Does anyone have any recommendations for what brands of other supplies I need to buy? I briefly skimmed some threads and it seems like a liner would be good. Allergy filter? Cleaning supplies? Mask cushions? A hose lift (is this necessary?)?

2. How do I adjust the pressures? I think the seller told me that it's currently set to 4 and 20; I'd like to change it to 5 and 5 probably?

3. Is there any way to get a mask faster? I am super hyped to get started with it and not having a mask is the main bottleneck for me right now.

Thanks so much y'all

newuser1002 wrote: ↑

Sat Jun 04, 2022 9:49 pm

2. How do I adjust the pressures? I think the seller told me that it's currently set to 4 and 20; I'd like to change it to 5 and 5 probably?

The clinical manual explains how to access the setup menu to change settings along with having more useful information about the machine.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

newuser1002 wrote: ↑

Sat Jun 04, 2022 9:49 pm

it seems like a liner would be good

Not upfront, only buy if needed.

newuser1002 wrote: ↑

Sat Jun 04, 2022 9:49 pm

Allergy filter?

Only if needed. My allergies cleared up well with the standard machine filter.

newuser1002 wrote: ↑

Sat Jun 04, 2022 9:49 pm

Cleaning supplies?

Alcohol swabs from the diabetic section of any pharmacy.

newuser1002 wrote: ↑

Sat Jun 04, 2022 9:49 pm

A hose lift (is this necessary?)?

Hose management is important. Learn to manage without a lift. The hose connects to the mask your ordered on the top of the head - this makes hose management easy. A lift just complicates things and is one more thing to pack and carry when traveling.

newuser1002 wrote: ↑

Sat Jun 04, 2022 9:49 pm

I am super hyped to get started.

1. Calm down
2. Sleep on your sides or stomach until your CPAP system is ready to use. OSA is worse on the back for most people.

Just set up my machine, gonna start my first night tonight and let you all know how it goes! Not sure how to work OSCAR though since my macbook pro does not have a SD card reader... anyone have any suggestions on how to collect data otherwise? Resmed 10 Autoset.

newuser1002 wrote: ↑

Tue Jun 14, 2022 1:23 am

Just set up my machine, gonna start my first night tonight and let you all know how it goes! Not sure how to work OSCAR though since my macbook pro does not have a SD card reader... anyone have any suggestions on how to collect data otherwise? Resmed 10 Autoset.

Does the Macbook have a USB port? If so you can use one of those SD card reader/adapter things to get the SD card data to your computer.