CPAPtalk.com

PhotoWolf wrote: ↑

Mon Mar 10, 2025 4:19 pm

... F40 ...

The N95 mask made me feel like my mouth was in a sauna.

It sounds like you are a mouth-breather. Eventually (sooner better than later), you should have a consultation with an ENT. She will examine your airway with an endoscope (painless) on your first visit. You might have some problems in your nasal airway which can be remedied. Nose breathing is healthier and makes using CPAP easier.

PhotoWolf wrote: ↑

Mon Mar 10, 2025 4:19 pm

robysue1 wrote: ↑

Sun Mar 09, 2025 9:25 am

Out of curiosity: Back during the pandemic did wearing a mask when you were out in public bother you in the sense of making you feel like you couldn't breathe right? If so, that was probably caused by some of the same things triggering your problems with trying to breathe normally with the CPAP mask on when you are at very low pressures.

As a matter of fact, yes. Even the cloth masks bothered me; the one time I tried to use an N95 mask, it was just impossible. Wearing a cloth mask, it felt like I could never get enough air when breathing in, while breathing out resulted in air going up around my nose and fogging my glasses, until I figured out how to seal the mask properly. The N95 mask made me feel like my mouth was in a sauna.

Given what you say about other masks that cover your nose or nose and mouth, I think a huge part of your current problem with the CPAP mask making you feel like you suddenly just can't breathe is rooted in a psychological reaction to the idea of having something (anything) covering your nose.

It's worth asking:

During the daytime do you typically breathe through your nose or your mouth?

If you don't spend a lot of time breathing through your mouth when you are awake, then it's reasonable to assume (for now) that you probably don't breathe through your mouth (much) when you are asleep. And if you are still using a full face mask, it may be time to try a nasal mask or a nasal pillows mask. Nasal masks can be less claustrophobic because they don't cover the mouth----i.e. when you "wake up feeling like you can't breathe", you can just open your mouth and take a breath that way to help settle the brain down enough to realize that there's nothing particularly "wrong" beyond the fact that the friendly CPAP monster is still on your face. Nasal pillows and nasal cradle masks are usually the least claustrophobic because they don't cover the entire tip of the nose the way a traditional nasal mask does. So swapping out the mask for a less intrusive one might do you some real good.

Apologies for the delay in responding -- I'm so scatterbrained due to all the stress right now (the rotten sleeping is only part of it) that I didn't even notice the thread had gone to a second page.

robysue1 wrote: ↑

Wed Mar 12, 2025 2:42 pm

It's worth asking:

During the daytime do you typically breathe through your nose or your mouth?

ChicagoGranny wrote: ↑

Tue Mar 11, 2025 5:36 am

It sounds like you are a mouth-breather. Eventually (sooner better than later), you should have a consultation with an ENT. She will examine your airway with an endoscope (painless) on your first visit. You might have some problems in your nasal airway which can be remedied. Nose breathing is healthier and makes using CPAP easier.

I breathe both ways - nose sometimes, mouth sometimes. I have chronic, untreatable sinus issues -- allergies to multiple things, which would take far more money than I have to figure out. Even such a simple thing as very cold, dry air can set it off. I believe there's some permanent damage in my sinuses as well, because I never had sinus problems before I went to college in a town a few miles downwind of a nest of very foul-smelling oil refineries. On days when the congestion is mild, I can breathe through my nose unless I'm physically active, then I have to switch. When the congestion is bad, it's like a bad cold: mouth breathing is the only way I can get close to getting enough air. I can't take most over-the-counter decongestants, because I have a history of atrial fibrillation and the most common decongestants drugs can induce a-fib. I use a plain saline nasal spray most nights, which usually knocks down the congestion for three or four hours (and yes, I've noticed the correlation between that and the maximum length of time I can tolerate wearing the mask).

PhotoWolf wrote: ↑

Sat Mar 15, 2025 7:01 am

I breathe both ways - nose sometimes, mouth sometimes. I have chronic, untreatable sinus issues -- allergies to multiple things, which would take far more money than I have to figure out.

Sounds to me like it would be well worth your time (and a bit of money in the form of co-pays) to figure out if there is someway to treat your chronic sinus issues particularly since you go on to say:

Even such a simple thing as very cold, dry air can set it off. I believe there's some permanent damage in my sinuses as well, because I never had sinus problems before I went to college in a town a few miles downwind of a nest of very foul-smelling oil refineries. On days when the congestion is mild, I can breathe through my nose unless I'm physically active, then I have to switch. When the congestion is bad, it's like a bad cold: mouth breathing is the only way I can get close to getting enough air.

Now when trying to come up with ways to treat those unresolved sinus issues that are leading to congestion which leads to your inability to tolerate the mask for even a few minutes, it's important to note that you also say:

I can't take most over-the-counter decongestants, because I have a history of atrial fibrillation and the most common decongestants drugs can induce a-fib. I use a plain saline nasal spray most nights, which usually knocks down the congestion for three or four hours (and yes, I've noticed the correlation between that and the maximum length of time I can tolerate wearing the mask).

So I've got a few possible suggestions:

1) Since a saline nasal spray typically helps for several hours, it's worth considering doing an honest-to-god nasal rinse---i.e. a neti-pot. Yes, the idea of essentially "pouring" salt water in one nostril and letting it drip out the other seems highly counter-intuitive (and disgusting). A Neil-Med nasal rinse bottle is easier to use than a traditional neti-pot. You can think about a neti-pot or a Neil-Med nasal rinse as putting that saline nasal spray on steroids: Done correctly, a nasal rinse will provide longer relief from congestion than just a nasal spray. I will add this, however: It's a bad idea to do a nasal rinse right before bedtime: It can take some time (30-60 minutes or more) for the last of the water to fully drain, and going to bed before it does is likely to result in a drippy nose that feels just as bad as rainout in the mask does. (I had to learn this the hard way.)

2) Have you ever tried something like Flonase? Flonase is not a decongestant or an antihistamine. But it does provide long term congestion relief for many people with nasal allergies. But it's also not something that immediately treats the symptoms: You have to use Flonase for at least a couple of weeks before you typically see much improvement.

3) Presuming you have a cardiologist who at least follows you for the history of atrial fibrillation, it's worth asking whether there are any antihistamines that are safe for you to take. Again, an antihistamine might not provide the immediate "clear the congestion" relief that a decongestant often does. But if the problem is genuinely allergy based, then the antihistamine may help provide longer term relief than decongestants would any way.

4) It may also be worth consulting an ENT about whether your sinuses do indeed have some permanent damage or a chronic infection in your sinuses. (A chronic infection could probably be addressed through a course of antibiotics.)

My point is: You've just been living with the chronic congestion thinking that nothing much can be done about it and that compared to other things that you are dealing with, the chronic congestion is a "minor enough" problem to just ignore and live with as best you can. But if that congestion is part of the problem keeping you from being able to tolerate the mask, then it's no longer a "minor" problem that you can just ignore.

PhotoWolf wrote: ↑

Sat Mar 15, 2025 7:01 am

I have chronic, untreatable sinus issues

Has an ENT examined your airway (endoscopy) and told you that?

robysue1 wrote: ↑

Sat Mar 15, 2025 6:20 pm

So I've got a few possible suggestions:

1) Since a saline nasal spray typically helps for several hours, it's worth considering doing an honest-to-god nasal rinse---i.e. a neti-pot. Yes, the idea of essentially "pouring" salt water in one nostril and letting it drip out the other seems highly counter-intuitive (and disgusting). A Neil-Med nasal rinse bottle is easier to use than a traditional neti-pot. You can think about a neti-pot or a Neil-Med nasal rinse as putting that saline nasal spray on steroids: Done correctly, a nasal rinse will provide longer relief from congestion than just a nasal spray. I will add this, however: It's a bad idea to do a nasal rinse right before bedtime: It can take some time (30-60 minutes or more) for the last of the water to fully drain, and going to bed before it does is likely to result in a drippy nose that feels just as bad as rainout in the mask does. (I had to learn this the hard way.)

2) Have you ever tried something like Flonase? Flonase is not a decongestant or an antihistamine. But it does provide long term congestion relief for many people with nasal allergies. But it's also not something that immediately treats the symptoms: You have to use Flonase for at least a couple of weeks before you typically see much improvement.

3) Presuming you have a cardiologist who at least follows you for the history of atrial fibrillation, it's worth asking whether there are any antihistamines that are safe for you to take. Again, an antihistamine might not provide the immediate "clear the congestion" relief that a decongestant often does. But if the problem is genuinely allergy based, then the antihistamine may help provide longer term relief than decongestants would any way.

4) It may also be worth consulting an ENT about whether your sinuses do indeed have some permanent damage or a chronic infection in your sinuses. (A chronic infection could probably be addressed through a course of antibiotics.)

1) A nasal rinse? Is that anything like the thing I keep seeing and hearing advertised -- Navage, I think it's called? I've never considered it because (as you say) it sounds pretty disgusting. To be honest, it has always sounded like a con to me, like a hundred other products and treatments that claim to improve your health but always have that careful disclaimer "not intended to treat or cure any disease or condition" attached. Does it really work?

2) I used Flonase once a number of years ago, a five-day course of it as part of an effort to see if my congestion could be treated. Five days didn't produce any change, so I set it aside. I was used to things like 12-hour Sudafed, which was effective. That whole exercise was pretty much a bust -- the only result was that I discovered I'm sensitive to prednisone.

3) Definitely worth a try.

4) I did have a doctor take a good look at my sinuses several years ago. A scan - an MRI if I recall right - found no visible damage, and I was told that if I really had a sinus infection that had persisted for several years, there would be visible damage. I still wonder if there's some subtle damage because (as I said), I didn't have any kind of congestion problems before college. Nice town, but on a windy day you could really smell the pollution from the petrochemical plants about five miles upwind.

robysue1 wrote: ↑

Sat Mar 15, 2025 6:20 pm

My point is: You've just been living with the chronic congestion thinking that nothing much can be done about it and that compared to other things that you are dealing with, the chronic congestion is a "minor enough" problem to just ignore and live with as best you can.

Pretty much, yes. That, and the fact that trying to keep to any kind of long term treatment plan is damn near impossible for me, because of my lousy memory.

PhotoWolf wrote: ↑

Mon Mar 17, 2025 6:09 pm

1) A nasal rinse? Is that anything like the thing I keep seeing and hearing advertised -- Navage, I think it's called? I've never considered it because (as you say) it sounds pretty disgusting. To be honest, it has always sounded like a con to me, like a hundred other products and treatments that claim to improve your health but always have that careful disclaimer "not intended to treat or cure any disease or condition" attached. Does it really work?

Navage is some kind of a fancy electronic version of a nasal rinse that uses a "power suction" rather than just gravity to get the water out of the nose. And the "power suction" is what is supposed to make it somehow easier to use. (Less messy? Probably. But a Neil-Med nasal rinse or a neti-pot is not really that messy---you just need to do it over a sink and have a hankie in hand for wiping the nose as it continues to drip for a few minutes.)

NeilMed nasal rinse is much cheaper than Navage. The basic starter kit for Neil-Med is about $15-$20 at just about any drug store. It contains the squirt bottle and a set of salt packages that are enough for 50-100 nights of use. Refills on the salt packages run about $12 or $13. (You do need the purified salt rather than ordinary table salt). Some drug stores have generic versions that are cheaper.

The NeilMed nasal rinse works quite well for reducing my congestion when my spring allergies start acting up. It's a squirt bottle that allows you to gently squirt the salt water into one nostril and it will drain out the other nostril and your open mouth. You're supposed to use about 1/2 the squirt bottle in each nostril. The squirt bottle is refillable: You put a salt packet in, fill it with lukewarm water. (Instructions say to use distilled water. The water is supposed to be about body temperature or a bit less--- 90-100 degrees F.) You use it while bending over the bathroom sink. I was absolutely shocked the first time I used it (on a dare from someone here at CPAPtalk) at how well it cleared up my congestion. I was also pleasantly surprised that it was not uncomfortable to do. And putting on the mask with no congestion did make it easier to tolerate. But you do need to be warned: It takes a while for the water to drain, so doing a NeilMed rinse right before bedtime is not advised.

Netipots are a bit more awkward to use since you have to tilt your head in order to pour the salt water in one nostril and have it drain out the other one.

But all three products "work" on the same principle: The salt water helps rinse the allergens and the excess nasal congestion (mucus) out of the nose. And even temporarily getting rid of the allergens and excess mucus out of the nose does make it much easier to breath for quite a while.

In my opinion: A NeilMed nasal rinse kit is cheap enough to try at $15, but I'd be leery of spending $99 on a Navage starter bundle (the device + 30 salt packets).

I have used both Netipot & Neilmed; both work great for me at reducing congestion.

PhotoWolf wrote: ↑

Mon Mar 17, 2025 6:09 pm

I used Flonase once a number of years ago, a five-day course of it as part of an effort to see if my congestion could be treated. Five days didn't produce any change, so I set it aside.

It's possible you made a mistake. If you are congested, Flonase will land on mucus and not be absorbed by mucus membrane. The medicine needs to be absorbed by the mucus membrane.

A good nasal rinse should be performed immediately before using Flonase (or its generic). Neti pots are great and NeilMed is a close second.

Have never tried a Netipot, but I find squeezebottles excellent. NeilMed isn't the only one.

Make sure the temperature is a gentle warm - if you let a drop on the back of your hand its unfelt. I warm the water in in a glass in the microwave, and now know exactly how long to warm it.
Also: I find the prepacked solution packets worth while.

Find nasal rinses especially helpful when I'm congested after a cold.
The feeling after the yuck is rinsed out is worth it.
There are videos showing you how to got about the rinsing.

I really do not think that the procedure that they use to get you started is a good one.

So, you get a sleep study........... and they say BOOM, your pressure should be..................... 14! You get a machine, and they set you up with a pressure of 14. But, you cannot stand the immediate pressure. They then shift you to maybe a BI PAP machine.........it will be much better, for when you exhale, you are not fighting the pressure as much. Also, they set a ramp pressure............. and somehow you go to sleep OK, but, you wake up as soon as the high pressure is back up to speed!

Think about it............ If you were to learn to do anything...........let's say be a jet fighter pilot...... would they put you in the top fighter on day one??? NO. you have to build yourself up to it.

Same goes for CPAP. Use OSCAR to view your nightly results. I don't care what the pressure "should be"........... you need to start out with a very low pressure........ 4 is as low as you can go........but I would say try it for a week. Yes, a flat 4. You will not feel much better, but, you will be able to use the machine for > 4 hrs each night. Then, slowly up the pressure; go for a 5, or, jump to a 7. Set it to what your body can handle. All the time, looking at those AHI numbers. That is all the doctors do anyway........if you are under 5, you are AOK, so they say.

I use a 4 to start with a ramp to 7. I am on CPAP now. I was on BIPAP for I could not handle the high pressure........ My Resmed 11 does both.

I feel like crap if I do NOT use my machine................ yup, true. And I use my machine religiously now - every single night! I actually feel that my jaw has changed enough that my tongue now fits in the top of my mouth, and that is helping me.

My numbers........... AHI is around 1.5, and sometimes it jumps to 8. It happens. But, I HAVE to use the machine.......... I feel like crap if I do not use it now. I look at my Oscar #s if I need to see something. I also have the ResMed app on my phone, so I can look back over time at my info.

Leak rate............... fagettaboutit............ really..........don't worry about it. If you had a 100% leak rate, but your AHI was 0.5 - would that be OK? I'll bet it is. And think........when that pressure is way up there........... you WILL have leaks..........you turn your head on the pillow and boom..........you have a leak........ I sleep on an incline with 3 pillows.......I sleep on my back, and just tilt my head to the side.

Good luck. Yes, I know this is probably different than all the other comments............. I think after 25+ years, I got it right.

Also used NeilMed and it helped a lot. My ENT had me do it twice a day. Rinse then wait 30 mins, then use Afrin (but only for three days!) then use Flonase (fluticasone). And yes you do need to do it at least than an hour before bed because it tends to gush out randomly for a while after.

I'm not doing it now because my allergies aren't bothering me this time of year. But when they do, this routine helps a lot. I really hate the nasal wash though, but when I want my nose to be clear I do this routine.

I also can't handle the covid masks and in fact, I never had a suffocation phobia before that but it created one in me. When I first used the CPAP (nasal mask) I had the suffocating feeling but somehow I got over it quickly, probably because the pressure of the air actually was getting more oxygen to me, and I was able to intellectually tell my lizard brain all was well, whereas with the covid masks you are in fact getting less air. I don't know how surgeons operate in those things.

Be careful. A side effect of CPAP is an obsessive overuse of inappropriately long ellipses.

Reviving this thread rather than start a new one...

I didn't even try to use the cpap for most of March -- cataract surgery on both eyes, two weeks apart, was so high stress that also trying to use the machine was out of the question. I have been trying to use it for the last couple of weeks, but without much better results. Some nights I manage three or four hours with the mask on, other nights I can't get to sleep with it at all. The night recorded here is more or less typical of the first type: https://sleephq.com/public/8e1a58f1-8fc ... c5336570e5

All I can tell from that is that I'm still apparently having apneic events. Increasing the maximum pressure might help, but on the other hand I know I can't tolerate much more. I got to 15cm the night of the sleep study, and it was like having a ten or twelve-knot wind blowing down my throat nonstop. Even if I can fall asleep like that, choking on my own breath while I'm asleep does not sound like fun. The machine is stupid enough to read that as an apneic event and increase the pressure even more, and then where will I be?

PhotoWolf wrote: ↑

Thu Apr 24, 2025 5:39 pm

Reviving this thread rather than start a new one...

Fine.
But that's no reason for you to come back with the same settings you had when the thread started.