Desperate for a Solution to Apnea/Sinus Problems

Hi,

I will try and keep this short. I've read a few posts before in the past but wanted to talk about my own situation and ask whether this is common, and whether anyone has suggestions.
I am a male, 38, 5 feet 8 or approx 170cm / weight 202 pounds or 92kg. I am stocky but not what people would usually class as particularly overweight, just "could lose a few pounds". I have a big neck at around 17 inches and a big tongue unfortunately. And you know what they say about people with big tongues.

Here's a summary so far:
- 3 years ago visited ENT surgeon complaining of excessive tiredness and facial pain behind the eyes.
- ENT suggested sleep doctor, which I did, and he suggested a sleep test. I assumed I knew better and that it was sinuses, didn't go back
- Another year passed and I visited another ENT, ended up with sinus operation to straighten my septum and a few other things
- As part of that I took antibiotics for over a month BEFORE the surgery on his recommendation and was amazed to find it cleared up nearly everything. So I knew I had sinus issues and went ahead with it.
- Not sure if I gained too much from surgery. Perhaps less infections but hard to say.
- Still tired and now with amazing TMJ pain in the jaw, I saw a dental surgeon. He suggested a sleep study, did two and this confirmed obstructive sleep apnea. I had 38 episodes an hour.
- He sent me first to a different ENT and I had a second sinus operation to open the turbinates to enable me to breathe better, which did a good job and when I don't have infections I can feel it's clearer
- Dental surgeon then prescribed Somnodent mouthguard. For the first two or three weeks I felt totally different, really good, and this then tailed off with no joy since.

I cannot see this guy for two months at a time as he's so busy. Last time he turned screws in the device six times from it's original setting, warning me against doing it myself as it stretches the muscles and makes this a problem to achieve what you want later in life. In desperation I've tried adjusting it further but it's not working.

I've now gone back to the original sleep doctor who was really good about it, and told him my results which he wants a copy of. In three weeks I start on a rented CPAP machine that will be set between 6 and 20 of whatever measure is used, I cannot read the writing, automatically compensating for the apnea. Apparently from there the data is downloaded and a constant pressure found for me in my own device.

I have several questions.
1) First, has anyone had similar and did the CPAP work? I am almost scared that if it doesn't, I am in big trouble.
2) I have almost constant sinus infections, perhaps more than 30 weeks of the year. With all this combined I am constantly exhausted. My work suffers, we have a one-year-old boy and I'm just too tired at the weekend to take him out and do the things I want to with him, much to the annoyance of my wife who is mostly sympathetic but understandably gets frustrated with me. The question here is, it's my opinion that because of the apnea I am so run down that I lack energy to fight off infections or importantly do stuff like exercise because I have nothing left. I'm interested in whether this is common, whether I'm talking nonsense, or just have any different opinions I can think about? I regularly flush the sinuses and so on, I get temporary relief but it doesn't solve things.
3) Have I missed anything in trying to get this sorted out?

I have to admit I smoke currently. Just can't get off them. I don't have the fight in me to do it, I've tried countless times. I am hoping the CPAP works and gives me the energy to take it on, because I sure a hell want to, as well as exercise. I also crave chocolate, I think for the temporary energy to keep going.

It may well be that the CPAP solves all my problems, but never having used ones and reading about people that cannot tolerate them, I am concerned. I often sleep face down into the pillow (I know, I know) and wonder if this is going to work out.

Appreciate any thoughts you might have. And perhaps some encouragement. Thanks very much
Richard

Welcome to the forum.

First things first:

rich74 wrote:I saw a dental surgeon. He suggested a sleep study, did two and this confirmed obstructive sleep apnea. I had 38 episodes an hour.

A diagnostic AHI of 38 puts you in the severe OSA category. Many insurance companies will not pay for an oral device to treat severe OSA. Any sleep doc who is not a sleep dentist will say try CPAP first; if you can't tolerate CPAP, then maybe an oral appliance might help some. But oral appliances are not likely to reduce the AHI down to the normal range if you have severe OSA.


Next, you write:

- 3 years ago visited ENT surgeon complaining of excessive tiredness and facial pain behind the eyes.
- ENT suggested sleep doctor, which I did, and he suggested a sleep test. I assumed I knew better and that it was sinuses, didn't go back
- Another year passed and I visited another ENT, ended up with sinus operation to straighten my septum and a few other things
- As part of that I took antibiotics for over a month BEFORE the surgery on his recommendation and was amazed to find it cleared up nearly everything. So I knew I had sinus issues and went ahead with it.
- Not sure if I gained too much from surgery. Perhaps less infections but hard to say.
- Still tired and now with amazing TMJ pain in the jaw, I saw a dental surgeon. He suggested a sleep study, did two and this confirmed obstructive sleep apnea. I had 38 episodes an hour.
- He sent me first to a different ENT and I had a second sinus operation to open the turbinates to enable me to breathe better, which did a good job and when I don't have infections I can feel it's clearer

Your sinus problems and your apnea are likely caused by different things in your anatomy even though both affect your breathing at night.

The sinus congestion and infections are caused by problems in your sinuses and in your nasal cavity. The root cause of the sinus problems needs to be investigated. Do you have severe nasal allergies? Then treating the allergies will have to be done in an effective way before any real relief can happen. And the problems with the sinuses (whatever they are) leave you with a high risk of sinus infection and when the sinuses are sufficiently stopped up it's hard to breathe---both when you are awake and when you are asleep. But whenever the nose is too stopped up to breathe, you simply open your mouth and breathing through it is possible because the upper airway is NOT collapsed---at least when you are awake!

The OSA is caused by a problem that is much further down the airway: For some reason when you are alseep (and only when you are asleep), the muscles that control the airway as it passes through your neck are prone to relaxing too much and allowing the upper airway to collapse. With a too large tongue and a thick neck, the problem is likely anatomical: The tongue relaxes and being overly large it falls back and blocks the upper airway. The neck being large means there's a lot of tissue that must be supported to keep your airway open, and when the muscles relax, they don't provide that support. The collapsing airway has nothing to do with the clogged nose further "upstream" so to speak. In other words, if you were able to completely solve your sinus problem, you'd still have the OSA problem. And unlike a clogged nose, you can't simply open your mouth and start breathing if the airway has collapsed in the throat. And the sleep study indicates your upper airway (the part of the airway in your throat) collapses about every two minutes on average when you are asleep.

And you've also got TMJ thrown into the mix. Sinus pain can aggravate TMJ pain; but TMJ pain can also manifest itself as sinus pain in some people. And oral appliances for treating mild OSA can severely affect the TMJs and create serious problems with TMJ pain in some patients.

Which brings us to:

- Dental surgeon then prescribed Somnodent mouthguard. For the first two or three weeks I felt totally different, really good, and this then tailed off with no joy since.

I cannot see this guy for two months at a time as he's so busy. Last time he turned screws in the device six times from it's original setting, warning me against doing it myself as it stretches the muscles and makes this a problem to achieve what you want later in life. In desperation I've tried adjusting it further but it's not working.

Did the TMJ pain start before or after you started using the Somnodent appliance? Has the TMJ pain gotten worse as you've made further adjustments to the Somnodent?

As to why things seemed better during those first two or three weeks of using the Somnodent: It could be that simply reducing your AHI from the 38-40 range down to the 19-20 range seemed like a big improvement for your body at the time, but the continued problem of needing to arouse yourself to restart the breathing 20 times an hour wasn't enough to provide long term relief and the fatigue and sleepiness came back. (An AHI = 19-20 on a diagnostic test is enough to get you a diagnosis of moderate sleep apnea and a strong invitation/coercion to join the Hosehead club.) Add the additional TMJ pain to the (significant) residual OSA that is not being prevented by the Somnondent, and volia---there's a reasonable explanation of why things went downhill for you in terms of how you're feeling.

I've now gone back to the original sleep doctor who was really good about it, and told him my results which he wants a copy of. In three weeks I start on a rented CPAP machine that will be set between 6 and 20 of whatever measure is used, I cannot read the writing, automatically compensating for the apnea. Apparently from there the data is downloaded and a constant pressure found for me in my own device.

This is becoming a fairly common way of titrating OSA patients. It has some real advantages to a second sleep test: You are in your own bed, for example. And the titration takes place over several nights, so if you sleep in very different positions or you don't hit REM until the second or third night on PAP, there's still data that shows what happens when you do. There are also some real disadvantages: All those nasty wires collect a wealth of data that help the techs really see what's going on---including your unconscious reaction to PAP.

I have several questions.
1) First, has anyone had similar and did the CPAP work? I am almost scared that if it doesn't, I am in big trouble.

CPAP is considered the gold standard of treatment for OSA. If a person doesn't give up PAPing in the first 3 or 4 months (out of frustration), then the person is likely to become a lifelong, happy and compliant PAPer. Most PAPers see real improvement in terms of their OSA symptoms sometime in the first two months or so; some take a bit longer. But most don't see real improvement in the first week or two simply because it does take some effort and time to teach yourself how to sleep with a six foot hose attached to your nose.

2) I have almost constant sinus infections, perhaps more than 30 weeks of the year. With all this combined I am constantly exhausted. My work suffers, we have a one-year-old boy and I'm just too tired at the weekend to take him out and do the things I want to with him, much to the annoyance of my wife who is mostly sympathetic but understandably gets frustrated with me. The question here is, it's my opinion that because of the apnea I am so run down that I lack energy to fight off infections or importantly do stuff like exercise because I have nothing left. I'm interested in whether this is common, whether I'm talking nonsense, or just have any different opinions I can think about? I regularly flush the sinuses and so on, I get temporary relief but it doesn't solve things.

Severe OSA (which you have) profoundly affects many parts of the body and the most common symptom the patient notices is extreme daytime fatigue and sleepiness even though the person is getting enough "sleep" in the sense of how much time they're in bed and think they're asleep.

So yes, it's reasonable to assume that some, possibly most, of your daytime exhaustion stems from the untreated (or undertreated) OSA. The sinus pain and the TMJ pain contribute to exhaustion simply because being in pain is exhausting. So once you start feeling a bit less tired after starting CPAP (maybe in a month or two after starting PAP), you'll have the energy to start tackling what needs to be done to address the sinus and TMJ issues. Because to completely eliminate your exhaustion will likely require getting those two conditions under control as well as the OSA.

One additional positive concerning CPAP: The air that is blown down your throat is filtered air. So if some of your sinus pain and some of those sinus infections are caused by nasal allergies, breathing that filtered, pollen-free, dust-free, mite-free, and pet dander-free air all night can make a difference with the sinus issues for some people.

I have to admit I smoke currently. Just can't get off them. I don't have the fight in me to do it, I've tried countless times. I am hoping the CPAP works and gives me the energy to take it on, because I sure a hell want to, as well as exercise. I also crave chocolate, I think for the temporary energy to keep going.

It's important to have realistic expectations of CPAP. The CPAP therapy will likely give you more energy in time. But it's not likely going to provide you with instant energy just as soon as you start PAPing. It may take a couple of months. It took me six months before I could identify anything that felt better than it did pre-PAP. And the improvement in daytime energy may be subtle and you may not notice it at first.

And as hard as it is, you need to find a way of at least cutting back on the coffin-nails. One thing you should consider is asking your PCP for help; the prescription nicotine patches and nicotine gum works wonders for many people in their quest to quit smoking.

It may well be that the CPAP solves all my problems, but never having used ones and reading about people that cannot tolerate them, I am concerned.

I need to be up front and honest here: I am one of those people who had an extremely difficult time adjusting to CPAP---saying I could not tolerate it is actually pretty honest. And yet, here I am almost three years later still plugging away putting the dang mask on my nose every single night. I had three months of genuine, bonafide hell at the start of PAPing. (You can read about some of it on my blog or if you go through my early posts from Fall 2010 here.) But I stuck with it night after (horrible) night after (horrible) night. And at the end of six months, there was some light at the end of the tunnel: I was waking up pain-free for the first time in years. At the end of 12 months, I was actually feeling refreshed and rested most mornings when I woke up. Last summer? I felt like I was 10-15 years younger. I'm currently going through a rough patch right now with the return of chronic headaches, serious TMJ problems, and a re-emergent insomnia monster as well as a (minor) uptick in overnight AHIs. But I've now got a medical team (including a new sleep doctor) that is interested in helping me get back to where I was a year ago.

And this summer I had a rude reminder of just how much pain I was living with from the untreated OSA pre-CPAP: On three different nights this summer I was literally unable to sleep with my BiPAP. And the pain and agony I had to deal with the next morning was quite a reminder that I really don't want to go back to living in that much pain every single day when the PAP machine reduces it significantly all by itself.

So PAP can work out even if you have a tough adjustment period. It just requires a whole lot of stubborness and a desire to not give up.

I often sleep face down into the pillow (I know, I know) and wonder if this is going to work out.

Pre-CPAP I slept with my nose stuck into my hubby's underarm. So I know what it's like to face the problem of "how heck will I ever be able to get to sleep in the position I want to be in". Surprisingly enough, the masks are pretty flexible---they're designed to be used in all sorts of sleep positions. I can't really get my nose into hubby's armpit these days, but I can snuggle into his backside without much trouble. There are plenty of PAPers here who prefer to sleep on their stomachs. So you'll be able to get all kinds of tips on how to do it. It may be that you'll need a special CPAP pillow. Or it could be that you'll find a soft squishy pillow can be molded into a way that provides a spot for the hose. It could be that you'll find that lying on top of the hose will let you get your face where you want it. And the hoses are pretty tough and stand up to a certain amount of abuse from being lain on.

Appreciate any thoughts you might have. And perhaps some encouragement. Thanks very much

PAPing is pretty much what you decide to make of it. If you have realistic expectations and a full data machine, then it's easier to stick with it if you run into some newbie troubles. And one thing to keep in mind in the early days is that it's actually rare for folks to feel better immediately. But it's equally rare for someone to have as difficult of an adjustment time as I had. Most people start to feel better in about two months. And if you are unlucky enough to land in the (small) minority of CPAPers who face really difficult adjustment periods that last months and months like mine did, posting here about your troubles will provide you with ample encouragement and constant positive reinforcement and even hope that it will eventually get better.

I saw a dental surgeon. He suggested a sleep study, did two and this confirmed obstructive sleep apnea. I had 38 episodes an hour.

A diagnostic AHI of 38 puts you in the severe OSA category. Many insurance companies will not pay for an oral device to treat severe OSA. Any sleep doc who is not a sleep dentist will say try CPAP first; if you can't tolerate CPAP, then maybe an oral appliance might help some. But oral appliances are not likely to reduce the AHI down to the normal range if you have severe OSA.[/quote]

RobySue,

I really hate to disagree with you but according to a study I posted previously on this board in which the link has unfortunately disappeared, someone in the severe apnea range who is prescribed a Tap III device has a 40% chance of success in getting the AHI to 5 or below. The sleep medicine dentist on the other apnea board has stated a 30% success rate with the TAP.

However, he has consistently said those odds are greatly improved with good nasal potency. With Rich's sinus issues, that could possibly be a reason why his dental appliance started failing.

Also, even though an AHI of 38 is in the severe range, it is just outside the moderate range in which the chances of success are greater. The study I posted had a range of 50 to 60% for various moderate ranges.

Sorry, I don't mean to sound like an apologist for the sleep medicine dentist industry even though it may seem that way according to my posts. Personally, I think what keeps the success rates low is there are lot of charlatans in the field and if you go this route, you have to screen the provider very carefully. But in my opinion, if you find a good provider, then it is a different ballgame.

Anyway, I just think people need to be reasonably informed about dental appliances in case they decide they are out of options with pap therapy. Yes, I agree that attitude helps with pap therapy but if your body doesn't want to accept it no matter how hard you try or what you do, then people need to know about other options and what the odds are of success.

Finally, to be honest, I am surprised by your statement that pap therapy is what you make of it in light of your previous struggles. I wonder how you would have felt if someone said that to you in light of the fact that you were suffering so much. Would you liked it if any of your sleep doctors had said that to you?

To be honest, as one who has to date failed pap therapy in spite of my best efforts, I found that statement extremely hurtful even though I am sure that was not your intention. I would plead with you and everything else who thinks that success on pap therapy is just a matter of attitude to think of an area you have greatly struggled with in your life and couldn't master no matter how hard you tried. I seriously doubt you would have liked hearing those statements although I acknowledge I could be wrong.

I hope you take my post in the spirit it was intended as to be honest, I hesitated greatly in saying what I have said. But I felt I had to say something.

49er




Next, you write:

- 3 years ago visited ENT surgeon complaining of excessive tiredness and facial pain behind the eyes.
- ENT suggested sleep doctor, which I did, and he suggested a sleep test. I assumed I knew better and that it was sinuses, didn't go back
- Another year passed and I visited another ENT, ended up with sinus operation to straighten my septum and a few other things
- As part of that I took antibiotics for over a month BEFORE the surgery on his recommendation and was amazed to find it cleared up nearly everything. So I knew I had sinus issues and went ahead with it.
- Not sure if I gained too much from surgery. Perhaps less infections but hard to say.
- Still tired and now with amazing TMJ pain in the jaw, I saw a dental surgeon. He suggested a sleep study, did two and this confirmed obstructive sleep apnea. I had 38 episodes an hour.
- He sent me first to a different ENT and I had a second sinus operation to open the turbinates to enable me to breathe better, which did a good job and when I don't have infections I can feel it's clearer

Your sinus problems and your apnea are likely caused by different things in your anatomy even though both affect your breathing at night.

The sinus congestion and infections are caused by problems in your sinuses and in your nasal cavity. The root cause of the sinus problems needs to be investigated. Do you have severe nasal allergies? Then treating the allergies will have to be done in an effective way before any real relief can happen. And the problems with the sinuses (whatever they are) leave you with a high risk of sinus infection and when the sinuses are sufficiently stopped up it's hard to breathe---both when you are awake and when you are asleep. But whenever the nose is too stopped up to breathe, you simply open your mouth and breathing through it is possible because the upper airway is NOT collapsed---at least when you are awake!

The OSA is caused by a problem that is much further down the airway: For some reason when you are alseep (and only when you are asleep), the muscles that control the airway as it passes through your neck are prone to relaxing too much and allowing the upper airway to collapse. With a too large tongue and a thick neck, the problem is likely anatomical: The tongue relaxes and being overly large it falls back and blocks the upper airway. The neck being large means there's a lot of tissue that must be supported to keep your airway open, and when the muscles relax, they don't provide that support. The collapsing airway has nothing to do with the clogged nose further "upstream" so to speak. In other words, if you were able to completely solve your sinus problem, you'd still have the OSA problem. And unlike a clogged nose, you can't simply open your mouth and start breathing if the airway has collapsed in the throat. And the sleep study indicates your upper airway (the part of the airway in your throat) collapses about every two minutes on average when you are asleep.

And you've also got TMJ thrown into the mix. Sinus pain can aggravate TMJ pain; but TMJ pain can also manifest itself as sinus pain in some people. And oral appliances for treating mild OSA can severely affect the TMJs and create serious problems with TMJ pain in some patients.

Which brings us to:

- Dental surgeon then prescribed Somnodent mouthguard. For the first two or three weeks I felt totally different, really good, and this then tailed off with no joy since.

I cannot see this guy for two months at a time as he's so busy. Last time he turned screws in the device six times from it's original setting, warning me against doing it myself as it stretches the muscles and makes this a problem to achieve what you want later in life. In desperation I've tried adjusting it further but it's not working.

Did the TMJ pain start before or after you started using the Somnodent appliance? Has the TMJ pain gotten worse as you've made further adjustments to the Somnodent?

As to why things seemed better during those first two or three weeks of using the Somnodent: It could be that simply reducing your AHI from the 38-40 range down to the 19-20 range seemed like a big improvement for your body at the time, but the continued problem of needing to arouse yourself to restart the breathing 20 times an hour wasn't enough to provide long term relief and the fatigue and sleepiness came back. (An AHI = 19-20 on a diagnostic test is enough to get you a diagnosis of moderate sleep apnea and a strong invitation/coercion to join the Hosehead club.) Add the additional TMJ pain to the (significant) residual OSA that is not being prevented by the Somnondent, and volia---there's a reasonable explanation of why things went downhill for you in terms of how you're feeling.

I've now gone back to the original sleep doctor who was really good about it, and told him my results which he wants a copy of. In three weeks I start on a rented CPAP machine that will be set between 6 and 20 of whatever measure is used, I cannot read the writing, automatically compensating for the apnea. Apparently from there the data is downloaded and a constant pressure found for me in my own device.

This is becoming a fairly common way of titrating OSA patients. It has some real advantages to a second sleep test: You are in your own bed, for example. And the titration takes place over several nights, so if you sleep in very different positions or you don't hit REM until the second or third night on PAP, there's still data that shows what happens when you do. There are also some real disadvantages: All those nasty wires collect a wealth of data that help the techs really see what's going on---including your unconscious reaction to PAP.

I have several questions.
1) First, has anyone had similar and did the CPAP work? I am almost scared that if it doesn't, I am in big trouble.

CPAP is considered the gold standard of treatment for OSA. If a person doesn't give up PAPing in the first 3 or 4 months (out of frustration), then the person is likely to become a lifelong, happy and compliant PAPer. Most PAPers see real improvement in terms of their OSA symptoms sometime in the first two months or so; some take a bit longer. But most don't see real improvement in the first week or two simply because it does take some effort and time to teach yourself how to sleep with a six foot hose attached to your nose.

2) I have almost constant sinus infections, perhaps more than 30 weeks of the year. With all this combined I am constantly exhausted. My work suffers, we have a one-year-old boy and I'm just too tired at the weekend to take him out and do the things I want to with him, much to the annoyance of my wife who is mostly sympathetic but understandably gets frustrated with me. The question here is, it's my opinion that because of the apnea I am so run down that I lack energy to fight off infections or importantly do stuff like exercise because I have nothing left. I'm interested in whether this is common, whether I'm talking nonsense, or just have any different opinions I can think about? I regularly flush the sinuses and so on, I get temporary relief but it doesn't solve things.

Severe OSA (which you have) profoundly affects many parts of the body and the most common symptom the patient notices is extreme daytime fatigue and sleepiness even though the person is getting enough "sleep" in the sense of how much time they're in bed and think they're asleep.

So yes, it's reasonable to assume that some, possibly most, of your daytime exhaustion stems from the untreated (or undertreated) OSA. The sinus pain and the TMJ pain contribute to exhaustion simply because being in pain is exhausting. So once you start feeling a bit less tired after starting CPAP (maybe in a month or two after starting PAP), you'll have the energy to start tackling what needs to be done to address the sinus and TMJ issues. Because to completely eliminate your exhaustion will likely require getting those two conditions under control as well as the OSA.

One additional positive concerning CPAP: The air that is blown down your throat is filtered air. So if some of your sinus pain and some of those sinus infections are caused by nasal allergies, breathing that filtered, pollen-free, dust-free, mite-free, and pet dander-free air all night can make a difference with the sinus issues for some people.

I have to admit I smoke currently. Just can't get off them. I don't have the fight in me to do it, I've tried countless times. I am hoping the CPAP works and gives me the energy to take it on, because I sure a hell want to, as well as exercise. I also crave chocolate, I think for the temporary energy to keep going.

It's important to have realistic expectations of CPAP. The CPAP therapy will likely give you more energy in time. But it's not likely going to provide you with instant energy just as soon as you start PAPing. It may take a couple of months. It took me six months before I could identify anything that felt better than it did pre-PAP. And the improvement in daytime energy may be subtle and you may not notice it at first.

And as hard as it is, you need to find a way of at least cutting back on the coffin-nails. One thing you should consider is asking your PCP for help; the prescription nicotine patches and nicotine gum works wonders for many people in their quest to quit smoking.

It may well be that the CPAP solves all my problems, but never having used ones and reading about people that cannot tolerate them, I am concerned.

I need to be up front and honest here: I am one of those people who had an extremely difficult time adjusting to CPAP---saying I could not tolerate it is actually pretty honest. And yet, here I am almost three years later still plugging away putting the dang mask on my nose every single night. I had three months of genuine, bonafide hell at the start of PAPing. (You can read about some of it on my blog or if you go through my early posts from Fall 2010 here.) But I stuck with it night after (horrible) night after (horrible) night. And at the end of six months, there was some light at the end of the tunnel: I was waking up pain-free for the first time in years. At the end of 12 months, I was actually feeling refreshed and rested most mornings when I woke up. Last summer? I felt like I was 10-15 years younger. I'm currently going through a rough patch right now with the return of chronic headaches, serious TMJ problems, and a re-emergent insomnia monster as well as a (minor) uptick in overnight AHIs. But I've now got a medical team (including a new sleep doctor) that is interested in helping me get back to where I was a year ago.

And this summer I had a rude reminder of just how much pain I was living with from the untreated OSA pre-CPAP: On three different nights this summer I was literally unable to sleep with my BiPAP. And the pain and agony I had to deal with the next morning was quite a reminder that I really don't want to go back to living in that much pain every single day when the PAP machine reduces it significantly all by itself.

So PAP can work out even if you have a tough adjustment period. It just requires a whole lot of stubborness and a desire to not give up.

I often sleep face down into the pillow (I know, I know) and wonder if this is going to work out.

Pre-CPAP I slept with my nose stuck into my hubby's underarm. So I know what it's like to face the problem of "how heck will I ever be able to get to sleep in the position I want to be in". Surprisingly enough, the masks are pretty flexible---they're designed to be used in all sorts of sleep positions. I can't really get my nose into hubby's armpit these days, but I can snuggle into his backside without much trouble. There are plenty of PAPers here who prefer to sleep on their stomachs. So you'll be able to get all kinds of tips on how to do it. It may be that you'll need a special CPAP pillow. Or it could be that you'll find a soft squishy pillow can be molded into a way that provides a spot for the hose. It could be that you'll find that lying on top of the hose will let you get your face where you want it. And the hoses are pretty tough and stand up to a certain amount of abuse from being lain on.

Appreciate any thoughts you might have. And perhaps some encouragement. Thanks very much

PAPing is pretty much what you decide to make of it. If you have realistic expectations and a full data machine, then it's easier to stick with it if you run into some newbie troubles. And one thing to keep in mind in the early days is that it's actually rare for folks to feel better immediately. But it's equally rare for someone to have as difficult of an adjustment time as I had. Most people start to feel better in about two months. And if you are unlucky enough to land in the (small) minority of CPAPers who face really difficult adjustment periods that last months and months like mine did, posting here about your troubles will provide you with ample encouragement and constant positive reinforcement and even hope that it will eventually get better.[/quote]

49er wrote:[I really hate to disagree with you but according to a study I posted previously on this board in which the link has unfortunately disappeared, someone in the severe apnea range who is prescribed a Tap III device has a 40% chance of success in getting the AHI to 5 or below. The sleep medicine dentist on the other apnea board has stated a 30% success rate with the TAP.

Hi 49er,

Just a friendly thought: If you got a TAP 3 and were able to verify to its efficacy yourself--that might elicit more "punch" to your support for this device. An AHI of 2.5 or over leaves me nonfunctional. So an AHI of below 5 is a game of roulette of to how one will feel even at a dental device's optimum effectiveness. I used the Somnodent with the cpap for over a year, and when REM came, my airway still collapsed too much even with the combination of both. Personally I don't think the touting of an AHI of less than 5 will help a whole heck of a lot of people, especially when their apnea is severe like mine is. Jus' trying to be helpful

Hello Everyone - As I am new to using the PAP device I can say that my sinus problems have greatly improved. Using now for only 15 days and I can feel the changes, not so much in my sleeplyness but sure in my sinus. I can't say my sinus problems were monsters, but a typical day for me was to sneeze several times, especially early in the morning, and blow my noise through out the day - every day. Using a machine with 2 filters, the ultra-fine (white one) and the black rough filter has had a big change. Of course I have cats, my wife loves them, for me they mess with my sinus problems. Now with the PAP machine - I have to say 14 days of good sinus in a row is a new record in my recent past. So, if the sinus problems are related to an allergy then it might help as it has me .. so far any way.. Paul

49er wrote:

I saw a dental surgeon. He suggested a sleep study, did two and this confirmed obstructive sleep apnea. I had 38 episodes an hour.

A diagnostic AHI of 38 puts you in the severe OSA category. Many insurance companies will not pay for an oral device to treat severe OSA. Any sleep doc who is not a sleep dentist will say try CPAP first; if you can't tolerate CPAP, then maybe an oral appliance might help some. But oral appliances are not likely to reduce the AHI down to the normal range if you have severe OSA.

RobySue,

I really hate to disagree with you but according to a study I posted previously on this board in which the link has unfortunately disappeared, someone in the severe apnea range who is prescribed a Tap III device has a 40% chance of success in getting the AHI to 5 or below. The sleep medicine dentist on the other apnea board has stated a 30% success rate with the TAP.

And that leaves 60-70% of the people treated with an oral appliance with a treated AHI > 5. And 60-70% counts as "most". And while insurance companies are beginning to come around, the sad fact is many insurance companies will not pay for an oral appliance for someone in the severe range unless they've tried PAP without any luck.

However, he has consistently said those odds are greatly improved with good nasal potency. With Rich's sinus issues, that could possibly be a reason why his dental appliance started failing.

Also, even though an AHI of 38 is in the severe range, it is just outside the moderate range in which the chances of success are greater. The study I posted had a range of 50 to 60% for various moderate ranges.

Could be. But without a sleep study we don't know if the device was ever genuinely effective. And many sleep dentists do not routinely send their patients back to a lab for a follow-up sleep test after the device has been titrated and worn for some time. And many insurance companies seem to balk at paying for multiple sleep studies ...

Anyway, I just think people need to be reasonably informed about dental appliances in case they decide they are out of options with pap therapy.

The OP has never tried CPAP. He jumped immediately to the oral appliance out of fear of CPAP.

Yes, I agree that attitude helps with pap therapy but if your body doesn't want to accept it no matter how hard you try or what you do, then people need to know about other options and what the odds are of success.

If someone has tried and tried for several months to make PAP work and just feels that they can't do it, that's one thing. But the OP has never tried CPAP; attitude makes a huge difference at the start of PAP. If you expect to fail at PAP, then you probably will fail at PAP. If you expect a miracle from CPAP---you expect to wake up the first morning feeling wonderful and fantanstic---then you increase your chances of failure because most people don't miraculously feel wonderful right after starting PAP.

Finally, to be honest, I am surprised by your statement that pap therapy is what you make of it in light of your previous struggles. I wonder how you would have felt if someone said that to you in light of the fact that you were suffering so much. Would you liked it if any of your sleep doctors had said that to you?

Actually my sleep docs said a lot of things that were far worse than what I said. In particular: I still believe the worst thing the first sleep doc ever told me was when he said that I would feel better in two weeks. I actually wish that either of my first two sleep docs had been honest and said that it can easily take a couple of months of PAPing before you will notice anything positive and that it takes real time and effort to learn how to sleep with a PAP machine. The second worst thing that was told to me? We can't do anything more to help you so go find an dentist and get an oral appliance even though you've got TMJ problems; and we'll be happy to give you a follow-up sleep test in 6 months to see if the device is working, but we're done working with you and don't come back until then. And why do I think this is such a "bad" thing to tell me? Well my severe TMJ is a pretty strong counter indicator for oral appliance therapy for OSA. Indeed, my TMJ specialist, who is also a sleep dentist and who knows I'm on PAP and have struggled with it, has said that with my TMJ issues, it's better for my TMJs to plug away and make PAP work as well as I can rather than expecting an oral appliance to be any easier.

During the bad dark days, the PA who was working with me gave me a lot of positive reinforcement for my dogged compliance numbers and a lot of encouragement that things would eventually get better with the appropriate work on both my part (keep using the machine) and her part (keep coming up with ways to tweak the therapy to eliminate my biggest documented issues.) And much of what I said is advice that was given to me by folks here

To be honest, as one who has to date failed pap therapy in spite of my best efforts, I found that statement extremely hurtful even though I am sure that was not your intention. I would plead with you and everything else who thinks that success on pap therapy is just a matter of attitude to think of an area you have greatly struggled with in your life and couldn't master no matter how hard you tried. I seriously doubt you would have liked hearing those statements although I acknowledge I could be wrong.

Again, if the OP had tried CPAP for several weeks and was saying, "I can't handle it, should I look into an oral appliance?" then I would agree with you. But the OP has NOT even tried PAP. And if he tries PAP with a positive attitude and realistic expectations, then there's good reason to believe that he will NOT be in the small group of outliers that you and I belong to 49er simply because most people are outliers.

I hope you take my post in the spirit it was intended as to be honest, I hesitated greatly in saying what I have said. But I felt I had to say something.

49er, your comments were one the gentlest, politest, but stern reprimands I've gotten on internet forums

In all seriousness, it is useful to remind people, including me, that when we're dealing with someone who is genuinely struggling with CPAP and has been struggling for several months and is ready to throw in the towel, that we should be saying: You've done your best and you've approached this with an open mind and realistic expectations and things haven't gotten better. Maybe an oral appliance will provide enough relief and maybe it will be easier for you to sleep with.

But that said, I also think that it's reasonable to tell folks who are just contemplating the idea of starting CPAP that attitude towards therapy and realistic expectations of what therapy is likely to accomplish will go a long way into insuring that they become happy PAPers.

49er wrote: To be honest, as one who has to date failed pap therapy in spite of my best efforts, I found that statement extremely hurtful even though I am sure that was not your intention. I would plead with you and everything else who thinks that success on pap therapy is just a matter of attitude to think of an area you have greatly struggled with in your life and couldn't master no matter how hard you tried.

49er,

Please don't take this the wrong way. It's an honest set of questions:

You have been working at making PAP work for you for a very long time with limited or no success. So what keeps you in the Hosehead club?

In other words, have you seen a sleep dentist about getting fitted with an oral appliance? If not, why haven't you gone through the process of trying an oral appliance to treat your OSA?

If you have seen a sleep dentist about getting fitted with an oral appliance, why have you decided to stay with PAP in spite of all your difficulties? Have you actually tried an oral appliance? Was it effective? Was it any easier to sleep with?

Just to echo what pbriggs wrote; I've had rather could luck in terms of cpap helping with sinus congestion (among other things). I've got some allergies, but nothing too severe. My sleep doc specified on the script that I should not get a humidifier to help dry out my sinuses (I've sure the DME would have loved to stick me with one). My snot locker is bone dry and I breath effortlessly when I take the mask off in the morning; but in and hour or so I'll be back to my normal post nasal drip and occasional mouth breathing. I'm also using a in-line hepa filter but I'm fairly sure that it is over kill. The point being that for some cases the hose is a friend to the nose (I suppose).

My other comment is that none of these therapies are 100% effective, what works for some doesn't work for all. And yes at times it's hard not to be emotionally invested given the cost and the effort involved. It is good that people share their personal experiences and fortunate that we have different perspectives represented here. It makes for some spirited conversations, but at least it helps to know that one size doesn't fit all. Respect mon (where the hell is the group-hug smilie when you need it?).

That being said, trying cpap probably isn't going to kill you. If it works, good for you. If it turns out to be a disappointment, at least you gave it a shot and you can try something else. I believe it was Dave Tate who posed the question that if you believed that there was a million dollars hidden under a rock in your yard, how many rocks would you turn over? The obvious answer is "as many as you have to". Your child is one year old, taking care of yourself is no longer a lifestyle choice. Don't stop trying no matter what happens. Anyway, I'll shut up now, this is supposed to be paptalk, not peptalk.

Have you tried nasal irrigation? It may other some relieve, it helps my chronic sinusitis.

I use NeilMeds premixed packets and their bottle:
http://www.amazon.com/NeilMed-Sinus-Rin ... hpc_text_z

You may find a better price on other sites, I only know of amazon.com catering for USA.
Also, you only need one bottle.

Is a dental device for apnea even compatible with TMJ?
I know of people who are intolerant of full face masks because of their TMJ.
As for allergies; my cpap and a nightly loratadine have eliminated nearly all my "colds",
and the bronchitis or pneumonia I suffered every winter.

chunkyfrog wrote:Is a dental device for apnea even compatible with TMJ?

According to my TMJ dentist who also specializes in oral appliances for OSA, the answer is "Usually the answer is NO."