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A couple of newbie questions
(12-23-2017, 11:45 AM)paulag1955 Wrote: I'm not sure what else I can do to minimize the post nasal drip. It's just really bad some nights.
Perhaps avoiding the worst of the mucous forming foods (dairy & soy) would help?
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Paula, you may have complex apnea. Your diagnostic study shows fully half of your total apnea events were either central or mixed,with the other half being obstructive. Most of your events were hypopnea, and the total AHI was 10.3 during the test. While this might seem mild to borderline moderate, your SpO2 (blood oxygen saturation) was very poor, with almost 19% of the night at low oxygen levels of 80 to 89% and a brief period less than 80%. Based on that AHI, your results on CPAP are as bad or worse than untreated. Feel free to relate that fact to your doctor.

You need a different treatment approach, and it would be best if that decision comes from your doctor. You should continue to use CPAP only because it shows a commitment to the therapy, even though it provides you no apparent benefit. It might be a good idea to invest in an oximeter that will measure and record your blood oxygen levels so you can see how important getting effective therapy is.

You probably need to be using an ASV machine. ASV uses low pressure to prevent obstructive events, and provides supportive pressure on a breath by breath basis to help you take a complete breath during any central apnea or hypopnea. They are very effective, but very expensive machines, and unfortunately you have to fail at CPAP and have a sleep study that shows you are treated with ASV, before insurance will cover it.

I have suspected you have complex apnea for some time, and the only solution I can recommend to you, and have recommended several times is to LOWER your maximum pressure and get rid of EPR. Both high pressure and pressure variation will make your complex apnea worse. I think your best results will be with a maximum pressure of 8 and EPR off. That will be a lower pressure than you have ever slept with yet. You can take my suggestion or leave it. Either way, you need to work with your doctor, and let him know that there is absolutely no benefit to CPAP, at his prescribed settings. Your event rate is the same or higher than untreated. You should be aware that there is a therapy that can help, but you need to push to move this process to the next step which is to evaluate bilevel positive pressure therapy with a backup rate. That is what an ASV or BiPAP ST is...a device that provides a backup breath when you don't take one. The difference will be life-changing for your sense of well being and fatigue.

[Image: zYEW7fb.jpg?]
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I already don't eat soy or dairy. It used to be worse.

Sleeprider, thank you for your thoughtful response. This is especially frustrating, because with my Kaiser insurance, the doctors are employed by the insurance company. You'd think they would be able to prescribe the most appropriate machine without jumping through all the hoops.
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Some people actually do respond well to CPAP and end of story. No point in paying $4000 for a machine if the patient responds positively to a $800 one. You on the other hand, have shown zero improvement, and your health remains at risk, mostly because of the effect this has on your oxygen saturation.
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(12-23-2017, 03:18 PM)kiwii Wrote:
(12-23-2017, 11:45 AM)paulag1955 Wrote: I'm not sure what else I can do to minimize the post nasal drip. It's just really bad some nights.
Perhaps avoiding the worst of the mucous forming foods (dairy & soy) would help?

There are many threads dealing with post nasal drip.  Here is one for example:


If you search to forum for post nasal drip you will find many suggested solutions.

Happy Pappin'
Never Give In, Never Give Up

Using Attachments to Post Images on Apnea Board 
Robysue's Beginner's Guide to Sleepyhead

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I've just been chugging along. I've lowered my maximum pressure to 8.2 and have EPR set to 2. I tried EPR at 1 but I felt like I was suffocating all night and ended up pulling the mask while I slept at some point during the night. Anyway, as you can see, my results have greatly improved. Where as before I was seeing results in the teens, twenties and even the thirties, since I've lowered the maximum pressure, all my results have been between 3.something and 8.something. Still not enough for me to feel any benefit from it. 

My doctor is going to schedule an in-house sleep study for me. I am not looking forward to that at all, but I am quite eager to get this settled.

Here are my charts from night before last.

[Image: cdP6llk.png]
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I am still waiting for my in-house sleep study to be scheduled. I'm seeing results consistently in the 3 to 6 range now, so there's been more improvement since I lowered the settings.

I have two issues. First, I still haven't found a way to sleep on my stomach that doesn't result in mask leaks. The end result of this is that a) I wake many mornings with one or both of my hips so sore from all night side sleeping that it feels like I'm going to develop pressure sores and b) being uncomfortable noticeably interferes with my sleep. So even though I've made gains in improving my AHI, I still don't feel any benefit during the day in reduced fatigue.

The second issue is irritation to the skin on my face, including redness over the entire apple of my cheek and occasional burst capillaries. Yes, I can wear foundation makeup to conceal it, but I'd rather not. I have looked at the strap pads and it appears they're made of the same material covering the straps on my ResMed AirFit P10, so I'm not sure what to do. I may try making my own covers from a natural fiber. Has anyone here had any success with that?
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Paula, I've just discovered your thread this morning.

From early on I suspected that Sleeprider (who has helped me immeasurably in my journey) was thinking you have complex apnea (as I do), and that seems to be the case.

ASV machines deal with this issue brilliantly. Unfortunately, they are expensive and--for that reason--there can be considerable "hoop jumping" before one is approved for ASV under insurance.

In some ways maximizing your numbers with APAP is counterproductive, as the failure of APAP is a necessary first step in the process. It is generally the case that your sleep doctor/sleep clinic need to hear loud and clear that you are experiencing a large number of CA events, feel poorly, you feel that APAP is failing, and that you wish to pursue other options for treating you mixed apnea types.

Do (as advised) continue to use APAP, even if the results are inadequate, as it shows the necessary commitment to therapy to move the process along.

You might be a "lucky one" whose doctor sees you need ASV right away. But it seems most of us need to be squeaky wheels in order to move the approval process (including a new sleep study) forward.

The good news I can offer is in my case, is that moving from APAP to ASV had a very profound positive impact in my sleep quality and how I feel.

Expect a process and some frustration. But make it very clear to your sleep team that APAP isn't working to solve your CA issues.

You received excellent advice in this thread. There is a technological fix. You will likely need to "push" to get the ASV machine you need. But it will solve the problem.


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Bill, thank you for the encouragement. I can be pretty squeaky when the need arises!
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(01-18-2018, 01:27 PM)paulag1955 Wrote: Bill, thank you for the encouragement. I can be pretty squeaky when the need arises!

Me too.

I have no doubt that without that quality and the invaluable information and counsel of wise forum members that I'd still be on APAP, and faring poorly.

For myself, the difference with ASV has been profound, and I would have been considered a "borderline case" I'm sure. The energy put into the process of getting ASV approval has been well-compensated in better sleep and vastly improved well-being.

Best wishes on this journey. If I can be of help, let me know. For now, you have the best and the brightest on the case. However, at this juncture failing on APAP is in your long-term interest.

My suggestion is that time to start self-advocating has come. Be nice, but be firm that APAP is not solving your CA issues and you wish to explore other options (ASV).

Ultimately you will want a ResMed AirCurve 10 ASV.

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