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CPAP with Deviated Septum
#1
CPAP with Deviated Septum
Hello, I just received my CPAP machine as well as nasal bongos. Last month, I was diagnosed with UARS and mild Sleep Apnea with an overall RDI of 12. My condition gets worse in my REM sleep with an RDI of 22 over that period.

About several years ago — Autumn 2018, my sleep issues became noticeable. In the Summer 2019, my Ent did a CT scan and diagnosed me with a severe deviated septum. Indeed, I had a lot of trouble breathing through my nose — so much so that I found it hard to concentrate during the daytime. I would have moderate to significant nose bleeds almost every other day.

The surgery helped a lot. And for the first time in what seemed like forever, I was sleeping without any interruption practically every night. 

But a year and a half after surgery, I’ve noticed that my nose has become more congested. I’ll sometimes wake up with my nose plugged 5 hours after sleeping.

My nose is not the only issue. My pulmonologist looked at my mouth and classified it as Mallampati score 3, after which he recommended a sleep study that confirmed UARS.

 After looking at my nose, my ENT said that the deviation is mild to moderate. My ENT’s first recommendation was not surgery a second time. Indeed, I no longer have trouble breathing through my nose during the daytime. But I have found that I need to take a shower before bedtime, blow out my nose, and wear nasal dilators to bed.

Last night, I tried nasal bongos and had to remove the dilators. The bongos did not help, and I had to take the device off after 4 hours of sleep. 

I have a ResMed AirSense 10 Autoset for Her that I am going to try for the first time later tonight. It has a humidifier, so I am hopeful.

But at the same time, I am wondering if I can wear nasal dilators with the CPAP treatment. Would it be dangerous to do so? Would they fall out or get pushed into my airway with the pressure from the CPAP device?

My mask is the ResMed AirFit P30i. I tried it on with the nasal dilators in, and it seemed to more or less fit. That said, I haven’t turned on the air yet — so I am unsure.

Nasal strips haven’t been as effective as nasal dilators for me in the past — so that is why I am thinking of wearing a nasal dilator.
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#2
RE: CPAP with Deviated Septum
Let's do this. Get a Resmed Airfit P10 nasal pillows mask, and you can forget the bongos. I assume you will use Autoset for Her mode. Also, start your therapy with a minimum pressure of 7.0, maximum 12.0 and EPR 3. This will specifically target flow limitation and RERA. If you're going to use a conventional nasal mask, the bongos that prop open your nostrils can be used, but give serious consideration to swapping to the P10. I have some of the same problems you do, and have never needed anything but the nasal pillows which use the positive air pressure to expand the tissues, sinuses and keep your nasal airway open, even with allergies or congestion.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: CPAP with Deviated Septum
Thanks so much for your response, Sleeprider. It was very helpful, and when I tried using it for the first time tonight, the Resmed AirSense 10 machine indeed helped clear my nose. However, I found myself working a lot harder to breathe in general. In addition, my chest was tight and my breathing was fast. I have moderate asthma, so I decided to take my prescribed albuterol inhaler thereafter. In terms of adjusting to CPAP for the first time, is it normal to feel more difficulty breathing? I am a bit scared of trying to use my device again since I just read that AutoCPAP could be bad for asthma, but then again, maybe my symptoms could have just stemmed from anxiety and last night being the first time trying CPAP. My doctor had mentioned the ResMed Aircurve 10 VAuto device earlier, and I am wondering if that device could be better. I understand that there are two different levels for IPAP and EPAP, but would I be able to adjust those to be the same? In other words, could I, for example, have IPAP set to 6cm and EPAP set at 6cm with a pressure support of zero?
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#4
RE: CPAP with Deviated Septum
It actually sounds like a successful first night. Any chance you can download and install OSCAR and post a chart? I could suggest lower pressure settings, but it would be helpful to see how you actually responded to the first night. With asthma, breathing can be restricted from airway inflammation. The bilevel pressure support from your Autoset, should have made breathing easier, but of course, you're not accustomed to that assistance yet. Also, we don't know what range of pressure your machine used, so we are really flying blind. As you adapt, the discomfort will rapidly diminish.

There is no point to having a Vauto and then setting it to a fixed pressure of 6.0. We could easily do that with your current machine. My thought is to try to get a better understanding of your response to therapy, then modifying. Something we could try, is to set the minimum pressure to 6.0 and maximum pressure to 10.0 and use EPR at 2. This would start you at 6/4 and go as high as 10/8.
Sleeprider
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____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: CPAP with Deviated Septum
Hey Sleeprider,

Thank you for your reply. After I developed chest tightness and some difficulty breathing last night, I stopped using my CPAP. Once I had taken my inhaler, I tried again with lower pressure settings for another 30 minutes or so, but I ultimately couldn’t fall asleep and went to bed without my CPAP device. Perhaps I was just a bit shaken as my pressure settings were really low. After my asthma flare-up, I set the EPR level to 3 and had inspiratory pressure of 4 cm. In hindsight, I should have probably tolerated that. Perhaps I am just having difficulty adjusting to CPAP. In any event, I unfortunately don’t have much in the way of data yet as I did not sleep with my CPAP device. That said, I’m going to try to use it again over the weekend, and I can update when I have that data. In the meantime, my doctor encouraged me to consider the ResMed AirCurve 10 VAuto. But my doctor also encouraged me to wait a bit before I make a purchase decision and try the Autoset again. So I am going to give the Autoset a few more tries, but I am just wondering if the IPAP and the EPAP could potentially be set to cancel each other out on the ResMed AirCurve 10 Vauto. More specifically, I am wondering if EPR could be set to the same level as inspiratory pressure — like 5 cm EPR and 5 cm inspiratory pressure. That way, would I be able to exhale like normal only to have pressure support when inhaling?
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#6
RE: CPAP with Deviated Septum
EPR has 3 pressure settings of 1-3 and I'm thinking full time or ramp only. These are in reality pressure settings of exhale relief. Here's the math formula to find out if EPR will do anything as EPR cannot lower pressures below operating parameters, in other words it can't go below 4cmH2O. Take your pressure setting and subtract EPR from it, example pressure 5 minus EPR 1 equals 4 on exhale, 6-2 EPR = 4 and 7 minus EPR 3 = 4. So if you want EPR 3, the pressure must be 7. Unfortunate but EPR doesn't have a larger range than it does.

You should take time during the day while reading or watching TV to get used to the mask and your PAP. I don't think turning down settings without knowing what hindrance you're implementing to your therapy is a great idea.

Also to see the pressure a CPAP creates, insert your CPAP hose into a tall glass of water. There's a method to see this with only 4 inches of water.

One more bit of trivia, 4cmH2O the lowest your PAP goes is .0568934 PSI. It can't blow up a balloon.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: CPAP with Deviated Septum
Thanks for your reply, Dave. Indeed, the highest level of EPR I can set my machine at is 3. But wouldn’t EPR be higher with a bilevel machine — specifically the ResMed AirCurve 10 VAuto? And in this case, could I have the settings at 7 cm min IPAP and 7 cm min EPAP to have an IPAP-EPAP differential of zero?
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#8
RE: CPAP with Deviated Septum
Oh my bad — I think I had misunderstood EPAP. Sorry — I am a newbie. And relatedly, I apologize for the long thread and my asthma concerns. I am just a bit shaken after my asthma attack since I have not had one that bad in years. So I guess my question now is two-fold — can the EPAP be set to zero on ResMed 10 AirCurve Vauto? And, also, with the Resmed AirSense 10 Autoset I currently have, would it be possible for me to suffer from an asthma attack in my sleep if I impose a limit on IPAP — say of 8 or 7 cm — and start out with 6 cm? That way, if I am struggling to breathe from asthma, the machine won’t raise the IPAP on me in a counterproductive, potentially life-threatening manner. And also, since the difference between the min and the max is slight, it might be unlikely for me to develop an asthma attack in the middle of my sleep anyways.
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#9
RE: CPAP with Deviated Septum
As a fellow asthma sufferer, I'd think you would want more air in your lungs, rather than less.  Asthma is a restriction of the air passages, or at least it is for me.  In a way it is a flow restriction, which is what ResMed machines try to alleviate by increasing IPAP.  Asthma attacks are horrible.  I get them rarely these days, since I also use a long term asthma drug, but alway have a quick acting inhaler on my person.

I find a shot of albuterol not only opens up the airways, but is a strong stimulant.  There's no way I could sleep right after a solid albuterol puff or two.  I'd do something else to wait to calm down before trying to sleep again.  Of course you may react differently.

Also have a deviated septum.  It makes full face mask fitting more difficult.  At times a single nostril gets blocked.  As long as the other one is unblocked, it shouldn't matter.

In any case, I use my VAuto all the time.  In my case, it has never triggered asthma.  It may simply have been in your case that your anxiety about the machine has triggered an asthma.  In that case, perhaps you need to train yourself to use the machine in the daytime, to get used to it, and to see that it will help you and not hurt you.
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#10
RE: CPAP with Deviated Septum
The minimum EPAP pressure for any bilevel machine I am aware of is 4.0 cm. Pressure support for IPAP is on top of that. A Vauto with EPAP of 4.0 and PS 3 results in 7.0/4.0 pressure. Similarly, the Autoset with pressure at 7.0 and EPR 3 provided 7.0/4.0 pressure. With bilevel, the more pressure support, the lower the "apparent" pressure will seem at EPAP. A machine with EPAP min 4.0 and PS 6.0 for IPAP 10.0 (10.0/4.0) will feel easier to exhale than the machine at 7.0/4.0. Higher pressure support will increase ventilation, and can even result in flushing the CO2 from your lungs, which may contribute to hypocapnea and potential central apnea events.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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