help UARS and cpap suddenly not working

[hgabs]

Hello All

After years of TMJ and morning migraines (sine 2008) I was finally diagnosed with UARS in 2018. I did a few soft palate and easy procedures with radiotherapy and laser (first was using nasal dilator and a MAD device. Anyways in 2019 September tried a cpap for the first time (dream station) and it changed my life. For the first time ever I barely had any migraines or fast heartbeat and so on. IT was like a miracle. Anyways now all of a sudden since January the symptoms are back and I even downloaded Oscar to start checking my data (I am clueless as to what I am reading) but I am desperate to find out why the symptoms are suddenly back. The only think I did different was I got off my Nexium in November so my doctor suggested I try a mild dose again (I have been starting). I was first using the DreamWear nasal cushion and it was great. Then after I came back from my laser surgery in January the symptoms have been returning. I tried to switch to the full face mask for a few days (I felt worse). Then now I switched to the Philips nasal pillows (they feel better) but my symptoms of exhaustion and moodiness and rapid heart rate are all back. I even tried Benzos one or two times to calm myself down from the anxiety of this coming back! Any advice you can provide would be really appreciated it! (note I also have a heated hose as well but the air still feels a bit cold). I wonder if my LPR (have nighttime reflux) is contributing or is it my opening of mouth at night (my husband said a few times my mouth was open (but there is no leak rate on the machine) I even suspected it could be my nose and allergies but I'm on immunotherapy and take Claritin and am wearing a nasal dilator with my nasal pillow mask. Please note also I am not over weight I weight around 56 kg. I am also happy to post some data but wouldn't know what to post. Thank you so much!  

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here are some of my oscar results

[Sleeprider]

For UARS, we like to see bilevel perssure which is provided by either a true bilevel machine, or the Resmed Airsense 10 series which provides up to 3-cm difference between inhale and exhale pressure (IPAP-EPAP). Pressure support does part of the work of respiration and can overcome the effects of upper airway resistance. Pressure support specifically targets flow limitation, which is the calling card of UARS, and it specifically targets hypopnea, while maintaining lower overall pressure. A good article to read is in our wiki http://www.apneaboard.com/wiki/index.php..._and_BiPAP

The Philips CPAPs are far less optimum for treating this. Resmed specifically targets flow limitation, and offers true pressure support, while Philips does neither, and the Flex comfort features do not work well for UARS or flow limitation. With all of that said, your charts show you get pretty good results. The overview demonstrates you achieved a better efficacy with a higher minimum pressure, which in turn stabilized the auto-pressure through the night. Therapy looks very good, but if you really want to take it to the next level, keep an eye out for a Resmed Aircure 10 Vauto. This bilevel machine has the best ocmfort features for treatment of UARS and flow limitation of any machine on the market. While your Philips lets you manipulate pressure, the Resmed Vauto provides full control of EPAP, IPAP, and the timing of inspiration as well as trigger and cycle sensitivity. Reasonable prices are often available from Supplier #2 and in the used marketplaces. I know that's not what you wanted to hear, but the difference to your therapy and feeling of good health are transformative.

[tarah]

Hello, welcome.

You are needing to use an oral antihistamine, a nasal dilator, and are on immunotherapy for inhaled allergies?  Has anyone taken a look at what's going on with your nose?  That is alot of stuff you are doing in an attempt to breathe through your nose.

[hgabs]

Hi yes I have multiple surgeries on my nose with no luck so its mostly allergies and the nighttime reflux. some nights it's fine others its not. 

So I shouldn't increase the pressure? 


Thanks

[tarah]

First thing, I would go back to the ENT and tell them you're still not able to breathe through your nose.  It is very common for turbinates to need multiple procedures, especially if you have allergies.  I'm pretty much expecting it within a year.  My ENT did say she's never had to shrink someone's turbinates more than 2 times in their lifetime.