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[Treatment] Spouse has very high AHI and congestion when trying CPAP
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snowboardjoe Offline

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Posts: 9
Joined: Apr 2014

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: ResMed H5i
CPAP Pressure: 4-11
CPAP Software: SleepyHead

Other Comments: On CPAP since 2010

Sex: Male
Location: Seattle, WA USA

Post: #1
Spouse has very high AHI and congestion when trying CPAP
I've have sleep apnea and have been treated for years successfully. My spouse I recently got him diagnosed. When he tried CPAP treatment, he realized how badly deviated his septum was and could not use nasal pillows. After surgery late last year, the problem was resolved. However, he is still having a major struggle using CPAP. During this year he has only managed to use it about 3 times and each time he abandons it within 90 minutes.

He is using the same machine model as I do, but uses a slightly different nasal mask right now. His main complaint is nasal congestion sets in within about 30 minutes to the point he can no longer breathe. When I look at his CPAP data with SleepyHead he's fine for the first 15 minutes, but then OA's build up very rapidly and his AHI is up over 50. He'll be in OA for about 10 seconds, take 2-3 big breaths and repeat the process over and over again until he finally wakes up and rips off the mask. I know his apnea is not that bad without the machine. We have the machine setup with the heated hose at a temp of 75°F.

My only suggestion right now is to get him on a FFM (I have an old one) so that he can still breathe when he gets congested and see how that goes. This is a problem because he gets claustrophobic with such a large mask attached to his face and it scares him particularly when he wakes up and forgets about it. My only suggestion to counter that has been to use it while he's awake to adapt to it that way.

Anyone have any other suggestions here? He can be very impatient, so I have to ease him into this the best way I can to make sure he stays healthy. Without treatment his SpO2 drops way too low (as does mine). The extremely high OA rate is very odd and I don't really know what's causing that with treatment vs. without (at least that's my perception).
02-02-2015 03:11 PM
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eseedhouse Offline

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Post: #2
RE: Spouse has very high AHI and congestion when trying CPAP
(02-02-2015 03:11 PM)snowboardjoe Wrote:  Anyone have any other suggestions here? .

My suggestion is that he needs his nasal congestion treated, and treated successfully. You need to insist that his doctor treat this and treats it soon.

I suffer from the same sort of thing, and getting it treated with a steroidal nasal spray has helped no end. He should get the state of his sinuses assessed and treated, if necessary, with antibiotics.

I am not a doctor and do not play one on T.V.

Ed Seedhouse
VA7SDH

I am neither a Doctor, nor any other kind of medical professional.

Actually you know, it is what it isn't.
02-02-2015 03:19 PM
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snowboardjoe Offline

Members

Posts: 9
Joined: Apr 2014

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: ResMed H5i
CPAP Pressure: 4-11
CPAP Software: SleepyHead

Other Comments: On CPAP since 2010

Sex: Male
Location: Seattle, WA USA

Post: #3
RE: Spouse has very high AHI and congestion when trying CPAP
I should add that he has no sinus issues as he goes to bed. He only develops the congestion after he starts CPAP therapy. In terms of the sinus congestion, he nose becomes blocked and his ears become plugged when the CPAP pressure is applied.

We do have an appointment setup in a few weeks to see his sleep doctor, but looking for alternatives and suggestions in the interim.
02-02-2015 05:00 PM
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retired_guy Offline

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Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: ResMed
CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #4
RE: Spouse has very high AHI and congestion when trying CPAP
Most people do very well with humidity and heated hoses. It sounds like your spouse may not be one of those. If it were me or mine: I would plop him into a nice "comfy" chair, and strap on a nice non-threatening pillows mask. --- I'd have him try this in his comfy chair for awhile to see if he does ok without the humidifier. If he did, I'd tuck him in for the night. After a day or so of this he should be used to the therapy if it's comfortable for him.

You did not mention the pressures, but if he's at minimum of 4 as you indicate in your profile, I would increase that to at least 6, maybe more. I would turn the "ramp" feature to the "off" position.

As to his max? It's unlikely he should be the same as you, with a max of 11, but until he's used to the therapy I'd go with something like 12 for a day or so to see what the reports show. He may need it to be higher, but if so you may want to turn the epr on to a setting of 3 for him to be comfortable. ..and for higher settings, I'd want the minimum to be a little higher as well.
02-02-2015 06:27 PM
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PaulaO2 Offline
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Post: #5
RE: Spouse has very high AHI and congestion when trying CPAP
Yes, have him wear it during the day. Try it with and without the humidifier. Try the FFM as well. Don't wait until night time to do this stuff or he'll never get used to it!

It could be the pillows are not going to work for him due to the septum issue. He may have to go to a nasal mask which still sends in the same pressure of air, just not in two single jets of air at once.

A FFM is not as claustrophobic as it seems like it would be. I was surprised, actually, at how small it felt and how minimally aware I am of it. The only time I feel smothered by it is when I try to speak. I can't. I can't push against the air and my chest starts to hurt. At first, I panicked and ripped it off. I've gotten more used to it now. I sat up with it on, during the day, and practiced talking. I also practiced taking it off, getting faster and faster at it until I felt "safe". This came in handy last night. The machine decided to shut down and I suddenly was getting NO AIR. Instead of panicking like before, I just automatically reached up and unclipped the mask and off it came, just like I had practiced. Go me!

So he's going to have to do the same thing. Get comfortable with it. Play with it. Become friends with it.

PaulaO2
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02-02-2015 07:17 PM
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Sleeprider Offline
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Machine: Resmed Aircurve 10 Vauto
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Post: #6
RE: Spouse has very high AHI and congestion when trying CPAP
Snowboardjoe, what pressure settings are being used?
Was your partner diagnosed and titrated?

Any environmental changes that could trigger an allergy? Is the machine clean, new and free of allergens with a new filter?

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(This post was last modified: 02-03-2015 02:36 PM by Sleeprider.)
02-03-2015 02:34 PM
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snowboardjoe Offline

Members

Posts: 9
Joined: Apr 2014

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: ResMed H5i
CPAP Pressure: 4-11
CPAP Software: SleepyHead

Other Comments: On CPAP since 2010

Sex: Male
Location: Seattle, WA USA

Post: #7
RE: Spouse has very high AHI and congestion when trying CPAP
(02-03-2015 02:34 PM)Sleeprider Wrote:  Snowboardjoe, what pressure settings are being used?
Was your partner diagnosed and titrated?

Any environmental changes that could trigger an allergy? Is the machine clean, new and free of allergens with a new filter?

Been super long since I posted this and there has not been much to update. He has almost given up on using CPAP, so this is still a major struggle for him. I'm still working all angles here to get compliance (and so that I can sleep without feeling like I married a chainsaw at night).

He has been the sleep doctor, but he was rather frustrated as there was little to no data to go on and has asked him to keep trying. Just using 2 hours per night would give him some useful information.

He did get a new FFM and he actually likes that part. I figured this would be a huge win, but it has not worked out. After about 15 minutes or so, his nasal congestion sets in and sets in fast. He ends up being force to breathe through his mouth, but this wakes him up and he's unable to sleep. after another hour of that mess he finally abandons CPAP. In about an hour, his nasal congestion subsides again. This is a ResMed S9 AutoSet set in full automatic mode. His apnea events become so frequent and severe the machines ramps up to 16 or higher before he rips off the mask. I tried limiting the pressure to just 8 and that does help, but we have have the constant nasal congestion that sets in shortly after he starts CPAP treatment and fades after he stops.

After reading some other posts, it seems we may want to try using no heat (humidifier or tube) and see if that's what doing it. That or just cranking the temp way down low. Maybe the warm humidity makes things worse for him? I would he could learn to breathe through his mouth, but he just can't do it right now.

It's really hard trying to get someone to adapt to CPAP when it appears treatment makes sleep worse. It's a big hump to get over, I know, as i went through the same issue many years ago.

I welcome any more suggestions or what may be causing this persistent congestion. He does rinse almost every night. We use HEPA filters in the bedroom, so the air is clean there.
03-05-2015 02:56 PM
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Sleeprider Offline
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Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #8
RE: Spouse has very high AHI and congestion when trying CPAP
Sometimes passover humidity without heat is enough for comfort and can avoid some congestion.

If you want to take a real flyer, try him on a nasal pillows mask. Last week I had a severe cold and was really congested, but as soon as i put on the Airfit P10 pillows, the pressure opened my sinuses and made breathing easy. I know it sounds counter-intuitive, but it might work. You are getting nowhere with a conventional nasal or FFM. It might be worth having him take some decongestants before bed. Some can induce drowsiness and help sleep as well as keep the airway clear.

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03-05-2015 03:32 PM
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retired_guy Offline

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Posts: 2,744
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Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
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CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #9
RE: Spouse has very high AHI and congestion when trying CPAP
I wonder if maybe something else is going on. For instance maybe he's throwing "hay fever" sort of a reaction to the silicone mask itself? Just thinking out loud....... Just for the heck of it, cut him a mask liner out of an old t-shirt to insulate between his face (nose mostly) and the mask. Have him use it in front of the tv tonight for a couple of hours just to see what happens. If that happens to work, let him sleep in his comfy chair for a night or so if that's what it takes to break this cycle.
03-05-2015 03:39 PM
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