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2 months in.... hard to judge success
#1
2 months in.... hard to judge success
Thanks to this board I made some changes to pressure, finally settled in on the Dreamwear pillow mask, learned to clean my face before going to sleep etc.  I’m able to go about 4-6 hours with the mask.  AHI is less than 4.  Leakage is controlled. I do still wake up a few times and have to adjust things.  And most days after about 5-6 hours I wake up and my nose itches or I just really want to sleep more on my side so I take the mask off and I might sleep another hour or two without.

I feel a little less groggy. As a really interesting side benefit, my sinuses seem to be staying open and clear more with the nasal pillows than without any CPAP usage.  I have a deviated septum and was considering surgery but now, I’m thinking no. I use sprays and antihistamines and such.  But I wake up now and I can breath. Without CPAP, most nights I’d wake up within a few hours and they’d be swollen shut.  Maybe it’s the warm humidified air.....

My question is this. I really started this because I’ve had two Afib incidents and my cardiologist says everything else with my heart is fine. He thinks my snoring and apnea stresses my heart into afib.  How do we know if I’m using this ‘enough’? Is 4-6 hours of sleep with successful CPAP usage helping? I’m less sleepy with 4-6 hours than I was sleeping 8 but snoring and waking up a lot.  How do we measure success?
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#2
RE: 2 months in.... hard to judge success
I think my main advantage from PAP is keeping my airway clear. I think it is a mixture of the humidity and air flow that do so.

I started out with horrible congestion. Had to use dymista every night and the odd night a decongestant. PAP didn't solve this for me though. Interestingly messing around with some food elimination diets made me realize I react to dairy and cutting it out of diet improved nasal congestion significantly. Keep an eye on what you eat and see if can notice any correlation with when nasal congestion is worse, in my case it was difficult as my worst congestion wasn't necessarily the day of ingesting dairy but sometimes 2-3 days later. It was only after multiple eliminations and reintroductions that it became obvious to me that it was the culprit and then full removal causes slow gradual improvement. I don't use nasal sprays at all anymore (well am currently using a rinse with steroid but that is because of post surgery).

In this process it was recommended I get septoplasty and turbinate reduction so I had that done. If congestion is an issue I wouldn't be opposed to that surgery. It does take a bit of recovery time and wont necessarily fix the issue on its own but I do believe it minorly improved my nasal breathing capability.

I think the exact answer to your question depends on your current situation which I am not aware of. If your apnea is minor then treating majority of sleep period is doing enough, I sometimes take off mask and sleep 1-2 hrs more if I feel I am not sleeping that great with it that night. If you have severe apnea I would try using it majority of time (even during naps etc) though. Trying to figure out why you don't get enough sleep with PAP would be my goal in your shoes, something must be causing you to be uncomfortable etc if you feel you sleep better without it and take it off like you do.

Edit: Even at 2 months in your body will continue to adjust which might help with some of this. Trying to use it as much as possible might coax body into agreement that this is preferred way to sleep. I didn't fully convert until months in when I tried quitting and realized that it was making a difference then it was easier for me to commit to regular use.
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#3
RE: 2 months in.... hard to judge success
Given what your cardiologist has told you, it's important to use CPAP for all of your sleep. During those non-compliant sleep times, your apnea and snoring can cause you to go into afib, you've been told, and of course you don't want that to happen.

So as geer1 says, the challenge is to make you more comfortable with your mask. For itchy nose, you mean on the inside, right? Have you tried simply pressing on the outside to see whether that helps? You can also turn the machine off, lift away the pillows, blow your nose, and reseat the pillows. Would that work for you?

You should be able to side-sleep easily with a pillow mask. What prevents that, do you think? Would it help to use a hose lift (aka hose stand) to get the hose out of the way? Or perhaps to use a lower, firmer bed pillow?
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#4
RE: 2 months in.... hard to judge success
Thanks for the thoughtful reply. I have allergies that tend to complicate my sinuses and a deviated septum.  But so far using the machine I actually wake up perfectly clear. It’s pretty interesting and a side blessing!

I should have been clearer about my afib. I’ve ‘only’ had two incidents. Both times during the day and I had to be shocked back into normal rhythm.  But I do have occasional skipped beats. It runs in my family.  The doc says it’s just an electrical thing and hard to say for sure the cause. Although literature says there is a lot of correlation with apnea.  I’ll see him in a month or two and will ask him about this as well.  He’s part of a large cardiology practice in my area that interestingly just opened a sleep clinic and service.

I am trying to use the machine every night and as long as I can. I realize that it may take more time to grow accustomed to it.
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#5
RE: 2 months in.... hard to judge success
The nose itch is on the outside. I’ll take the mask off and under my nose is usually pretty oily and once I rub for a minute or two is fine. 

I need to eliminate the ramp and make it easier to just put back on. I actually do better with it running at the recommended level from the start.

I do sleep on my side….kind of. I’m on my side with my face kinda twisted up so it doesn’t push on the nasal pillow.  When it does it tends to break the seal with my face and start hissing. That wakes me and the misses.
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#6
RE: 2 months in.... hard to judge success
Ah, the end of your nose. You might try wiping with an alcohol prep pad before bedtime to get the oil off. They're sold in my pharmacy in the diabetes care section.

I've had a handful of tachycardia episodes, all during the day, and I REALLY would not want one at night. It's good you'll be talking more with the cardiologist.

It sounds as though you *might* do better with a firmer bed pillow so your head would not sink into it. That could be part of the reason why your mask gets knocked out of kilter. You might also look into a CPAP pillow, which have cutouts on the side so you can hang your nasal interface off the edge more easily.

And something to think about: the Dreamport mask, aka Bleep mask. "Ports" stick on the ends of your nose, and an interface snaps into them. Skin prep with alcohol wipes is essential, and fastening the interface to the port is fiddly at first. But I love this mask. If you decide to try it, be sure to get the newer version, which is the one with the little black gizmo that holds filters in place over the vents. It also has a longer, more flexible hose.

Honestly, I wouldn't really advise trying the Bleep now, when you're still working on full-night usage. But it's an option to consider down the road.
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#7
RE: 2 months in.... hard to judge success
Untreated apnea can cause heart issues and afib. Trying to figure out how to maximize treatment reduces long term risk of these issues and is believed to extend lifespan in people with heart issues. Both my grandfathers are still alive probably in part to CPAP helping them breath and reducing stress on their hearts, one has congestive heart failure and the other afib (but I don't think he has had any issues since using PAP consistently).

The trick is to learn ways to deal with the issues you think affect you. If you wake up with greasy oily nose, have tissues close by and temporarily remove mask, wipe off nose, give it a good itch and then put mask back on. Potentially might be worthwhile adjusting humidity settings (I would think reduce one point if condensation/oily inside mask).

I like to sleep on my side and had trouble getting nasal masks to seal properly. My full face mask is more bulky and you would think it would be counter intuitive but I can tighten up the straps a fair bit which holds it secure when I sleep on my side. Finding the best mask and pillow arrangements etc to allow you to be comfortable can take a lot of trial and error, I tried at least 6 masks (P10, N20, P30i, N30i, F20 and F30) before I settled on F20 being the best for me. One trick I use for side sleeping is sleep with head towards edge of pillow so there is more room for mask to sit while allowing head to tilt flat or even downwards a bit.

Turn off ramp. It it useless unless you require high pressures and are not able to fall asleep at those pressures.
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#8
RE: 2 months in.... hard to judge success
I suggest to use the pap as long as possible and don't sleep the last hours without, since it's when you are having the longest REM phase, which is where most people gets issues.
Usually success is considered when AHI drops below 5. But the real success to me is solving symptoms, which often doesn't happen if there are still some flow limitations/apneas and arousals.
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