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My opinion is that too many doctors follow a fairly rigid if --> then procedure to diagnose and treat people. It works for lots of stuff, but I think a lot of folk have lost sight of the fact that OSA is a syndrome, not a disease, which means there are any number of underlying causes that can cause a similar kind of trouble. Sleep docs are too keen on fighting the OSA fire by simply aiming the extinguisher at the flames with CPAP.
Part of that may have been the reputation in the past about OSA being a disease for people who are old and fat. Age and weight are still considered risk factors today, but when sleep disordered breathing is looked for, it is found in more and more people of all shapes and ages. It's frustrating as a relatively young and healthy person to get told by the sleep center to try CPAP, or if you don't want to do that you can ignore it until it starts impacting your health even more and then try CPAP later. Then following 3 years of trying different things, take matters into my own hands, get a camera up the nose, and immediately told there's easily correctible stuff causing most of the problem. It sounds like your doctors came to you with the proposal to pick the low-hanging fruit, which is a credit to them in my book.
I might be biased because of my own experience, but I'm starting to notice a pattern here at this board. I think the age distribution of folks here is too young. By that, I mean that the majority of folk who get an OSA diagnosis are probably still older on average, but those are the same people who are the best candidates for CPAP and it works for them and we never hear from them here. There are a ton of threads started by people in their 20s and 30s who are trying to use CPAP and it's not working well for them, I think we are the ones who need to dig deeper and find what's burning before we spray the extinguisher.
It's totally your decision what to do next. As a mechanical engineer, I completely support digging deeper into the physical components of the system to see which of them are improperly performing their functions. A sleep endoscopy is the closest you'll get to finding out why your particular airway is occluded, so if you want to tunnel further down the rabbit hole, that's the next step because you already had surgery to correct the stuff that appeared problematic when you were awake.
Look, I'm an engineer, not a doctor! Please don't take my opinion as a substitute for medical advice.
That makes sense BoxcarPete. I'll keep the sleep endoscopy in mind as something to ask my sleep doctors about the next time I consult with them, if it comes to that.
And it sounds like you're saying that CPAP is oftentimes prescribed in a blanket way, often without much regard for what the underlying "mechanistic" causes of the OSA may be. And as patients, unfortunately the onus is often on us to do the deeper digging to figure out what might be at the causal root of things when the CPAP approach isn't working. I was a math major, so I appreciate the mechanical engineering framework
Thanks for the suggestions, Sleeprider. I'll try the settings you're recommending and will report back after a few nights. I've also ordered a cervical collar to try out.
01-24-2024, 06:39 PM (This post was last modified: 01-24-2024, 06:41 PM by bloom25.)
RE: CPAP issues after tonsillectomy + septoplasty
So, for the past five nights, I've tried Autoset min pressure 8, maximum pressure 12 and EPR full-time at setting 3. I also have been using a "poor man's" soft cervical collar (an airplane travel pillow worn backwards). I received a soft cervical collar from Amazon today, so I'll be using it from now on.
These adjustments definitely seem to have helped with the flow limitations, as well as with the frequency of hypopnea and obstructive apnea events!
The subjective feeling of restfulness has still been very up and down, though. I felt "normal" on two out of the last five days. Attached are three Oscar graphs. The 1/19 night felt very refreshing. The 1/22 night was rough -- I felt physical and emotionally fatigued the next day. 1/23 was somewhere in the middle -- felt more physically refreshed, but with a "hangover" feeling and brain fog the next day.
Would turning down EPR to 2 be a next step here, to see if that brings down some of the centrals? I also have an n20 mask, which I could try using with these same settings.
Tried going back to using a nasal mask (n20) the last couple of nights. Also set EPR to 2 (down from 3) to see if that might reduce some of the CAs while still keeping down the flow limitations. The Oscar charts are attached.
The data continues to look cleaner, as far as obstructive apneas, hypopneas, and flow limitations. I'm registering almost no apneas other than CAs ever since I put on the cervical collar and turned on EPR.
But still lots of brain fog and not feeling normal during the day, and continuing to wake up throughout the night.
I'm getting much higher leaks with the nasal mask than I used to, so I'm gonna go back to using the FFM, with which at least the leak rate wasn't complicating things. Will try that with an EPR of 2 for the next few days, unless there's any other suggestions. That seems to be the remaining setting I haven't tried, yet