Pokey49 - Therapy Thread

[Jay51]

Excellent explanations by Dave and super7pilot about CA's.  

1.  Clear airways - probably most common.  A deep breath (after a flow limitation or position change, etc.) can cause these (quickly flushes out CO2).  

2.  Treatment emergent CA's - a lot of new xpap users experience this because of increased flushing of CO2.  They usually adapt to this in a few weeks or more. 

3.  "Sleep-wake junk" - these can occur anytime during sleep when a person transitions from sleep to wake or vice versa.  The transition is not perfectly efficient. 

4.  Real, true (brain oriented) central apneas - caused by a problem with the brain or possibly phrenic nerve or diaphragm.  Just occur "out of the nowhere" like super7pilot eluded to previously.  

And a person can take a home sleep study or polysomnography on different nights and have a different number of CA's - the inconsistent nature of CA's.  Mask type and leaks can be a factor.  Pressure(s) can be a factor as well.  Medications.  


Isolating and treating the specific type of CA can take time and lots of analysis.

[ejbpesca]

My spiel for a BPAP will be concentrated on breathing comfort.  After much research I think they will want me to do another in lab sleep study to see if BPAP is necessary which will not be found by their standards but a simple case of an APAP being so uncomfortable it can't be used is a reason to get a BPAP, no sleep study needed.  In actuality, I am going for a reduction of Flow Limitations by using BPAP.

It is sad we don't have machines with all available modes in them.  I understand the software in the machine is the difference.  One OP claims he has converted his Autoset 10 to an ASV machine by flashing the software.  Not sure that's possible but interesting how he/she may have connected the machine to a computer and uploaded the ASV algorithms.  The post is on the first page of the forum.

My sleep studies are not concerned with Flow Limitations and I understand they are controversial as is UARS with some clinicians thinking they are normal events unless they lead to an apnea event.  A polysomnographer YouTuber claims FLs may simply be snoring and snoring is not apneas so his lab is not concerned with it.

But! There is hope for me yet with my APAP.  With my new cushion installed and pressure up a bit I have had 3 consecutive nights of AHI < 1.00!  Pop the cork! Ha!  Unfortunately, within a few days, the cushion will be leaking and I will be losing effective therapy.  It will go from 5/L to 30/L at the end of the month.  If I could afford a new cushion every week it would be nice.

[super7pilot]

Well said Jay. As has been said. CA's are very much consistently inconsistent.

Case in point. Last night I had 7 CA's. 2 nights ago I had 3 CA's. 3 nights ago I had ZERO CA's and 7 more before that.  So I'm sat at my laptop doing this:  And end up doing this:

[lsparks1]

Hey Pokey, and further updates with your progress? I can't believe I've read this entire 62 page thread, but I found it interesting and I learned a lot. Thanks.

[Pokey49]

Ispark. Welcome to the party!!’

[Pokey49]

Last night turned out to be one of the more restful nights I have had in some time. I cannot explain the difference why. I was up a couple times due to back pain, thats why you will see the gaps in therapy. Amazingly I was able to go back to bed and go to sleep. My CAs were confined to occurring just before waking up mostly  and my flow rates were the cleanest Ive had in some time and I actually fee relatively rested today. I have not a clue as to what the difference is but I'll take it.

[Pokey49]

I’ve been on cpap about 3 months now. Still struggling with it. One problem that I havent been able to fix yet is nasal congestion.  Soon after I put on my mask (P10) my right nostril, yes only my right, starts plugging up.  My humidity is set to auto and temp is at 84. I still plug up on that side. I’ve tried a couple full face hybrid masks which helps with the congestion issue but they present other issues not to mention I really dislike them on my face. 
I’ve been using a squirt of Afrin up that right nostril but I can’t keep doing that. 
Any suggestions on humidity settings??

[Pokey49]

Gentlemen. What should I set my humidity and temp to to prevent nasal congestion. I only get plugged up on the right side soon after starting therapy. I’ve been using one squirt of Afrin for several nights but I can’t keep doing that. So just now I bumped my humidity up to 6 and temp to 84. I see I can even go a bit higher. I really don’t want to go back to aF40 or F30 if I don’t have to. I basically hate them. I get fewer leaks with a P10 pillow mask, better therapy I think and I’m not claustrophobic with a P10 or Nuance gel pillow mask.

[SarcasticDave94]

You probably do not want to use Afrin very long. I would look into getting Flonase to replace it.

Set your humidity to manual, and number 4 which is the middle setting. Try it and if it's not humid enough, go up to 5. If it's too humid at 4 go to 3. Repeat this edit until your humidity is where you want it.

[super7pilot]

You could crank it up. Your room humidity has a dramatic effect as well. So a humidifier for the bedroom is an option.

And i would ditch the afrin. You will get rebound stuffiness and ramp up your blood pressure. Flonase is an option you can use long term.

I do a nasal saline rinse every evening. But after that vivaer procedure. I just don’t get much stuffiness anymore.