Allergy is a problem using CPAP..... ~ Allergy season is coming!

Hard to sleep when I have stuffy nose ....

I have been using CPAP when I sleep.  The symptoms such as sleepiness in daytime and some pain on my chest are going away.  However, I am having trouble due to allergy in spring time.

Started a few weeks ago, my allergy got worse due to pollen and it is a cause of problem to sleep with CPAP since it is hard to breath during sleep due to stuffy nose.

Solution for now?

To avoid the situation, I take an allergy pill which is anit-histamine pill a few hours before going to bed and put a gel which is shown in the top of this posting before sleeping per advice by a doctor.

It seems to be working for now, but I am not sure if the symptom gets worse....

SPO2 trend during sleeping

I have been using CPAP during sleeping.  I do not have much update and not many thing to post this blog recently.  Today, I review SPO2 trend last a few months.

I have been collecting SPO2 data during sleeping almost every day since May 26, 2018.

Here is the average data and I can see a good improvement.

3rd week of May to 2nd week of June (without CPAP)

• SPO2(Average)                            94.0 %
• SPO2(minimum)                          87.0 %
• SPO2 drop more than 5%            1.3 / hour
• SPO2 drop 4 ~ 5%                       3.0 / hour
• SPO2 drop 3 ~ 4%                       8.4 / hour
• Weight                                          165.6 lb / 75.1 kg

3rd week of June to 2nd week of July (excluding days for CPAP trial)

• SPO2(Average)                            94.6 %
• SPO2(minimum)                          87.3 %
• SPO2 drop more than 5%            1.1 / hour
• SPO2 drop 4 ~ 5%                       2.4 / hour
• SPO2 drop 3 ~ 4%                       6.9 / hour
• Weight                                          161.4 lb / 73.2 kg

3rd week of July to 2nd week of August (with CPAP)

• SPO2 (Average)                            95 %
• SPO2 (minimum)                          89.2 %
• SPO2 drop more than 5%             0.6 / hour
• SPO2 drop 4 ~ 5%                        1.6 / hour
• SPO2 drop 3 ~ 4%                        5.5 / hour
• Weight                                           158.7 lb / 72.0 kg

8月下旬から9月中旬　（CPAP使用）

• SPO2 (Average)                           95.6 %
• SPO2 (minimum)                         91.2 %
• SPO2 drop  more than 5%           0.3 / hour
• SPO2 drop 4 ~ 5%                       0.9 / hour
• SPO2 drop 3 ~ 4%                       3.8 / hour
• Weight                                          156.1 lb / 70.8 kg

SPO2 drop less than 3%, I do not see any difference therefore I did not show here.  It is probably including some measurement error and I do not believe there is no point to compare them.

Before mid June, I felt some symptoms such as felt tired right after waking up and very strong sleepiness during daytime.   However they are going away after that.  I started using CPAP in mid July and the number is significantly improved.

The average SPO2 value is improved by 1.6%.  I think CPAP works very well.  However I think this improvement is not only CPAP but also weight reduction.  Before using CPAP, the value is improved with weight reduction.  I lost about 4 lb.  However, I also tried to improve the symptom with changing sleeping positions as well.  (I think sleeping position is one of factor to improve the value)

After starting using CPAP, there is some improvement.  I think this is due to weight reduction as well as I adopted using CPAP device and the quality of sleeping is getting better.  At least, CPAP and weight reduction works very well in my case.

Follow up appointment for Sleep apnea after started using CPAP

I saw a doctor for the first time since I started using CPAP as a treatment of sleep apnea.  It was really hard to make an appointment with the doctor and it took almost two months.   Finally, I saw the doctor today.   This is a summary.

Nothing to do with the CPAP device

When I made the appointment, I was told I had to carry the CPAP device when I would see the doctor.   Therefore, I packed it into a carrying case before the appointment.  However it was not touched at all during the appointment.
I just asked a question why I needed to carry it.  The reason is it is possible that the doctor consults how to use / adjust it if people have issues.  In my case, there is no issues at all and the doctor does not have to do that.

Thee symptom is improved, no issues

As a conclusion, the symptom is significantly improved and I just need to do whatever I have been doing with the CPAP device.  That is only instruction from the doctor.
The event per hour, which is breath stopping events detected by the device, is 0.5 per hour.  That is a pretty good number and I just need to continue to use CPAP.  The target is 5 per hour and my number below the target.  There is also no issue for air leak from the mask.

Possibility to eliminate CPAP

One thing I am really interested in was a possibility not using CPAP device.  As a conclusion, the doctor still believer I have to use it for a while.

The primary reason is the setting of CPA device is 6 cm H2O ~ 8 cm H2O.   Overall average is 6.1 cm H2O which is recorded by the CPAP device.  However, the maximum value is 7.5 cm H2O, that means the CPAP device adjusts the air pressure to high due to apnea events.   If there is no event, there is no reason the pressure is going up and staying below 6 cm H2O.   Therefore, it is better to use it for a while.

Weight reduction might help some improvement, however, jaw structure for Asian would be a primary cause of Sleep apnea in many cased.  Therefore, even if people loose a lot of weight, it is still better to use CPAP device in many cases.
On the other hand, reducing weight and keeping a right weight is very important to stay healthy for the other reason, thus, it is better to continue reduce my weight anyway.

Next appointment

The next appointment will be a year from now.   Of course,  I might need to see him any time if I have any issues / problems.  Other than that, the doctor thinks once a year would not be a problem in my case.

So, it seems that I have to use CPAP for a while and continue to do the weight reduction targeting to 63 kg.

Progress of weight reduction ~ still getting very good progress!

Due to using CPAP during sleeping, I do not have much new topic....
Since it is the end of August and I report a progress of weight reduction project

The previous update for the weight reduction is about two weeks ago, the average weight of a week was 157.9(lb).  After that, the average changed 155.9(lb) -> 155.8(lb).  There were a few days the weight was less than 155 (lb).  My weight on April 18 was 170.6 (lb), therefore, I have done about 15 (lb) reduction!  My target weight is somewhere less than 140 (lb) so, it is probably a half way now.  (140 lb is BMI less than 22 with height 5 feet 6 inches).

I do not really restricted diet.  Therefore it was not very heard and I sometimes eat some extra when I feel really hungry.


Key is to be "Habit"

I realized that the key for the weight reduction is "to be habit".  I guess I could loose more weight if I more restricted diet.  However, I think it might be hard to sustain that diet.  I guess a better way to maintain a reasonable small adjustment.  For now, I am note sure if I need to reduce amount of what I eat to reduce more weight.  I just watch the trend of my weight with the current "habit".

Improvement?

Since I am using CPAP, the symptom is significantly improved.  The event of Sleep apnea CPAP device detects is somewhere less than 1 event per hour in the average.  (The original event rate in the sleep study was 7.1 event / hour)

Web service by CPAP vendor ~ MyAir

I have not tried any new things recently.  I've just been using CPAP equipment when I sleep nowadays.
The device I am using is ResMed Air Sense 10 AutoSet.  It sends data during sleeping through mobile network and doctors and insurance companies can access my data.  They also offer to access the data through PC and mobile application.

The insurance company decides to cover this treatment based on the usage. 
Due to on-going weight reduction effort, my symptom is getting much better and the event is only less than one event.  (This is based on data the CPAP device detects)

I think weight reduction helps at least my case!

CPAP treatment ~ about 1 month

CPAP machine!

It's been a month since I started using CPAP during sleeping.  Initially, it was hard to get into sleep with the mask and hard to wear mask during sleeping.  I sometimes took the mask off during sleeping.   Now it is getting better.

SPO2 with CPAP

I continue to collect SPO2 data during sleeping, I still see SPO2 drop below 90% once or twice a night sometimes.  It is not everyday, however, it is still happening.  Before using CPAP machine, I tried a couple things to improve the symptom.  Some of them are probably helping to improve, but I still saw SPO2 drops a few times a night.

On the other hand, I do not have any symptoms I had before.  They are gone!  Even without CPAP, it was really improved.   However, I have been using CPAP machine for now.

Insurance coverage!

My insurance covers 90%  of cost using CPAP.  Originally, I was told that I had to buy the machine after a trial.  However, it is still renting it.  Based on the explanation, it will be rental base for a while and will switch to purchase it later.  So, the due for using CPAP is not much!  The initial cost is around USD $ 15 and monthly due is probably less than USD $10 for now.

However, I have to use it more than 4 hours a day and if it is less than 70% of total days, then the insurance company will stop covering it.   During summer, I probably go camping a couple times where I could not use it due to no power source.  Therefore, I have to use it as long as I stay home.  Also, it might be hard to do some other experiment without CPAP for now.  The CPAP machine keeps sending the data through a cellular network and doctors, insurance carrier will be able to check the usage daily !
 

Mask for CPAP

”Pillow" type mask

"Nasal" type mask

When I did a trial for CPAP, the device the hospital gave me is from "Res Med".  The product name is "AirSense 10" as I mentioned in the previous post.   For masks which is attached to the device and wear when I sleep, I could try two different types during the trial.  Actually, there are three types of mask I can pick.  (Two of three selections).    "Pillow", "Nasal" and "Full face".

See all type of masks in the vendor's web, Res Med

In my case I picked "Pillow" and "Nasal" since the area the mask covers are small.  I do not like big mask during sleeping.

For myself, the both types worked very well.  I guess "Nasal" type is probably much easy to fit without leaking air.  However, area it covers a little bigger than "Pillow" type and I had a bad experience when I had a congestion in my nose.  One of nights during the trial, I had a hard time to get into sleep with this mask and switched to "Pillow".

I guess it is a good and a bad.  It is sometimes getting loose or out of position during the sleeping.  Those cases were not working properly.  However, it is probably better to continue sleeping even if I have a bad congestion.  Also, it is probably much easy to get into sleep due to less covered area on the face.   So I picked "Pillow" type for long term use.

Overall, it works all right most of time including my actual treatment with CPAP after the trail.

In general, it is really a preference for each person.  One gentle man who got the same session for the trail prefer either "Nasal" or "Full face".  He did not like "Pillow" at all.  I think the key is reasonably comfortable with a mask.  Since people need to ware a mask for long term with a CPAP device.  Getting a better sleep is goal.

The trial system is working very well for me since I could try different type of masks during the trial and I could pick the best one for myself.  I think we could try all of them.  What I was told was just two types at the same time.  As long as I request to swap one of them to the other type, I could try all.  In my case, I was not comfortable with a full face mask and I did not pick it.