[Tolob]

Greetings all - I'm new to this site, and in fact found it because I was searching for an answer to this question:

I was recently diagnosed with Obstructive Sleep Apnea - fairly mild, but still annoying for both myself and my wife. Of course, the inflicted treatment was a CPAP (Continuous Positive Air Pressure) machine, which basically blasts air into one's lungs at a high enough pressure to keep the airway open. I understand its common to find this annoying at first, and admittedly I've only tried it for a few hours each night for a few days, but am really not liking it.

The (largest) issue for me seems to be that I am just barely able to exhale. At first, I thought that this was just a new sensation, and certainly nobody would have prescribed this if it in fact prevented exhalation. But then I thought, 'wait a minute, as a C5/6 quadriplegic I really do have limited ability to exhale.' In fact, if I understand correctly, I have use of my diaphragm, but this is only used to inhale. Normal exhaling then is just the release of the diaphragm, which causes air in the lungs to want to escape to maintain pressure equilibrium with the external air pressure. Able bodied folks can also use inter-costal muscles to achieve this (as well as to cough, etc) but for a quad these muscles aren't available.

Which leads me to think that a CPAP is completely unreasonable for a quad. But then again, I read that some quads can use them. Plus, my limited ability to exhale at all seems to disconfirm my hypothesis (because if I was completely right, I shouldn't be able to exhale at all).

Any thoughts? Alternatives to CPAP (I've tried it on 'C-flex', which wasn't much better... therapist is suggesting something she called 'automatic' which supposedly turns down the inward pressure when you exhale)? Other remedies?

Thanks,
Tony

[greybeard]

Yes you can get one that eases the exhale pressure. I have one. It's a Resmed Escape II.

[E-DOG]

My respiratory therapist at the VA says I have the worst case he's ever seen.
I use a By-pap, what the difference is I don't know. But I do know this. When I first started using one, I couldn't tolerate the damn things.
Frigging super charger blowing air into my face. I was good for maybe 20 minutes at a time.

Since then vast improvements have been made to the machines, the face masks, (mine has two dealies that fit comfortably in my nostrils) etc.
My new By-pap doesn't blow hard at all but seems to do the job.

It may take some trail and error, but eventually you'll come up with something you can deal with.

I have a brand new by-pap I can sell you fairly cheap. If you are interested PM me and I'll dig it out and we can kick and scream over the particulars.

Last thought. Are you fat?
When I weigh less I snore less.

E

[greybeard]

I've been using one CPAP for over 15 years. One of the first things they did was measure my neck. They reckoned that anybody with 18" neck size or greater was probably going to have OSA. A sleep study showed I stopped breathing when the airway collapsed over 500 times during the one night test. I had no idea.

The mask and the pressure were a little uncomfortable to start with, but the benefits of getting proper sleep were immediate and astounding. They far outweighed the slight initial discomfort. You soon get used to that. ......and of course, because now folks with untreated OSA are reckoned to be at much greater risk from heart attacks and strokes, you get to live longer. Persevere.

[goldnucs]

I use a bi-pap which supplies 2 pressures which enables easy exhalation. I began with it in August I believe and has taken some getting used to. Besides the obvious issue of having a mask with a hose on it coming out of your face, it does makes you sound a bit like Darth Vader and the headgear takes some tweaking to get comfortable with.

I love the thing now. I even wear it when I'm just laying down in bed. With my sleep apnea I was "sleeping" 10+ hours per night but waking up exhausted every day. A sleep study showed that I was only getting 3-4 hours of real rest and hardly any REM sleep before they ordered me the bi-pap.

r

[Trinity]

E-DOG, on Dec 1 2009, 10:35 PM, said:

I use a By-pap, what the difference is I don't know. But I do know this.

Ok, excuse my nerdiness here please! The difference is that CPAP applies a constant continuous pressure throughout the whole breath where as BiPAP has a different pressure for breathing in to breathing out (higher on the breath in) This can mean that you can have far higher pressure on your inhaling breath, this helps to open all your airways up and lower pressure on your exhaling breath allowing for you to breath out completely.

If you are having problems tolerating CPAP then a switch may well be beneficial

[greybeard]

If you haven't got one already, get a humidifier for your CPAP/BiPAP, otherwise your nose is likely to get more and more sore and cracked inside over time. It's best to use only proper purified water in the humidifier. You are less likely to get chest/nose infections.

Mask design has improved an awful lot since I first started and I've found the full-face one is the best for me. It stops air escaping through your mouth, which can disturb your sleep. The nasal pillows that E-Dog has, usually get over that by having a strap under your chin but I found that uncomfortable.

[goldnucs]

I use the nasal "pillows" which I find to be a lot less invasive but, yeah, takes some getting used to. If on too snugly, my nose is sore as hell in the morning [or middle of the night requiring a lot of fidgeting] and if too loose, air leaks out very annoyingly.

Definitely insist on the humidifier. The bi-pap I have is programmable to allow for various pressure settings for both inhale adnd exhale pressures.

r

[Tolob]

Thanks all for your replies. I'll work with my home health folks & doc to try to get a bi-pap.