Diagnosed with sleep apnea

[AuntPeggy]

I got a new doctor nearly a year ago because my old one quit the business abruptly. I went in for my annual physical in October and brought along all my usual complaints - overweight, tired all the time, feeling nauseous easily. I added that acid reflux and tinnitis had become a problem. Although the old doctor had always brushed aside these complaints, the new one scheduled me for studies with an amazing number of specialists, including a sleep study.

For the sleep study, I spent the night hooked up to 17 electrodes, mostly in my face and scalp, but also chest and legs. There was a video camera on the wall to observe my night. People were all very nice. Surprisingly, I was able to sleep despite the strangeness of it all. Next morning, after being unhooked I showered and tried to wash all the electrode goo from my hair. I did not feel rested at all and since it was Saturday, took a nap after getting home.

Yesterday my voice-mail got the call I was dreading. "Obstructive sleep apnea" are the only words I really heard. Today I made an appointment for a follow-up with the doctor for a CPAP fitting and hopefully an explanation of what to expect. Then, I have an appointment for a follow-up sleep test. Needless to say, it got my attention this morning when an advertisement on TV came on touting a company that provides CPAP supplies for such things as replacement hoses, filters, and "comfort gel".

The nice voice at AOPA let me know that this probably means at least a 3-month grounding. Well, I can still carry on working on my Instrument Rating, but no more flying around by myself simply because it is so enjoyable. No more Eagle Flights.

Anyway, my reason for posting this is to have a place to record the process -- sort of my own version of the student pilot blogging about getting their first certificate.

 

[bbchien]

Peggy, this can be a three week process if it is important to you.

First you get the CPAP machine.
Then you tryout different settings.
Then the do the sleep study again.
Then you get a letter: Ms. Peggy X has sleep apnea and is under control with CPAP Y cm/H2O. Her chip shows compliance. She is well rested wtih no tendancy beyond the normal to fall asleep. There are no findings of right heart failure.

Your AME calls OKC and gets authorization to issue.
Once a year you need to go get the letter and send it in. You DON'T need the sleep study or the MWT to renew, if your doc writes a good letter.

 

[gkainz]

Welcome to the hosehead club, Peggy. CPAP user since 1990-something

 

[Doggtyred]

Peggy..
Let me start by saying I'm currently an aviation lurker. I let my medical lapse about 4 years ago and quit flying due to finances... but in the past 90 days I was diagnosed and treated for OSA. Keep in mind I'd HAD it for 10 years. I knew I had it. I had people tell me over the years I would stop breathing and snore loudly while sleeping. I did everything I could to "manage" it on my own (medical folks are the worst patients)...

I tried sleeping prone with my cheek turned on a pillow, so my jaw would drop open when asleep.. I practiced denial... then I started really gaining weight with little change in habits... and the fatigue set in.. then I started nodding off at work... and I'd already finally made the decision to pull the trigger when I started having narcolepsy while driving in the middle of the day. (yes.. I just admitted that out loud).

They hooked me up, studied me overnight, and when it was over the sleep tech said he was amazed I was still functional with the severity of my disease. Sleeping while laying on my back was actually dangerous for me (desats and decelerating heart rate). I had practically NO REM sleep or deep sleep, and was waking myself up 80/hr with my obstructions. The tech told me when you have it that bad, you are living constantly stressed, which causes the body to secrete stress steroids, which will cause weight gain even if you try to diet. Lets not even talk about the bad things it can do to your heart and blood pressure.

We expedited the process and came back in for the CPAP titration study within the week.

That night, I didn't feel like a million bucks the next morning, but the sleep tech told me I had significant REM rebound.. my body playing catch up. The insurance company didn't move fast at all (took 3 weeks to get the device from them). In the meantime I bought a "backup device" from the used market, programmed it (I work in healthcare, I know these things) and was using it within 48 hrs of my CPAP titration and started getting the best sleep I'd had in years. NO more nodding off. NO more need for naps. NO NARCOLEPSY.

I have dreams now. I remember some of them from time to time. I dont feel as worn down. I am significantly overweight, and am heading in the right direction now. My blood pressure is responding to meds and I am optimistic that I can lose the weight without surgery, and come back off BP meds. I dont think I will ever get off the CPAP.. as I've ALWAYS been a loud snorer since my teens.... (maybe if I get my tonsils yanked.. maybe..)

I'm sharing all this because for every person that knows they have OSA.. there are several others who dont.. This stuff kills people slowly, insidously, by causing other problems.. Fatigue, weight gain, nodding off, sleeping many hours yet not feeling rested.... all point in that direction. The FAA's beef with it is the narcolepsy that can FORCE you to fall asleep out of the blue uncontrollably.. Its scary when it happens to you.. It also causes heart failure, which is bad juju (aviation implications notwithstanding)

The CPAP is my best friend.. (I have two).. I dont overnight without it. It puts the crimp on tent camping, but other than that its not a big lifestyle speedbump. If anything it will give you more energy and you will enjoy a much better quality of life.

Doc Bruce has the aviation side of this covered. I'm speaking from a health standpoint in general.

 

[AuntPeggy]

Thanks, Dr. Bruce. I don't fly for a living, so I guess all my stress is over a life-style change. When should I contact my AME? I assume that I couldn't fly LSA now, either, since I know there is a medical problem. Or could I since my medical has not been denied? In any case, my CFI needs to know.

Thanks, Greg. Good to know I'm in such good company.

Thanks, Dave. Lots of what you say applies to me, but I don't believe it is so severe. I'm still pretty much in denial. "Ladies do not snore, bla, bla..." The weight gain has seemed gradual, but I've put on 100 lbs over the last 20 years and nothing will get it to stay off even when I diet rigorously. As far as dreaming, no I don't. Now I know to contact the insurance company as soon as possible. I sent an email just before beginning this post. The idea of a used CPAP sounds icky. Tent camping -- oh, no. Does that mean no more camping under the wing at Oshkosh?

I'm grateful to this new doctor who sent me to see a handful of others. I've been taken off Fosamax which was probably responsible for the continuous feeling of nausea and probably contributing to GERD. The GERD was creating problems with my vocal cords, so I am now taking Prilosec to control that. My blood pressure and cholesterol medication have stayed the same, but the thyroid supplement is increased. Best of all, I have enrolled in a medically supervised weight-control program that my insurance company will cover because my BMI is so high. In all, counting the vitamin and calcium, I take 8 pills a day.

 

[wabower]

Are we still suffering from the delusion that tent-camping is a good thing for anybody who is no longer eligible for boy scouts and has completed their military obligation?

Peggy..
I dont overnight without it. It puts the crimp on tent camping, but other than that its not a big lifestyle speedbump. If anything it will give you more energy and you will enjoy a much better quality of life.

Doc Bruce has the aviation side of this covered. I'm speaking from a health standpoint in general.

 

[steingar]

Are we still suffering from the delusion that tent-camping is a good thing for anybody who is no longer eligible for boy scouts and has completed their military obligation?

Camping is great. Gets you away from all the grumpy old farts.

 

[bbchien]

Thanks, Dr. Bruce. I don't fly for a living, so I guess all my stress is over a life-style change. When should I contact my AME? I assume that I couldn't fly LSA now, either, since I know there is a medical problem. Or could I since my medical has not been denied? In any case, my CFI needs to know.

Thanks, Greg. Good to know I'm in such good company.

Thanks, Dave. Lots of what you say applies to me, but I don't believe it is so severe. I'm still pretty much in denial. "Ladies do not snore, bla, bla..." The weight gain has seemed gradual, but I've put on 100 lbs over the last 20 years and nothing will get it to stay off even when I diet rigorously. As far as dreaming, no I don't. Now I know to contact the insurance company as soon as possible. I sent an email just before beginning this post. The idea of a used CPAP sounds icky. Tent camping -- oh, no. Does that mean no more camping under the wing at Oshkosh?

I'm grateful to this new doctor who sent me to see a handful of others. I've been taken off Fosamax which was probably responsible for the continuous feeling of nausea and probably contributing to GERD. The GERD was creating problems with my vocal cords, so I am now taking Prilosec to control that. My blood pressure and cholesterol medication have stayed the same, but the thyroid supplement is increased. Best of all, I have enrolled in a medically supervised weight-control program that my insurance company will cover because my BMI is so high. In all, counting the vitamin and calcium, I take 8 pills a day.

Peggy, if you are going to go LSA all you need to do is let your 3rd class expire. However, after you get your CPAP setup and the "titration" done, you have no reason to know you can't be PIC and so you can do LSA.

OR, if you do the items on the list below, a good AME can get you renewed on the spot with a phone call.

Your choice.
I dont' see a problem here.

 

[Capt. Geoffrey Thorpe]

I assume that I couldn't fly LSA now, either, since I know there is a medical problem. Or could I since my medical has not been denied? In any case, my CFI needs to know.

First, good to hear you have turned up something that can be dealt with. That's a good thing.

But for LSA - I would suggest that if you aren't safe to fly an LSA because you might doze off, you might want to think about if you really are safe behind the wheel of a car where things can go very wrong in a much shorter time frame. On the other hand, if you and your doctor have no issues with you in a car...

You should make it clear to the CFI that he/she is acting as PIC.

 

[AdamZ]

I have seen advertisements for surgery by ENTs , I presume that claim to stop snoring and cure sleep Apnea. Is this a viable option Bruce or is it snake oil?

 

[gkainz]

CPAP is 90-something percent successful in treating OSA (not as effective for central apneas, just discussing Obstructive here), while the surgeries I've casually read about are significantly less successful, invasive and very painful, from what I've read.

Tent camping is still possible with CPAP. A number of them run directly off 12v so if you can cart around a 12v power supply with you, that's the best solution. Second best is the 12v source and an invertor, but given the choice, go with a 12v direct CPAP - there's really no difference in price, nor does the insurance company seem to care. I do it that way on the rare occasion I tent camp. RV camping with CPAP is a non-event.

btw, once you round up the ducks that Dr. Bruce noted and get them all in a row, the SI for OSA is a non-event as well.

 

[Doggtyred]

Are we still suffering from the delusion that tent-camping is a good thing for anybody who is no longer eligible for boy scouts and has completed their military obligation?

Oh hell no... I'm saving my lunch money for a 5th wheel toy hauler travel trailer with memory foam mattress.... no delusions here.. just simply trying to make the point that a CPAP isn't that much of a crimp on style..

Makes you MORE attractive to your partner too, because you dont keep her up all night with snoring.

 

[jesse]

I don't mind tent camping at all. Sleep like a baby.

 

[Doggtyred]

First, good to hear you have turned up something that can be dealt with. That's a good thing.

But for LSA - I would suggest that if you aren't safe to fly an LSA because you might doze off, you might want to think about if you really are safe behind the wheel of a car where things can go very wrong in a much shorter time frame. On the other hand, if you and your doctor have no issues with you in a car...

You should make it clear to the CFI that he/she is acting as PIC.

If you are being treated properly for OSA, you are getting enough sleep and the dozing off/narcolepsy is "no longer a factor". It doesn't happen. Goes away overnight (well, after about 24 hrs).. poof!.

As for other folks mentioning corrective surgeries, I've seen a few of those end up in the ICU overnight for observation. Its a pretty barbaric approach to something that can be fixed with a few centimeters of water pressure in the form of blown air (and a couple dozen watts of electricity).

AND.. if the surgery doesn't work, you've totally altered the elasticity of the tissues of the upper airway, which makes the backup option (CPAP) much much more difficult to implement. I would never take a scalpel to my throat for something that can be fixed with positive air pressure.

All of the mention of LSA is with regards to after treatment: do I jump through these hoops for a class3, or do I just self certify. Untreated narcolepsy is OF COURSE unsafe for operating planes, trains, automobiles and machinery..

 

[gismo]

I don't mind tent camping at all. Sleep like a baby.

Yeah but you're still barely older than most Boy Scouts.

 

[flyersfan31]

Weight loss can be an effective cure for OSA.

 

[bbchien]

I'd do surgery last. Only if CPAP is a problem or can't get it corrected. There are machines now that are the size of the little black case Princess Grace carried into Jimmy Stewart's apartment in Hitchock's "Rear Window"

 

[flyersfan31]

There are machines now that are the size of the little black case Princess Grace carried into Jimmy Stewart's apartment in Hitchock's "Rear Window"

You're dating yourself, Doc......

 

[AuntPeggy]

I'd do surgery last. Only if CPAP is a problem or can't get it corrected. There are machines now that are the size of the little black case Princess Grace carried into Jimmy Stewart's apartment in Hitchock's "Rear Window"

Ooh one of my all-time favorite movies. Now I'll have to watch it again to check out the little black case.
[Edit: I found a picture.]

 

[Matthew]

About 6 or so years ago I looked into the surgery.

Disclaimer: not a doc, and this info is at least 6 yrs old.

1) CPAP is the Gold Standard
2) Surgery involves burning away tissue at the back of your throat with a laser. Recovery is painful.
3) Surgery is considered sucessful if it cuts your apnea events by 50%. That may still leave you with a diagnosis of OSA.
4) The number of patients that have a recurrence of OSA after surgery is not insignificant.

Go with the box. As soon as your sleep debt is paid off, you'll feel better. It could still take a number of months to get used to it, though.

 

[Sportpilot]

Hi Peggy....my sleep study went so well/bad the sleep tech woke me up in the middle of the first night (was supposed to be a two-night study), said he'd seen enough and hooked me up to the CPAP gear that night. Long story short....I slept better the remainder of that night, and since, than I had in years. I could not remember the last dream I had...now they happen on a regular basis. Do the CPAP gear ASAP. You will not regret it. BTW...I fly LSA without any problem. Best of luck.

 

[gkainz]

Weight loss can be an effective cure for OSA.

Not necessarily a true blanket statement. Yes, I noticed the "can be", but I had sleep apnea in high school (hindsight being 20/20) as a wrestler and football player and had no excess weight. One more common factor than overweight appears to be large neck. I know a number of fellow hose-heads that are not overweight and still have OSA.

 

[One Short]

I don't mind tent camping at all. Sleep like a baby.

You wake up frequently during the night crying?

 

[bbchien]

Jesse, check email...

 

[flyersfan31]

Not necessarily a true blanket statement. Yes, I noticed the "can be", but I had sleep apnea in high school (hindsight being 20/20) as a wrestler and football player and had no excess weight. One more common factor than overweight appears to be large neck. I know a number of fellow hose-heads that are not overweight and still have OSA.

Ergo, the "can be." :wink2:

 

[gkainz]

Somewhat ironically, a co-worker mentioned this morning that his doc just scheduled him for a sleep study to diagnose OSA ... this guy's skinny as a rail.

 

[bbchien]

Don't forget guys, there are two types of Sleep Apnea- the common one is obstructive, the other one is "central" and is not certifiable.

 

[AuntPeggy]

I've also joined a supervised weight-management program with my medical group. The doctor has prescribed a drug (fortamet) for appetite suppressant that is normally used for Type II diabetes. I haven't been diagnosed for diabetes, so I don't want to put myself into that bucket. If I take the drug do I have to get a diabetes SODA?

My thinking on this is that since I'm already having to self-ground because of the sleep apnea, there is no reason to avoid taking a diet drug that also requires self-grounding. But I don't want to get involved with additional complications.

 

[Doggtyred]

I've also joined a supervised weight-management program with my medical group. The doctor has prescribed a drug (fortamet) for appetite suppressant that is normally used for Type II diabetes. I haven't been diagnosed for diabetes, so I don't want to put myself into that bucket. If I take the drug do I have to get a diabetes SODA?

My thinking on this is that since I'm already having to self-ground because of the sleep apnea, there is no reason to avoid taking a diet drug that also requires self-grounding. But I don't want to get involved with additional complications.

I am guessing that once you get on the CPAP your weight issue will be easier to manage - remember bad sleep = stress, stress= natural steroid production, steroids= weight gain. Feeling more rested will make it more likely you will have the energy to exercise too.

Fortamet is slow/controlled release Metformin. Wasn't aware of it being used for appetite suppression, but hey.. it could work.

Doc Bruce will have to weigh in on the airworthiness of the med.

 

[ScottM]

You wake up frequently during the night crying?

 

[bbchien]

Peggy, they'll treat you to the same stuff as a pill controlled dibetic. That's mostly becaue the "getting large" phenomenon is associated with the same end organ resistance to available insulin which makes up NIDDM.

 

[AuntPeggy]

Peggy, they'll treat you to the same stuff as a pill controlled dibetic. That's mostly becaue the "getting large" phenomenon is associated with the same end organ resistance to available insulin which makes up NIDDM.

OK, I won't take the pills.

 

[AuntPeggy]

My overnight stay for the apnea fitting was horrible. Absolutely horrible. It began well enough with a pleasant conversation with the sleep technologist as she scrubbed my face and placed electrodes all over just as for the initial sleep study. She brought in a plastic card with various shaped cutouts and placed a couple of holes over my nose to determine its shape, then she came in with a plastic mask with attached straps. "Some people panic," was the odd warning. After placing the mask over my nose and adjusting the straps' velcro comfortably, the hose was attached, the machine was turned on and I settled down.

The air blowing was not unpleasant. The noise of the machine was less than that of the air conditioner under the window. The mask seemed comfortable enough that I would be able to sleep. There was some difficulty learning to swallow against a slight air pressure, but that was OK. If I opened my mouth, the air from my nostrils rushed out, ruffling my cheek like a flag in the wind.

The study begins with a series of instructions coming over the intercom: open your eyes, close your eyes, blink, move your right leg, left leg, count, etc. Talking with the mask blowing up my nose was a bit of a challenge. I sort of burbled. I lay there on my back as instructed, feeling alert, staring at the ceiling, and not ready to sleep for a long time. Finally, I rolled over to my side expecting to sleep nearly instantaneously as usual.

Slowly, I noticed the mask becoming uncomfortable. It was digging into my face. I rolled onto my back and the discomfort turned to pain. As the pain intensified, I thrashed around in the bed and finally, gave up and pushed the call button. The nurse loosened the straps on the headgear, returned to her station, and I went back to waiting for sleep again. The pain returned unbearably and I pushed the call button. This time the nurse removed the mask while I massaged my aching cheek. When I wasn't ready to put it back on, she left the room for a few minutes and I examined the device. Since the face of the mask was very soft silicon, it could not have been causing the pain. But, there is a hard plastic fixture holding the hose on a swivel. I put the device on my face and moved it around seeing that the hose was pulling the hard part of the mask into my cheekbone. When the nurse returned, I showed her and she cut the hose shorter so it would not pull on the mask, then put it back and we both went back to waiting for sleep.

Tap, tap, tap. There were three slight taps on my face from the mask and then no more. Then after a pause, another three taps. I felt around the edges of the mask to find if there was a leak and didn't find any. Tap, tap, tap. It was like Edgar Allen Poe's raven tap, tap, tapping. I was thinking how this device that would allow me to sleep all night would keep waking me every few minutes instead. The pulsing taps continued, but finally I was able to sleep.

I dreamed for the first time in years. It was a short comic strip sort of dream in which I was talking to my father. Only, it was not me, myself. It was a comic strip "me" in full profile, all black, slender, young, and confident. My father was also a generic, healthy "father" and we had a good off-hand sort of conversation that real me would never have had with my real father. Unfortunately, the conversation was also comic strip and I didn't read it.

When I awoke from the dream, the air pressure had increased and the tap, tap, tapping had increased in frequency and number, becoming five or six in a row following a shorter pause. Once again I tried to find a leak. Once again I endured the tapping by staring at the ceiling waiting for sleep to return, which it finally did. I awoke once or twice more and each time the pressure and the tapping had increased.

Suddenly I was jolted awake with a huge snort. The mask had sucked itself onto my face like some deranged octopus and was attempting to force me to inhale. I sucked in the breath it insisted upon and then, before completing an exhalation, the mask once again clenched my face, forcing the next inhalation. I opened my mouth to allow the excess air to escape and my cheek rippled like a flag in a tempest, giving off a raucous Bronx cheer.

I tried to relax while this squid continued forcing air into my unwilling face. I tried to go along with it and found myself hyperventilating. I tried to teach it my natural rhythm, but it would have none of it. I held my breath and it relented for a second then became more insistent. I clenched my jaw tight to keep my cheek from unfurling. How I went to sleep with the fiend clutching my face is beyond me. Nevertheless, I awoke twice more. And as before, the pressure was greater each time. I clamped my jaw against the pressure until my teeth hurt. The final time, I was convinced it was 5:30, the time I usually wake up naturally. I looked at the window for a glimmer of sunlight, which the New England October sun would not really provide until after 6:30. It seemed like an hour of clenched jaw and hurried breathing before the voice on the intercom announced morning and the monster instantly subsided to a docile wisp.

I hopped out of bed with an incredible fart. The next four hours were an unbelievable belching and farting gala from swallowed air. On the drive to work, I noticed one yawn. My average is about a dozen in the 20 miles or so to the office. During the day, I was noticeably more alert than usual. The next day, when I was back to normal, I realized that this monster would be sleeping with me for the rest of my life. Even after being completely awakened at least a half-dozen times, I'd gotten better sleep than when I think I've slept the night through.

 

[AdamZ]

Peggy, Pehaps the flow was set to high? I don't know but have to tell you you write pretty well and gave me a hell of a chuckle.

 

[Doggtyred]

Peggy, Pehaps the flow was set to high? I don't know but have to tell you you write pretty well and gave me a hell of a chuckle.

Lets talk about what was happening, Peggy.. but first I can assure you the problem you had was.. you weren't getting enough pressure, which caused you to obstruct so you woke up/had an arousal.

I use a nasal pillow system rather than a mask (they even did my titration with it). Its a giant nasal cannula that fits flush against the nostrils and doesnt clamp down like a mask. Clamping forces are much less. Its worth it, even if the insurance doesn't cover it (which mine did).. You just need a doc to prescribe it.
http://www.resmed.com/us/products/swift_fx/swift-fx.html?nc=patients

Ok.. I cant tell you what the tapping was with any certainty, but a loose hanging hose could possibly oscillate and cause it. The solution, reroute the hose around your pillow.

Next... understand that as your titration study progressed, you started out low pressure and got turned up slowly. They monitored you for apnea/arousals and stepped up the pressure as they occurred. The longer you are in bed the greater you relax, and the more pressure is needed to take your elastic upper airway tissues and inflate them to allow air to flow around your tongue (which is the cause of the obstruction)

If the required pressure gets high enough, they will switch from CPAP (continuous positive airway pressure) to a mode called Bi-Pap (Biphasis positive airway pressure). This gives higher pressure when breathing in, and backs off the pressure when exhaling, reducing the work of breathing as well as preventing cardiovascular effects from higher airway pressures. This is a good thing, but both modes are foreign to new patients. You may have sensed the bipap mechanism as trying to force the breath in, but its triggered only by pressure/flow caused by the patient.

Something that wasn't happening much in your study, which is what they call "ramp". This is a period of time from when the machine is turned on, til 20-30 minutes later, that the pressure starts off low and gradually "RAMPS" up to the prescription settings. Make sure when they set up your machine at home they get this programmed for you, and that you can select it if needed (mine at home can select RAMP with a single button push).

Then.. if you wake up for any reason, you can hit RAMP and it backs off the pressure to allow you to not be overwhelmed by the pressure as you drift off to sleep. Over 20-30 mins it slowly increases, so its not as distracting. I used the ramp feature for about 3 weeks.. now.. its a non-issue for me and I have a fairly high setting (15 cm pressure)

Something else that will help at home is sleeping with your neck extended (chin up) rather than flexed (chin down). Use a roll pillow or scrunch up your regular pillow to accomplish this.

One other thing.. You can seal your mouth nose passage way with the back of your tongue.. You do not need to clamp your jaw/grit your teeth. Talking, of course, will be difficult with the machine. And drinking/sipping.. will be impossible. But.. mask on/off at home is a simple away/up/over maneuver so not such a big deal.

 

[bbchien]

The tapping was condensed moisture pooling in the hoses at the low point, resonating through the mask as the gas bubbles through it. As the condensate pooling increased, the tapping got stronger. When the device ramped up the pressure, (by increasing flow) you got four or five stronger "taps" (gurgles, really).

 

[Doggtyred]

The tapping was condensed moisture pooling in the hoses at the low point, resonating through the mask as the gas bubbles through it. As the condensate pooling increased, the tapping got stronger. When the device ramped up the pressure, (by increasing flow) you got four or five stronger "taps" (gurgles, really).

Great point. I intentionally dont use the humidifier feature because of the "rain out" that could occur in the circuit, as well as the much increased cleaning requirements that a warmed humidifier basin requires.. I didn't think about it..

This of course, is contrary to the prescription, so I guess that makes me noncompliant with medical therapy.

My only complication is a few dried boogers in the morning.

Guess the tech should have been more attentive. Surely Peggy is not the first person to have condensation rain out in the sleep lap.

 

[gkainz]

Very good explanations, guys. Right on. And Dr. Bruce nailed it with the condensation in the hose ("rain out" as Dave noted). I use the humidifier on high year round, as my nose dries out so badly, especially in the CO low humidity. I just loop the hose up over the headboard and down again, so the condensation runs back to the humidifier, or tuck the hose under the covers with me when it gets colder. Others have used a hose sleeve (fleece or cotton sleeve or sock over the hose).

Dave, I may have to give the ResMed Swift a try. I currently use the Nasal Aire II http://www.cpap.com/productpage/innomed-nasal-aire-ii-all-size-kit.html - even more of a cannula style device than the Swift nasal pillows. I ried a number of standard masks, but my moustache and beard never allowed a satisfactory seal with any of them.

 

[AuntPeggy]

You guys are setting my mind at ease some. How does it work, trying to change the kind of mask? I'm just assuming that the person who comes to the house to setup the system is also a salesman for the vendor, sort of like the Verizon technician setting up FIOS. How do you find out about costs? No one seems to list prices. Is the choice of mask and accessories up to me?

I also found this. It does list prices. Any thoughts?
http://www.cpapsupplyusa.com/100x-SleepWeaver-Mask.aspx#more

Also, not mentioned in my story, the top strap floats above my head, making no contribution to fit whatsoever. The lower strap went across my ears, causing them to ache. It looks like these other brands would not have that problem.

 

[AuntPeggy]

If 15 cm is a high pressure, what is normal?