Another newbie....help please

[Mal777]

Hi guys
I'm new to the cpap world, having recently purchased a Resmed airsence 10 autoset to solve my sleep apnea, frequent awakenings, hypertension and fatigue. I've been using the machine for about 2 weeks but still have fairly high AHI's .  I started on low pressure (5-9) and have gradually increased it to 8-16 last night, and although slightly improved, still far from ideal (last night AHI 15.16). As my maximum pressure of 16 is getting close to top of 20, I wonder if there is any advice on how to lower my AHI's

Ive included following screenshots

22/7/19 (pressure 5-9)  AHI 21.87
26/7/19 (pressure 5-12) AHI 14.07
1/8/19 (pressure 6-13)  AHI 15.15
2/8/19 (pressure 6-13) AHI 20.90
3/8/19 (pressure 8-16)  AHI 15.16

Any help appreciated

[Gideon]

Welcome to the forum.

You asked for help, well that is easy.
You have very significant Positional Apnea.  The best fix is a soft cervical collar worn loosely.  The concept is to prevent the chin from tucking down.

With the chin-tuck theory, the soft tissues under the jaw are pressed upward causing a restriction or collapse during inspiration. It takes very little pressure to make this happen and the negative pressure of the airway during inspiration increases the restriction. You can simulate the chin tuck by pressing lightly upward on the tissues at the back of the lower jaw. Relatively light pressure on this tissue creates an increasing flow limitation ultimately resulting in a series of apneas. The series of apneas causes an arousal that either corrects the airway and/or causes mouth breathing.

below is a wiki article with charts, note how the before chart closely resembles yours.

http://www.apneaboard.com/wiki/index.php...onal_Apnea

This is the second large change you will see with your sleep apnea, the first was getting a CPAP machine.

you have some significant centrals also so I would like you to set your EPR = 1

on your charts, drop the AHI and Mak Pressure and add Flow Limitation

I expect to see a real big difference with the c-collar.

[Mal777]

Thanks so much for your reply Fred.....much appreciated

Very helpful Wiki article too. I will definitely get a soft collar.
I presume the snoring collar without a back is just as effective and more comfortable? And what type of cpap pillow do you suggest? There are just so many

And are the centrals of concern? Anything else I can do to limit these apart from lowering EPR to 1 ?

thanks again
Mal

[Gideon]

Actually yes. Get a full copy of your Sleep Studies, not just the summaries, so we can see what was detected before you started CPAP. Usually mention of Centrals is not mentioned in summaries even when a significant portion of detected Apneas are detected.

This fact can significantly impact the direction your treatment goes.

CPAP machines, with the exception of the very high end ones, ASV and for the very few with significant non apnea breathing disorders, the ST, cannot treat Centrals so we avoid them.

Avoid means reducing pressure variance and reducing pressure both these actions can raise obstructive Apnea.

We need to learn the nature of your apnea then apply the proper means to eliminate it.

If your Centrals are treatment emergent they could disipate over 2 to 3 months.

[Melman]

Fred didn't mention but an anti-snoring collar without a back will be just as effective.

[Gideon]

And likely be a bit more comfortable.

[Mal777]

I just bought a soft cervical collar. Also ordered a cpap pillow, and a new mask (Dreamwear full face mask) as the F30 was chafing around the base of my nose
Unfortunately couldn't find the backless snoring collar, and we cant order from Amazon here in Australia.
Also have EPR on 1.
Will try it all for a week or two and then post my results, with the full sleep study

thanks again for your help