Apneas out of control

[BrassCat]

Stan here. Been on the board before. Wonderful place. Last year had heart attack, bypass surgery. Glad I knew how to adjust pressure in hospital, they were no good at that. Pressure way down, chest too sore to allow regular pressures. Could increase a step every day or two. Now over 8 months.  Also. my Bipap went dead. Now running again. Had to "blow it out" as I could not exhale, although could inhale OK. Literally, with an air compressor. Now working. This fiasco is another whole topic.

In screenshot I see pressure increase in response to apneas during the night. It tops out around 16 cm/h2o but I have set the DreamStation Bipap upper limit higher. Not sure at all where to go with this problem. Is the 2.5 differential pressure too low. If so, why doesn't the Bipap adjust it?

Thanks for any suggestions or help. Stan.

[mesenteria]

Wow...that's....ummm……..unpretty.

Your events cluster very heavily.  Do you by any chance use a soft foam cervical collar?  We generally advise people to deal with clusters as soon as they can manage, and we urge them to make use of a cervical collar which will keep you from tucking your chin.  This is what the clustered events signify....generally.

You have some leaking going on, and that is only from a poor fit.  It might mean a change of mask to something better, or it might only mean that your cushion is being deformed or displaced by inordinate contact of some kind, whether from an arm or pillow, or maybe head-fall forces your head gear to one side when it gets trapped between the pillow and your hair, and that displacement affects the seal of the cushion.

I'll watch for feedback about treatment regimen from the seasoned gurus, but perhaps auto-bipap isn't indicated for you any longer.

[BrassCat]

Thanks mesenteria.

I do not wear a cervical collar. I do kinow from the past, head forward increases my apneas, head back is better. Have not considered it currently.

[Damiansd]

Hello Brasscat,

My graph looked relatively similar to yours although not as busy, I was getting an AHI of 8-20. My RDI (which include RERAs) made it even higher.

I was recommended a cervical collar and I'm not getting clusters like that anymore. Overnight I dropped 4cm of pressure and 5 points in my AHI.

As they are only about $10, it is a small thing that may make a big difference.

Regards,
Damian.

[Gideon]

The thing is no amount of pressure will fix your chin tucking. The results are usually night and day. I have see an AHI drop by over 30 overnight, just from the use of a soft cervical collar. Read the wiki linked in my signature.

[Sleeprider]

Brasscat, as Bonjour said, we have many members that have used the soft cervical collar. Please read the wiki http://www.apneaboard.com/wiki/index.php...cal_Collar There are examples of other members before and after using a soft cervical collar. Your charts are classic, and I think you can look forwards to a remarkable change. Keep in mind, you are looking for the correct height to keep your chin from tucking, and a comfortable fit in diameter. It does not need to be tight, but needs to keep your chin from getting behind the support.

[BrassCat]

Hello forum members.
Thanks for the responses. I have now also read the
WIKI on soft cervical collars. Will reread. I will be trying
one asap.

I wanted to post last night. One big episode occurs after
I got up at about 5pm. Turned Bipap off and back on,
gives me a marker in the data. I deliberately went back
to sleep on my back, with intent to stay on my back.
That caused a large single episode. Totally minimal
head/neck support, a rolled hand towel. Not propped
up on a pillow.

Stan

[Dormeo]

It's hard to know whether the problem was chin-tucking or just the effects of gravity on your relaxed air-way tissues. Do try a collar, and do try to sleep on your sides. Do you think side-sleeping would be a problem for you?

[BrassCat]

Hello Dormeo, I will be trying. We got a new mattress a few months ago. Firmer. I find I don't sleep as well on my side now. My wife is putting two tennis balls on a sleeping shirt around where my shoulder blades are. Hope it keeps me off my back during sleep. I wish my Bipap could set off an alarm when my AHIs get to high!!! Will post results.

[becker44a]

Hello Dormeo, I will be trying. We got a new mattress a few months ago. Firmer. I find I don't sleep as well on my side now. My wife is putting two tennis balls on a sleeping shirt around where my shoulder blades are. Hope it keeps me off my back during sleep. I wish my Bipap could set off an alarm when my AHIs get to high!!! Will post results.

Hi BrassCat,
I went thru this in early 2014 when I started therapy.  In my sleep study, it showed my AHI was nearly 20x higher when supine than on either side.  So I started trying the various tricks avoid back-sleeping:  large pillow, tennis balls on the back of a tee-shirt, etc.  Nothing worked.  I wound up using a school backpack loaded with light, lumpy objects like tennis balls, plastic dog toys, etc.  This worked and continues to work now.  Before doing this, I rarely saw an AHI under 10.  Now I'm averaging less than 0.5.  

Back then, the Soft Cervical Collar was not discussed as an option, but recently I acquired and tested one.  I first tried it without the backpack, and that didn't work at all.  my body likes the supine position too much, and the SCC doesn't counter the (presumably) gravity-based effects in that position.  So I'm still backpacking here for now.

Just thought I'd pass this along.