CPAP for 10 Years - STILL HIGH AHI's!

[jennie54]

I've been reading on another part of this board about whether people are using the correct CPAP machine to be of more benefit to their therapy. A response that was suggested to me was possibly the need for a  ResMed AirCurve 10 VAuto, any ideas on this machine before I run the idea past my doctor in a couple of weeks?

[ajack]

My advice is to get the cpap working, then decide with your doctor if your need bpap. first of all you need to fix the leaks

[Sleeprider]

I've been reading on another part of this board about whether people are using the correct CPAP machine to be of more benefit to their therapy. A response that was suggested to me was possibly the need for a  ResMed AirCurve 10 VAuto, any ideas on this machine before I run the idea past my doctor in a couple of weeks?

Jennie, the reason I want to see a zoomed in view of your respiratory flow rate (2-minute) is to see the flow limitation.  Ajack mentioned you may have emphysema.  Usually with restrictive pulmonary disease a bilevel like the Aircurve 10 Vauto or even the ST is desirable, and improves efficacy because you can use pressure support to offload some of the inspiratory effort to the machine.  These machine provide a higher inspiratory pressure and lower expiratory pressure which makes breathing easier, and improves your volume and consistency with lower effort.  This specifically treats the hypopnea events you have been experiencing.  

You do not have any apparent problem with spontaneously breathing, so the Resmed Aircurve 10 Vauto would be ideal for you.  You do not need the backup rate (timed breaths) of the Aircurve 10 ST.   I am certain this machine would be the best for you, and would allow you to breathe much more easily.  If you do have a diagnosis of emphysema, then this probably meets your insurance or Medicare dsefinition of medical necessity for bilevel.  If you can pursuade your doctor to prescribe bilevel PAP therapy (Resmed Aircurve 10 Vauto), then based on your current results, I would suggest settings of IPAP max 18, EPAP min 9.0, (EPAP max 14.0), PS 4.0, as starting settings.  This will provide bilevel pressure in the range of 13/9.0 to 18/14.0 in Vauto mode.  If you need more pressure support to comfortably breathe and eliminate flow limitation and hypopnea, then higher pressure support can be tried.

The reason I want to see a close-up of your respiratory flow rate is to verify that you would benefit from the pressure support of bilevel, an to help you with this discussion with your doctor.

[jennie54]

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Back on after about 10 days - thought I should upload my Data from June 19 through last evening.  I tried turning off all of the tabs you suggested but noticed that there was hardly any data to go by, so I'll post last night's data.  A few of these past few nights I had leak rates of 23% and 56%.  I also had a PB rate of 5 one night. I tried the cervical collar and used it part of the night a few nights ago but it was so restrictive and I panicked so I had to remove it. (2 collar) With my breathing problems I felt like it was just squeezing the life out of me and extreme anxiety set in.  I had some incidents many years ago when I was in my early 20's that involved someone strangling me and I guess those bad memories come back time and again.  Maybe that even may be why my airway is so very narrow in the first place.  Anyhow, if I can get myself in a more relaxed state at bedtime I may give the collar another try.  
Anyhow, some data from last night:

[jennie54]

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Flow chart from last night - still having some problems attaching the right data. 
The 1st  post is some brief data from the June 19th that you may not have seen yet. Any new problems that I should talk with my doctor about on Monday July 1st next week?

[Sleeprider]

Have you tried a soft cervical collar for the positional apnea?

[jennie54]

Like I posted earlier today - I tried the soft cervical collar and it was so restrictive and gave me so much anxiety that I had to remove it partway through the night. I took away my wedge pillow from  my head and just used 2 memory gel foam pillows for my head to try to keep my chin from slipping into my neck.  I'm running out of options real quick.

[Sleeprider]

There are many styles of soft cervical collar or wedge. In your case it may take a couple attempts to find a solution that is comfortable, but it will help. Without posting a link what collar did you try before?

[sheepless]

suck was a bad word in my day but besides 'effective' I can't immediately think of a better description of the soft cervical collar. they suck. even so:

you might decide you're just plain intolerant of the collar but I encourage you to keep trying because they are effective. there's nothing particularly comfortable about them, even in time, but it doesn't take long to realize they aren't terribly uncomfortable either. we get used to it just as we get used to mask, hose, noise and pressure. I can't say I like it but I can't pap without it, and that's much worse.

wear it somewhere between snug and loose for as long as you can when not asleep too, increasing your wear time over days or weeks. try a half collar/wedge or neck pillow. rolled towel. anything to help keep neck straight, chin up and jaw closed.

hard to say wo seeing but 2 foam pillows sounds like too much if they're more than a couple inches thick and stacked.

[Gideon]

Try a towel under your chin, nothing wrapping around your neck.

Also set flex at Full-time and flex =2.  And increase pressure to 14 and expect it to increase in the future as you get guided in.

This is a combination intended to attack your positional apnea, hopefully without tension, your OSA and your flow limitations and RERAs.