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[Diagnosis] Sometimes extremly high AHI withe new CPAP
#1
Sometimes extremly high AHI withe new CPAP
Hi I have problems finding the right pressure with my RESMED 10 autoset. 

I have a pillow construction i used to minimze apnea before I got my machine (this inlcludes 3 Pillows, so my head lies very high) , with this construction  I have an AHI of 2-3 but stiff shoulders and neck too.

What I changed now is, that I went back to my normal two pillows(one big, one small ) I always used before the apnoa, but as you can see this does not work so well.


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#2
RE: Sometimes extremly high AHI withe new CPAP
It is your pillow arrangement that is causing your positional apnea with characteristic clusters of intense OA. We can fix this, but you need to ditch a few pillows and understand that good sleeping posture is not with your head propped up high in a way that causes your chin to tuck towards your chest. With some people, we recommend a soft cervical collar, but since you are probably causing the issue by using excess pillows, you my just be able to learn a better way of sleeping with a lot less crap under your head. I think you might benefit from an increase in EPR setting to 2 or 3 to reduce flow limitation.

Here are a couple wiki articles for you to consider:
http://www.apneaboard.com/wiki/index.php...Limitation
http://www.apneaboard.com/wiki/index.php...onal_Apnea

Try to obtain a pillow arrangement that lets your head fall back slightly, or if you sleep on your side, pull a corner of the pillow between your shoulder and jaw. This will keep your head aligned properly and prevent pressure from chin tucking. The soft cervical collar or wedge is a very effective fix, but you might as well try these free measures first.
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#3
RE: Sometimes extremly high AHI withe new CPAP
Thanks for the fast response. So I will change erp from 0 to 2 and regarding the pillows, please note that right now I experience better values with more Pillows  Dont-know .

The Image from last night was with a very small pillow until the second mask removal and with normal and small afterwards.

I attached a picture withe the pillow construction that for some weird reason gets better results.

What is also quite high is the current position of the head part of my bead.

I have gotten my self such a soft foam collar, but I find it very uncomfortable and could not get to sleep with it.

See Image below, what I tried when the oa cluster occured was the white one and one black (Hand for scale).

Second Image is with all three pillows and about 25 degree up of bed head part.


What would be your advice? Bed Head part down? completely?
Which pillows? White one only?


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#4
RE: Sometimes extremly high AHI withe new CPAP
Result of last night, only one pillow and I switched the head part of the bed was flad.

Help please.


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#5
RE: Sometimes extremly high AHI withe new CPAP
I would increase max pressure to 20 then post results tomorrow. Looking at your flow limits you may be better with a bit thgher pressure support on a BiLevel like the VAuto..

Let's see what happens tonight.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Sometimes extremly high AHI withe new CPAP
I agree with an increase in maximum pressure, and EPR at 3, however the pattern is strongly suggesting positional apnea and flow limitation. I think a trial on an inexpensive soft cervical collar will be productive. The fact you were trying to adjust your head position with pillows also points to this as a likely problem.
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#7
RE: Sometimes extremly high AHI withe new CPAP
I have such a collar already. I already  tried it one time, but could not get to sleep with it and removed it after one hour.
Is this ok? Commercial Link Removed, instead search Amazon for collar (Soles Halskrause und Nackenbandage) (Such ruff and neck bandage).

But I am willig to try it again. So pressure 20 ERP 3 and Collar tonight, right?







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#8
RE: Sometimes extremly high AHI withe new CPAP
I'm a 20 tonight and collar tomorrow. One change at a time
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Sometimes extremly high AHI withe new CPAP
The main criteria for a collar is that it prevents the chin from dropping, and it is comfortable. It sounds like this one is not comfortable to you. A loose fit that is supportive seems best.
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#10
RE: Sometimes extremly high AHI withe new CPAP
People seem to swear by the Coldera Releaf Collar - I use a tougher constructed one as found this too soft. If you tried a regular one and found it too hard then the relief being that much softer may work great for you ?

Rob
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