Going rogue, temporarily at least

[allanri]

So based on available appointment times for various doctors, combined with my own schedule for travel, etc., it seems the soonest I can realistically expect my sleep doctor to make any kind of NEW recommendation for me will be December.  In the meantime, I continue to have kind of lousy nights, as this suggests:
[attachment=8070]

I've been on fixed pressure for months now, 10 cm H20. The doctor started me on APAP, 8-12 cm, but it didn't do much for me. Maybe I didn't try it for long enough, and maybe he didn't choose an appropriate pressure range. Anyway, he put me on a fixed pressure after a few weeks, and I've been there ever since.

I thought I might try using APAP to see if it makes any difference. I set the machine to 9-15 last night, and ended up with this:
[attachment=8071][attachment=8072]

It seems to me that in trying to push through my OSAs, the machine is going to the maximum setting of 15 cm.  I wonder if I should give it a wider range, or at least a higher upper limit?  Thoughts?

[Walla Walla]

I would give using a soft cervical collar a shot. Some of those clustered events may be caused by your chin tucking in and cutting of your airway. The collar can prevent that from happening. You might also be able to drop the pressure while using the collar. Not much you can do about the CA events with the machine you have.

[allanri]

I do use a cervical collar already.

But along those lines, I’m thinking a different pillow might be indicated. I use a memory foam pillow, a fairly firm one. It’s not overly thick, I feel it might prop my head up just a little too much.

[Walla Walla]

A flatter pillow may help. Make sure the collar is under jaw bone so your chin doesn't slip into the collar while your sleeping.

[sheepless]

fwiw, I've given up my foam shaped contoured fancy pillow in favor of a buckwheat one. foam was too firm against cheek and headgear, sometimes mask; also probably contributed to bent neck chin tucking. now I stand the foam pillow on it's long edge between the bw pillow and the wall to help keep bw pillow compressed in the shape I want. collar and buckwheat is best combination for me so far for reducing leaks (last night my max epap was about 13; max ipap about 23.5 with 2 short large leaks at about 17.5cm; with collar and bw pillow I think my leaks occur more from rolling onto my back than from pressure) and clusters of events (last night ahi 0.32). not saying you will get similar ahi with your machine but do encourage trying buckwheat or similar pillow as it might help.