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Hi all - help optimising Auto CPAP
#1
Hi all - help optimising Auto CPAP
First of all a huge thank you to everyone on this board, it's an incredible resource! I've had symptoms of OSA for years but things started deteriorating about a year ago, leading to a sleep study. Unfortunately I don't have access to the report (I've requested it but it will probably take some time), but they suggested starting CPAP. After a long delay thanks to current world events I finally got my Philips Dreamstation Auto CPAP about a week ago. I'm using a BMC Fealite nasal pillow mask, non-heated tubing and the Phiips humidifier. I do have a full face mask that I bought as well as I've had a lot of nasal congestion in the past and was worried about mouth breathing, but so far this doesn't seem to be an issue so I haven't used it.

The first couple of nights on CPAP seemed very positive - I was able to keep the mask on all night and felt more alert during the day. After that a few difficult nights followed where I removed the mask in my sleep on 3 or 4 consecutive days, getting only 3-4 hours of treatment as a result. This corresponded to feeling tired again. I've adjusted the fit of the mask and have managed to keep in on all night last night, but woke feeling pretty exhausted again. AHI seems to be resonable at around or below 5.

The mask fit seems ok and I don't notice any major leaks. I don't think I'm mouth breathing, as far as I can tell. I've found it easier to sleep on my back with the mask on but have tried side sleeping a few times too. From what I can tell I think that I'm waking up when the pressure ramps up due to snoring or hypopnoea events.

I'd be grateful for your thoughts on the OSCAR data attached. I wonder if the auto settings could be optimised further, or if anything else could be tweaked to improve things? 

   

   

   
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#2
RE: Hi all - help optimising Auto CPAP
Welcome to the forum. Your current experience is very common and easily fixed. Notice how your events are mainly obstructive and occur in clusters? That is the signature of chin-tucking or what we often refer to as positional apnea, but it can happen in any sleep position where you chin tucks in and obstructs the airway. No amount of CPAP pressure clears it, but preventing chin-tuck is easy with an inexpensive aid. Many of our members have found a soft cervical collar works effectively and comfortably, and sometimes works to train you back to a sleep position where this does not occur.

Read our articles on positional apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
and the Soft Cervical Collar http://www.apneaboard.com/wiki/index.php...cal_Collar

You will see examples of individuals much more affected by this than yourself and charts of their sleep taken just days apart as a before and after comparison. You will experience much lower pressure and better sleep by addressing your positional apnea.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#3
RE: Hi all - help optimising Auto CPAP
That's really interesting, thank you. I definitely notice that standard pillows make my breathing worse so addressing this will hopefully help. I've ordered a soft collar to try out, do you still use it with a pillow or sleep flat with the collar on?
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#4
RE: Hi all - help optimising Auto CPAP
my guess is it's best to sleep without a pillow, especially if supine, but it's not what most people are used to & may not be so comfortable.

while it might not be my first choice if I didn't have to wear a mask, I find a buckwheat pillow to be reasonably comfortable. more importantly, it's nearly infinitely adjustable, conforming to anatomical contours & headgear, resulting in fewer mask leaks. in addition, it's easy to hang your face & mask off the side of the pillow for side sleeping. it can be bunched up under the neck, which may assist a collar in reducing clusters & mouth leaks.

I've used a collar for at least 2 years to reduce obstructive clusters & mouth leaks. for most, it takes some determination to get used to it. few say it's actually comfortable, but it is easily tolerable with some acclimation, particularly if found to be effective and we feel better during the day. some give up after a night or two; if you aren't one of the lucky ones that immediately takes to it, I suggest giving it at least a couple weeks to adapt. it's worth it.
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#5
RE: Hi all - help optimising Auto CPAP
Quite a few people like using a fairly low, firm pillow, but what will work best for you might be different. Try experimenting.

You mentioned that pressure changes disrupt your sleep. I would happily defer to the experts, but I'd like to suggest that you turn the ramp off and raise your minimum to 10, which is around your current median. That may head off some of the events that trigger a pressure increase, and the smaller pressure range may be less disruptive to you.

You're off to an excellent start. The improvements you saw on the good days will become more consistently yours with time.
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#6
RE: Hi all - help optimising Auto CPAP
I increased the minimum pressure to 8 and turned off the ramp as suggested - it made sense and I'd considered doing that anyway. The pressure changes alone seemed to make some difference, but I was still waking quite a lot and struggling to keep the mask on through the night. So I ordered a 3M Futura collar and used it for the first time last night. It does take some getting used to, but it really seems to have made a difference! Thank you all.

Screenshot attached. Anything else that I could improve on?

   
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#7
RE: Hi all - help optimising Auto CPAP
Well, look at you! Congratulations on the progress.

My recommendation would be for you to increase your minimum pressure in increments of .5, staying for at least a few days at each new pressure. If it starts feeling bad, back down again, but my guess is that it will feel fine to you.

This course of action could bring your AHI down further and reduce pressure swings further. You are still in the early stages of adaptation, so you should expect some ups and downs. What we're looking for is a general trend of improvement and a more rested feeling during the day.

Thanks for mentioning which collar you're using. I'm going to stash that away for future mention to other people.
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#8
RE: Hi all - help optimising Auto CPAP
Once you get some hours on the 3M collar your review would be very appreciated. The results with a starting pressure at 8.0 cm and the collar makes a dramatic difference. I agree you should try increasing pressure in 0.5 cm increments but at this point focus on comfort over AHI numbers. This is already a huge improvement. Congratulations.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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: Hi all - help optimising Auto CPAP
The collar is interesting. It certainly does the job but there a few things to be aware of. I have a 17.5" neck and the medium sized collar just about fits me - I suspect if used as intended for neck support it would be quite a bit tighter. It takes a bit of care to ensure it's lined up correctly, on a couple of nights the velcro strap at the back was at an angle and this meant that the collar didn't sit correctly and was uncomfortable. Im not sure how useful the height adjustment feature is to be honest, it works by just compressing part of the foam with a velcro strap so the range of adjustment is pretty small. Most of the support seems to come from the non-adjustable bit around the jaw.

Some ups and downs over the past couple of weeks. Sleeping with both the collar and a mask is not easy - it can feel quite claustrophobic with the restriction of neck movement as well as the presence of the mask. I had quite a few nights where I wound up taking the mask and collar off midway, so I only got between 2 and 4 hours on the machine overnight. In addition to that I've had a spell of insomnia which has made getting consistent results a bit tricky. I can imagine that many people wouldn't persist with a collar in addition to XPAP, but I'm pressing on as I want the best from this. 

Some recent screenshots attached - on one night I had an amazing AHI of 0.2 but this was only half the night as I couldn't get to sleep before 4am. I was suprisingly fresh the next morning! I seem to be averaging 2-2.5 at the moment but would love to get it consistently lower as I do seem to notice a difference with lower AHIs. Suggestions very welcome.

   

   

   
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#10
RE: Hi all - help optimising Auto CPAP
You felt a lot better when your AHI is lower, so that tells me it's well worth your while to continue creeping your minimum pressure up.

Maybe you're doing some sleeping off the machine, but it looks as though you're not getting enough sleep. Can you try to get at least 7 hours per night, with a pretty consistent bed-time?

I know the feeling when your entire head seems to be covered with weird devices: mask, collar, tape. I've tried re-imagining this as a kind of comforting cradle keeping me safe while I sleep. That doesn't always work, but it's worth a shot.
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