I need some advise please [on AHI results]

[Ron AKA]

Ron and Sleeprider,

Thank you both for your advice. I made one change last night and that was to wear my flex collar. It was more than a bit claustrophobic, but i muddled through. I did not want to change more than one variable at a time. I will wear the flex collar for a few days before i make any changes.

I am attaching the sleep report for yesterday May, 4. I do not think it captured all the sleep data as it says I woke up at 4am. I did but went back to sleep till 0700. It shows myAHI went from 28 to 2. Im not sure if i believe those numbers but will look at it as one point in a continuum of points.

I would not make any changes other than wearing the collar for a couple of nights and trying to capture a good complete SleepyHead report to show where you are at. The last one you posted is not long enough to tell anything from.

[Jarhead1947]

Thanks, Will do

[Mogy]

Hi Jarhead1947,
To me it looks like it may be 'positional', as in sleeping  on your side, then onto your back. For many people sleeping on their back increases the apnea events significantly.
Some people have set up recording video cameras to determine their position while they sleep.
If you have a copy of your sleep study it probably has some information about 'supine and 'lateral' AHI.

[Jarhead1947]

Mogy,

I do not have a copy of the sleep study, but its easy enough to get, which i will do.

Thanks for the feedback.

Jarhead
Hal
SF

[Jarhead1947]

Good Morning,

I used the flex cervical collar the past two nights and it seems to have made a difference. The mix of events seemed to have changed substantially. I have not changed the pressure yet.
In any event, I have attached the data for the night of May 5.

As usual, your feedback is appreciated.

Best

Jarhead,
Hal

[Sleeprider]

When you feel ready, I'd like you to try reducing maximum pressure. You have flow limitations that cause your machine to increase pressure, but it is no longer treating obstructive apnea. You are currently using PS 4 with EPAP min 15, IPAP max 22. I think you could easily use lower pressures, and one possibility may be EPAP min 13, PS 4 IPAP max 18 or 19. Your machine will likely rise to whatever maximum pressure you set due to flow limits, so the automatic function is somewhat negated. It might be best to find the lowest pressure you tolerate without OA, then start increasing the pressure support in a separate step to deal with the residual hypopnea and flow limitations. Glad the collar seems to be working.

[Jarhead1947]

Sleeprider,

Thank you for the feedback. I will continue to use the collar alone for the next few days so I have a good baseline. Then I will change the pressures as
you suggested.

Once again thanks for your feedback and,

I remain,respectfully,

Jarhead
Hal
SF

[Ron AKA]

Good Morning,

I used the flex cervical collar the past two nights and it seems to have made a difference. The mix of events seemed to have changed substantially. I have not changed the pressure yet.
In any event, I have attached the data for the night of May 5.

As usual, your feedback is appreciated.

Looks better. My recommendation would be the same. Leave max IPAP at 22 and reduce your pressure support to see if the hypopnea events reduce. You could do it all at once or in steps. This change is going to give you more pressure on the exhale portion of each breath. 

If that does not reduce hypopnea, then you may want to try increasing pressure support. However if you go that way, you will probably have to increase the IPAP max the same amount as you increase pressure support. This change would give you more pressure on the inhale part of the breath.

One could speculate as to which direction is the best, but it may be easier just to try it and see...

[Jarhead1947]

Ron,

Thank you. I will try after getting used to the collar for a few days.

Jarhead,
Hal
SF

[JesseLee]

Hal,

Keep us updated on how things go, and keep a positive attitude. You know attitude goes a long way no matter what. So long as your comfortable a conservative approach is absolutely fine. I know it's early but how do you feel?