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Looking for any advice
#1
Cool 
Looking for any advice
Hello all,

I have been diagnosed and on Cpap treatment for obstructive sleep apnea for 2 years. My sleep clinic does not do a very good job (in my opinion) to set up my machine and alleviate my concerns. Any assistance would be greatly valued.

Some facts about my situation.

- I do not believe I mouth breath, I rarely wake up with a dry mouth.  (maybe once a month)
- Made changes to my hose layout so it hangs from above, with elastic material so it can be stretched and pulled a bit.
- Connected my Nasal pillow straps to a skull cap to keep it in place,  it is not too tight, and generally stays put for the night.. It does on occasion come off a bit, which causes me to wake up and re position it. 
- I use the swift nano nose pillow and clean it regularly.
- Last night I bumped the max pressure up by 1.
- I am constantly waking up feeling tired, muddy thinking, and a headache / pain behind my eyes.
- Usual sleeping for 7-8 hours, occasionally less then 7


I added the last 3 days of usage screenshots to the post. 


August 29th,  I felt bad all day with headache..  I woke up and shortly after fell back asleep without the machine I was so tired.
EDITED --(Wrote about the night before)-Originally...
   


August 30th, I felt okay first thing in the morning, but then got a day long headache and cloudy thinking.
   


September 1st, Feel a bit tired but no cloudy thinking or headache
   


Any ideas on what I can do to improve my sleep.  I am concerned with how many events I still am having,  Should I be?
My sleep clinic seems to be okay with this treatment...
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#2
RE: Looking for any advice
I think your pressures might be okay for now*, but when you do have an event, it isn't just one.  You get several in succession, or what we call 'clusters'.  Almost always this is an indication of sleeping in the wrong position.  It might be on your back, it might be with your chin tucked toward your chest too much, maybe a bit of both.  

We suggest a potential remedy, and that is to wear a soft foam cervical collar loosely around your neck while you sleep.  They can be had at most pharmacies and box stores of the department type, or more expensively at medical supply stores.

* Why the discrepancy between your tombstone info at left where you say your low pressure limit is 5.5, but your flow chart shows it down all the way to 4 at times? I think it's really 4, and that is quite a bit too low for the heavy majority of people using PAP therapies. Try the 5.5, or even 6 for a few nights to see what, if any, changes it brings. You may only feel better, but I'd like to see those AHI figures down below 4 if possible.
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#3
RE: Looking for any advice
Phillips machines are slower to respond to flow limitations than Resmed. Since your median pressure is over 8 I suggest an increase in minimum to 7 or 8 to reduce your obstructive events. I also agree with mesenteria that a soft cervical collar will probably prevent some of your clustered events and may also prevent your machine from going to it's max pressure which may improve comfort. The collar should be worn loosely. Just tight enough to prevent your chin from dropping to your chest but not snug around your neck. You should be able to easily get a finger or two between it and your neck without stretching it.
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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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#4
RE: Looking for any advice
Thanks so much for the responses,  I will pick up a collar tomorrow and give it a whirl.  
For tonight ill try increasing minimum pressure to 8.

Im not sure about the discrepency,  I always thought it was 5.5.  I did use the ramp one night which starts at 4.  (I usually never use ramp)

I think you guys are right about the collar  like and in relation to my chin position ect..  I do tuck it in which while awake can physically feel closes off my passageway. I am suprised my sleep clinic would never have mentioned to try one out. 


I will post back and let you know how it goes.

Thanks Sleep-well
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#5
RE: Looking for any advice
The gurus here advise people to figure out how to wean themselves off ramp.  It's usually better, not always; we all adapt to the novelty and imposition of PAP therapies as best we can, and some barely ever get comfortable with it, or find that it serves them well and that they feel better during the days that follow.
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#6
RE: Looking for any advice
Makes sense not to use ramp, as i would suppose it would also make it harder to refit the mask if it comes off in your sleep as your not used to the higher pressure. I only used it because my girlfriend was over and she has a hard time falling asleep.


Here is a screen shot from last night with the new min pressure set to 8, Still seeing those cluster events. Tonight I will have the cervical collar and will see if it can alleviate some of those.
   
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#7
RE: Looking for any advice
First night with the Collar. I had a heck of a time falling asleep with it, and woke up a couple times. It will take a bit of getting used to. Looks like i was snoring more frequently, maybe due to spending more time on my back. I have been told I snore more when on my back. 

I found when using the collar, that i really wanted to chin tuck to fall asleep and when not in the chin tuck position my tongue, jaw, and mouth felt out of place. almost as if i never slept in that position with pap treatment. The pressure felt very odd on my tongue. A friend told me about some tongue exercises,  maybe I should do those?  any thoughts on this?

Getting used to the collar is my priority now,  Ill try wearing it around the house and build up my tolerance.  Cool

Here is the chart from last night.  I feel pretty good, a bit tired but it feels different then usual. More like i am tired from having a hard time sleeping. We shall see as the day progresses.
   
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#8
RE: Looking for any advice
Second Night with the collar,  I was able to fall asleep faster and easier this night.. The collar did not bother me or wake me up at all.  Shy


Here is last nights therapy. (at 2:20ish, I woke up and went to the bathroom. Hence the Large leak, pun intended.)
   



I will keep trying with the collar before changing anything else, However has anyone had any luck with the tennis ball Tshirt?  I have been thinking about trying this for quite some time. I'm wondering if laying on my back causes some issues for me as well.
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#9
RE: Looking for any advice
Glad to see your sense of humour (Cdn spulling), is undiminished.  Smile 

I don't like seeing all those red flat-lined max pressures in your pressure chart.  This indicates that your machine would be happier if it had a higher upper limit in order to accomplish your mutual aims....of treating your apneas.  Your AHI well above 4.9, the upper limit in the profession, is proof that you are not being adequately treated.  I would bump up that top pressure another two cm at least, maybe even three, and try that for a couple of nights.

I have heard of the tennis ball technique, but have never needed to pursue it or to learn more about how it is achieved reliably.  Duct tape?  You'd want a firm mattress for it to work well.

Please wait for other opinions and observations.  You are sure to get some before long.
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#10
RE: Looking for any advice
I'm no help on the tennis ball question but am interested in responses too. I always thought it silly to arouse yourself enough to roll off your back when the whole point of all this is to reduce arousals. I'm not sure I believe that anymore considering the increased leaks and events I get while supine are more frequent and probably worse than a tennis ball arousal. I've read here that some people use some kind of backpack or fanny pack for the same purpose. maybe more convenient for those of us lacking sewing skills.
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