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(09-22-2022, 12:40 AM)Expat31 Wrote: I was just like you, kept sleeping on my back, and had terrible positional sleep apneas (shown by bunches or "cluster" events of breathing flow patterns in the graph), and had of course rotten nights.
My body had a mind of its own, just couldn't train it.
It took me months to find the solution after trying all types of pillows, collars etc.
For me the only solution was was a velcro chest support with 3 tennis balls tucked in the lining. It is sort of a belt about 10cms/4" wide made out of a firm elastic material. Bought it on Amazon (France) but probably available elsewhere. It makes back sleeping totally impossible. Total cost (including tennis balls, if I remember correctly, around €25).
For me it changed my life.
I fail to see the clusters and patterns that you mention. Maybe it's that I have been rushed of late and without time for myself.
I have yet to try a collar or special pillows. I saw in someone's thread a mention of a wedge that was working to remain in a side position, but I am not sure of what the product is. I haven't come across any wedge shapes in my search for pillows. I will keep the tennis ball solution in my memory as a last resort. I found your old thread and gave it a read. It was helpful. Thanks a lot for the advice.
I don't know why, but I fall asleep in a side position and wake up on my back, even though I find the side position more comfortable. I have tried putting a pillow behind my back and one between my legs, but that hasn't helped.
I haven't changed the settings on the Airsense 10 yet. I gave in and bought the p30i locally. Expensive, yet I am glad I did. It is much better than the N20. it is much more comfortable and I have no issues sleeping on my side or changing positions. It does slip a bit, something I need to figure out. Having the pillows directing the air into my nostrils has been great for preventing my nostrils form collapsing. I will spend a few more nights with the new mask and see what the data says. Then go from there. Maybe I will try a collar next?
I have attached an example of one of my past experiences with supine positional apnea. I think it is easier to see the clusters than your screen shot, as a bit more obvious.
Sleeping on your back can cause your tongue to fall back causing your airways to be blocked partially or fully during the night's sleep stages when the muscles relax and gravity comes into play. Also the jaw can drop and cause more complications, in my case I need tape to stop air leakages using a pillows mask.
I think my issues may be caused by stage 3 of the sleep cycle (see below)
(For me personally also, the positional supine/dorsal apneas can only be stopped by physically blocking any chance of my sleeping on my back.)
Quick overview of the sleep cycle (that can be repeated several times over the night)
Stage 1(NREM 1) -Light sleep Transitional period between wakefulness and sleep, duration 5-10 minutes.
Stage 2( NREM2) - Light sleep Body temperature drops Heart rate begins to slow. Change in brain activity Duration approx 20 minutes.
Stage 3 (NREM3) -Deep sleep Muscles relax. Blood pressure and breathing rate drop. The deepest sleep occurs.
Stage 4 (REM sleep) Brain becomes more active Body becomes relaxed and immobilised Dreams occur Eyes move rapidly. (REM=Rapid eye Movement)
A footnote to my last reply..
Just like you, I would fall asleep on my side, and wake up on my back. My body had decided that's the way it's going to be! Very frustrating!
I had to take drastic measures to stop this.
I use a buckwheat pillow that I can fashion into a sort of wedge, but not very efficient really. Use as a backup only.
For information, I use a Breveda pillows mask. What I like is that no rushing of air noise, as it has a sort of "silencer" with it.
I have attached an example of one of my past experiences with supine positional apnea. I think it is easier to see the clusters than your screen shot, as a bit more obvious.
Sleeping on your back can cause your tongue to fall back causing your airways to be blocked partially or fully during the night's sleep stages when the muscles relax and gravity comes into play. Also the jaw can drop and cause more complications, in my case I need tape to stop air leakages using a pillows mask.
I think my issues may be caused by stage 3 of the sleep cycle (see below)
It's interesting. Looking at my sleep study report, I can see where what you, Red and StaceyBurke may be coming into play. But yet, none of this was mentioned to me by the ENTs that I visited. All that was mentioned was to try a MAD and, subsequently try CPAP. It's a bit disappointing from the top university in Seoul. Granted, the 2 profs I saw aren't sleep specialists. They are ENT profs/surgeons. One would think that the uni would have some sleep specialists. I will definitely be enquiring about that next time I visit. The sleep lab was nice. One of the techs said that she'd being dong it for 20 years. Maybe they know more. Come to think of it, the oral medicine prof at the dental hospital unit seemed to know more than the ENTs.
I found that I was experiencing mouth leaking with the N20. I have been refraining from mouth taping until I know how bad it is. I have hope that I will subside. I feel as though I don't experience the leakage as much with the p30i. At least not while falling asleep. This someting I want to look into once I figure out how.
I saw the Brevida pillows mask in a clip on YouTube by the Aussie cpap guy. I was immediately sold on the diffuser he was pointing out. The jetting air on the N20 is quite annoying. The p30i has a diffuser as well. There is some jetting air at the top that remains annoying. It's not too bad. I just had to try the freedom form the elephant trunk. Actually someone somewhere on this forum saved me last night. I woke up to the p30i whistling like mad. I couldn't figure it out. Then I recalled that I read if the double layers of the pillows aren't aligned properly, it can cause some issues. Sure enough. A bit of squeezing solved the issue. I must have been sleeping on my face.
Before the Breveda, I could not tolerate the constant "air blasts" with the N20, F20, and Amara view.
The Breveda for me is excellent, and unobtrusive. I found that it is important that it must not be too tight, which was my mistake in the beginning.
I started my CPAP therapy with the N20, supplied by the equipment supplier. Constant leaks, the provider convinced it was a mask, so gave me I think, a total of 6 masks. For me FFM were a non starter as cumbersome and noisy, although in theory it is a solution to banish mask leaks.
It took me months to isolate the problem, which was one night when I awoke withair rushing out of my mouth. Even then after getting various mouth tapes, although no more noise, leaking was horrific. After much trial and error managed to solve the problem with 5cm tape long anough to properly cover the edges of my mouth. That was the key.
Just a note, lots of leaking stops the machine's algorithm to function properly. Vital to pay attention to this issue..
In the very beginning of my therapy, I had a MAD mouth device which was good for a year, but after that was adjusted to it's maximum, so unfortunately that ended.
(09-28-2022, 09:49 AM)Expat31 Wrote: Before the Breveda, I could not tolerate the constant "air blasts" with the N20, F20, and Amara view.
The Breveda for me is excellent, and unobtrusive. I found that it is important that it must not be too tight, which was my mistake in the beginning.
I started my CPAP therapy with the N20, supplied by the equipment supplier. Constant leaks, the provider convinced it was a mask, so gave me I think, a total of 6 masks. For me FFM were a non starter as cumbersome and noisy, although in theory it is a solution to banish mask leaks.
It took me months to isolate the problem, which was one night when I awoke withair rushing out of my mouth. Even then after getting various mouth tapes, although no more noise, leaking was horrific. After much trial and error managed to solve the problem with 5cm tape long anough to properly cover the edges of my mouth. That was the key.
Just a note, lots of leaking stops the machine's algorithm to function properly. Vital to pay attention to this issue..
In the very beginning of my therapy, I had a MAD mouth device which was good for a year, but after that was adjusted to it's maximum, so unfortunately that ended.
The Brevida mask is on my radar to trial with my allotment of one mask/year. I will look into how to identify mask leaks and control them. Thanks for the heads up. Glad I was advised to pass on the MAD.
Just to terminate my comments concerning the Brevida and leaks,
Initially I had irritation with the prongs going into my nostrils, too tight. Adjusted the straps equally, then OK, except for one side still giving trouble, I guess it from pressing aganst the pillow on that side. Loosened that side only by one notch and all OK.
I know I keep going on about the importance of leaks and their impact on the algorithm working efficiently , I attach a example screenshot of one of my many nights of hell in the early part of the year (Feb).
Expat31, thanks for the details. They are helpful.
It has been a week with the new mask. I haven't had any crazy AHI nights. Nothing over 5 yet. Many of the nights are not informative, because I have been having a bit of trouble with the mask slipping. Unfortunately, I didn't document which days that happened, so I am guessing by looking at the information in OSCAR. One thing that I have noticed is that when I do the mask test I find it really hard to breathe out with the new mask. I am assuming the EPR setting does not function during the test. Would this be right? When I go into therapy mode after, I seem to be fine.
One thing I find very puzzling, is that the results of my second night with the new mask look great. I remember I thought it was weird that I felt good that day, even though I slept for only 6:30. I thought I was just confused because I was quite busy. Seems to have been right. Every night I seem to wake on my back as well so I had to be on my back that night. It makes me wonder about how the positional apnea is affecting me. I have been trying to keep on my sides as much as possible. It has been much easier with the new mask. I move around a lot most nights, but I am trying to learn to switch from side to side.
I am certainly more motivated to get treatment dialed in, after that great night I had. Should I proceed with changing the pressure settings to Red what suggested , try a collar, or attempt something else?
I sure wish I had a video of my sleep from that good night.
Thank you for the help. I am thankful this resource exists.
Here are some suggestions and observations that may be useful. These are based on my actual experiences over the last year, with lots of trial and error, research, and quite a lots of ups and downs.
Regarding the mask test, I believe it is for testing only, and not for therapy purposes. The pressure seems to me to be fixed, perhaps at a test pressure of 20 cms of water which I think is the maximum pressure the machine can achieve.
Regarding your second night with the new mask, compared with the first, I don't think you have sent this, but I think even so, that just one night is not enough to draw any conclusion. Several days of data are realistically needed.
I would suggest a good "rule of thumb'' method is at least a 5-8 day sample.
Concerning dorsal sleeping, I would suggest again you need more historical data for confirmation. Your last two screen shots seem to show an absence of clumps of obstructive apneas. Looks good so far. Leaks look OK, taking into account you had some mask slippage.
As regards to settings, my opinion is as there are so many variables involved, I would change just one at a time, each change cautiously and incrementally, and check with the graphs to see the results, and of course how you feel.
Concerning your questions on pressures, firstly the minimums, 7 is a good start, as you get the full range of the EPR.
However looking at your graphs, you could in this case perhaps make a jump in your minimum pressure to 8 cms that may reduce your hypopneas and obstructive apneas.
If no significant change, you may want to increase further, incrementally this time with steps of 0.4, see the impact on sleep quality to eventually find the "sweet spot" - good AHI and above all good sleep quality and comfort.
It's a process of trial and error.
Concerning the maximum pressure setting, you may wish to find it examining the maximum pressure graph. If it is bumping continuously against the actual set limit, it may be interesting to increase a bit. The "sweet spot" again is to have the cap high enough to do the job, but not too high. Only you can decide what is right for you.
Take your time, step by step, and as always, cross check back to the graph data results.
Regarding collars, I would wait a while until you have more data and have a clearer picture generally.
Some additional points :-
I think it is very important to use the "Notes" tab to systematically record how your night went, for how you feel, events such as mask problems, any therapy changes you made before the night started, colds, flu etc. You can then refer back at any time as needed for comparison purposes.
Another tab that is quite interesting is the "Events" tab. This gives automatically the duration time of each apnea event recorded by the machine.. for example, an obstructive apnea lasting for (let's say) 55 seconds, meaning likely no oxygen for 55 seconds….
Spend time going through in detail in the Help section of the Board, the explanations of the graphs and definitions. Well worth investing the time and effort.
A bit of a long reply from me to cover these points, and a lot to digest, but hopefully it will give you enough information to help.
