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Need help solving apopnea issues
#1
Need help solving apopnea issues
Just joined the board, but have been a come-and-go lurker for a year or so.

Diagnosed with sleep apnea two years ago, have been using CPAP literally every day since getting my hardware. I don't feel like I'm getting the quality of sleep that I could be getting, however obviously it's been a dramatic improvement since pre-treatment. I am on a quest to optimize my treatment and get full quality shuteye at least most nights.

For the majority of my two years using CPAP, I've been using a Dreamwear or Airfit headgear mask where the air supply travels along the sides of your face and connects at the top. I like this mask, and my AHI number is always less than 5 and usually between 1-3, however I do frequently see a lot of large leak numbers. I assume that large leaks do at least partially corrupt all of the data, as the machine cannot tell exactly what is going on when this is happening.

In addition to the large leaks, I also wear headphones to sleep and it seems as though they might be at least partially reducing the airflow running down the side of my head.

In the effort to alleviate my two issues, I recently purchased a handful of nasal pillow masks that connect at the nose in addition to a chin strap, which I am slowly trying one-by-one to find my preferred mask. My OSCAR data does show that I've completely alleviated my large leak problem, however it brings about an entirely new issue: Hypopneas. I googled this term and have a basic understanding of what it means, however I'm not sure exactly what is going on when they occur, nor am I sure of how the machine can accurately measure this without a blood oxygen sensor. I do wear an Apple Watch to bed every night, and my levels are consistently above an average of 96% throughout the night.

If anyone can help shed some light on what might be going on or anything else they might see from the two nights of OSCAR data I've shared, I would be eternally grateful.


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#2
RE: Need help solving apopnea issues
A hypopnea is a 50% to 80% reduction in airflow for 10 seconds or longer. Think of it as an apnea of shorter duration. The machine measures it the same as it measures apnea. Most of your hypopnea on Jan 3 are in clusters indicating what we call “positional apnea”. (See http://www.apneaboard.com/wiki/index.php...onal_Apnea ) It’s usually due to tucking the chin towards the chest which constricts the airway. This may be caused by sleeping on your back with too thick a pillow or tucking your chin to your chest while on your side. This is corrected for many of us by wearing a soft cervical collar (see the link below). If this was just a one night occurrence it may not be an issue. Flow limitations are probably also contributing to the hypopnea and in themselves can disturb sleep. Use of full time EPR should reduce them and the RERA as well. I see that you were using an EPR setting of 3 when using the dreamwear mask and your data looked much better. Suggest you go back to that setting.
Download OSCAR

Organize Charts
Attaching Charts

Mask Primer
Soft Cervical Collar

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: Need help solving apopnea issues
THANK YOU! Absolutely priceless information for me that would've taken ages for me to figure out on my own.

I will look into a cervical collar, but jeez'o'man between the CPAP, the chin strap, and now a cervical collar, I'm gonna be a freakin Frankenstein

I already suspected that EPR was helping me, but I ran into endless demonizing of that feature all over the webs, which had me steer clear of turning it back on. I will enable it tonight and see what effect that has.

FWIW, I sleep on my back with an adjustable base propped up similar to how the guy in the attached file is laying(new user and can't post images yet)

Thank you again for taking the time to help out a stranger!
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#4
RE: Need help solving apopnea issues
I would wait and see if the event clustering happens frequently before trying the collar. It did not show up on your other chart. I use a collar myself and don't find it uncomfortable but some do.
Download OSCAR

Organize Charts
Attaching Charts

Mask Primer
Soft Cervical Collar

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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#5
RE: Need help solving apopnea issues
It's happening every night since I changed masks. There is some variance each night and occasionally an outlier evening, but I chose examples that were the 'jist' of what each mask and settings were yielding me
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#6
RE: Need help solving apopnea issues
Here are some basics

CPAP is a single pressure machine, so Pressure = exhale pressure/EPAP = inhale pressure.
BiLevels are dial pressure in that EPAP and IPAP are different managed pressures.  Pressure Support/PS is simply the difference between exhale and inhale pressures.

Exhale pressure is what splints open the airway and manages OA, Obstructive Apnea, events. This is true even on CPAP machines.

Hypopnea, Flow Limits, RERAS are all treated best with PS, the difference between inhale and exhale pressure.   This is important.

EPR is essentially PS on a CPAP. It is also the difference between inhale and exhale pressure. 
It is calculated differently so it gets confusing for many.  On a CPAP  Exhale pressure = (inhale) Pressure - EPR.  

On a BiLevel IPAP = EPAP + PS

Both of your charts show high flow limits.

Why is EPR so belittled out there? IMHO it's because EPR has the reputation of causing central apnea, and yes it can, but of it does we react to it.  These machines do not report events during the ramp, the just do not.  Not being reported they then don't exist, and therefore many of those that say EPR is bad say it is ok during the ramp because you don't have any CA events there.  At least that is the logic.  Following this bad logic deeper down the rabbit hole, just using a CPAP can cause Central Apnea.  By their logic why do they even think CPAPS can be good since they can cause central apnea?

These particular central apneas are caused by flushing too much CO2 from your system, down to below what is referred to as the apneic threshold below which a central apnea occurs.  Simply stated, It is the need to remove CO2 from our system that provides our drive to breathe, not a need for oxygen.

Most here see EPR as a tool, a very effective tool, that is used to treat obstructive apnea.  Should se see an increase in CA events we react to it and consider the knowledge a good thing.  

Anyway EPR is nothing to be afraid of.
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#7
RE: Need help solving apopnea issues
Okay so I tried it and my numbers look a lot better. I do feel like I had a horrible night's rest, but that could be due to virtually anything outside of whether or not I was able to breathe.

Going to test this for a few more nights. Is there anything else that you notice I could change in order to get that AHI down even further?


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#8
RE: Need help solving apopnea issues
The chart looks really good. Hopefully, You'll feel really good soon.

QAL
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#9
RE: Need help solving apopnea issues
Flow limit is still quite high.
Hopefully one of the experts weigh in again to help.
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#10
RE: Need help solving apopnea issues
I ran into a new issue last night, or this morning rather. I was expelling air/gas in extreme amounts, for instance I burped for far longer than I ever have in my entire life, a full 4-5 seconds or so. I must be swallowing air? Is there a straight-forward fix for this one?


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