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Never understimate the importance of Position
#1
Never understimate the importance of Position
I'm starting to think I'm going to have to change my nickname.  Smile

When I first came here, I'd just gotten a Resmed Airsense 10; had seen my pressure, first, upped to 14, then set to Autoset with a top range of 20.

Even *with* those changes, I was having 100 events a night.  Some nights, I was having as many as 160 events.  Lots of obstructions and hypopneas.  A bunch of clear airs and RERA's.  I was fighting leakage and dry mouth because my mouth was being blown open as the pressure ramped and the full face mask cushion couldn't handle it.  I wasn't sleeping well

My respiratory therapist didn't know what to do...she eventually just kicked me back to my pulmonologist who, in turn, thought I "shouldn't worry too much about my AHI".

The advice I got on this forum was what changed things for me.

Looking at my numbers, the forum gurus suggested that I might have positional problems.  Too many pillows that was allowing my head to tip forward and letting gravity (and CPAP pressure) blow my mouth open and drop my chin.  They also suggested I try a cervical collar to help keep my neck straight and my mouth closed.

I tried the collar first, and my numbers dropped.  Pillows next, and my numbers plummeted.  I had *never* had an AHI under 5 until I started laying flatter, using the collar to keep my neck straight.

I also suffer from GERD and, laying flat, started to have reflux issues, so to the above changes, I propped the head of my bed up a brick high.

That change has let me see AHI's of 1 and a few that are less.  And I haven't had a single obstructive event for days.  Still HA's, a few CA's, and mostly RERA's, when I have events.

---

While it's always worth noting that not everyone will have the same issues or experience the same successes and failures in apnea therapy, I've become a firm believer in the notion that addressing positional problems should be a "try me first" step.  Apnea is hard enough to treat if the neck is crimped and pushing the airway closed.

Of course, you should always talk with your doctor, especially if you think things aren't working or when you're looking for advice from the Internet.  Smile

Fixing position might not be the solution for everyone, but it's *also* something you can try without having to buy a lot of super-expensive equipment.  It's also *not* something that doctors and respiratory therapists seem to know as much about or are as willing to suggest their patients try.
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#2
RE: Never understimate the importance of Position
now that the positional issues are effectively dealt with, I wonder if you can reduce your APAP pressures and still have effectively low AHI.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#3
RE: Never understimate the importance of Position
Yep, gonna have to change your name!   like 

Well done, congratulations!
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#4
RE: Never understimate the importance of Position
I didn't pay much attention to positional issues until the last two years or so, and then really started to see results in people that seemed to have intractable problems with apnea. It has been a revelation, not based on my personal experience. As you say, I tend to look at some members charts and saying "try this first". I used to be all about the pressure. Not any more.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#5
RE: Never understimate the importance of Position
Although going from a fixed pressure of 10 to autoset of 9-14 has helped, the biggest help for me came from addressing my head and neck position.  I thank Sleeprider for suggesting it. The simple use of a buckwheat chaff pillow to stabilize my head position resulted in an immediate drop in AHI from 6-15 to below 1. This was before going to autoset. I also use a soft cervical collar for when I change positions. With few exceptions, my AHIs have been consistently under 1.0 for several months. I haven,t seen an AHI value above 3.2 since I began using ht buckwheat chaff pillow.
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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#6
RE: Never understimate the importance of Position
As a fellow gastric reflux suffer... I can tell you that lying on your left side will help reduce the reflux.

I can't sleep on my back due to lower back issues, and I hate trying to sleep propped up as my head tips forward and closes off my throat making it hard to breathe. 

Good to hear you are making progress.. but your name is your name, I think you should keep it as a reminder of the progress achieved.  Bigwink
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#7
RE: Never understimate the importance of Position
also use house bricks to prop up the head of the bed ip 4-5", so there is a slope.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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