Persistent OA, Hypoapneas and RERA events despite Pressure Increase

[chewielotuses]

Hi Guys/SleepRider

My diagnosis from PSG is Moderate Obstructive Sleep Apnea. Overall AHI 17.6, REM AHI 27.

I've been using an Resmed AirSense 10 since Nov 2022 and have been progressively moving upwards using fixed pressure of 12.6 (recently managed to get comfortable using pressure 13.2). I do experience quite a fair bit of aerophagia at these pressures.

My main concern is fragmented sleep throughout the night (i.e waking up once every 90 - 120mins) and waking up still feeling tired and groggy.
I do note that I definitely feel better being on CPAP than without (I'm a complete wreck/zombie without PAP).

Here are my OSCAR charts showing pressures 12.6 EPR 1
and also fixed pressure 13.2 without EPR.

Eager to hear what you guys think I can do to solve my fragmented sleep issue. I've also ordered the V-COM device from SleepRes so am hoping that could increase the comfort during inspiration.

Best regards
Chewlotuses

[Sleeprider]

Remind me again why you're using almost no EPR. Apnea are clustered suggesting positional issues. Got a collar?

[chewielotuses]

Hi Sleep rider,

Sleep Tech I'm talking to was initially wanting to see if fixed pressure without EPR would establish adequate airway patency but it didnt seem to work ( nor in preventing fragmented sleep). I'm back on fixed 13.4 and EPR 1 right now and some of the obstructive events (flagged) are re-emerging.  Most of the events I have are still over-whelmingly me taking in deep breaths followed by 20-30s induced clear airway events.

We are thinking of having me move to Bi-Level soon...

Btw the clustered apneas I posted above, they dont happen often. maybe like 1 out of 15 nights or even rarer. Tech was also thinking I might have slept on my back "accidentally". I usually sleep on my side.

Tech thinks my issue is just having an airway that isnt easy to sten open, "stubborn" as he puts it. Do you seem members here having a similiar problem?

[Sleeprider]

The pattern of intense clusters of obstructive apnea, with periods of no events is typical of what we call "positional apnea". It is actually any sleep position that bends the airway or causses impingement of the airway with soft tissue, and is often chin-tucking or a fetal position with chin tucked. Even sleeping prone with the head to the side has caused this pattern. Read our wiki and see if this pattern matches your issues. The problem is very common and when resolved allows the user to get reliable efficacy with lower pressure. Your flow limitation 95% index is relatively high and can likely be resolved by more EPR which is analogous to pressure support in bilevel. FWIW, the Resmed Aircurve 10 Vauto is the best machine available for obstructive apnea, but we can accomplish more than you think by manipulating your CPAP and making more use of EPR. If you are deep breathing or hyperventilating after a period of increasing flow limitation, that is a RERA, and it is setting up the scenario for destabilizing your respiration leading to CA events. All of this is manageable.

Positional apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft cervical collar http://www.apneaboard.com/wiki/index.php...cal_Collar

[Rice95]

I agree with Sleeprider. Positional apnea is my issue. I sleep with 2 foam wedges (one on each side of me for each time I turn over I remember to wedge it under my side to keep me off my back)
I also sleep with a small pillow between my knees to keep my spine straight which helps keep my head from drooping and cutting off the airway. I also use a soft collar. I also can’t stress enough using a thinner pillow. High or thick pillows can kink your neck and cut off your airway. This routine has been the key. Occasionally I’ll slip onto my back but for the most part I’ve finally licked the problem after a year of struggling with positional issues. Often this is overlooked by apnea sufferers. My fired doctor was anxious to straighten my deviated septum to solve the AHI issues and I opted with no surgery. I’m glad I did because I’m doing great and I’ve heard surgery can sometimes make things worse as in my wife’s case. 
I hope this helped!