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[Pressure] 22cm and I'm still having OAs
#1
22cm and I'm still having OAs
I've been on APAP for 6 months. I originally only had an in-home study.

My 95% pressure was 19.8cm and I was still at an AHI of 2.5ish.

I did an in-person titration study and they moved me over to BiPAP pretty quickly. My ideal pressure was 19/15 for NREM and 21/16 for REM.

My Dr. Prescribed a BiPAP with a pressure of 19/15.

I felt so much better, but my AHI raised to 5.0.

I tried it at 21/16 and had obstructive apneas as well.

I now have it on VAuto mode starting at 21/17 and it often goes up all the way to 23.5/19.5 and I'm still having obstructive apneas.

I suspect it's possible that some of the obstructive apneas I'm seeing are actually central apneas, but I'm not sure. 

I'm a really big dude, but isn't this crazy high pressure? What can I do to clear out those OAs?


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#2
RE: 22cm and I'm still having OAs
Welcome to the Apnea Board,

Although these flagged events aren't right on top of each other, it's possible there's some Positional Apnea attribute to this.

Check your pillow; is it a stack of several thick pillows or a thinner single one? If the thick stack is more what you have, you may want to try moving to the single, thin pillow. The goal is to prevent chin tuck, which has been reported to close off the airway by way of kinking it closed. Consider you garden hose being kinked as a similarity. When kinked, the water flow is restricted. This is much the same as your neck kinking the airflow.

Experiment, point your chin towards your chest. Is it now harder to breathe, more resistance? If so, then that's the chin tuck and Positional Apnea effect.

If the pillow thickness passes, then there's a soft cervical collar you may want to research. Look in my signature for the wiki on this as well.

Let's see what results from this investigation into your situation.

BTW this Positional Apnea is not the same as your sleep study and that mention of the word positional is meaning side, back, or stomach, as a body position.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: 22cm and I'm still having OAs
I sleep in a hammock with no pillow, at an angle so that my torso is slightly elevated.

I try to position myself so that I don't get the chin tuck like you described. I might have to focus on that more.
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#4
RE: 22cm and I'm still having OAs
OK copy that. Keep us updated. Alternatively, it might be that you do need the higher pressure for successful therapy. I think the jury's out still though.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: 22cm and I'm still having OAs
OTOH, while we all know that the Doctor's opinion is that 5 is good enough, we also are pretty sure that between 2 an 3 is 'well treated'.
If your 1.36 is near your average for many nights, I'd say that you are doing very well. You will almost never get a 0.0 night, and you shouldn't try. You should be aiming for a comfortable, restful night's sleep.
I'd be tempted to tell you to back off on the minimum pressure and keep an eye on your AHI and flow limits. As long as your AHI is consistently 3 or below and you are resting well, you're fine.
Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#6
RE: 22cm and I'm still having OAs
In last 30 days, my average AHI was 2.37, CAI was 0.14, and RERA was 2.43 (RDI of 4.94), flow limitations are 0.53 times per hour.  I get good sleep.  Some with same results don't get good sleep, and I am always very sorry when I hear that.  Some continue to struggle for rest, having brain fog and utter exhaustion with much better AHI.  I am so fortunate.

The Philips Series 60 System One counts flow limitations differently than the Resmed machines.  And, for the last seven years I have not ceased to use a full face mask.

My normal position for sleeping before therapy was on my back, with several thick pillows, my chin tucked to my chest, and often with a sheet tucked over my head.  I remember this was a standard throughout my childhood, and slept rather calmly and blissfully this way. (Apparently, I was shorting myself oxygen, and boosting my CO2 rebreathing as a general rule.)  Gee, I wonder how I developed Apnea?

BTW, the test suggested about tucking your neck and trying to breathe - I feel no restriction at all, so I fail to prove to myself that it is a bad thing during sleep.  My brain has to do arguing, bringing up testimonials to say it could be bad while I am asleep.

Now I do prop myself on my side, and use a soft cloth travel neck pillow filled with walnut shells to take up space between chin and chest.  I don't get worse results, but do not necessarily see better results either.  Still, mostly happy all the time.

Seek the happiest, most restful.

QAL



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#7
RE: 22cm and I'm still having OAs
(10-23-2021, 06:05 PM)SarcasticDave94 Wrote: Welcome to the Apnea Board,

Although these flagged events aren't right on top of each other, it's possible there's some Positional Apnea attribute to this.

Check your pillow; is it a stack of several thick pillows or a thinner single one? If the thick stack is more what you have, you may want to try moving to the single, thin pillow. The goal is to prevent chin tuck, which has been reported to close off the airway by way of kinking it closed. Consider you garden hose being kinked as a similarity. When kinked, the water flow is restricted. This is much the same as your neck kinking the airflow.

Experiment, point your chin towards your chest. Is it now harder to breathe, more resistance? If so, then that's the chin tuck and Positional Apnea effect.

If the pillow thickness passes, then there's a soft cervical collar you may want to research. Look in my signature for the wiki on this as well.

Let's see what results from this investigation into your situation.

BTW this Positional Apnea is not the same as your sleep study and that mention of the word positional is meaning side, back, or stomach, as a body position.

I put a towel under my neck, and I think that significantly decreased the obstructive apneas. This is super exciting, because these longer obstructive apneas only started to appear AFTER switching over to BiPAP. It's mostly been Hypopneas and flow restrictions that have been my problem until now.

Having the hypopneas finally under control then seeing these new type of obstructive apneas all over the map was kind of concerning.

Previously, whenever I had an obstructive apnea... you could almost see it coming in the flow rate waveform. It would be preceded by a hypopnea or leak or some other disorder in my breathing pattern. These new obstructive apneas that were showing up would come out of nowhere--- the waveform would be nice and perfectly even... then out of nowhere.... bam... no breathing. 

I'm glad the towel under the neck resolved those.

I think what might have happened is that as I fell into deeper sleep (FINALLY I'm getting deep sleep) the positioning became more of a problem. In a hammock, much more so than on a flat surface, when your body relaxes your position can change. (It's drastically different than in a bed-- for example, moving your legs to one side will cause the elevation of your torso to raise or lower. That being said, in a hammock, I wake up in almost exactly the same position I fall asleep in. If I fall asleep with no blanket on my feet and my phone on my face, that's how I'll wake up.)

Part of my reason for sleeping in a hammock is because it helps me fall asleep and stay asleep. When you have an arousal, you move around a bit and the hammock swings. It lulls you back to sleep and you don't notice it. It took a long adjustment period to learn how to position myself. I gradually worked my way down to smaller pillows, and recently have only been using a folded up bath towel. (The towel ends up being more soft and comfy than you would think)

I've been camping in hammocks for decades. My first one was a Vietnam war era military surplus jungle hammock that I used when I was a boy scout. I had a really tough time recovering from sinus surgery a few years back, and moving to hammock sleeping indoors is what saved me.

I did also try backing off on my pressure a bit. That brought back Hypopneas and flow restrictions and my flow rate waveform just looks "messy." I'm going to go back to Vauto starting at 21/16 with the towel under my neck, and we'll see what happens. I'm excited.


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