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[Pressure] Back at it - new charts
#1
Back at it - new charts
After a 6-month hiatus (due to some "fun" medical conditions and surgical recoveries - nothing related to apnea), I'm back at seeing if I can get further improvements to my numbers. 

Unfortunately, since last time my best numbers are about twice what they were before (from below 2 to about 3.5 AHI). A SWAG nightly average would be between 4 to 5. Some of this may have been due to the gain of about 10 pounds (due to medically-directed "thou shalt not do squat" associated with the above recoveries - I'm currently in the process of recovering from the recoveries), not sure how much.

Some background info since the last time: 
  • Bonjour suggested that I up my minimum pressure from the factory-default 4 to 7. I made this adjustment at that time: may have improved things a small amount.
  • Based upon leak rate, at the suggestion of a couple of folks I tried to switch to a cervical collar: both a "standard medical" foam one and the "Releaf" travel version. Despite attempts to "tough it out", multiple nights trial with each resulted in waking up with a significantly-stiff neck and a splitting headache due to the pressure that this was placing on my neck. Aside from getting some resulting quality time with my chiropractor, my numbers were actually worse, due to the fact that the collar was essentially forcing me to sleep exclusively on my back. I'm therefore back to the chinstrap at this point.
  • During one surgical recovery when I was directed to sleep face down, my numbers were consistently below 2 AHI, frequently below 1 AHI. My apnea is very positional, with a significant tongue-obstruction component. Unfortunately, forcing myself to sleep all night exclusively on my side or face down creates other physical problems. 
  • I'm still battling somewhat with my mask. The AirFit P10 seems to work best overall from a comfort standpoint, although it's a bit sensitive to being bumped when I shift position. My AirTouch F20 is okay for short naps, but AHI numbers were actually worse when I gave it multiple nights, not to mention the couple of experiences of being force-fed air. I tried the AirFit P30i, but couldn't find a way to keep the pillows from being painfully forced into my septum. 
Suggestions appreciated, especially new ones that I haven't tried yet. Thanks much!

         
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#2
RE: Back at it - new charts
Look at your obstructive events.  They are a bit clustered at a somewhat lower level.  The typical 'fix' is a cervical collar, but for now just watch them to see if they get worse.  If they do we will need to find some way to maintain your cervical alignment.  

Was your previous cervical collar too tall?  This is different than managing leaks.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#3
RE: Back at it - new charts
(01-20-2020, 07:40 PM)bonjour Wrote: Look at your obstructive events.  They are a bit clustered at a somewhat lower level.  The typical 'fix' is a cervical collar, but for now just watch them to see if they get worse.  If they do we will need to find some way to maintain your cervical alignment.  

Thanks for the response, Fred - I'm up for trying again with an SCC, or possibly an anti-snore collar like the Eliminator (which to my memory wasn't available when I instead tried the Releaf). I'd just need the eliminate the previous symptoms somehow.

As it stands now, I'm back to waking up once or twice a night, as well as the associated tendency to fall asleep on the couch in the afternoon. Some of the latter could be due to stamina lost during the weeks of sedentary recovery, but not likely all of it.

Quote:Was your previous cervical collar too tall?  This is different than managing leaks.

Not sure ... I'm not an expert at cervical collars, so it might have been. The problems with the SCC were IMO related to a combination of its stiffness, it's relatively-square edge, and the thickness in the back. Even after a lot of gyrations with the pillow and the tightness of the velcro strap, laying on my back often felt like I was trying to dislocate my cervical spine from the base of my skull with a (square-edged) tennis ball. Laying on my side, my shoulder would force the "edge" of the collar into my ear and / or lower jaw: there was no position or collar tightness that I could find that would avoid this.

My attempt with the Releaf was intended to address the square edge of the SCC. It helped somewhat, but still had the same problems - just to a slightly-lesser degree. This makes me wonder if an anti-snore collar like the Eliminator / Dr. Dakota, which lacks padding in the back, might help solve these issues.

From past experience (which was positive up until a year or two ago, hence the switch to APAP) with a dental appliance, I was getting significant benefit from preventing my jaw and tongue from falling back, as well as keeping my mouth closed ... to the tune of AHIs reducing from 38 to 0.5. Between that and my recent experience with sleeping face down, it seems like the key for me might be in there somewhere.
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#4
RE: Back at it - new charts
The chart didn't say to do it now, but to watch for it possibly increasing. For a trial you can wrap a towel around an old tie, make sure the knot is not in the back.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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: Back at it - new charts
The "towel around a tie" idea is interesting - I'll likely try it out in the next couple of days.

Thanks, Fred!
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