Seeing more UA and CA - due to being sick or AFIB med?

[MyronH]

I did buy a Cervical collar and tried it the other night. It didnt seem to make a difference. But i can try again tonight and also change minimum pressure to 9. 

If it is my tongue blocking the airway, the pressure should be able to break through that obstruction too right? At least according to my doctor he said it should. 

I'm laying exactly the same way as i did in sleep study on my back. The only difference... They had a flat bed Sleep Number air mattress. My bed has adjustable head and feet that I can raise and lower. I thought raising my head would help with obstroctions but apparently not. 

Maybe i should get a dental appliance to move my jaw forward and keep tongue out of the way. Or buy a tongue retainer. I need to do something soon since I feel tired all day.

[MyronH]

So I do have one of those special neck pillows that can also keep my neck straight. But I dont think I can use that at same time as the cervical neck device.

What about over the counter tongue devices that keep your tongue out of your mouth?

[MyronH]

UPDATE: Just got a call from my sleep doctor. They want me to leave my APAP pressures at 7-14 and have the machine auto-adjust. They didn't seem concerned as long as my AHI <5, and even last night when it was 7, they are concerned. The multiple 20-30 second OSA in a row, are also not concerning them.

Should I got to yet another sleep doctor, or are all of these events really considered "normal" and "safe"?

[Sleeprider]

I did buy a Cervical collar and tried it the other night. It didnt seem to make a difference. But i can try again tonight and also change minimum pressure to 9. 

If it is my tongue blocking the airway, the pressure should be able to break through that obstruction too right? At least according to my doctor he said it should. 

I'm laying exactly the same way as i did in sleep study on my back. The only difference... They had a flat bed Sleep Number air mattress. My bed has adjustable head and feet that I can raise and lower. I thought raising my head would help with obstroctions but apparently not. 

Maybe i should get a dental appliance to move my jaw forward and keep tongue out of the way. Or buy a tongue retainer. I need to do something soon since I feel tired all day.

If you did not have a titration study, request one.

If your obstruction requires physically moving around anatomy, I will be surprised if a few cm of air pressure will  displace it.  Regardless, solve the problem in a clinic.  If the problem can be resolved with pressure, then they will tell you. If you need surgery or a dental device, they can recommend it.  You are apparently not a good candidate for self titration.

[MyronH]

I'm not sure I understand. I told you already that I just had a sleep study done this week Tuesday. This is the 2nd sleep study I've had with this clinic, and the 4th sleep study total in the past year! They said they titrated me and adjusted pressures to have no apneas during the night. I layed on my back, just like at home, and had no apneas during the sleep study. They didn't tell me what pressure they used during the sleep study. But the doctor then told me to set my machine to 7-14 auto. I confirmed again today with the doctor, that they want me to use 7-14 auto pressure for now.

I just don't understand though, why during the sleep study, they were able to get me to have no apneas, but at home using my machine, it clearly still shows I have them. Sleep doctor was against me going to a dentist to get a dental appliance and said i didn't need one. But he said it in a way, that sounded like he didn't like Dentists getting into the same field as him.

Not much else I can do for now, but use the pressures they've instructed me to use. If things don't get better, all I can do is call the clinic back on Monday and harass them and tell them these pressures are not working for me.

[Sleeprider]

Get a copy of the study. It would be interesting to see the results by pressure. We never expect zero, but the study should show the effective pressure for OA, and if you have clusters of OA at that pressure, then I would conclude what your are seeing in your CPAP data is primarily a physical or positional obstruction. I'm not a big believer in MAD (mandibular advancement devices). After working with many members here, I just find using a cervical collar or similar positional manipulation takes care of nearly every OA cluster we see. I'm open to the idea of using a MAD or tongue restraining device, but I'm yet to see it be the actual root cause of a problem.

[MyronH]

Get a copy of the study.  It would be interesting to see the results by pressure.  We never expect zero, but  the study should show the effective pressure for OA, and if you have clusters of OA at that pressure, then I would conclude what your are seeing in your CPAP data is primarily a physical or positional obstruction.  I'm not a big believer in MAD (mandibular advancement devices).  After working with many members here, I just find using a cervical collar or similar positional manipulation takes care of nearly every OA cluster we see.  I'm open to the idea of using a MAD or tongue restraining device, but I'm yet to see it be the actual root cause of a problem.

Thank you for Sleeprider. I'll call them on Monday and ask for a copy of the study. Tonight I will try my cervical collar again. When using the cervical collar, I'm not sure how I should position myself in bed. Should I just put it on, and lay on my back as usual, and hope it keeps my neck straight and not allow my chin to dip?

Or when you say "positional obstruction", do I just need to try different sleeping positions every night with the collar? Tilt head one way or the other with collar on, or sleep on side?

[Walla Walla]

The main thing is to make sure the collar fits under your chin so it can't drop to your chest. You can sleep on any side you prefer.

[Sleeprider]

Walla answered this well. Be comfortable and sleep in any position that works for you. The collar is just to prevent torsion of the airway arising from poor alignment of the head and neck. The most common way people cut off their airway is when the chin drops toward the chest. You can simulate this just sitting in your chair; relax and let your chin drop. If you feel increased breathing resistance, that is what happens at night.

[MyronH]

Well here is last night results. I lowered EPR again from 2 to 1.
For part of the night, I used my old Tempur-Pedic Neck pillow that angles the head slightly back to keep the neck straight. I haven't used this pillow in a long time, since I prefer a regular pillow, and didn't think this pillow made much difference. But I did notice once I layed down on it, it was a little easier to breath. My AHI went down to 2.64. Didn't have any very long 40+ sec OA either. Only had 5 OA last up to 14sec. I tried using the cervical collar the last part of the night, but it was uncomfortable compared to using my neck pillow.

But I do see an increase in clustered CA's which is weird. From 12:30am-4:30am all good. 

I wore my Contec Oximeter, and that damn thing kept going off! I had it set to 87%, and it went off like 5 times last night. So I'm still having oxygen desat, but during my last sleep study, they said my oxygen was all good.

I'm also trying to correlate data with my fitness watch, as it tracks my max heart rate. It appears when I have an OA/CA my heart rate goes up to 100-140bpm depending on the length of the OA. I suppose that is normal for everyone with sleep apnea? Heart gets stressed and it speeds up during the OA.

 Most of my OA's happened at pressure 10-10.8. What I dont understand, is that the machine will ramp up a little afterwards to prevent more OA, but then it goes back down again, which may cause another OA. I guess it is trying to use the lowest pressure possible in the range that it is set to? I guess the machine also doesnt learn from previous nights either. It takes each night as a new night.

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