[Treatment] 60+ days of treatment, Lowest AHI 1.44 & Highest 13.39

[miker19]

Hello All,

I'm coming to this board to get advice on my current treatment and how I can improve it. I haven't had any noticeable improvements since using my APAP. My AHI over the last month has seen a low of 2.88, a high of 13.39, and an average of 7.40. I wake up feeling exhausted and in a fog still. When I got the machine, DME said I should be getting under 1 and if I am seeing any numbers above 10 I should go back to the sleep clinic. Well the sleep clinic won't see me until the average is over 10 which is frustrating as my current set-up is not working for me. My PCM is understanding and trying other things to help with my sleep. My sleep study did say "sleep deprivation" as well as "OSA" as my diagnosis. I'm not taking any sleep meds.

My current setup is a Dreamstation APAP set at 4-20cmH20 wearing the dreamwear nasal pillow mask. I have tried the dreamwear full face mask and gel pillows but neither worked for me. I don't mind the nasal pillow mask and usually keep it on the whole night. It does wake me up if I move on my side and the seal loosens up sending up loud escapes of air but overall I am doing ok with it.

I've downloaded OSCAR and looking at the data is a little overwhelming. I'm also not sure which screenshots would help in giving advice for treatment. I've attached the overall view from last night's sleep. 

Please let me know what data is needed for treatment improvement. I really just want a good nights sleep.

Thank you in advance! 

[Crimson Nape]

Hi miker19 - -

Your CPAP is set wide open.  Philips CPAP's are slow to respond OA's and Hypopneas.  For that reason and viewing your data, I'd try a pressure range of 8cm to 12cm.  The higher starting pressure should help eliminate the hypopneas.  Your data doesn't show you going that high but the upper limit of 12cm allows for those nights when a little more kick is needed.  

I welcome your thoughts on these changes.

[mesenteria]

When you look at the spatial distribution, or the temporal one, your choice of how you interpret the relative position of each event with the one next to it, you can't help but notice that they tend to 'cluster'.  They come one right after the other, at least in pairs, often more numerous.  When we see this, we anticipate that the person's chin is probably tucking toward their chest, bending the neck, and closing off the airway, or at least restricting the flow by partially closing the cross-section.  Instead of it being 'fully open', its pinched a bit.  This can cause hypopneas and even obstructive events.

A remedy that often works quite well is to start wearing a soft foam cervical collar available at department stores in some cases, pharmacies, and at medical supplies outlets.  It's not for everyone as they take some getting used to.  They tend to be warm around the neck.  If you wear it too tight, it will be warm.  It's best if it is rather loosely fit.  Before jumping on this, though, I'd try what Crimson Nape has suggested; see if some pressures tweaking improves things for you.

Otherwise, I agree with Crimson Nape. Your lowest pressure setting of 4 is something we immediately ask people to raise if they can do this themselves and feel comfortable doing.  Many of us need at least 5, but find that 5.5-6.0 is even 'nicer' in the way it feels.  Your top pressure, if your AHI is well controlled, should be a hair above the max that a free roaming machine finds itself reaching.  If your machine rarely reaches 11 or 12, then you'd put yourself at 13-14, as an example, and see how that goes.

[Melman]

I agree with both of the previous posts. Go here  http://www.apneaboard.com/wiki/index.php...cal_Collar  for more information on soft cervical collars/

[miker19]

Thank you all for the reply. I have upped the pressure settings on my machine but I woke up this morning with a 9.8 AHI. However, I did find the pressure was more comfortable throughout the night as I didn't wake up like before when it would go from really low to higher pressure. 

When I get home later today I will look at the OSCAR data to see what was going on. I also plan on ordering the foam cervical collar as I probably need it.

[OpalRose]

Assuming you made the pressure changes suggested by Crimson Nape, and if you still see a lot of CA’s, try turning the Flex setting to off.

And definitely try the collar.

[miker19]

Assuming you made the pressure changes suggested by Crimson Nape, and if you still see a lot of CA’s, try turning the Flex setting to off.  

And definitely try the collar.

I did follow the suggestions from Crimson Nape.

DreamMapper shows 29 CAs, 3 OAs, and 41 Hs. I will turn the flex setting off. 

Thanks

[miker19]

Ok I thought I changed the min pressure to 8 last night but it was 7. I changed it to 8 now and turned flex off.

I've attached last night's data. The foam cervical collar will be arriving tomorrow and hopefully will help get rid of the cluster of events.

Anything else I should try adjusting?

[OpalRose]

Ok, post a chart tomorrow with the new settings. Or give it a couple days if you like.

[miker19]

Ok, post a chart tomorrow with the new settings.  Or give it a couple days if you like.

OK last night was definitely better breathing wise but the new settings caused me to wake up a few times throughout the night. The pressure was pretty intense without the flex setting turned on. I'm guessing I will get used to that? I did lose the seal quite a bit more with the higher pressure. I think I will try the dreamwear nasal gel pillows tonight to get a better seal. Although, that mask made it feel the next day like someone upper cut punched me in my nose and caused extreme dry skin in the nostril. 

Dreammapper - AHI 3.4 (CAs 5, OAs 9, Hs 11) This seems like a higher amount of OAs than I normally have though.

I feel tired this morning but not the usual exhausted/jetlag feeling.  I'll post OSCAR after a few days of data.