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Relatively New Dreamwear User - daves677 - 12-31-2018
I have been a lurker for far too long. Really appreciate the help that is provided here. I was using a Simplus FFM but the top of the mask irritated/cut the bridge of my nose too much. Based on comments here I went to the Dreamwear and am getting used to it. My stats seem to be all over the chart. Attached are from the last few days. Any assistance greatly appreciated.
RE: Relatively New Dreamwear User - Sleeprider - 12-31-2018
If you've been lurking for a while, you may know what's coming. Your apnea and hypopnea re in clusters, and you might (or probably will) benefit from a soft cervical collar to prevent chin tucking. It will also help with leaks. I'd say a pressure range of 9.5-14 looks better than 9 to 12.5. All of the RERA action is most likely flow limitation. This pattern is better addressed using the Resmed Airsense 10 Autoset with the EPR pressure difference between inhale and exhale pressure, or even a bilevel, but we will work to improve this. The first step is to deal with the flow limits and use a soft cervical collar. The Wiki on Flow Limitations has some specific information on this including its role in positional apnea. http://www.apneaboard.com/wiki/index.php?title=Flow_Limitation
RE: Relatively New Dreamwear User - Gideon - 12-31-2018
Welcome to the forum. I see a definite indication of Positional Apnea on all of your charts.
The first thing to do is to manage that. This is best done with a soft cervical collar that is loose fitting, we want to keep your chin from tucking, not lock your neck into a fixed position.
You are using a PR machine and it looks like you may have a bunch of flow limitation occurring which can disrupt your sleep. The best way to see is to post an expanded view of your flow rate. I would also raise your minimum pressure to 10 cmw and your max to 14 cmw so 10 to 14 range. Why, mostly because the PR machines respond slowly to events and work better at a tighter range around where your events occur.
Th e flow limits I see are better treated with a ResMed machine and its EPR though we may try flex once we see what happens with the changes you make.
Fred
RE: Relatively New Dreamwear User - daves677 - 01-01-2019
Bonjour and Sleeprider, thanks for the quick response. I have had to sleep on my back due to a knee replacement back in May. Can that be a contribution to the positional apnea? I changed the pressures to 10 to 14. I had lowered it because with the Simplus FFM the pressure went up and I had bad mask leaks that woke me. I am due for a new machine. It sounds like the Airsense 10 Autoset may be a better fit. Attached is the snip from last night.
RE: Relatively New Dreamwear User - Gideon - 01-01-2019
The positional I am seeing is not from sleeping on your back but rather from chin tucking. I still see some in this latest chart. But your numbers are good so I ask How do you feel? The goal at this stage is to impact the quality of your sleep.
Fred
RE: Relatively New Dreamwear User - Sleeprider - 01-01-2019
Only the doctors and therapist think "positional" apnea means supine. We know it is really a chin tuck in any position. It happens a lot on your back because we like to rest our heads on pillows that facilitate chin-tuck, but we have seen positional apnea in any position and even while using so-called "ergonomic" or cervical support pillows. So the professionals erroneously attribute to gravity, what is really just a body position many people naturally have. The simple way to prove this is to sit comfortably in a chair and relax. As you relax further let your chin drop towards your chest. People prone to this obstruction will sense more airway restriction, a snore or even complete apnea. This happens naturally during sleep, even sleeping on your side in a "fetal" position.
If it had not been a factor in at least 1/3 of the members here, we would quickly dismiss it, but the results are amazing. We have seen some members go from AHI over 30 to less than one without changing any CPAP settings, but adding a soft collar. Someday, even the medical community is going to capitalize on this and start measuring patients for collars, but for now you can DIY for less than $20.
RE: Relatively New Dreamwear User - Gideon - 01-01-2019
Thanks SR, I just added that to the wiki Optimizing therapy Positional Apnea
RE: Relatively New Dreamwear User - daves677 - 01-02-2019
SR, is there any special brand/type of soft collar or preferred vendor?
RE: Relatively New Dreamwear User - Sleeprider - 01-02-2019
Soft cervical collar choice is a bit of trial and error. We want a comfortable fit that prevents the chin from dropping and we certainly don't want to compress the tissues at the front of the throat. You need to be sure the circumference is adequate for your neck and the height is supportive based on the measurement from the top of your sternum to the base of your chin as you look straight ahead. Since these are individual measurements, what works for me or someone else may be completely wrong for you.
Read this thread Best Soft Collar
In your case, the best suggestion may be to take Greggor's advice http://www.apneaboard.com/forums/Thread-Best-soft-collar?pid=262743#pid262743
Quote:No need to take my word for it...$15 and a visit to the corner drugstore can get anyone started; fine tuning with the "collar of your dreams" can come later. Good luck and good sleep!
RE: Relatively New Dreamwear User - daves677 - 01-08-2019
SR and Bonjour, you were spot on WRT the positional effects. I got the Dr. Dakota chin device and these are the results for the second night of use.