Dewberry Therapy Thread: Autoset 11 to Aircurve 10 ASV

[Sleepless in Dewberry]

I purchased a Cervical collar and I have worn it the last 3 nights.
I am considering a Knightsbridge chin strap if indications are it will help.
I have ordered an Oximeter to see if I am getting desaturation, I wouldn't be surprised if I am.
I am still a long way from giving up, just another challenge in life.
I was diagnosed with Apnea 20+ some years ago, but ignored it, not a wise move.
Here are my last 3 days, numbers disturb me. something is going on, but what.

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Here is a  screenshot zoomed in.

[Expat31]

I purchased a Cervical collar and I have worn it the last 3 nights.
I am considering a Knightsbridge chin strap if indications are it will help.
I have ordered an Oximeter to see if I am getting desaturation, I wouldn't be surprised if I am.
I am still a long way from giving up, just another challenge in life.
I was diagnosed with Apnea 20+ some years ago, but ignored it, not a wise move.
Here are my last 3 days, numbers disturb me. something is going on, but what.

---

Here is a  screenshot zoomed in.

Try just try sleeping on your back for a few days to see what happens.. without collar..

[Expat31]

Sorry, big typing error!!! Should be:-

Try just try sleeping on your SIDE for a few days. without a collar... to see what happens...

Sorry

[Sleepless in Dewberry]

I switched to side sleeping and the results are the same.
I am getting quite a few Central apneas.
My DME dropped me and said he wanted nothing to do with someone  who lives with chronic pain
and all the accompanying baggage.
I found he sold me a machine with 30 hours on it, passing it off as new.
Trying to find a different technologist, fun, and games.
Thanks for your help, it is greatly appreciated.

[Expat31]

Hi, 

I think my last post was too brief and maybe confusing. 

Best for me to start from the beginning and work through point by point, giving better explanations and reasoning behind them, breaking down the problems as I see them. 

1. Clusters - (obstructive positional apnea) . 
2. Settings. 
3. Central apneas and sleep report. 
4. Professional support.

So the breakdown is as below

1. Clusters. (positional apneas) 

These are perhaps the most important to deal with first as the algorithms cannot work effectively in this environment, and will most likely produce confusing readings. I think no real point in modifying settings at this stage until this fundamental problem of clusters is resolved. 

I believe they are caused principally by air flow being cut, either by:-
 
   a) A kink (fold) in your windpipe caused by chin tucking when your head/chindrops forward during certain sleep positions and certain sleep stages*. I think this is likely on sleeping on your side, when there is nothing to stop your head or chin moving towards your chest, and creating issues of unimpeded airflow through your windpipe

The favoured solution is using a soft cervical collar which removes or reduces this impediment by straightening this airflow passage. The trick is to get the fitting just right, not too loose, not too tight. Easy to say, but not so easy to get there.
I think this may be an excellent solution for some side sleepers. 
   
b)  If you are sleeping "flat" on your back, your tongue can sink back on your soft palate, which can act like a "flap" and effectively fall back under the effects of gravity and block your upper airway. The phases of sleep play a big role here regarding "muscle tone"  (*see below on notes on sleep stages and impact on this type of positional apnea) The simple way to stop this is do not sleep on your back. Saves a lot of hassle. 

I think a soft cervical would be likely ineffective in this case, as the airway would already likely be already quite straight, as gravity would prevent the head from lifting and flexing the windpipe. 

It may be best to start with the simplistic first, (b), and if that does not work, go for (a). 

2. Settings. 

I don't see much point in changing anything until the  cluster problem is resolved. 

However the current base minimum pressure of 4 is too low. It should be at a minimum of 7 to make best use of your EPR setting of 3. You could at least change this. 

3. Centrales and sleep report

I must admit I am not familiar with the layout of your summary sleep report; I can see a figure of 8 (/h ??) but can't relate it to the other  indexes.  

The author, (doctor or sleeptech) of your report should at a minimum be able to go through it with you. Have you all the pages showing the detailed supporting backup?

However, assuming that your report does not indicate anyserious underlying central apnea issues, once you have all the fundamentals in place as above, any centrals should disappear or greatly reduce in time. 

4. Professional support.

I don't know how support is organised in the US, but I expect it is similar to my location in France.

Doctors dish out prescriptions for C-PAPS, once a year or so do a cursory review of overall results, mainly AHI under 5, and compliance, likely not delving into real detail at all, understandable perhaps as not having enough time with so many other patients.

Equipment suppliers do just that, supply masks, hoses etc. So usually not much help is available there! 

In conclusion, try to work through the cluster fundamentals, reviewing forum posts and the solutions already found; general research on the Internet, and trial and error.

Personally it took me nearly a year to get rid of terrible, terrible positional apnea. I wasted a lot of time on useless settings as I had not addressed this fundamental problem. 

The above are my personal experiences and interpretations of what I have learnt.  I am not a medical guy, 

Best wishes and hang on in there! It ain't easy, but what is… 


*Elements of sleep cycle phases 

During certain phases of sleep, the body muscles partially shut down, especially in REM sleep when muscle tone is lost.

A summary of the 4 sleep cycles to better understand this is as follows. 
     1: This is when you are transitioning into sleep and lasts about five minutes.
     2: Body temperature drops, heart rate slows, brain patterns change. This is the first stage of true sleep and lasts about 20 minutes. 
     3: Muscles relax, blood pressure and breathing rate drop, deepest sleep occurs.  The blood flow is directed away from your brain to your muscles, which restores physical energy in your body.
      4: The final stage of sleep is REM sleep, or dream sleeping. Brain becomes more active, body becomes relaxed and immobilised, dreams occur, eyes move rapidly.

[Sleepless in Dewberry]

Hi, Thank You for all your help.
 I sleep on my right side as much as possible, till my hip is hurting too much then switch to the left side till that hip hurts too much.
I rarely sleep on my back which I am aware of. My wife will wake me to move if she finds me in that position.
I have been researching Positional Sleep Apnea solutions, and I was hoping for a reasonable cost help.
Everything I have found requires a prescription and is expensive, which really shouldn't surprise me. 
I am attaching last night's sleep, I had changed my low pressure to 7.2  after reading that it should help.
Imagine my surprise when I woke up at 0315 and found I had AHI of 32, I switched it back to 4 for the rest of the night.
I will go back to 7 if you figure it will help, as it got worse after I switched back to 4.
I am wondering if I am getting desaturation during the night, I have an Oximeter but it doesn't record.
 I have worn it for a time at night and it gets down to 90. 
My sleep report is all there is other than the personal information I removed.
Our system here in Alberta, Canada is family Dr sends a prescription request to a sleep clinic for the sleep test.
We get a home sleep study done, 1 night and the results are what I posted. The sleep clinics have a Clinical Sleep Consultant
who recommends what machine we get and the settings for it.
I am waiting for an appointment with a sleep Dr. however that will be close to a year down the road.
As I posted before I found out my technologist had sold me a used machine, completely illegal here, and dropped me
as a patient because I live with chronic pain and all the baggage.
 If you have the recommendation to help me stay on my side at night I am all ears,  I am really tired of being tired all the time.

[Expat31]

Thanks for the update, and especially your graphs. 

Firstly this is really familiar to me. Take a look at the attached shot of one of my old ones  during a very torrid and unpleasant period late 2021 and the first 3 months in 2022. I did have a lower AHI that you, but the principle is just the same.

I found it very comfortable sleeping on my back, but the sort of trouble I had afterwards resulted in the same shocking level of clusters.

I started sleeping on my side and results were better, but still patchy not good enough at all. 

I discovered by chance one night after a while, that I unconsciously turned over on my back again.

The instinct was really so strong that even wedging a pillow behind my back did nothing. I even considered getting two heavy bricks in an old pillow case, heavy enough to stop all this once and for all. 

Finally I came up with the attached DIY device (see photo) which is self-explanatory. 

This was over a year ago, and works as a dream for me. There are other more elegant possibilities on Amazon, like "Woody Knows".  They are however pretty expensive. 

This was my "magic bullet". 

Are you however 100% sure you are not rolling over on your back during the night at Al, even for a minute or two?  This would show up on the graph. You could get an idea on what is going on by looking at the "events tab which gives the duration of apnea, hypopneas, leaks and centrals. I have attached an example of this also. 

You say your wife checks on this, but she cannot be vigilant all night long as she needs to sleep as well. 

If you are still sure at 100%, then I see the only possibility left is the soft cervical collar route, to ensure you airways stay pretty straight and open. I can't think of any other possibility. 

On the forum there is lots of advice on best practice on fitting collars. It would be worth while looking at all these. 

Also, use the search box to find posts and threads on this topic

That's aIl have at the moment. If I can think of any more, I will let you know.

Step by step now..

[Sleepless in Dewberry]

I am attaching last night's Oscar results.
I am 95% positive that my night was spent on my right side.
I had 3 tennis balls, stuffed them in a sock, and put the sock behind the low of my back.
It definitely let me know when I attempted to roll over in my sleep.
Not perfect but will suffice for the interim.
I have ordered a kidney belt, which should be here in a couple of days and I will attach the sock to it.
As you can see I upped my minimum pressure to 7.2 and left it there all night.
I am going to try wearing the cervical collar to see if that makes any difference.
I have ordered a Knightsbridge chin strap, will try it whenever it finally arrives.
As you can see my numbers are up quite a bit,  I was hoping for better results.
If I don't experiment, nothing will ever change.
Thanks again for your help.

[Expat31]

That is really disappointing. I expected at least some initial improvement. 

I can't think of much more. Perhaps the left side may be better. 

It's all trial and error I am afraid. 

It took me month after month to sort outthis particular issue. 

When I did eventually, there was only a 30% improvement, as 
the tennis balls where slipping all over the place. 
Now they are pinned together ang now at 98%. We are all different, but should have been some early improvement. Hope the collar will have an impact.

There is certainly something there that is causing these positional apnea problems, that at the moment we seem to be missing. See how you get on with what the new stuff you are getting.

I expect you have tried a flattish pillow.  I answer is not in plain sight for the moment, but it is there somewhere. 

It does seem difficult to get timely profession help, and we are just amateurs trying to help where we can. 


The country I am in has generally, a first rate healthcare system, is well funded and organised, and well funded, but sleep medicine is a bit pushed to the back of priorities,

[Expat31]

Couple of further points, 

You note that your minimum pressure is at 7.4, but all the charts you have sent so far are at a fixed pressure of 4, (top left hand corner under calender. - Not that it matters too much still with the unresolved cluster problem). 

In the clinical menu, don't forget to validate the change by pressing the radio nob. 

I have attached a revised anti positional apnea brace "design" (!) which may be more comfortable and less cumbersome, with just 2 TBs aligned vertically.

On reflection the root cause has still has to be in the upper airways somewhere, from the nose down along to the the windpipe. 

We are all we physically differently of course, and one particular solution may not be solution may not be suitable necessarily. 

I don't know if your mask situation has been considered in light of these issues. Currently you have an  FFM. 

In theory, a sure choice, but can be difficult to get a good seal as having a large surface area on the face. They can be cumbersome for some people, and can be perhaps dislodged on turning towards the pillow, causing leaks. 

I think it is important not to leave any stone unturned....

This all means dogged perservence and can't be achieved necessarily in just a few weeks. 

Don't leave any stone unturned...