AHI tweaking help needed

[Melman]

I don't know if anyone has suggested a buckwheat chaff pillow. It can be configured to support your neck and hold your head in position to prevent chin tucking. Because of the density of the chaff it keeps its configuration, which can be changed by remolding it. A buckwheat chaff pillow resolved much of my chin tucking before I learned about the collar. The collar works best for me but I also still use the pillow. Amazon has a large selection.

[mesenteria]

I'm seeing a strong correlation, timewise, between significant leakage and recorded events.  It may be nothing, but I wouldn't bet on it.

Have we discussed UARS yet?

[rlchau]

Hi Melman, thanks for the suggestion... I just checked and CanadaCPAPSupply sells some for 35$ CAN. AI also saw one in that price range on [Commercial Link Removed]  Amazon in Canada.

I will try a few other options before and may consider buying one

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[rlchau]

Hi Mesenteria. thanks for the feedback.  Not sure this is the case... attached my ResScan stats for the period I wore the soft cervical collar (8 days - Aug 28th to Sep 4th).  My median leak is very low , 6 L/min, my 95 percentile is 8.4 L/min and my maximum is 12 L/min. Actually my leaks have always been very low, a median of 6L/min for the last 41 days (BPAP machine). I double-checked each of those 8 days, and I only have 5 Large Leaks (more than 24 L/min), each of those for a very short period of time that is a few seconds.  Only one of these 5 LL is in a cluster.

[rlchau]

I deleted the previous attachment and added a new one without personal info

[rlchau]

Like many solutions, it seems results vary with the soft collar.  It is successful with enough people that we will continue to recommend trying it, but if it's not working for you, by all means get as comfortable as possible, and look for alternative means to accomplish the same objective...avoid chin tucking.  Be aware of pillow height and shapes, sleep positions and other factors that may cause your neck to bend or obstruct the airway.  Your pressure is already at high levels and I don't think there is much more we can do with positive air pressure other than possibly increasing EPAP min or PS.  You can try PS 5 and see if it helps suppress flow limitations and hypopnea.  I'm not sure it will resolve the OA clusters that seem to make up much of your AHI, but it may be worth a try.

Hi Sleeprider, as per your recommendation, I’m back with more results... after having changes my PS from 4 to 5 four days ago, I was quite excited that my results were getting better, AHI wise. For the first three days, I went from a median AHI=7 (have been at that median for close to 30 days now) to an average AHI=3.5 for those first three days.
Last night was a deception…. Back to an AHI=7.38. Following my observations:
-         As you predicted, my hypopneas came down for the last four days even including las night (refer to my spreadsheet attached)
-         As for my flow limitations, my median of 0.0 and 95th percentile of 0.2 makes is not significant enough to worry about… I think
-         The problem that seems to surface now is the increase in my centrals. I went from an average of 0.5 (since July 19th)  to 0.5, 0.7, 1.2 and 2.1 for the last four days (at PS=5).  That same issue of centrals happened too for my first two days on a BPAP at PS=6 (central respectively 4.8 and 5.8) … then a change to PS=4 was made. I realize that last night was just one night, maybe I can stay at PS=5 for a few more days and see what happens!
-         My breaths/min. remains good at 14-15 per min.
-         My tidal volume at 690 average for the last 4 days, little higher that before (660 range)
-         I still wear my soft cervical collar
-         I was quite tired this morning even after my usual 7+ hours of sleep
-         I’m attaching the images of the last four days at PS=5 and a PDF of my spreadsheet

[rlchau]

Have we discussed UARS yet?

Hi Mesenteria, I just realized I haven’t address your question re : UARS...  sorry
Before I got my BPAP, I was in titration mode with another firm for 57 days, using an AirSense 10 set at the “autoset for her’ mode; my RERA average and median were both at 1.8 events/hr.  I quit that firm because I knew almost for sure very early in the process that based on my results and pressure needed that a BPAP was probably the solution for me… according to the ResMed clinical guide, the autoset for her mode doesn’t treat apneas when needing more than 12 cmw… they did not want to address that possibility yet after 57 days !!! so I left that firm.
So, with my current firm, I also started with a AirSense 10 also set at the “autoset for her” mode for 30 days (I had no choice to follow their protocol again before finally switching to a VPAP).  While using the AirSense 10, my RERA average and median was also 1.8 events/hr.
I’m aware the scoring of RERA isn’t perfect with those machines but it still gave me a sense that my RERA’s weren’t too high.
The Air Curve 10 VPAP doesn’t show the RERA events. I realize that one can get an idea looking at the flow rate patterns. I haven’t yet specifically done that exercise but I suspect it would probably be in the same range as with the AirSense 10.

[rlchau]

 I realize that last night was just one night, maybe I can stay at PS=5 for a few more days and see what happens!
 

-  I kept the same settings for 4 more days… up to sept. 14th. I was happy with the overall AHI results at PS-5 (PS-5 previously recommended by Sleeprider);
 o  My median AHI for the 8 days at PS-5 = 4.3
 o  My central apneas median stayed at 1.2 versus 0.5 at PS-4 since July 17th
-    I then, for the last 4 days, experimented at PS-4.6… hum. Seems not to be a good idea:
 o  My median AHI for 4 days at PS-4.6 went up to 7.1.. yuck!!
 o  My central apneas median increased to 1.6.. yuck too!!
-   My plan now…
 o  Go back to PS-5 and…
 o  Increase my EPAP from 14 to 15 to hopefully improve my median AHI results at PS-5 of 4.3… hum.. will this work? Increasing EPAP should mainly have an impact on my OAI (according to my reading) which is at a median of 1.9 at PS-5
 o  Am I in the left field????
-  See the attached updated PDF spreadsheet as a reference

P.S.: I have been wearing a soft cervical collar since August 28th; I observed that since then, my breaths/ minute went down to the 14-15 range, a decrease of 3-4 points and my I:E ratio is constantly since then at a 1:2 range… there is one exception, Sept. 5th, the only day I did not wear my collar and my breath\minute went up to 19 and my I:E ratio was 1:1.19.  hum… interesting

[rlchau]

 o ... Go back to PS-5 and…
 o  Increase my EPAP from 14 to 15...

 

Oh well...  slap in the face this morning ... my worst result ever (11.5 AHI) on VPAP therapy that started July 17th. So discouraging! My median pressure was at 22.25 cmw last night (7 ¼ hours of sleep) and I got nowhere ... maybe one of those "one off" 

I’m attaching last night view and my redacted home study in case some could find it helpful ... thx

[Gideon]

Just looking at the current chart. Your chin is likely tucking to the chest causing a lot of positional apnea. See the link on soft collar.
This is Bab enough that it can hide other issues.