[CPAP] kenaloha - Therapy Help

[kenaloha]

    Sleep test showed 31 events per hour.  Now in third week, don't see much progress.  Some of  the OA's in the early data for the night I was awake -- also have insomnia.  Any suggestions are very welcome as I don't get much from doctor only to show me how to change the settings. I guess that having severe means I need high pressure.  I now set at low 9, high 15, but see lots of events even with this setting.

[jdougc]

Welcome to the forum,
How did you feel during the day?
Try not to chase numbers, but how you feel.
Hide the calendar and show device settings.
Can you post a copy of your sleep report with your personal info redacted?
Are you on any medications that may affect your breathing or your sleep?
Do you have any health issues that may affect your breathing or your sleep?
Are you a side sleeper or do you sleep on your back?

If you sleep on your back, gravity can pull your tongue or soft palate back and block/restrict your airway. You may need a lower flat pillow or a ramp pillow or something under your mattress to raise your torso.
You have positional apnea, where you are tucking your chin to your chest or if you are on your back, gravity is pulling your tongue or soft palate and collapsing your airway. No pressure increases can open up your kinked airway.
You may need a soft cervical collar.

Your flow limits are very high, you need EPR to deal with that, use a setting of  EPR of 3
If you feel airstarved with EPR on, don't turn it off, but raise your minimum to 10 cm. We don't know if you are using EPR, since the device settings are not showing.
Hopefully you get some rest.

[kenaloha]

I really appreciate your feedback on this information. It seems doctor should have given more help to start me off. 
After being a side sleeper, this 81 year old 185 lb. male now with hip issues needs to sleep on my back. Back sleeping started the apnea issues like waking up gasping for air. 

I use and adjustable bed with about a 20 degree rise and I ordered a soft cervical collar.  I do have EPR on my resmed 10 that the doctor had turned off. When I went to get a better mask (F20) they set the EPR to 2. I found it very difficult to deal with the lag as if it was breathing for me at its rate, not mine.  Will this improve if I raise the lower pressure to 10 or above?  

Attached are pictures from the sleep report and last night's data from Oscar. Feeling much better and am very happy to be part of this forum for the help offered is greatly appreciated.  

OH,              I see from the limit on attachments that I will have to post the other parts of the sleep report later.

[jdougc]

There are back sleepers here that can help you more than I can, raise your minimum to 11 cm for a few nights.
Raise your maximum to 17 cm and see how you do.
Try raising your bed a little more.
You may want to raise your knees with pillows to stop from sliding.

[SarcasticDave94]

Look into Positional Apnea in my signature link below. You're very likely chin tucking and kinking off the airway externally. If you don't yet have that collar, it may help.

[ejbpesca]

I do not see a pressure settings prescription on your Sleep Study and I am surprised your Min. and Max. pressures are not higher.  I see on the Sleep Study that the majority of events happened while sleeping on your back.   

If while sleeping on your back your head lowers due to a high pillow or other reasons this can pinch the airway.  If this happens, air pressure from your machine cannot keep the airway open at any pressure.  This is called "chin tucking."  Some successfully use a soft cervical collar to keep their chin up during sleep.


Either your Min./Max. pressures are not enough to treat your apnea and other events or the events are caused by chin tucking. 


Considerations not instructions:

1. Use a thin pillow that moves the head upward very little.
2. Try a cervical collar to prevent the chin from lowering.
4. Increase Min pressure by 1 cm then more if this improves AHI
5. Increase Max pressure by 2 cm to allow the machine to raise Max pressure to 17 and see if it still hits the top of the Pressure graph.
6. If possible try side sleeping to see if it drops the AHI. (I understand hip issues may prevent side sleeping for you.)
7. Consult with your doctor, sleep technician, or supplier concerning the pressure settings.  How were they established?

[Deborah K.]

I, too, am a back sleeper due to a pain issue.  I first used a soft cervical collar, which worked well.  I had tried several, and liked the Caldera Releaf Collar the best, but then I decided to try something else.  I bought a child-size pillow with a raised edge.  It tips my head back slightly, keeps my chin up, and solves positional apnea.  Mine is no longer made, but Amazon has some that should work.  Here's a link to a highly rated one in case you want to check it out:

https://www.amazon.com/MLILY-Adjustable-...r=8-2&th=1

Best wishes for achieving great therapy and comfort!  

[kenaloha]

Thanks for the tips about chin tucking.  Sarcastic Dave's link about Positional Apnea showed how chin tucking can be the key to lowering AHI's.  I ordered a neck collar and raised my adjustable bed to reduce the air flow issues that bring on the AHI's. Since no pressure increases can open up a kinked airway, I'm leaving my low pressure setting at 9 and my upper setting at 15 until I see if the reduced chin tucking works.  

[kenaloha]

The EPR change made a huge difference! I tried a few changes before turning  EPR on and you can see how much it changed for the better. Also attached is more of the sleep study results. 

What's the next step? I guess raising both the minimum and maximum pressures to continue to lessen the AHI's?

[SarcasticDave94]

Still there's severe Positional Apnea patterns within those areas before 04:45. Whatever you tried to minimize those unfortunately it didn't work.