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Looking for advice
#1
Looking for advice
I'm a new member to Apneaboard.com.  I am a male 45 years old and I've been on cpap therapy for 2 years now.  I was hoping that I could post some of my Oscar readings to see if anyone wanted to help me dial in my AHI numbers and also alleviate my fear of possibly having Central Sleep Apnea.  The vast majority of events show as Clear Airway or Hypopneas with very few Obstuctive events shown.  In my initial in lab sleep study two years ago I only slept for 45 minutes but I was diagnosed with moderate obstructive apnea 29 events per hour.  The initial pressure prescribed was 8.  I felt extremely air starved at that setting and have moved the pressure on my machine myself all the way up to 14.6 and found that to be the most comfortable pressure setting.  I was at a pressure of 14 for almost a year with good results of 3.52 AHI.  I have put on about 30 pounds in the last year and my AHI number was slowly climbing so I tried to raise my pressure setting with no results.  Ever since I moved it my numbers have spiked and I'm now averaging 5-6 AHI some nights being 10+. I have been diagnosed with a deviated septum. I do not have a DME that I go through and my sleep center doctor locally has been of very little help.  I use a Resmed Airtouch F20 full face mask.  I use a chin strap because my mouth is very dry when I wake if I do not use one.  I feel like I have been on this journey alone and am hoping some of you could help me with some suggestions.  I'm sure I forgot to include alot of valuable information, please let me know what other information you need.  

           
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#2
RE: Looking for advice
Raising the pressure tends to raise the central apnea index. You want the pressure just high enough to relieve the obstructive apneas and the hypopneas. Try turning down the pressure and raising the EPR.

For the leaking and the dry mouth I would try a different full face mask and a soft cervical collar.
Sleepster

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Looking for advice
Thank you Sleepster for your input. Would you think dropping the minimum pressure from 14.6 to 12.6 and setting the EPR at 2 full time would be a good place to start or should I drop the minimum pressure lower? I do have a soft cervical collar on order that is supposed to be delivered today. As far as the dry mouth I didn't think I was getting very much leakage from my mask but I don't know how to read the data to be honest. Am I leaking quite a bit? I appreciate any input you can offer and I will try your recommendations and post the results tomorrow.
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#4
RE: Looking for advice
BetterDays, I'm of a similar mind to Sleepster that your high pressure is not helping here, and I think we can easily address your sense of not having enough air. You are currently using EPR in "ramp-only" mode and that needs to be changed to "full-time" so you get ramp consistently. I'd like to bring your pressure back to 10.0 minimum in Autoset mode and set a maximum pressure of 15.0. Let's try EPR full-time at setting 2. This will give you a range of 10/8 to 15/13 (inhale/exhale). You have a fairly high leak rate, and that can often confuse the machine and lead to more CA events. The zoomed image of your apnea cluster is not typical of central apnea, where breathing usually reduces gradually to a pause and resumes. It is far more like obstructive, positional apnea where significant flow disruption and likely flow limitation is present, followed by an apnea and ending with a large recovery breathing. Your flow limitations occur in episodes that correspond with the apnea clusters, so I think you may be on the right track with the soft cervical collar. I assume you have read the positional apnea article http://www.apneaboard.com/wiki/index.php...onal_Apnea and have seen the soft cervical collar wiki.

If we can eliminate the possibility the apnea being flagged as central is actually obstructive, we will want to come back and use the maximum EPR of 3. It will be interesting to see if the collar changes things for the better by reducing leaks, flow limits and the clusters of potentially obstructive apnea. Chin straps often pull back on the jaw and increase the problem of upper airway obstruction. This often looks a lot like positional apnea. I'd like to see you control mask leaks with the collar or some other means including a change in mask style, model or size.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Looking for advice
Sleeprider,

I am definitely willing to listen to all suggestions and tonight I will set the minimum to 10 and maximum to 15 with the EPR full time at 2.  You assumed correctly, I ordered the soft cervical collar after I saw your link that you posted on another users thread for positional apnea.  Unfortunately my soft cervical collar was not delivered today so I will try that tomorrow if it is delivered. I will ditch the chin strap.  I will try controlling mask leaks with the cervical collar and if that doesn't work I am up for trying a different mask style or size.  I will post my Oscar data tomorrow afternoon and hopefully you can chime in on what you notice.   I greatly appreciate your suggestions and am ready to try them out.
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#6
RE: Looking for advice
Good morning Sleeprider,
Last night I set the minimum to 10 and maximum to 15 with the EPR full time at 2 and did not use the chinstrap.  Ordinarily any minimum pressure set under 11 had made me feel air starved in the past.  I was amazed at how comfortable my breathing was with the EPR on last night.  I do notice that last night I had a bunch of Obstructive events.  I normally very seldom get an obstructive event, mostly all central events.  There were also a few RERA events which I normally do not see.  Another observation that I see is I had a little activity on the snore chart.  I usually do not see anything on there as well.  Overall I feel about the same today as I normally do when I wake up with the exception of feeling like I can breathe a little easier this morning.  Some mornings my breathing feels restricted for the first hour or so when I wake up.  I'm assuming that is from the EPR.  I would love to hear your input about what you see from my Oscar data and where you think I should go next.  I'm feeling very optimistic!

               
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#7
RE: Looking for advice
The clusters of OA are a strong indicator of positional apnea, or chin-tucking. http://www.apneaboard.com/wiki/index.php...onal_Apnea You will notice how your results look like other members that have had this problem. It often resolves with a soft cervical collar, or avoiding multiple pillows or sleeping positions that cause your neck to be bent. http://www.apneaboard.com/wiki/index.php...cal_Collar

Your results are bringing me closer to the opinion your problem is positional obstructive apnea and not central. Let's do another night with EPR 2 and think about how your head and neck position might be contributing to blocking airflow. We may move to EPR 3 if the CA events continue to fall.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Looking for advice
Sleeprider,

I am predominantly a stomach sleeper who lays the side of my face directly on the mattress with my arm curled around a small pillow/ hand touching my chin. At times I have felt my hand end up touching my throat.  I have no doubt that I most likely end up tucking my chin and possibly even restricting my air with my hand pressed against my throat.  Even though it is not my preferred position, I have had been able to sleep on my side successfully in the past.  I would imagine with the collar,  sleeping on my stomach will not be very comfortable so I will try sleeping on my side tonight.  I will leave the pressures and EPR the same.  My cervical collar should be here today, if not I will be buying one from the store today and returning the other one.  I will post my Oscar data results again tomorrow.  Feeling like I've been on this journey alone for two years, I can't express how grateful I am for your help.
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#9
RE: Looking for advice
You are not the first prone sleeper with this pattern. Obviously sleeping on your stomach results in an acute turn of the head and this makes the airway vulnerable. You can probably devise some simulations of how this would happen. In the Positional Apnea article we talk about sitting in a chair and relaxing, allowing the head to drop and observing airway restrictions. The same thing can be done starting in a prone position and allowing the chin to drop or tuck. I'm sure you will find that there is a place no air moves. I don't often have a problem with position, but a technique that works while sleeping on my side is to pull the corner of a pillow between my shoulder and jaw. It does the same work as a SCC.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Looking for advice
Sleeprider,

I just received a notice that my SCC is delayed in transit. I will be going to the store now to pick one up.  I'm excited to try it tonight.  The corner of a pillow between the shoulder and jaw is a nice back up plan in case I have problems adjusting to the comfort level with the SCC.
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