Need help improving my AHI, notably reducing CAs

[Dormeo]

Your plan to bring pressure back down and increase soft pap sounds good to me. When I scroll through the SleepHQ flow rate graph, I see a whole lot of arousal breathing and a lot of breathing that doesn't look to me like asleep breathing. That's actually more striking to me than the FLs. At any rate, it doesn't look like a restful night. I hope the revised settings will be better for you.

[jdougc]

From about 1am to 3am and from 4:30 to 7:30 many 'sleep' Flow limitations from SleepHQ.
Not sure if the Oscar chart time is off by an hour, but similar FL events .

[LaurenceShaw]

Make sure you chin strap pulls straight up and not back.

Re a chin strap that lifts vertically and doesn't force the jaw backwards, the Knightsbridge Dual Band chin strap (Supplier #37) has straps that pass under the jaw and lift vertically. 

jdougc is referring to the fact that traditional neoprene chin straps wrap around the tip of the chin and the top back of the head.  This produces a backwards force on the jaw, which can narrow the airway.  And the jaw joint (which is located just in front of the ear) roughly falls along the line beween the tip of the chin and top back of the head, which means traditional chin straps force the jaw almost directly into the jaw joint, which is the least effective and most uncomfortable angle possible to be applying the force. The x-ray view drawing at the top of the More Info page of our website illustrates this.

Please use the Supplier #37 link rather than a keyword search, otherwise you will likely end up with a counterfeit!  (The hearing in federal court is scheduled for April 17th and this problem should finally be rectified shortly thereafter.)

[pcboy]

> Make sure you chin strap pulls straight up and not back.
> Re a chin strap that lifts vertically and doesn't force the jaw backwards, the Knightsbridge Dual Band chin strap (Supplier #37) has straps that pass under the jaw and lift vertically. 

I have the Philips premium chinstrap that is supposed to pull straight up (or I would say more than most chinstraps) 
I intended to buy the Knightsbridge originally, but with current USD/JPY rates + shipping, this was quite a cost to bear. 

Yesterday I tried 7.5cmH2O with soft-pap level 2 (PS=2). I didn't increase the pressure because I didn't want to change 2 things at once and wanted to compare with 2025/03/24 (7.5cmH2O PS=1). 
This was my worse night so far sadly. 

AHI: 8.73 (in the last hour the AHI graph even shows it going up to 30)
CA: 5.61
H: 2.59
FL: 21.13
RERA: 1.94
DeepSleep: 3.62%


https://sleephq.com/public/e0f79524-526f...4ed1c3549c

I'm really tired today sadly.


Notes: 

- I basically woke up at 5.30am for some reason. And if you look at the events, you will see that I have no more FL events up to around 8:45am when I finally started sleeping again. 

- I got multiple CA clusters, notably at the beginning of the night and then again at the end.

- The deep sleep % is even lower than before. What I don't understand, is that without pressure support, I get much higher deep sleep (25% to 30% usually). If the deep sleep was affected by the FL events, wouldn't that mean then I get _less_ FL events without the pressure support? I know that would be counter intuitive, but I can't explain it otherwise. Your logic makes sense to me but results don't seem to follow somehow.

Now I guess I should try again with this soft-pap level 2 with 8cmH2O and later with 9cmH2O to make sure. I have a flight to Korea tomorrow and important events to attend to so I may have to go back to my previous "best" settings for the next few days until I can re-experiment.

Thanks!

[LaurenceShaw]

...

I have the Philips premium chinstrap that is supposed to pull straight up (or I would say more than most chinstraps) 

Since the Philips Respironics Premium is designed to have the chin portion wrap around the tip of the chin and then the strap tilts somewhat towards the ear, the force isn't really vertical.  But yes, "more [vertical] than most chinstraps."

[jdougc]

I usually ignore the events as I fall asleep and right when I wake up as my breathing is erratic, wake junk breathing.
Your Flow Limits are still high and probably disrupting your sleep.

I agree that chin strap probably is pulling back on your jaw a bit and making your Apnea worse.
You need a chin strap that goes under the chin and pulls straight up.
I cut this cheap $10 Amazon strap in half and put new velcro on it enabling me to adjust it more forward, but LaurenceShaw has a more reliable product.
[attachment=77144]

Good luck on you trip.

[Dormeo]

That looks like a lousy night. I'll be curious how you do with your "best" settings. Keep us posted after your trip.

[pcboy]

Hello guys,

I came back to Japan yesterday. While I was in Korea, I just tried to switch to APAP 8.5 / 11.5 as I noticed my symptoms tend to be better than with constant 7.5 only. 
See for instance April 10:

https://sleephq.com/public/4e04bd99-3654...e02e753a53

Now, yesterday as I came back home, I thought I was going to try again the soft-pap level 2. While keeping the same APAP settings. 
Results are quite bad. AHI at 14.86, FL 70.28, DeepSleep 0.14%, eMO (moderate obstruction events) 43%, CA 6.4, H 8.03

https://sleephq.com/public/0a57b1c2-bfd5...28039c3019

What is exactly happening with soft-pap that it would alter so much my results? I can understand the increase in CA due to the ventilation only.  Am I maybe hyperventilating?
Suprisingly my 95% now got to 11.5, which was the max, never happened before.
Note that I don't really trust that deep sleep value, I know that I slept.. But I suppose because of the FL events, it stops counting it as deep sleep.
If you look at my respiration rate too, it's a bit all over the place with soft-pap. 
Without softpap April 10:



With softpap April 11:


I wonder if I would get the same issue with Resmed EPR or not.

Note that in both of these nights I still had my chinstrap. I have made something similar to what jdougc mentioned with a ankle taping supporter and plan on using from tonight. But I have doubts my chinstrap is the problem here, we can see the big difference with and without soft-pap while wearing the same chinstrap. 

If you want more OSCAR graphs from that last night: https://imgur.com/a/april-11-2025-ahi-14-86-GSlqTvh

[jdougc]

You probably should have raised your pressures when you turn the softpap on.

On Resmed machines, the inspiration does not recover/start as quickly as a bilevel after an exhalation, so I used to increase my minimum pressure to compensate when I used EPR. 

You might have been a bit air starved after that huge increase in softpap causing the rough breathing. 
Plus big changes like that take awhile for our body to adjust too.

Looking at your breathing in SleepHQ, your flow limitations were undercounted, so it was worse.

[pcboy]

You probably should have raised your pressures when you turn the softpap on.

On Resmed machines, the inspiration does not recover/start as quickly as a bilevel after an exhalation, so I used to increase my minimum pressure to compensate when I used EPR. 

Actually, on Lowenstein machines, my understanding is that it's not needed to increase the min pressure when softpap is on, in contrast to Resmed's EPR. See this Aussie guy video where he is talking about that difference.