New start - AHI is high

[Callig02]

I folks,

My story so far.

I have returned to CPAP after some years away, at the request of my Cardiologist.

Initially I reset my machine settings and cleared my CD card.

My first nights results were poor, but I put that down to a low minimum pressure.

I increased the pressure to 7.8 and saw some improvement.

Encouraged, I experimented over the next few nights by gradually increasing the pressure, but saw no consistent results.

Previously I had purchased a cervical collar, but hadn't found it any help (plus it made sleeping very uncomfortable).
However I tried it again, but again failed to notice any improvement.

I looked back at my earlier figures and was surprised that I had a min pressure setting of 14 cmH2O.
So I tried the higher pressure, but figures were just as bad.

Have returned the min pressure to 7 cmH2O

Normally I sleep on my left side, so decided to try sleeping on my right.
Tried that for a couple of nights, but again no improvement (plus there was an increase in CSR).

see attached

The CSR has me puzzled, as I don't normally see it.
I don't think CO2 is a problem, as I always have a window partly open.

Incidentally, previously I would wake with blocked sinus, however since returning to CPAP I find my sinus are clear when I wake.
Plus when I saw my Cardiologist recently, she was pleased that I'm back on CPAP, and commented that I "looked much better".

Other than continuing with my present settings, I've run out of ideas..

Suggestions and comments will be welcome.

[jdougc]

You had better nights after this, May 25th 2025 "I increased my minimum pressure from 8 to 9 cmH2O."
Not sure why you didn't go back to this setting?
You may want to keep a journal of changes and how these changes may you feel.

Try a minimum of 9cm for a few nights.
Also try ramp at 9cm for 5-10 minutes. 

This may may your start and restarts more comfortable, without pressure increases and since ramp will be at your minimum pressure, you will have some therapy. 

I feel that it helps me, as I stretch my legs and don't have to be concerned with wild pressure increases as I am not asleep yet.

[SarcasticDave94]

Note that unless you have a diagnosed heart condition involving Congestive Heart Failure, this ResMed reported CSR is not flagging that, but instead a variable breathing issue.

[Jay51]

Agreed with what Dave said.  

Here is some reading on CSR from our wiki.  There is a very slight possibility you have one of the other conditions that may contribute to CSR "Associated Conditions", but most CSR is associated with Congestive Heart Failure.   

• Cheyne-Stokes respiration
  

[super7pilot]

I was one of those that has pretty strong neck muscles and I actually over powered my "SOFT" cervical collar. So I made the switch to "the eliminator sleep cushion". It has very firm foam and only has foam in the front with a strap around the backside. So it is much cooler and comfortable. 

By the looks of your chart. You def appear to be having positional apnea. And you might not know this, But no amount of CPAP pressure will power through and stop a positional apnea. And thus you might do better with this very firm cushion. It works so well that I have not even needed to wear a chin strap to keep my mouth shut.

Here is a link. This is unavailable via Amazon so this link is only to show the cushion. I was only able to find it on ebay.

Eliminator sleep cushion

[Callig02]

jdouc,

> You had better nights after this, May 25th 2025 "I increased my minimum pressure from 8 to 9 cmH2O."
> Not sure why you didn't go back to this setting?

Long story short..
I had expected to start at a relatively low pressure, then when results stabilise, gradually increase pressure until I achieved satisfactory results.

Unfortunately it didn't work out like that...

As you say, I increased my pressure to 9 and results improved, but then on subsequent nights the results were all over the place.
Even subsequent sessions on the same night were wildly different.

Next I tried to find the wild card which was causing these crazy fluctuations, but no luck. 
So decided to go back to the beginning and start again..

> Also try ramp at 9cm for 5-10 minutes. 

Based on previous experience, I find that disabling the ramp to be less intrusive.
I usually get to sleep quickly, but having to wait for the machine to kick in is frustrating.

I don't know what to do next, except continue with the present settings (with a min pressure of 9 cmH2O).

When next I visit my doctor, I'll ask him to organise a visit to the sleep doctor and hope he can sort out what is happening.

Unfortunately I'm in a fairly remote area, and visiting specialists is a problem.

see attached for latest results


Thanks again.

[Callig02]

super7pilot,

Thanks for your comment.
I am grateful to those who argue that my problem is positional apnea.

My existing collar is of fairly stiff construction, and I don't think that it is allowing me to curl up,
however something is going on, so I feel I must give a better collar a try.

So I have ordered a Eliminator collar on ebay. It will take a while to get here, but will report back when it arrives.

Thanks again.

[super7pilot]

Callig. Glad you found one. I saw the seller i got mine from was sold out. Maybe you got the last one.

I can’t find them any where. I like mine so much i wanted another one. I just fear the maker has gone bust.

[Callig02]

super7pilot

> I can’t find them any where. I like mine so much i wanted another one. I just fear the maker has gone bust.

Is on ebay as "Neck Chin Support CPAP Sleep Apnea Stop Snoring Travel Sleep Cushion Pillow"

No mention of "The Eliminator", although the illustration clearly identifies it a such.
We shall see..


Good luck

[super7pilot]

I recall the seller had ‘glide’ in the name. And shows as sold out.

I’ll just check back with them periodically.