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Greetings all,
After feeling like crap for several years, Doc had me do a sleep study. AHI 65. So here I am looking for advice on settings. I only have one night's data so far... and yes, I tinkered with settings on my ResMed 11 before I really got out of the gate. First night I was on the standard 4/20 settings and had an AHI of 12. After playing around, my AHI was 13. So I'm looking for some evidence based advice on where I should set the machine. Anyhoo... here's my OSCAR from last nite:
It looks like you have periods of apnea from the position you are sleeping in. Also called chin tucking where your chin drops down to your Sternum cutting off your airway.
No change of pressure will help. Think of it as a kinked garden hose. Nothing can get through the hose until you get the kink out of the hose.
Sleeping on your back MAY be the cause or sleeping on high pillows can cause it. If you can’t help it that simply you may need a collar to stop you chin tucking. Please look at the link I have posted in my signature. It shows people using collars and the same people without collars- huge difference.
You do not do it all night, you can see it where there are grouped O or H events.
I would also see if thes settings improve your sleep.
Loath, as I am to add a collar to this mix, I am picking one up today. I told myself i'm going 101% in on this CPAP therapy... took me a couple months to convince myself... but I digress.
staceyburke's recommendations are spot on. I would only add that I had a similar issue and tried the neck collar. While it definitely does work. I was able to get away with getting a MUCH flatter pillow and that solved the problem for me. Even though I sleep on my back I have very, very few positional apnea events. I too had an AHI score of around 65 (I think it was 67 actually) and now most nights I am between .2 and .8
I got a sleep collar... and I'm frustrated. The first night with it my AHI was 14. I don't have a chart to post (my sd card got corrupted). Last night's chart is attached... AHI 16 with large clusters of OA. The first break I had gone to the loo. Second break the mask was leaking. I suppose due to the high pressure? So the second break is me changing the upper pressure from 20 to 17. At 3:30 am I was done. Between the mask leaking and making pooty noises, the sheer annoyance of the collar, and ongoing kidney stone pain, I took off the mask and chucked the collar across the room.
What can I look for that might be causing the OA's given I was wearing a collar?
Yes you still have positional apnea and maybe you have a poor fitting collar. the height of the collar is the distance from the chin to your sternum. Check and see if it is close to that.
The problem I see is your flow limits are quite high. FL are apnea just like O and H events but they are not as long of a duration and 50% smaller than O and H. We use the EPR to control them. The problem is the machine you have goes up to 3 which is the highest it will go. There is a resmed aircurve that will go much higher but the cost is more also and insurance will not cover it unless you can get your dr to prescribe it by name. So about all we can do is try to change settings.
One of the problems with FL is the resmed increases pressure to stop the FL from becoming larger O and H events. That increase in pressure can in itself cause problems keeping people awake or awaking them up.
I would suggest you try the collar again adjusted as well as you can but I would also try changing the pressure as follows.
Min 8
Max 12
Keep the EPR where it is.
I don't think the max is helping here, it just allows the machine to go up to high to fight the FL. I would bring the max down 1 point a night depending on how many apnea events are happening.
My wife is out of town this weekend... I think I'm going to set up one of my ring cams to video my sleeping to see if/when/how I'm chin dropping.
Also, I'm dealing with a 6mm kidney stone right now. I've been on vicodin for pain. Could that be affecting my numbers? Hopefully getting lithotripsy next week.
I am by no means a doctor. But my understanding is that pain relievers can sometimes be also muscle relaxants. If your throat area is further relaxed I would theorize that you may be experiencing a higher AHI number as a result. That has certainly held true for me in the past. Even things like having a warm shower or (ahem) having sex right before bedtime can cause you to fall into a deeper sleep and higher AHI numbers can result.
However, even taking all of those things into account. Your AHI number is still way too high. There is more work needed here to get at the root cause of the matter. But give your body time to get used to the new machine settings you made (as much as a week perhaps) and it will be important to not just see your total AHI number but an attached PDF of the breakdown of what kind of events they were, to get a better understanding of how to help you further.
