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[Pressure] Should I change my pressure?
#1
Should I change my pressure?
Hi everyone:  I’ve been on therapy for 3 years while lurking and appreciating the expertise on this amazing Board. This is my first post. 

My details: 2018 sleep study diagnosed borderline mild/moderate apnea.  Sleep Doc prescribed ResMed 10, Auto ramp start at 4.0 then 8.0 pressure CPAP, 81 degrees heated tubing, humidity 4, Essentials Plus, SmartStart ON. Spent 90 days in hell trying to find the right mask (settled on pillows), then a switch went off in my brain and therapy magically started working allowing me to stay fully awake all day on 7 hours sleep (was previously sleeping 10 hours and still needing a nap). 

Why am I here now?  For the past few months, AHI creeping back up to 10+ (due to a bit of weight gain due to COVID?).  A few weeks ago, after AHI back to 10+ (screen shot June 1) I raised pressure from 8.0 to 9.0 and started with the new Dreamwear Silicone Pillows – that returned me to AHI 1-4 (great improvement - screen shot June 2).  However, in the past 2 weeks, despite those numbers, I am experiencing constant daytime sleepiness (screen shot June 17).  I have also noticed the return of restless legs, too, while falling asleep.  Sleep hygiene: room quiet, dark, cold, mouth closed all night,

(1) Can someone offer guidance on what, if anything, I should adjust or change to fight daytime sleepiness? 

(2) Also, going into clinical mode today (following this Board’s excellent directions) I just noticed my mask was set as nasal all these 3 years. Therefore, I changed the setting to “pillows”. Question: did the error of a setting on “nasal” while using “pillows” make much of a difference? Let me know if different screen shots would help clarify my situation. 

Thank you!


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#2
RE: Should I change my pressure?
Welcome to the Apnea Board Forum.

No I don't think a mask choice setting really caused the issues. However, I'm thinking at least at times, you've got some Positional Apnea. See all those event clusters on June 1? That's what I'm referring to. One event following another and another... This isn't back versus side sleeping stuff. The Positional component is in some way your neck is being bent while sleeping. Sometimes a thick stack of pillows can cause this. Other times it's just that one's chin points downward towards their chest. Either way, what happens is the airway is restricted much like the garden hose can get kinked and shut off the water flow.

I'll suggest you read the wiki about Positional Apnea and about the fix, a soft cervical collar. This is similar to neck injury collars but aren't intended to be very rigid, just enough to prevent kinking the airway.

The link's in my signature at the bottom. And almost no doctor will know anything about this. As is they struggle with plain vanilla Obstructive Apnea treatment.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Should I change my pressure?
SD94: Thanks so much for your suggestions, will read the wiki about pos apnea. however, i will add that I use a very flat pillow and try to sleep as much as i can on my back - but eventually I get tired of back sleeping and roll over to my left side which is what i really prefer
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#4
RE: Should I change my pressure?
Positional apnea just basically means that your chin tucks towards your chest. It doesn't necessarily mean that it's specifically a single position you sleep in (though that can be a trigger). It could be your head dropping in deeper sleep towards your chest when on your back. It could be that you curl up on your side. It could be that your head turns on the pillow or you shift further up or down on the pillow. Just anything that "kinks" your airway and causes obstructive events that the machine can't necessarily fix.

Welcome to the board. Smile


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#5
RE: Should I change my pressure?
Ratchick:  Thanks for the extended description of PA.  If you have a minute, can you review my screenshots and give me your opinion - (1) are my events more likely due to PA?  If so, do you have any advice to supplement the Wiki page on how to choose the best SCC suitable for me? (2) Do you have other guidance on how to improve my sleep quality? Many thanks for any advice you can share.
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#6
RE: Should I change my pressure?
The pattern of chin-tucking or positional apnea is very apparent in your charts. Please read these wikis. I'm sure you will see how your charts resemble the examples in the articles. This pattern is nearly always quickly resolved once the problem is identified and mitigated.
Positional apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php...cal_Collar
Sleeprider
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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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#7
RE: Should I change my pressure?
Agreed with what Sleeprider and Dave said. Definitely looks clustered to me. No amount of pressure will resolve it, so raising the pressure is unlikely to help right now. Definitely, a soft collar would be my recommendation and then go from there.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#8
RE: Should I change my pressure?
On top of the periods of what appears to be positional apnea you also have significant flow limitation and obviously restricted breathing the majority of the night. Your current settings are not adequate even when positional apnea is not an issue.

I would switch to autoset mode with min pressure of 8 cm, max pressure of 12 cm (start you out slow), also turn EPR on and to 3 cm.

I would make these changes and then play with positional apnea, being in autoset mode will make it more obvious when you find a positional apnea treatment that works.
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