Zero reductions in AHI after 4 masks

[jmamacat]

Hello,

I tried really hard to understand how to analyze this data myself, but given the brain fog I am hoping to reduce by addressing my (mild) sleep apnea (~8-12 AHI, mostly OA but some CA) I honestly can’t make enough sense of the instructions to get anywhere. 

I’ve tried four different masks (as well as different sized pillows/cushions) and have repeatedly had the pressure re-adjusted by my respiratory therapist, but so far I can’t reduce my events whatsoever. How is this even possible? The latest mask I’m trying (a F&P Micro Nova) seems to be the least intrusive to my sleep and best-sealing of the ones I’ve tried, yet I’m still in the same AHI range and never feeling rested when I wake up. I’m a side-sleeper, 56, healthy, not on any crazy meds…it was years of brain fog that made me want to take the sleep test, and once it showed ‘mild apnea’ I then had to fight to get the machine covered by insurance — since I have a mitral valve prolapse we used that as a secondary condition.

I’m attaching a screenshot from last night’s OSCAR readings (hopefully formatted as requested) in the hopes someone might see something my somewhat-helpful but not very insightful therapist is missing. Usually I do wear the mask all night, but last night I gave up in frustration after waking and realizing the numbers weren’t any lower than usual.

Thank you so much for any insight you can share! I truly appreciate it; I feel like I’m going crazy after fighting with this machine for months on end and still not getting a single night with lowered API. 
HOW IS THAT POSSIBLE?  

[SarcasticDave94]

Welcome to Apnea Board,

It's possible you present a pattern associated with Positional Apnea, which is the chin tucking towards the chest, kinking off your airway. OSCAR shows the repetitive event flags that are seen indicating it's likely.

This Positional aspect isn't the body position but the chin tuck. Back or side sleeping can have this.

Check your pillow. Is it a stack of several, or one very thick one? Either can push your chin downward while back sleeping. If side sleeping, you may be curling into the fetal position.

If you can block this physically by changing slightly, fine, you may be able to avoid this further. Otherwise maybe you'll want to demo a cheaper soft cervical collar from CVS or etc. Just to see if clusters of events diminish.

Please read up on this Positional Apnea info in the wiki, is linked below in my signature.

[jmamacat]

Thank you so much! 

I side-sleep and very likely do often tuck into the fetal position for comfort (although that’s been harder with the CPAP) - I will definitely read up on positional apnea and see if any adjustments might help. I really appreciate your help!

[jmamacat]

Hi again -

Here is a question - if the cervical collar helps reduce my API, is the CPAP machine also contributing anything to that reduction? 
I did read the wiki and the final paragraph there but couldn’t quite understand the conclusion.

 

[super7pilot]

In a nut shell Cat. When you close the airway from a chin tuck. PAP pressure will not open it. It's like kinking a water hose to stop the water. Most homes have 50psi water pressure and that won't break the kink. A pap machine at 20cm is equal to 1/3 psi.

And there are other options to a soft cervical collar. I use one that has a firm pad in front but a simple strap in back. It is a bit cooler that a full collar.

[jmamacat]

That makes sense!
What I’m wondering is whether the kink is what’s causing the apnea, and if fixing it will get rid of the apnea without the CPAP even being necessary?

I’d love to hear about your collar! I’m getting a Releaf delivered tomorrow, but options would be great (especially as it’s getting into summer).

Thanks!

[super7pilot]

As for the apneas. The only way to make a connection would be to review your sleep lab camera footage and compare it to the apneas. If they all happened at the same time you would have an answer.
You could ask your sleep lab about it.

But it’s not likely that all your lab apneas were from chin tuck.

As for the collar. Search ebay for “eliminator sleep cushion apnea pillow” seller is ‘glide gear’

I have a strong neck and i could overpower the relief collar.

[jmamacat]

Ah, I did an at-home test (insurance won’t cover a lab test) so there’s no way of knowing. 

Ty for the collar info - will check it out!

[SarcasticDave94]

Others that I've seen their charts with Positional Apnea patterns, it's typically the collar is working to prevent the physical external airway kink and then CPAP is able to do its job better.

[ejbpesca]

I am curious why your Maximum pressure is limited to 12 when the machine would take it higher.

I see your median pressure is 11.2 not the 9 cm Minimum setting.

Your AHI is as high as the lower end of your home sleep test.  I am not familiar with home sleep studies and how pressure settings are determined by them.

Considerations:

The Median pressure under statistics is often prescribed for Min. pressure setting.

Raising Maximum pressure allows the machine to attempt to treat Obstructional Apneas with more pressure. (20 is highest) The 95% Pressure number resulting from PAP therapy with a high Maximum over some time is an indication of where the Maximum can now be set.

The goal is to fine-tune the machine's pressure settings to treat OAs with the least pressure setting amounts to get the two as close together as possible.  Your machine has pressure settings close together but it is not providing enough pressure to treat OAs.

There are video instructions on this topic available on YouTube.  Search How to set pressures for CPAP.  You will find a recommendation on some to raise your Min. pressure to the Med. pressure as shown by OSCAR.  That would be quite a change for you so approach changes cautiously and if made do them slowly over several sleep sessions. Is your respiratory therapist familiar with OSCAR? Tell him/her the concept I describe. 

The possibility of "positional apneas," is a common topic.  Some positional apneas as I have when I lie on my back to sleep can be treated by pressure, while others may not due to pinching off of an airway.  I have an extra high min. setting and 20 maximum.  

Consider your settings.  Raising the maximum can tell a story.  If the machine goes to max pressure of 20 and OAs are not treated, then it could be a pinching of airway problem or another type of PAP machine may be needed.  If the Max. is opened up to raise pressure and OSCAR shows at what pressure OAs are treated then it is not a pinching of the airway problem and a proper Min. pressure can be established.