help with optimizing AHI--positional apnea?!?

[Tsukuyomi]

I've had sleep apnea for ~8 years years. I'm a mouth breather so that nasal PAP wasn't an option and I've always used a chin strap with a full face mask. While living in Los Angeles, I had few problems and a low AHI for several years with pressure set a (9-14) and climate control set at Auto, but after moving to the Bay Area a couple years ago, things have been more challenging.

I tend to have worsening AHI in the fall/winter months and I spent the past year fighting leaks (which worsened after my sleep doc told me to increase max pressure to 20) so that I was having to tighten my full face mask down to the point of causing a red mark on my nose. I finally got the leaks under control and fixed the nose problem with a new hybrid mask (ResMed f30i) and recently upgraded to a new CPAP machine (ResMed AirSense 11).

Things have finally been better recently, but I still often have AHI in the 2-5 range and occasionally higher ones (last week was horrible until I switched to a fresh mask). I've decided to try to optimize my treatment since I know that many people are able to get down to AHI <1. I've increased pressure to 10-16, but no significant difference yet. I played around with EPR, but find it more comfortable at 3.

Since things seemed to worsen moving to the Bay Area and higher AHI in the winter months, I've long suspected problems related to ambient humidity and spent a lot of time trying to tweak the humidity and tube temp settings. But after switching to a new AirSense 11 and setting it on auto, I now suspect the real culprit is positional--it may be that my chin strap pulls my jaw back and makes things worse. I also started using a wedge in the past year which seemed to help, but these days I just slide down and sleep at the bottom of it so that it's not really service it's purpose. Based on information here, and the fact that increasing pressure didn't really help, I suspect positional apnea and just bought a cervical collar to see if that helps.

In the meantime, here's some recent Oscar data from some less successful recent nights. Seems the hypopopna/OSA cluster support a positional culprit--looking to confirm.

       

[UnicornRider]

Yes, definitely looks to be Positional Apnea.

It really helps the forum members to quickly analyze data from your OSCAR Report if presented in a standardized format. Please follow the link in my signature for OSCAR Chart Organization . Then Hide the Calendar and the Pie  Chart. That will allow more valuable information to come into view.

Your Positional Apnea could possibly benefit by the use of a Soft Cervical Collar (SCC).

You need to control your leaks a little better that indicated in your OSCAR Report. Follow the information in the Mask Primer, Especially when you get down to Jeffy1958, he puts all of the little bits of knowledge presented previously on that page, into practicable application to achieve a leak free fit.


As always, any questions, concerns or comments, please post back.

[Tsukuyomi]

Soft collar is on the way. I'm hoping it can replace the chin strap instead of having to put 3 things on my head!

I think the higher leak rate in the night displayed was likely because the max pressure was increased to 18. Most nights, the leaks are pretty well controlled.

[Deborah K.]

Yes, the neck collar will replace the chin strap.  You don't need both.

I would not worry about your leaks.  Sleeprider, an expert at such things, says anything under 5.0 is acceptable.

Your pressure settings are too low.  Your median pressure is a bit over 14, so your start pressure should be 14.  You are constantly hitting 18, so you need to raise your high limit to 20, the highest your machine can reach.  If you frequently hit that you may need a different machine, a ResMed AirCurve 10 Vauto.  If that is the case, you might want to read the link below my post where Sleeprider helped me obtain that same machine.

Again, welcome, and best wishes for achieving great therapy and comfort!  

[jdougc]

As you can see, the higher pressure did nothing for your therapy during the positional apnea. Hopefully you will get relief when the soft cervical collar comes. Then, if you don't see that rise in pressure from the present positional apnea, your leaks might even drop.
Good luck

[Tsukuyomi]

As you can see, the higher pressure did nothing for your therapy during the positional apnea. Hopefully you will get relief when the soft cervical collar comes. Then, if you don't see that rise in pressure from the present positional apnea, your leaks might even drop.
Good luck

Exactly. Not only did it not help, but at higher pressures it becomes all but impossible to keep the mask on.

I'll try the collar tonight, see if it fits well enough to keep my mouth shut, and collect some data before changing pressures again.

[jdougc]

It may only help a little to keep your mouth shut, but it works to keep your chin up and not kink your airway, like we kinked hoses when we were kids.
Do you use kinesiology tape, regular original cotton elastic athletic tape? I use a 2in×16.4ft ,cut into 5 inch pieces.

[LaurenceShaw]

If the collar doesn't work for you, you might consider a chin strap that doesn't force the jaw backwards.  The Knightsbridge Dual Band has straps that pass below the jaw and lift vertically.  We are Supplier #37.  

(Please use that link rather than a keyword word.  A keyword search will still likely lead you to counterfeits, although that should be rectified by court order in a few weeks.)

[jdougc]

LaurenceShaw is right about using a chin strap that doesn't force the jaw backward. My DME gave me one that did that an my sleep was way worse.

[LaurenceShaw]

Millimeters can make all the difference ...