help with optimizing AHI--positional apnea?!?

[Tsukuyomi]

I did use a pillow when I was using the wedge. My GERD is intermittent and not bad--it wasn't actually the main reason I started using one; it was because I started to suspect positional issues. I'll go back to it if fiddling with different pillows doesn't bring my scores down the way they were last week.

Seems like the low pressure during ramp would only affect events during the ramp. I'll have to double-check, but I think I only have ramp on for 5 minutes or so because I fall asleep very fast, so that seems like a trivial tweak.

I'm tempting to increase ERP again--I'd previously tried to turn it down and my scores worsened, so I'm still unclear on how that's affecting my scores.

I'm still a bit puzzled by the pressure adjustments. It seems like a LOT of my events are positionally-related and can't be overcome by PAP. TBH, Given how much aerophagia I often have and the possible contribution of pressure to central apnea, I'm tempted to turn pressures way down to essentially perform a new sleep study without PAP but with the CSS.

As far as needing more sleep, sure... although last night, I fell asleep on the couch for several hours before I woke up and later went back to sleep in bed with the PAP.

[jdougc]

A soft cervical collar will help with positional apnea. When you used EPR 3, you might have had CAs which are treatment emergent and should lessen as your body gets used to the change .

[Tsukuyomi]

It really is almost like I don't have apnea anymore if I don't have any positional kinks. But when I do, CPAP is useless.

   

[jdougc]

Positional apnea is like kinking a garden hose. No amount of pressure will clear the airway. That is why soft cervical collars or wedge pillows for back sleepers are called for.
Also you sleep time is too short, 7 1/2 to 8 hours is needed for most,

[Tsukuyomi]

Positional apnea is like kinking a garden hose. No amount of pressure will clear the airway. That is why soft cervical collars or wedge pillows for back sleepers are called for.
Also you sleep time is too short, 7 1/2 to 8 hours is needed for most,

yes, i get it. but my point is that the data suggest I don't benefit from, or need, cpap then.

[jdougc]

The data might suggest that you don't benefit from CPAP if you do not address the positional apnea.
In no way does the data suggest that you don't need CPAP. Other than the Positional apnea your therapy is quite good.
It does take weeks, even month to feel better after years or decades of suffering from the effects of Apnea.
Apnea places a great burden on your heart and other organs.
Stay safe and good luck.

[UnicornRider]

Before removing the wedge the amazing AHI score and sleep you gained was due to the SCC  enabling the PAP therapy to perform it's job.

You still need PAP Therapy. The SCC by itself can not provide the restorative sleep you have been robbed of all these years.

We know we can get your AHI score down, we could let you be satisfied with that.

  But there is a very good chance with some further adjusting of your sleep environment and sleep hygiene you can eliminate the external forces that negatively influence the quality of sleep.
                                                                       

• Sleep hygiene
  

   I am positive that you have knowledge of and practice many of the bullet points in the above Wiki link. And as many times as I have read & reread the Sleep Hygiene Wiki, I always feel guilty that I am not 100% compliant with so many of the bullet points, it is amazing that Mr. Sandman occasionally brings me a dream, I suspect just like St. Nick, Mr. Sandman keeps a list of who is naught & nice. Guess where I usually find my name, on either list.

I would encourage you look at some of the "CPAP Pillows"  that have a sculpted recess for the head, but still supports the neck while back or side sleeping, and the sides of the pillow are scooped out to provide clearance for the mask while side sleeping. I am trying to encourage you to consider making a very concerted effort to side sleep. If you are like me, I have to have a knee pillow also, otherwise I end up on my back. Side sleeping is so good for PAP Therapy, but difficult for some of us to achieve.

    So referring to the OSCAR Report from the 27th of March, it looks to me as though your events were related to movement most likely rolling over to your back, hence the Positional Apnea, as indicated by the timing of leaks, pressure rise and multiple events stacked up on each other.

So do not give up on the PAP Therapy, research sleep hygiene, pillows and other items bullet listed under Sleep Hygiene.

 Then after we get some more OSCAR Reports we can suggest some tuning and tweaking of the AirSense 11, to provide optimum sleep at this time.

  Your PAP Therapy needs will change with seasonal allergies, respiratory illness and time (don't grow older). Weight changes can have a big effect on the PAP Therapy. This is a long journey, every effort you make now will have big payoff in the future.

[Tsukuyomi]

I appreciate your comments. I was being somewhat facetious when I was suggested maybe I didn't need CPAP. Still, the latest data seem to indicate that I was at minimal pressure with no events and maximal pressure with events which I take to mean 1) tweaking things to improve the positional issues as you suggest is paramount and 2) at the very least, it might be possible to reduce pressures further if #1 is achieved though the flatness of the line for the first few hours does make me wonder if a CSS could really be all that I need.

But first things first. For now, I'm going to continue experimenting with pillows. Thanks for the link.

Back in the day, I used to sleep on my stomach, but CPAP has made me a dedicated back sleeper. Part of the reason I switched to an f30i mask was to allow me to sleep on the side more, so we shall see.

It has been rainy here, so I'm also dealing with inspiratory leaks earlier in the morning which seem to be related to a combination of pressure and moisture getting under the mask. With my previous machine, I ended up turning humidity down to 2 which seemed to help, but with the new machine Auto has been working OK.

[Tsukuyomi]

I tried another pillow--this was the flattest of the bunch (and the one that I use on top of the wedge) and got terrible scores last night with lots of positional events.

Looks like I'll be bringing the wedge back.

I seem to remember a page here with reviews of CPAP pillows, but I'm not finding it now. Does anyone have a link?

[UnicornRider]

Scroll to the top of the page, in either the Grey or the Black Bars, on the very left click on "Home".

That will take you to the forum directory, scroll down to the third tomato, Product Review Forum, look for the sub-forum:   Other Product Reviews .

But while you are at the top of the page snoop around, lots of valuable resources located at the top of the page.

Do not forget the Search this Forum: option in the lower right corner, of each of the sub-forum directory pages. 

Take your time, look around at the various pillow options available, like many of us you will probably try a couple and change a couple of times.