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[CPAP] Positional Apnea/Mask Selection - Printable Version

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Positional Apnea/Mask Selection - rwhimlin - 05-08-2023

Hello new friends,

I have been on CPAP for a little over a month with no good results yet, one visit about 2 weeks in to my provider which resulted in some blah blah blah an adjustment to my machine (DreamStation 2 Auto Advanced) that was not effective.  I since have found your forum and installed an SD card into my machine -- thank you so much for existing!!! My questions center on looking at my detailed results for possible postional apnea, a concern for how many CA events I am getting (my doctor claims these "usually clear up in the first few months"), and differences in results when I switch out my full face mask for a nasal pillow mask.

Exhibit A is my results from a few days ago, when I wore my usual full face mask and got really bad sleep, was tired all day Sunday.  


I have a Garmin Forerunner 945 sports watch with Pulse-ox and HRV sensors that includes what Garmin calls a "Body Battery" -- a charge level indicator for how ready I am for my next workout (I am a marathon runner).  After this night, it only charged up to 29% (from 5% when I went to sleep), and showed lots of "stress" during the night.  I noticed a similatiry with a post on here that recommended a SCC device or similar to correct chin drop that would result in positional apnea events, and it looked kind of like my chart.  I was encouraged that there were periods of time without apnea events, so I hope that using an SCC or similar device will maybe clear this part of it up.

Again, this was with my full face mask, that I obtained after a few days using a nasal pillow mask and noticing worse AHI than my sleep study.  As an aside, my sleep study noted several events where I was not breathing for over 2 minutes, which I find scary, and it is why I started pursuing CPAP therapy.  I feel like these events are not accurately accounted for in a number like AHI since one event can last for so long, you can only fit so many 2 minute intervals into an hour, but even 20 of these events would mean I wasn't breathing for 40 minutes out of the hour!!!  Anyway, even with CPAP, some of my events last longer than one minute, and the DreamStation 2 seemingly tries to jolt me out of them by applying "pressure pulses" every 10 seconds.

Here is Exhibit B from the following night (last night) where I initially switched to my nasal pillow mask (first for a nap to try it out around 5pm, and then for the first 2 hours overnight).  After that first 2 hours, I was feeling like I would never be able to sleep with it on, so I took it off and slept with no mask until just before 6am when I switched in my full face mask again. 


For the first segment here, as I was just experimenting, I did not tape my mouth shut,  but I did start out with mouth tape when I tried to go to sleep for the night (middle session).  Here, in looking at the data, I see many more CA events than the previous night, even after finally switching to full face, and I don't know how concerned to be about these.  Zooming in it doesn't look to me like CSR, but maybe I need an ASV if these continue after I make my positional adjustments?

I strongly prefer to sleep on my back for proper spinal alignment, but I have turned on my side in order to sleep when I can't fall asleep on my back.  I haven't yet learned how to stop mouth breathing and although I have never noticed my mouth being very dry before starting CPAP, now every morning I wake up with a dry mouth.  I am trying the "tongue trick" pointed out here to try and move in the direction of nasal only breathing, and anticipate if I get a SCC device, I may be able to get closer.

Thank you for any help! I'm newly disgnosed and am tired of racing my marathons already tired out!

RE: Positional Apnea/Mask Selection - staceyburke - 05-08-2023

From your charts you have a lot of potential apneas which you know. The only way to help is a use of a collar which again you mentioned in your text. I have a link to collar use with the same person with and without a collar HUGE difference.

You can see positional apnea when there are groups of apnea in the O and H graphs

RE: Positional Apnea/Mask Selection - rwhimlin - 05-09-2023

Last night, I wore a "poor man's" SCC -- an airplane travel wrap-around pillow worn backwards, and the OAs cleared up, but I am left with now a lot of clear airway events.  I zoomed in on a cluster of these, and I am wondering if there is anything I can adjust regarding the pressure settings on my machine, since it seems to happen during a controlled ratcheting down of pressure.  These look a lot like Cheyne-Stokes graphs that I've seen, so I wonder if I need to look into being evaluated for an ASV device or if there is something I can try with my DreamStation 2.  This is the close-in view of the CA cluster during the pressure ramp-down.


And here is the zoomed out version that includes the onset and recovery back to normal breathing.  As far as sleep position, by this time I had turned onto my side if that matters at all.


Any help reading the tea leaves would be appreciated. Thanks in advance.

RE: Positional Apnea/Mask Selection - staceyburke - 05-09-2023

You can try to turn off the flex and see if that helps.