AHI 15 one night, and 3 next night - How can I be more consistent?

[mbransom]

            Hello!

I'm hoping someone can review my charts to guide me in the right direction.  I've spent hours and hours searching and studying how to read and interpret the info on OSCAR, but I still don't feel confident that I'm understanding it correctly.  

History
I've been on cpap, well, actually apap, for about 4 months.   Initial home sleep study gave me an AHI of 37.9.   Doctor had the machine set at 4.0 - 12.0.    I previously didn't have issues in sleeping soundly.   I have chronic shoulder pain so I have to sleep on my back all the time.   I don't move around in my sleep much at all.  My  nightly AHI average can range from an occasional 3 to 19.     And I'm not sure what I'm doing differently.   I feel like I should be able to figure this out and be more consistent.   I don't wake up to what I used to call allergy headaches anymore (and I had those frequently) so cpap has already made a huge difference.   But I do still feel tired much of the time and heavily depend on caffeine to get through the day.  I'm very consistent using the machine every night all night.   I've been sleeping more during the Christmas break, but I normally get 6-7 hrs of sleep each night.   I'm using the full face resmed airtouch f20 mask with liners and tape on the bridge of my nose.

My Guesses & Changes:
I read on this board that I can set the minimum to an average pressure, so I increased my minimum to 8 this past week, and didn't notice any change.    I'm thinking I see clusters so I'm also guessing that positional apnea is involved.   I have a cervical collar to try for tonight.   I already sleep with a flat pillow.    Am I mis-interpreting anything?    

Questions
1)  It seems like I have quite a few events when the pressure is up at 12, so it's made me wonder if I need higher pressure?  That makes me nervous because although I show that I don't seem to have leak problems, I feel like I am woken up frequently hearing  mild leaks of air escape from the mask.  
2)  I'm not sure I understand the relationship between flow limit and OAs.   I thought flow limit caused OAs, but I feel like I've seen some OA's without any flow limit showing up.

Thanks for any guidance you can provide!   I've provided 3 nights this week.    

[staceyburke]

You need a higher min pressure.

I would suggest these

Min 8

Max 14

EPR Full time set to 3

[Expat31]

Yes, you certainly need higher pressure as suggested. Certainly a good place to start.

I believe positional apnea is a significant problem, explaining a major reason for the variation in AHI from night to night.

This video is self explanitory - supine positional apnea. 

Hopefully a collar will resolve this.

[SeePak]

Hi bransom

Positional issues are your main problem that i can see at this time.
I have had and still having similar charts.

I suspect that as long as you sleep on your back you will have these issues, unfortunately.

I too have shoulder issues, and sore burning hips a lot of the time, and i love laying on my back, but....

That's when i get 'crazy' charts!
All kinds of CA, OA and/or H event groupings.

If you have anatomical airway issues like Palatal Prolapse, large long uvula, large tongue, small mouth etc. you will have trouble sleeping on your back .

I think you really need to try fixing your shoulder issues, exercise etc.

Wedge pillow may help if you must sleep on back, not sure.

Neck collar can really help, not sure on your back though.

I dont see making any pressure changes until you get the Positional issues straightened out.

The max. 12 cm pressure changes are due to the position you are in at the time, closing your airway, and no amount of pressure will help with that.

OA and flowlimits may be relatable, however when you have the positional issues going on, cant read too much into that for now i think.
Airway narrowing has all kinds of causes, for instance, if you have muscles out of whack, (neck/shoulders) that can/will cause problems.
Finding the right pressure to keep airways open is what we are trying to do with PAP therapy, but that is complicated when these other issues are in play.

I have had great sleep with highish flow limits, so that is not the be all end all for me.

Looking at the 21st, yes flow limits are high, however, that is positional type issue, chin tucking or airway pinching of some type, or as i mention earlier, uvula or tongue blocking airway etc.

Try the neck collar for sure, but i think you need to get off your back!

Hope this helps you ?

[Deborah K.]

I sleep on my back because of lower back pain and solved my positional apnea.  First I wore a soft cervical collar and it worked, but I didn't like wearing the collar.  I bought a child-size pillow (always flatter than adult pillows) which has a raised front edge that keeps my head tipped back slightly.  This solved it completely.

Back sleeping does not prevent a solution to positional apnea.