AHI all over the place, new to AB

[Oihead]

Hi, 4.5 months in and my AHI fluctuates.  Wish I had found Apnea Board earlier, found it about 3 weeks ago.
My sleep doctor is not much help, said see you in a year.  Home study with AHI at 14.5. Start pressure was 4-20, then doctor updated to 4-15.  Thanks to AB, I got into clinician mode and was able to see my AHI and other info.  Last week I tried using a soft cervical collar and got some good results for the week under 5.  The AHI over 8 was from previous night, first section sleeping on right side, next sleeping on my back and the 3rd section sleeping on my right side.  Last night AHI was 7.77 (not lucky)...I had increased the min from 5 to 6.  I think I need to keep increasing my min pressure??  Any suggestions welcomed.
I tried to update some images to Imgur but not sure if I did it right.  Thank you Apnea Board!

h ttps://imgur.com/a/d2rT0

[ajack]

yes, I agree with increasing the min, I'd go to 8 and see how it goes, you may need 9. Did you have Central apnea in your sleep study? If they are pressure induced, they will most like subside within 12 weeks, you could try reducing the flex if it's not too uncomfortable. the big differences in nights, may be some positional apnea, have you tried a soft foam cervical collar to keep your airway straight?

[Walla Walla]

I also think a increase to 8cm in the pressure will help get rid of the events along with some of the flow limitations. You only had one CA event which is nothing to worry about. Everyone gets one now and than. I'd leave the flex alone if it makes you more comfortable.

[Sleep2Snore]

Yes, take the minimum up in pressure, the closer the minimum is to what you need to easier it is to use and less sleep disturbance when you do have an event.  To let you understand I have the low set at 10 and the maximum it has got to is 12 and I never notice any pressure change, but my body sure does.  Start at 8 as suggested, then if the maximum pressure the machine gets to is a lot higher, take it 1 closer until you are comfortable.  There is a pressure relief (EPR) for when you breathe out if you find it a bit difficult, the lower the number you can tolerate the better, if you need to use it, try it at 1 then go up the numbers for more relief.  Most people believe it is better not used, but if you have to for comfort, use it.

[Sleeprider]

Oilhead, what a great start on the forum...nice chart!  You are currently at 5-15 pressure with Flex at 1.  You're getting good results in this particular chart, with some notable flow limitations and hypopnea, but no OA.  I agree with the suggestions to increase minimum pressure to 8.0, and hopefully resolve the residual hypopnea and flow limitation.   I would rather have seen you using a Resmed machine which offers more pressure difference between inhale/exhale (IPAP/EPAP) pressure, but this seems to be doing a decent job. 

You have all the tools you need to optimize your therapy, and using Sleepyhead and the forum resources is a strong start.

[Oihead]

Thanks ajack, Walla Walla, Sleep2Snore and Sleeprider.

Everyone agrees that I should set my min pressure at 8 so that is what I will set for tonight.
I was slowly increasing the min because the last week or so I have experienced aerophagia, belching like balloon pops.
Will visit flex next so as not to change too many variables.  Think I am at 2 right now.

I am using a soft cervical collar for 10 days,  first days saw the lowest AHI but went back up again.  I had tried a 3 inch one
but it was a little uncomfortable so I switched to a 2.5 inch.  Maybe go back to 3 inch since I had better numbers then.
I tried an ergonomic memory foam pillow but it did not work well for side sleeping, AHI over 20 that night.

It was my first time using Imgur and I think I stacked 6 charts together, will separate for next posting.
If you scroll down you can see all 6 graphs.

I will try to get the Resmed next time around.  Sounds like the forum users prefer that one.  I was not given a choice.

Will let everyone know how I make out in the morning.

[Oihead]

This is not what I was hoping for.  AHI at 12.27 with a lot of OA and CA.  I will remove the cervical collar tonight to determine if I am fighting it.  I checked my original home study and the CA was at .4  I'm thinking my problem is mostly positional and not sure what to do next.  I have included charts from last night as well as some random closeups, not sure how to interpret.

h ttps://imgur.com/a/GJzP6
h ttps://imgur.com/a/AplTq
h ttps://imgur.com/a/P9z8y

[trish6hundred]

Hi Oihead,
WELCOME! to the forum.!
Good luck with CPAP therapy and getting it fine-tuned to meet your needs. Hang in there fore help with interpreting your graphs.

[Sleeprider]

Well now you know what a crappy night looks like.  This is an increase of minimum pressure, and didn't work out so good compared to 5-15.   Let's go back to the original 5-15 settings, and give this some time to develop a trend.  I don't actually think the pressure settings made this change in results.  Your previous median pressure was 9.3, and this is an increase of 1.0 cm.  This looks like a positional issue, and perhaps the cervical collar increased obstructive issues rather than helped.  Changing more than one variable at a time often creates this confusion as to what helped or hurt.

[Oihead]

Thank you trish6hundred for the words of encouragement to myself and other "Newbies" out there.  I know that initially I would lay awake for hours trying to sleep with the CPAP, prior to using CPAP I would fall asleep within minutes.  I wanted to just rip it off my face at times but I stuck with it, at least for 4 hours to meet my compliance.  Eventually it did get easier.  Funny, I remember telling my husband that if I died in my sleep to take the contraption off my head before reporting my death.