AHI higher on cpap than before therapy.

[Sweetpea]

Trying again. Still trying to figure this out. Thanks for your patience helping me. It's greatly appreciated

[Sleeprider]

Well we have our answer, don't we? You are setup with a minimum pressure of 4-15 and getting crushed on a Philips Auto. No surprises. The pattern also suggests you would benefit from a soft cervical collar. Thanks for getting some useful data posted.

Raise the minimum pressure to 7.5 and call me in the morning. Forget everything I suggested about complex apnea, you just need more stable higher pressure that makes your airway behave.

[Sweetpea]

Sleeprider, What would the purpose of the soft cervical collar be? I did not think I was mouth breathing, if it is to help with that. I will try the collar, however I have had a radical neck dissection so anything on my neck or pushing down even a little bit on my right shoulder could be painful. I do not know how to change pressures, and was led to believe that would need to be done by the doctor. Guess I better look up a manual for this machine. Being very new to this, I do not understand the charts.  Thanks!
Sweetpea

[Sleeprider]

First give the pressure suggestion a try. The fact your obstructive apnea occur in clusters suggests to me that you are in a position or posture that increases airway resistance. For example, sleeping on your back or side, and letting the chin tuck towards the chest. the soft cervical collar is a soft foam collar worn around the neck, and serves to keep the chin from dropping, and to support the neck, even if your pillow is tilting the back of your head up. It does not put much pressure on the shoulders. What you describe about a neck dissection, makes me thing even more-so that this might be a factor. The soft collar is a supportive device, used to prevent the airway from eing occluded due to neck or body position. Considering that you have had major surgery that would affect the strength of your cervical column, makes it more likely this could happen. This is a protective, soft and supportive tool.

Do this easy experiment. Breathing normally, let your head tilt forward. Do you notice the increased airway resistance? Your main problem right now, is that that your minimum pressure is too low. The Philips machines are slow to respond to the need for higher pressure, and they tend to return to minimum pressure too quickly resulting in the kinds of events you are having. Increasing to near the median pressure need, will not affect what you feel during sleep, but it gives the machine a considerable head-start at stopping obstructive events, compared to the minimum pressure you are using now. If you look at the pressure graph and where the OA events are occuring, they are all near the beginning of a session before pressure rises enought to keep your airway open The idea of higher minimum pressure is simply to stop all those events.

[Sweetpea]

Sleeprider, I read the manual and about the only thing I can adjust is the time.  Any pressure change will have to be done by the provider. Why do I feel a little annoyed by this? 

[ajack]

if you go to the top of the page, there is the clinical setup manual link, It's easier than setting up a VCR
if you are more comfortable and have a provider willing to help, they can adjust it for you.
http://www.apneaboard.com/adjust-cpap-pr...tup-manual

[Sleeprider]

Sweetpea, just push the control knob and ramp button at the same time, and the clinical menu will open. You can get the clinical manual at the CPAP Setup Manuals like on top of this page, or just follow these easy instructions http://www.apneaboard.com/dreamstation-c...structions

I apologize. I often forget our new users are not aware of these settings. Please read the manual and ask any questions you may have. There are features on your machine you should consider using that would make it more comfortable and work better. Unfortunately, the DMEs are not well equipped to help you optimize the machine.

[Sweetpea]

Yes, I sleep on my back and my head does tilt forward. Neck strength is compromised, as you guessed.  I tried your experiment, and you are right. Air flow is definitely blocked. Smart cookie, you are!   I will go to the clinical
Setup manual (I see where that is now) and set the pressure for 7.5. No ramping. I'll let you know how it goes with t h e collar on. I have some poor sleep habits to break.
Thanks again (and to ajack, too) 
Sweetpea

[Sleeprider]

With regard to the neck and head position, there are many options. An ergonomic pillow that supports the neck may be as good for you as a cervical collar. Even a neck roll used for sleeping on planes and such can keep your head in a position less-likely to cause airway occlusion. How you address the problem is up to you, but awareness is key.

[Sweetpea]

Sleeprider,I will try sleeping again tonight with 

• I saw the doctor today. He  deemed me competent to change my own settings as I see fit, using good judgment (should I actually have any). He suggested a low of 5 and a high of 7 for now. I also tried sleeping with my head back on my ergonomic pillow, allowing for a more open airway. This caused my mouth to fill with air every 30 to 45 seconds. My nasal pillow did not leak at all. My mouth was not open,  but my jaw was not clenched, either, just relaxed. So I needed to open my mouth to let the air escape, which seemed preferential to swallowing it. I imagined should I fall asleep swallowing air, I might wake up on the ceiling, like a gas-filled balloon. The doctor thought a chinstrap might be helpful and he ordered one for me with the idea of just trying it. Don't know if I can get used to wearing a muzzle. Woof!  I'm thinking the collar might be more comfortable. I'll figure this out.
  
• So you can go ahead and feel pretty smug right now. You were right. Again, thank you!
  
• Sweetpea