Advice on increasing pressure

[HaL R]

Thanks, Stacey. Now I know what to work on. I'll check back after I've made changes. I appreciate your help.
Hal

[HaL R]

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Last night I used a homemade pillow and collar and the result was terrible.  Do these charts continue to show positional apnea?

I have a new pillow on order and will be using the foam cervical collar.

Hal

[OpalRose]

Yes, this is positional apnea. I don't think your collar and pillow are helpful in keeping you from tucking your chin.

[HaL R]

OK, thanks Opal Rose.

[HaL R]

I sleep on my back. Last night I used a new pillow that has a recessed area to contain the head and I thought it worked well to restrict my movement. Also used the foam cervical collar and (for the first time) a Breath Right nasal strip ( I have a deviated septum). The results were terrible. Not sure what is my next move.  I'm thinking of going back to the nasal mask and mouth tape just to see what I get. I had single digit AHIs before I switched to the FF mask.

Hal R

I'm getting frustrated but not yet like this guy. 

[OpalRose]

I never liked the Cpap pillows.  We're not trying to restrict movement, just trying to keep you from chin tucking.  A normal thinner pillow should work.  You want a pillow that doesn't cause your head to be pushed forward.  

Question:
Did you ever have a sleep study?  If so, did it show Central Apnea?  Some folk sometimes experience treatment emergent CA's when starting therapy, but you've been on Cpap for a while, so curious about the CA's. Also, not to pry, but do you have any heart issues? Do you take any medications that would cause the clear airway events?

I'm thinking that you should move EPR down a little, maybe to 2. Let's see what effect that has.

We originally recommended using EPR for the Flow Limitations, but FL will probably be there as long as there is positional apnea. Keep working on that.

[Gideon]

This is still showing as massive positional.

Your 7-15 with no EPR was pretty good so reduce EPR to 1

[clownbell]

I'd venture a guess that the collar is not high enough to prevent chin tucking. OP mentions a deviated septum, which may be an issue. And I notice a huge difference between inspitation time and expiration time, plus a very large tidal volume. Not sure what these mean, but the experts will.

[HaL R]

Thank you OpalRose and Gideon. I'll reset the EPR to 1.  And tonight I'll go back to the nasal mask and mouth tape. Just for the science of it, since I was doing fairly good with that mask although the tape was annoying. If the 7 is too much min pressure I'll have to back it off. 

My new pillow is not marketed as a CPAP pillow. It's basically contoured for front and back sleepers and a center area can be pulled out to make the head area about an inch off the mattress.  The ends are contoured for the arms. One long side is shorter than the other. The short side  is just behind my neck. It doesn't apply any force to the top of the head. I'll certainly keep that point in mind.

To answer your questions (and I don't mind the questions):  I had a sleep study. It said I had 93 CA's and 174 OBS. I had a heart attack at at 57 (23 years ago), after which they said I had heart disease.   And I had a stroke 2 yrs ago at 78.  My meds are 80 mg aspirin ER, Clopidogrel, Metoprolol ER and Atorvastatin 75 mg this was added 2 yrs ago after the stroke. 

Thanks for your concern. Hal

[OpalRose]

Hal,
Thanks for responding. I'm in agreement with Gideon. Go ahead and try EPR 1.
Let's see if that helps with CA's.

At least we know the CA's aren't treatment emergent since they showed up on your sleep study. You probably should have been put on a ASV machine, but most doctors shy away from that when heart issues exist.

Hopefully you'll find the right combination of collar and pillow to help with positional apnea. Don't give up! The main thing is to sleep well and be comfortable.