Any advice on improving my results?

[kevinz]

Hello,

I hoping that folks on this board can offer me some advice on adjustments I can make to improve my AHI and get a better night's sleep.

I had an in-home sleep study done, that showed an untreated AHI of over 40. After 66 days of CPAP use, my AHI dropped to a median of 7.51. However, I was uncomfortable with the nasal mask and thought I could still get a better night's sleep. I had an in-hospital sleep study, that showed I could have a AHI of 0 at 9 mm H2O. My doctor set my prescription at 10-20 mm H2O. Since then, I have a median AHI of 8.2. I've posted two screen shots, one of my best night's AHI of 1.5, and a more typical night, last night.

I think what's happening is that I develop small leaks during the night. I sleep on my stomach, with my face pressed into the pillow and mattress. I think this starts a small leak that the CPAP machine tries to correct by increasing pressure. However, this just makes things worse, until I finally awake fully at the machine's maximum pressure. For instance, see last night from 22:30 to 01:00.

Right now, I'm using the medium size Respironics DreamWear under the nose nasal mask, with the medium size nasal cushion. 

Thank you for your advice and expertise. I really appreciate any guidance you have. Let me know if I've forgotten any important details.

-Kevin

[Gideon]

On the 14th the clusters of obstructive events indicate that you are tucking your chin, the 9th not. If this is happening with any degree of frequency you need to look at a cervical collar, (see my signature). Since you do describe that as typical get a collar. That will resolve most of your issues. Then let's re-evaluate.

[kevinz]

Geezawhizz, right now, with a nasal mask and a chinstrap, my wife won't touch me and the dog's afraid of me.

bonjour, thanks so much for your advice. I'll look into it. Amazon seems like they have a wide selection. Anything in particular I should look for, or avoid?

Thanks, again, for your help.

-Kevin

[Gideon]

The hard part is that size matters. ReLeaf is one that many like.

[sheepless]

for a no frills trial, you can pick up a basic soft cervical collar at walgreens and other big box drug stores for $20 usd.

[Gideon]

no-frills, roll a towel around a necktie and tie it around your neck. We are only trying to keep from tucking your chin.

[Sleeprider]

The hard part is that size matters.  ReLeaf is one that many like.

Geeze the poor guy is saying his wife won't come near him and the dog is scared, and you're telling him "size matters"?  Cold!

That aside, what Fred is saying is you want a "comfortable" fit that is fairly loose, but prevents the chin from getting behind the collar, and just tall enough to keep your head and neck aligned.  No need to look at the sky.  We have a really large number of members that use a collar, and they (and their wives and dogs) do adapt and get used to it. Even better, the collar has a kind of training effect and many find that once they correct the posture that causes the positional apnea, they often can move away from using the collar.  Lots of people thin "positional apnea" is from sleeping on your back, but we have found it is really a matter of poor neck alignment that closes the airway by compressing the front of the throat.  You can easily test this by sitting comfortably and relaxing, let your head drop and pay attention to the additional resistance for breathing as you do.  It is a real simple and effective way to eliminate nearly all obstructive apnea without raising pressure.

[Gideon]

SR, just not my day ;-)

[kevinz]

Thanks so much for your suggestions. Last night, I just tried to go to sleep with my neck extended and straight. It made a big difference, as you can see from the attached chart. I'll be ordering a cervical collar today.

Thanks, again, for your help.

-Kevin

   

[Gideon]

That has the numbers OK, how do you feel? additional changes should be driven by your symptoms, much more than numbers.