Apnea clusters

[stillaliveca]

Here are the same 5 days of data posted the 'correct' way (I hope)

[PaulaO2]

For one, your machine is set for "wide open". You may want to narrow that range some. You can look at the days your gave, look at the Min, Max, and 95% for each day. Your min for a good night and a bad night was about the same (11ish). The Max was about the same too (14ish). If this were my data, I'd set the machine to run at 10 minimum and, oh, 15 maximum. Then I'd collect more data over a span of about 10 days and see how it goes.

What an APAP does is it senses your airway is closing, so it increases the pressure. If it detects an event, it raises it more then keeps it there until it detects the event is far over, the narrowing is gone, and then it starts to lower it until it detects airway problems again and adjusts. When the APAP is set to wide open (4-20) there is the potential for the machine to "fiddle" too much, or take too long to raise to what you need. Look at where you fall asleep. It goes from 4 to 11 immediately. Or it could take too long to go down to where you need. Eliminating that span will help the machine help you.

[Crimson Nape]

Your flow limit is probably causing your pressure to climb.  This is common on the Resmed.  I would explore using the full-time EPR feature to attempt a reduction of these limitations.

[stillaliveca]

Paula, I can try lowering the upper range and see if that helps. I am reluctant to raise the lower range because I like falling asleep at 4 as my breathing feels natural as I fall asleep.

As for the comment about flow limit and EPR - sorry I do not understand these terms at all so I really have no idea what you mean, Crimson

[Sleeprider]

What would work better is to set the minimum at 7.0 with EPR (exhale pressure relief) on full-time at a setting of 3. That will make your inhale pressure 7 and exhale 4. You can also turn on Ramp on automatic mode. This will make your starting pressure 4 until you fall asleep, then it will automatically rise. The benefit of using EPR with different inhale and exhale pressure 7/4, is that it will help with your effort of inhale and counteract the flow limitation. This should give you a more complete and comfortable breathing with less flow limitation. Your median pressure is over 12, so this change with ramp should not be noticeable. I do think you can also reduce your maximum pressure to 15. The flow limitations and obstructive clusters should respond to the use of a soft cervical collar that helps to keep your airway straighter, as well as the extra assist you get from EPR.

This easy tutorial shows you how to enter the settings to change therapy pressure and comfort settings like EPR. https://www.apneaboard.com/resmed-airsen...setup-info

[fozsleep]

Paula, I can try lowering the upper range and see if that helps. I am reluctant to raise the lower range because I like falling asleep at 4 as my breathing feels natural as I fall asleep.

As for the comment about flow limit and EPR - sorry I do not understand these terms at all so I really have no idea what you mean, Crimson

I'm certainly no expert, but EPR is Expiratory Pressure Relief.  In order to change these setting you need access to the Clinicians Manual for your machine.  See the Thread on the Forum Home Page to request the manual by e-mail.

http://www.apneaboard.com/forums/Thread-...P-Pressure

[stillaliveca]

I have made some of the changes suggested on the Forum, one of which is to exchange the chin strap for a foam cervical collar. After 4 nights my apnea readings are good so far (1's and 2's) and the leakage is greater than before, but not bad. I am mouth breathing a lot more as evidenced by a dry mouth when I wake up. Is that the usual experience with the cervical collar?

[Sleeprider]

Your obstructive clusters have apparently resolved with the collar. Usually the collar helps with leaks by supporting the back of the jaw and encouraging a closed mouth. Make sure the collar is fitting below the jawline so it cannot displace the mask. Hopefully you can find a way to improve both the AHI and leaks. Which collar did you select?

[stillaliveca]

It's a 4" Medium collar bought at a medical supplies store. I would say it's about 1" thick and fits very nicely. I wondered if a thicker collar might keep my mouth closed better but I don't know if there is such a thing.

I am not ready to conclude that the clusters have disappeared until at least 2 weeks have passed, but so far so good.

[stillaliveca]

It is now almost 2 months since I exchanged the chin strap for a cervical collar and changed various settings on the CPAP. My AHI since that time has averaged 1.88 and the clusters I used to see have disappeared.

I have switched to a slightly narrower collar but still have a persistently stiff neck during the daytime. Has anyone else experienced this and if so, is there a remedy?

Thanks.