Auto Titrating Machine Recommendation REM dominated OA

[SarcasticDave94]

Just my opinion, you may eventually need both cervical collar to reduce or eliminate positional apnea, and you may also need a ResMed AutoSet for treating obstructive apnea.

Something to experiment in the meantime, flatter pillow but still comfortable, then maybe a rolled hand towel under the chin to see if you can reduce positional apnea.

[Sleeprider]

The characteristic of positional apnea is a rapid series of obstructive apnea or near-apnea with enough arousal to break the obstruction for a couple breaths between events. We are really good at surviving and getting air, even when in REM and might even incorporate this into dreams. It would not take long to figure out if it makes a difference and it's cheap.

[BoxcarPete]

Thanks for all the replies so far! I'm learning a lot here and I'm feeling myself shift from "just give up" or resigning myself to marriage to a machine to a much more curious state, and my desire to experiment and look for answers is back, which is tremendous!

I'll also note that even as a kid I had sleep issues. Had my tonsils and adenoids out around age 10, and it was life-changing. That bought me 20 years of decent sleep, so I have no doubt that if I find something like new pillows and/or cervical collars help me, even if it only buys me 10 more it'll be a blessing.

So now let's look at how this all fits in with bruxism. I went with the MAD as a "two birds, one stone" approach, but due to the semi-permanent changes to my jaw alignment (it is slowly going back to normal), discontinued its use. The effectiveness seemed to wane over the course of the year I used it also, prompting me to advance the lower jaw several times until I hit the adjustment limit, and then my dentist told me to definitely stop doing that and also stop using it. Any idea why that reduction in efficacy might be?

I read also that bruxism is a bodily response to apnea, to shift the jaw in an effort to make up a little space in the airway. I am noticing a lot of evidence of night time teeth clenching now that I have swapped over to CPAP from MAD, and I'm honestly a bit concerned about it especially because it's my front teeth and canines that are taking the beating due to jaw alignment issues from the MAD.

[Sleeprider]

MAD is a form of positional therapy that physically blocks or encourages a less obstructed sleep position, but its efficacy is relatively low and side effects high. You already discovered this. Its diminishing efficacy with time is probably an adaptation where you found a way to get around the device. The interesting part of using a SCC, is that we actually see a training effect, where some individuals using a good, properly fit collar actually acquire a 'memory' to sleep in a position that avoids obstruction without the collar. As you saw in the article, the problem is not limited to back sleeping, but is relatively common in side-sleeping, especially with a tucked fetal position, and even in prone sleepers that must turn their head to the side, again obstructing the airway. The objective with a SCC is not unlike a MAD in that we seek to support the jaw rather than the chin. This maintains a head/neck position that keeps the airway open similar to when artificial respiration is performed, and it helps encourage an upward and forward position of the lower jaw without the impacts on your teeth. So it's not to confine the chin and certainly not to apply pressure to the throat, so much as apply pressure to the jaw. Try resting the back of your jaw on the back of your closed hands, and try also to rest your chin on a single hand, and you should feel the difference in pressure. When relaxed and letting your head sag, both forms of support draw the jaw up and forward. Pressure from the back or sides of the jaw are less likely to impinge on soft tissue behind the chin and the throat.

[BoxcarPete]

Good news so far! I'm up north for deer camp so no CPAP this week. However, I picked up a soft cervical collar and wore it last night. Hard to say from one night alone, but man it seems to make a huge difference! Last time I slept up here in this bed it felt like the angel of death paid me a visit but decided at the last second not to finish me off, but last night 5.5 hours with the collar and I feel more alert and functional than I did with 8 on the CPAP!

More testing to follow.

[SaminDenver]

About the MAD - I am currently wearing braces to correct what the MAD did to me.

[Sleeprider]

Good news so far! I'm up north for deer camp so no CPAP this week. However, I picked up a soft cervical collar and wore it last night. Hard to say from one night alone, but man it seems to make a huge difference! Last time I slept up here in this bed it felt like the angel of death paid me a visit but decided at the last second not to finish me off, but last night 5.5 hours with the collar and I feel more alert and functional than I did with 8 on the CPAP!

More testing to follow.

You are young and active, and it's great if you can find a solution that lets you continue to enjoy camp and the outdoors without lugging a CPAP.  Good luck!

[BoxcarPete]

Thankfully, the changes to my bite and jaw from the MAD appear to be reversing, after a few weeks it's almost back to normal.

Second night with the SCC didn't go as well, but I think that's a combination of the excitement of deer camp wearing out a bit along with the late nights and booze followed by early mornings catching up to me quickly since I haven't been sleeping well lately in the first place. Took it easy on the alcohol and got to bed a little earlier last night, much better. I feel like a human being again!

I think my final conclusion is to get the new CPAP, it costs less than even one more overnight PSG and if nothing else will allow me to collect a ton more data than a single night at the sleep center.

I think this thread has mostly run its course then, unless we want to update it to be an ongoing story of my personal experience and tweaking to get rid of those REM apneas. Probably better to start a new one for that though.

[REMhunter]

Hey Pete,

We're in the same area (SE Michigan) and have the same issues, REM dominant OSA.  Maybe we're related...

Anyway, we have similar medical histories, I had my adenoids removed as a child as well.  I went undiagnosed into my 40's when the health impacts were getting severe and I couldn't figure out why.  Ophthalmologist was the first to bring it up.   My AHI overall was "mild" but jumps to the high 30's in REM sleep (at least during my sleep study, I suspect it was much worse in reality), my chart looked just like yours.  I'd be fine for hours, then BAM: apneas all over as I went into REM sleep, then they'd go away once I was out of REM.  I felt like it was cumulative as well, since I was always short on REM sleep, I'd be trying like crazy to get there, only to choke.  Repeat all night...
I was fitted for an occlusial guard as well, I would grind my teeth like crazy.

My Airsense 10 has gotten me to zero apnea events for weeks at a time. I only occasionally have one or two events even on my "worst" nights now.  When I started I had a few more but I was really struggling getting used to the treatment: Mask journey, sleeping position, etc.  Now it feels weird to lay down without it.  At the beginning of treatment I'd sleep 10 or more hours, and I had what looked like central events on OSCAR.  I think that's not unusual when someone has a high AHI, then starts treatment and the OSA vanishes overnight.  The dreams were WILD for a while, now back to normal.  I'd say I'm "through the woods" now and sleep is normalized (6-8 hours, one bio-break).

I have it set for 7, EPR of 3, Auto.  Works great for me.  My lab work is much improved.  Lost a ton of weight.  I'd buy another AS10 in a minute if I had to.

I picked up a Breas Z2 auto for motorcycle trips/camping.  It's "Ok".  My CPAP "Birthday" is coming up in March, I'm probably buying an AirMini to replace the Z2 as a "gift to myself".  I'm only willing to go without in dire circumstances as my apnea impacted my vision.  Going without isn't really an option for me.  I've got an Easylonger battery backup since the electrical around here is not reliable.  I can go 3 nights without charging it (no humidification or heated hose).  It might be an option for you to consider.

For me, alcohol has a huge negative effect.  I could see when I'd had a margarita with dinner, as my AHI would go up. For reference I'm the size of a NFL lineman, so one margarita is hardly a bender in Las Vegas or anything.  I'd advise eliminating it entirely if you can and see if it helps.

[BoxcarPete]

Wow, that is a weirdly similar history, right down to suspecting that the PSG test night wasn't even as bad as most nights at home. 

What kind of effects on your vision did you notice? I have the all clear from my ophthalmologist so far but I have had some odd effects that I have attributed to ocular migraines lacking any other explanation.

What's odd to me is that you slept so long when you started treatment. With everything I've experienced so far, on a new treatment attempt I'd sleep for like 6 hours or so and wake up feeling at least as refreshed as a "normal" (i.e. bad) night and not be able to get much more sleep if any. Of course, even 6 hours of decent sleep is not enough, so it's been hard for me to get into a better rhythm. In fact, the collar has been like that. First night only 5 hours and I felt great. Next night 6 or 7 and felt bad. Then last night I slept from like 7 to 8pm and then again from 10pm to after 8 the next morning, but now even as I type this 12 hours later I'm starting to drag. For some reason nothing has seemed to really stick.

Ditching alcohol entirely is certainly a possibility, in fact I went bone dry for about half of this year already. Wasn't enough to fix anything, but I can tell it does make it worse, so I'll probably keep a real tight leash on it and only indulge for special occasions. Just another variable to experiment with when I get OSCAR up and running.