[CPAP] CA Clusters

[MoritzP99]

Hi guys,
my APAP already helped me tremendously, but I would still like to improve. Can you help me? Note that I don't have a prescribed pressure range since I bought the CPAP on my own after the sleep study diagnosed me with an AHI of 97 and I couldn't wait 4 months for insurance to approve the device.
Thanks a lot in advance and greetings from Vienna 

[Sleeprider]

You need to investigate why your chin is tucking and causing what we call positional apnea. Eliminate the possibility of excess pillows and if necessary move to a soft cervical collar, or pull a corner of your pillow between your shoulder and jaw. Increase minimum pressure to 9.0 with EPR 3 and don't use ramp.
positional apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
soft cervical collar http://www.apneaboard.com/wiki/index.php...cal_Collar

[MoritzP99]

Thank you so much,

what should my max. pressure be? And is turning off ramp really necessary? 

Thanks in advance

[Gideon]

Personally I'd set your max pressure to 20, the machines max.  You should not approach that pressure unless something changes, that would be a flag that says something should likely need to be adjusted.

[Lucid]

Hi, MoritzP99

It's not absolutely necessary to turn ramp off if you feel it's essential.  However, there some downsides:  the pressure level during ramp is less than half what you need, so you're not getting treatment during that time, and also EPR can't work properly at that level, since 4 is the lowest the machine goes.  Furthermore, most adults feel they are not getting enough air when the pressure is below 6.  So getting off ramp should at least be a goal.

Here's a video that explains some of this:

https://www.youtube.com/watch?v=6hAUkOk9vwQ

You have it on Auto, so it probably isn't staying on for that long, but it's going to restart the ramp if you get up for bathroom break or whatever.

Please take good care and enjoy your beautiful city!

[pholynyk]

Ramp on Auto is often a good choice, and there is no reason to leave the Ramp Start pressure at 4. I think you would be more comfortable falling asleep with the Ramp Start pressure set to 6. After a while, youu may find that the lower start pressure isn't needed; Ieventually ended up starting at 11, with no ramp at all. Just an example, not a goal.

[MoritzP99]

Thank you very much, I was now able to get my AHI down to 8, is there anything else I can do? I have already switched to 1 pillow, haven't tried the collar yet.

[Sleeprider]

The answer is pretty simple. once you start using a collar, you should see a significant change. Your apnea is clearly mostly obstructive and is occurring in clusters.

[MoritzP99]

    Hi guys,

so in the last few days my AHI has been climbing up from 10 to 20. It seems to mostly stem from CA, but I would like you to take a look. Any suggestions welcome. I also tried a soft cervical collar one night but it didn't decrease my AHI.

[Sleeprider]

Do you have a chart from the night you tried the soft cervical collar? We have frequently seen that the collar sometimes takes several nights to achieve efficacy as there is a training effect. Your current chart shows a very high complex AHI, and unfortunately not a very clear path forward. For CA events we would usually suggest reducing EPR and for obstructive apnea, increasing pressure. You can achieve both of those end-points by just reducing EPR to 1 to see what happens. This will increase the minimum exhale pressure to 8.0 and reduce ventilation CO2 exchange by reducing the EPR pressure difference.