[CPAP] Struggling to get AHI lower than 5

[flabberjabber]

Hey all, I figured I'd post a new thread as updates to the old one managed to slip through through the busy cracks of the board.

Per previous suggestions, I've been using a soft cervical collar to prevent chin tucking and have started using REMzzzs mask liners to decrease leaking. Things have improved, and without this board I wouldn't be heading in this direction. Thank you Debra and SarcasticDave!

I was initially between 12 and 18 AHI. I think with a combination of moving to the AirTouch F20, the liners and the soft collar, with the kind help of people on this board, I've managed to get the leaking down to mostly minimal levels (with the occasional night that's worse than others - as you can see from the data).

The problem is I'm still get hypopneas, and my AHI is generally floating between 5 and 8. I feel a bit better, I'm dreaming again which is a good sign, but my persistant fatigue, gut and the OSCAR data is telling me there's more improvements to be had here.

I'm open to any further suggestions anyone might have. I'm not all that convinced that the outstanding problems are positional apnea in nature, nor due to leaks. As, the hypopneas seem to be present with or without the small leaks that are continuing to occur per the data. I'm convinced I've fixed the positional apnea with the cervical collar; it's completely changed the way I sleep (partner confirms this). But please do say if you think I'm wrong .

Look forward to hearing any thoughts you might have .

[staceyburke]

I'm not familiar with your machine but you are having positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

[Phaleronic]

@staceyburke

Did you look at the charts are are you spamming?

[staceyburke]

Yes I did there are over 21 times in the chart where the H events shows positional apnea.  All three charts had positional apnea with clusters of H events.

[Phaleronic]

Hello flabberjabber, please raise your minimum pressure to 9cm this will help some of the hypopneas and obstructive apneas, you're on very low pressure settings, but you also need to please sleep on your sides and on a flat pillow. I use the F20 airfit system too, but it took me a bit to find the correct cushion size to minimize leaks (regardless of pressure).

What size are you using and have you tried the other sizes?

[Phaleronic]

Yes I did there are over 21 times in the chart where the H events shows positional apnea.  All three charts had positional apnea with clusters of H events.

You can't tell if they are positional apnea events (let alone 21 of them) in that chart based on our forum's own classifcation:

https://www.apneaboard.com/wiki/index.ph...onal_Apnea

I believe this is a case of flabberjabber's inappropriate pressure setting, hence the need to raise that minimum pressure to open the airway.

[staceyburke]

As you MUST know no change of pressure will stop positional apnea.

[flabberjabber]

Thanks to you both for responding @Phaleronic and @staceyburke.

I'm using an AirTouch large, having started with the medium which was too small. The large was initially leaking really badly especially at the sides of the nose (why the nose is so tall and thin I have no idea!?) and occasionally at the bottom when my chin would go lax. Obviously the cervical collar has resolved the chin leak issue. Deborah K recommended the REMzzzs liners as well. Since these two changes, the leak rate has been significantly and consistantly lower. Thing is, now that I've found some liners that work for me, I could probably switch back to the AirFit if need be, which I think would fit my nose area better. Originally, the AirTouch was chosen by me because I am allergic to silicone, but the liners remove that issue. However, persuading the NHS to send me yet another mask might be a challenge (I'm on attempt six at this point). I can always buy it myself though if you think it might improve the leaks further.

I'm a natural side sleeper and rarely if ever end up on my back at night. I have a thin single pillow that I use and bunch up slightly at the end to support my neck per SarcasticDave's advice. Before being given advice on this forum (about a month ago) I was definitely chintucking at night, as my natural position was side lying fetal. Since then, I've added pillows between my knees and to hug to my chest. These changes along with adding the cervical collar has straightened me out considerably. It's difficult to say which changes exactly brought my AHI down. But before as I said in my intial post, it was 12-18 on average, and now it's consistently between 5 and 7 every night so there's definitely been some improvement. I think, just from experimenting over this last month, and experimenting whilst awake with what positions close my airway, that I've resolved the positional apnea. I don't see how, for instance, changing my cervical collar would improve the situation as I've yet to wake up with my chin tucked since the addition of the collar.

I'll increase the minimum settings to 9 tonight @Phaleronic as per your suggestion. But if it is positional apnea, it's an unusual side sleeping variant of it. Perhaps the next stage is to film myself whilst asleep to see what exact positions I'm getting into.

Also I've just noticed some central apneas in the last couple of nights data. I'm not diagnosed with CA! And this is the first time they've popped up in the last month. Any thoughts? Hopefully just a blip? D:

[staceyburke]

You can have positional apnea in any sleep position. The size of the collar is the distance from your chin to your sternum, that is the height you need the other is of course the size to go around the neck.  The height of the collar is the most important to check.

[flabberjabber]

"You can have positional apnea in any sleep position. The size of the collar is the distance from your chin to your sternum, that is the height you need the other is of course the size to go around the neck.  The height of the collar is the most important to check."

@staceyburke I realise this. I've read the wiki section on positional apnea and had this discussion previously with members of the board here. I've implemented previous suggestions regarding positional apnea, I've bought the things, I've experimented with my anatomy to get to know my own positional apnea triggers and I think I've resolved the positional apneas. Those initial charts looked much more clear cut as positional apnea, I've attached two of them below. Do you think the recent charts are still clearly grouped? Isn't it also possible that we're looking at the hypopneas that remain after positional apnea has been removed from the equation?


My cervical collar is tall enough to support my chin as evidenced by the massive decrease in critical leaks since adopting it, I was leaking slightly from my nose, and critically from my chin it seems (compare oscar1.png with any of the three recent ones attached to this thread).

I'm looking for some new ideas of how to fix this, because I am quite desperate. I'm convinced I've had sleep apnea since at least a teen if not earlier (I'm now 35) and the cognitive decline I'm experiencing day to day is terrifying me. I really feel like I'm slipping into dementia. I have no functioning short-term memory at all. I've tried everything to do with positional apnea that's been suggested. My ears are open to any ideas you might have. I'll try increasing my minimum pressure to 9 tonight. I hope that makes some difference. I realise you're a volunteer, but you keep suggesting stuff to me that I've already tried and told you about in my original post. I'm all ears for anything else you might think would be good to try; including other ways of dealing with positional apnea that I've not yet tried.

To be absolutely clear with what I've already tried: I have a functioning cervical collar that supports my chin and is both big enough and tall enough. I am a side sleeper (rarely on my back - maybe once a fortnight my partner will find me like this). I've tried a thin pillow. I've tried upping the maximum pressure. I've tried REMzzzs mask liners for leaks. I've changed between nasal pillows and full face masks and hybrids six different times and have managed to get the leaks to a more manageable state with the current F20 AirTouch.

Also more generally, any thoughts on the CA's? Cheers