[CPAP] 'mild' apnea but increasing. Can anybody provide tips?

[Willem1978]

Hello all,

This is my first post, but I have been reading a lot of the existing posts already   Great that this forum exists.
I will now post myself, because I do not know what to do anymore. Half of the days I feel pretty terrible.

In 2017 I had a polysomnography: AHI 7.2. Mainly hypoapneas. 10% during sleeping on my back.
I received an oral appliance to wear at night. This worked (a next polysomography showed an AHI of 2.2), but eventually impacted my teeth (I now have a gap between my upper and lower teeth when I close my mouth). After that I received a sleep position trainer, but this did not work. The device showed that I slept on my back 0-1% of the time. So, I started using the Dreamstation (see specifics in my bio). After some tinkering with A-FLEX and the humidifier I managed to get an average AHI of 3.2 in the first few months. This felt ok. However, there were some days with score of 5 or 6, and on those days I really feel bad. It really affects my ability to work. The problem is that days with a score of 5 or 6 have increased significantly in the last month (they now happen multiple times per week, also increasing my average). 

Does anybody have any ideas as to what I can do about this? The healthcare professionals in my country (the Netherlands) do not know. I have attached 2 OSCAR screenshots of the same AHI 5.6 night (last night).

[OpalRose]

First, I would turn the ramp setting to off.  Sometimes it's needed where someone is using a high minimum pressure, but your pressures are fairly low.

As the DreamStation's algorithm is slow to respond to apnea events, turn the minimum pressure up to 7cm.  This would fall in line with your 90% reading which I believe is where it needs to be to tackle some of the Hypopneas.

Also, there does appear to be some positional sleep issues, not too bad though.  Try to stay off your back if possible, and be sure your bed pillows aren't too high as that can push your neck forward causing chin tucking.  We see that a lot here, and some folk will try a soft cervical collar to keep the neck aligned.  Or anything that props the chin from tucking into your chest is good.  Just be aware of that.

The goal is to make you more comfortable and not tired during waking hours, so how you feel is important.

And Welcome to Apnea Board!

[Willem1978]

Thank you for your quick response! I have tried increasing the minimum pressure in the past, but only for 1-2 days and that did not help decrease the AHI. But I will try it longer now. Also turning off the ramp function.

[OpalRose]

Thank you for your quick response! I have tried increasing the minimum pressure in the past, but only for 1-2 days and that did not help decrease the AHI. But I will try it longer now. Also turning off the ramp function.

Also, try Flex setting of 2. I wasn't sure what you were using, but a flex setting of 3 is uncomfortable for many. So a setting of 1 or 2 may work better.

[mesenteria]

Thank you for your quick response! I have tried increasing the minimum pressure in the past, but only for 1-2 days and that did not help decrease the AHI. But I will try it longer now. Also turning off the ramp function.

Don’t mean to sound forward or combative, but you haven’t acknowledged the advice about trying a soft foam cervical collar. This one item may turn your PAP treatment and experience, including your confidence in it, around entirely. I second the suggestion.

[Willem1978]

I already own a soft collar, because I read about that as well on this forum. But I found it very hard to fall asleep with it (how do people do that?). That is why I will first try the CPAP settings. I am hesitant to trying out too much at once.

[Willem1978]

Ok, I have some results:

Increasing min pressure from 5 to 7 (A-Flex 2, not using ramp) led to a night with an AHI of 6.5 (H, 4.3, OA 0.93, CA 1.31), This is the exactly the same AHI score I got from previous experiments where I tried to increase to 7.

After that I set my min pressure to 6.5. This resulted in three nights with AHI's of 3.8, 2.9, 4
One night I also wore a cervical collar. On this night I had an AHI of 4.4

So, setting my min pressure to 6.5 does appear to help a little bit. But I think it is very strang that I keep getting worse results when I increase my pressure to 7??
My 90% pressure was 8.6 in the last month. In the months before, when I was happy with the therapy, the 90% pressure was 7 with an average AHI 3.2. This was very stable, I rarely got AHI's of 5 and 6 in that period.

[Gideon]

Charts help us a lot, please post them.
At 7, exactly when did you get what events, what caused them, why were they not prevented

Thanks

[Willem1978]

This is a screenshot of the AHI 7 night. Or actually the first part of it. I see in the Oscar that I set the max pressure to 6.5 after waking up. Sorry for the confusion, I am not thinking clearly.

[Gideon]

The charts are similar except for the Central Apnea which is in consistent.
Higher pressures can lead some individuals into higher Central.