casaroyan therapy help

[csaroyan]

Hi there.

I am new to therapy.  I've had a huge improvement since starting therapy about 4 weeks ago.  I worried I would struggle with the sensations but I have adjusted relatively quickly.  I've been doing a lot of reading but this is my first post. 

I was using the N30 (and eventually N30i) for the first three weeks with relatively good results.  A few nights I woke up and one of my nasal passages was closed.  I didn't see anything being registered in OSCAR when this was happening.  However, I thought if I changed to pillows (P30i) instead of cushions, maybe that would help.  My AHI went up from around 1 to about 6 with a bunch of hypopneas and RERAs.  I am wondering a) why would the pillows cause such a big change? Nothing else has changed over the last week or so and b) is it possible the cushions were not accurate in assessing the flow limitations and I was actually having issues there?

I like the cushions better anyway I think and so I plan to switch back tonight but I wondered if anyone had any other thoughts about this.

Attaching one night of data from the N30i and two from the P30i.
__PRESENT

[PeaceLoveAndPizza]

You have done a good job starting with it. I think you need to increase your min and can lower your max pressure settings. You also need more pressure support to help with the flow limitations which will reduce the pressure swings.

Try the following:

Mode APAP
Min pressure 9
Max pressure 14
EPR 3 full-time
No ramp

You get no therapy during the ramp time, so unless it is absolutely necessary turn it off. Give yourself some time to relax and breathe with the machine, and you will likely adapt quickly.

[csaroyan]

Thank you! I will try these settings later.

I actually realized I double posted the screenshot twice.  Here is one using the N30i which seems much better than the P30i ones I uploaded.  Any thoughts as to why this might be?

Should I stick with the pillows or switch back to the cushions?

[PeaceLoveAndPizza]

Pillows, cushions, full-face, hybrid, so many mask choices. I cannot recommend what you should use based on a few nights charts. Folks have been successful on all of them, so it is a personal choice. From a waveform perspective, they are similar, so no clear choice.

What is more comfortable to you?

[csaroyan]

I think I am going to go back to the cushion.  It felt more comfortable aside from the few occasions of the nasal passage closing which may have just been adjusting.

I will use the new settings for a few days and report my findings 

[staceyburke]

The mask has nothing to do with the large increase in AHI. 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.

[csaroyan]

No, I haven't made any changes positionally with pillows or anything like that.  I am a side sleeper mostly.  I did think about the positional apnea issue also but I did not seem to have any issues with positional apnea in the prior three weeks before I made the mask change.  Maybe something about the pillow mask is making me tuck my chin more?

Thanks so much for the input.  I will post my updates here too.  Hopefully for others to see too! Reading the advice given to others helped me so much already!

I do think maybe a flatter pillow might be helpful anyways so I may try that as well.

[staceyburke]

Many times it is sleeping on your back but you said you were a side sleeper. Sometimes we just get into a position that is a problem and the next night we don’t. I would not worry about it unless it happens more nights

[csaroyan]

Hi!

I have an appointment next week with the pulmonologist.  I would like some advice on my therapy and also how to talk to her.  This is only my second appointment.  She seemed helpful and attentive the first appointment, so I am hopeful she will continue to be that way.

Here are two screenshots from different days.  I started with what was recommended here and then increase it little by little until the OAs were almost 0.  For the first one I used:
Min pressure 14
Max pressure 20
EPR 3 full-time
No ramp
   
AHI was staying around 2-5, with about half hypopneas and half CAs  I know drs will say under 5 is "well treated" or whatever.  But I feel MUCH better (less day time sleeping, fewer headaches and night sweats) when the AHI is closer to or below 1.  

I thought maybe reducing the EPR from 3 to 2 might reduce the CAs a bit, and maybe it did, but it seemed to really bump up my flow restrictions.  It also seemed to possibly increase hypopnea.  So settings:
Min pressure 13
Max pressure 20
EPR 2 full-time
No ramp
   
I've also tried steps between the min pressure, from 9 to 14.  I can share that data too if helpful.

I also looked back at my sleep study, which was done at home.  My AHI=6 and was mostly hypopneas and a few OAs, and no centrals.

I have been on therapy for 2 months now.  I am wondering when/if these CA events will work themselves out.  I know treatment imergent CA is a thing, and I can try waiting it out longer, but I am tired!! 

So any recommendations on adjusting the settings would be welcomed.

Lastly, at what point would biPAP or ASV be considered?  Should I push this with the doctor or might there still be a sweet spot within the APAP parameters that could keep me at or below 1, where I feel the best?  

Also-- what does the insurance (typically) do with that?  If I am under ahi=5 will they just flat out refuse to cover a more sophisticated machine?

Thanks for weighing in