Donna's therapy thread

[DonnaR]

I'm a regular user of the board but I've created an account for my mother and am posting on her behalf. Hope that's OK.

A 70 year-old newly diagnosed with OSA in late 2022. Non-smoker. Healthy BMI. The main issue to me, seems to be chin tucking. She had tried using an N20 but the mouth leaks were an issue so she switched to an F20 and the therapy looks fairly stable to me with the exception of what I think is chin tucking. On Feb 9th, she complained of waking up gasping for air at 4am which I think is her cutting off her own breathing. What do you think?

   

   

   

I'll post the sleep study results in a separate post below this one.

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Sleep study results.

   

[Melman]

I agree that her problem is chin tucking and would benefit from a soft cervical collar. See the link below.
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[quiescence at last]

it does seem like all at once no amount of pressure can splint the airway. probably this is some time when the airway collapsed under the weight whatever is bearing down. I think the collar might help, but lying on her side might be something that can relieve this. DonnaR seems to do better on the EPR setting of 1. And she is very resilient having all those pressure spikes and being able to sleep through them.

Investigate if she likes a particular position, or she has a large pet that likes to crawl up on her stomach or neck. 25 extra pounds does not help much if it is used to snuffle the owner.

There is one strange thing I was not expecting. In most of the positional dependent apnea, you also see it correlates with flow limitations. Well, in some of the early morning spiky (rattle-jack) apnea clusters, there does not seem to be a correlating flow limitation peak.

These regions may not be positional in the normal sense, but maybe with more data it will occur to us what is going on.

Good luck, and thanks for helping your mother get the best treatment.

QAL

[Melman]

I sleep on my side and tuck my chin if I don't wear the collar. I suspect side sleeping is not the answer.

[DonnaR]

Thanks for the great feedback QAL and Melman!

We think she chin tucks when on her side most of the time. We've ordered the Eliminator neck pillow to see if that will help but it will be a couple weeks before we get that. She has asked her sleep doc if they would consider lowering the max pressure since that's what seems to wake her up most of the time. The tech at the DME had requested to lower it to 10 so we pre-emptively tried that just to see if it made her sleep any better. My concern is that it's actually worked against us by NOT waking her up during the chin tucking sessions. A good example of this is on Feb 17th when she chin tucked for almost 2 hours. If the pressure had bumped up to 15 cm, it probably would have woken her up earlier so she would move positions but instead the chin tucking episode was prolonged.

Here are some recent charts.

   

   

   

Thanks again!

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Any reason to be concerned about this CSR on Feb 17th?

   

[DonnaR]

Just posting an update with last night's charts.